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Public Act 102-0077


 

Public Act 0077 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0077
 
SB0110 EnrolledLRB102 11332 KTG 16665 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5.2 as follows:
 
    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
    Sec. 5-5.2. Payment.
    (a) All nursing facilities that are grouped pursuant to
Section 5-5.1 of this Act shall receive the same rate of
payment for similar services.
    (b) It shall be a matter of State policy that the Illinois
Department shall utilize a uniform billing cycle throughout
the State for the long-term care providers.
    (c) Notwithstanding any other provisions of this Code, the
methodologies for reimbursement of nursing services as
provided under this Article shall no longer be applicable for
bills payable for nursing services rendered on or after a new
reimbursement system based on the Resource Utilization Groups
(RUGs) has been fully operationalized, which shall take effect
for services provided on or after January 1, 2014.
    (d) The new nursing services reimbursement methodology
utilizing RUG-IV 48 grouper model, which shall be referred to
as the RUGs reimbursement system, taking effect January 1,
2014, shall be based on the following:
        (1) The methodology shall be resident-driven,
    facility-specific, and cost-based.
        (2) Costs shall be annually rebased and case mix index
    quarterly updated. The nursing services methodology will
    be assigned to the Medicaid enrolled residents on record
    as of 30 days prior to the beginning of the rate period in
    the Department's Medicaid Management Information System
    (MMIS) as present on the last day of the second quarter
    preceding the rate period based upon the Assessment
    Reference Date of the Minimum Data Set (MDS).
        (3) Regional wage adjustors based on the Health
    Service Areas (HSA) groupings and adjusters in effect on
    April 30, 2012 shall be included, except no adjuster shall
    be lower than 1.0.
        (4) Case mix index shall be assigned to each resident
    class based on the Centers for Medicare and Medicaid
    Services staff time measurement study in effect on July 1,
    2013, utilizing an index maximization approach.
        (5) The pool of funds available for distribution by
    case mix and the base facility rate shall be determined
    using the formula contained in subsection (d-1).
    (d-1) Calculation of base year Statewide RUG-IV nursing
base per diem rate.
        (1) Base rate spending pool shall be:
            (A) The base year resident days which are
        calculated by multiplying the number of Medicaid
        residents in each nursing home as indicated in the MDS
        data defined in paragraph (4) by 365.
            (B) Each facility's nursing component per diem in
        effect on July 1, 2012 shall be multiplied by
        subsection (A).
            (C) Thirteen million is added to the product of
        subparagraph (A) and subparagraph (B) to adjust for
        the exclusion of nursing homes defined in paragraph
        (5).
        (2) For each nursing home with Medicaid residents as
    indicated by the MDS data defined in paragraph (4),
    weighted days adjusted for case mix and regional wage
    adjustment shall be calculated. For each home this
    calculation is the product of:
            (A) Base year resident days as calculated in
        subparagraph (A) of paragraph (1).
            (B) The nursing home's regional wage adjustor
        based on the Health Service Areas (HSA) groupings and
        adjustors in effect on April 30, 2012.
            (C) Facility weighted case mix which is the number
        of Medicaid residents as indicated by the MDS data
        defined in paragraph (4) multiplied by the associated
        case weight for the RUG-IV 48 grouper model using
        standard RUG-IV procedures for index maximization.
            (D) The sum of the products calculated for each
        nursing home in subparagraphs (A) through (C) above
        shall be the base year case mix, rate adjusted
        weighted days.
        (3) The Statewide RUG-IV nursing base per diem rate:
            (A) on January 1, 2014 shall be the quotient of the
        paragraph (1) divided by the sum calculated under
        subparagraph (D) of paragraph (2); and
            (B) on and after July 1, 2014, shall be the amount
        calculated under subparagraph (A) of this paragraph
        (3) plus $1.76.
        (4) Minimum Data Set (MDS) comprehensive assessments
    for Medicaid residents on the last day of the quarter used
    to establish the base rate.
        (5) Nursing facilities designated as of July 1, 2012
    by the Department as "Institutions for Mental Disease"
    shall be excluded from all calculations under this
    subsection. The data from these facilities shall not be
    used in the computations described in paragraphs (1)
    through (4) above to establish the base rate.
    (e) Beginning July 1, 2014, the Department shall allocate
funding in the amount up to $10,000,000 for per diem add-ons to
the RUGS methodology for dates of service on and after July 1,
2014:
        (1) $0.63 for each resident who scores in I4200
    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
        (2) $2.67 for each resident who scores either a "1" or
    "2" in any items S1200A through S1200I and also scores in
    RUG groups PA1, PA2, BA1, or BA2.
    (e-1) (Blank).
    (e-2) For dates of services beginning January 1, 2014, the
RUG-IV nursing component per diem for a nursing home shall be
the product of the statewide RUG-IV nursing base per diem
rate, the facility average case mix index, and the regional
wage adjustor. Transition rates for services provided between
January 1, 2014 and December 31, 2014 shall be as follows:
        (1) The transition RUG-IV per diem nursing rate for
    nursing homes whose rate calculated in this subsection
    (e-2) is greater than the nursing component rate in effect
    July 1, 2012 shall be paid the sum of:
            (A) The nursing component rate in effect July 1,
        2012; plus
            (B) The difference of the RUG-IV nursing component
        per diem calculated for the current quarter minus the
        nursing component rate in effect July 1, 2012
        multiplied by 0.88.
        (2) The transition RUG-IV per diem nursing rate for
    nursing homes whose rate calculated in this subsection
    (e-2) is less than the nursing component rate in effect
    July 1, 2012 shall be paid the sum of:
            (A) The nursing component rate in effect July 1,
        2012; plus
            (B) The difference of the RUG-IV nursing component
        per diem calculated for the current quarter minus the
        nursing component rate in effect July 1, 2012
        multiplied by 0.13.
    (f) Notwithstanding any other provision of this Code, on
and after July 1, 2012, reimbursement rates associated with
the nursing or support components of the current nursing
facility rate methodology shall not increase beyond the level
effective May 1, 2011 until a new reimbursement system based
on the RUGs IV 48 grouper model has been fully
operationalized.
    (g) Notwithstanding any other provision of this Code, on
and after July 1, 2012, for facilities not designated by the
Department of Healthcare and Family Services as "Institutions
for Mental Disease", rates effective May 1, 2011 shall be
adjusted as follows:
        (1) Individual nursing rates for residents classified
    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
    ending March 31, 2012 shall be reduced by 10%;
        (2) Individual nursing rates for residents classified
    in all other RUG IV groups shall be reduced by 1.0%;
        (3) Facility rates for the capital and support
    components shall be reduced by 1.7%.
    (h) Notwithstanding any other provision of this Code, on
and after July 1, 2012, nursing facilities designated by the
Department of Healthcare and Family Services as "Institutions
for Mental Disease" and "Institutions for Mental Disease" that
are facilities licensed under the Specialized Mental Health
Rehabilitation Act of 2013 shall have the nursing,
socio-developmental, capital, and support components of their
reimbursement rate effective May 1, 2011 reduced in total by
2.7%.
    (i) On and after July 1, 2014, the reimbursement rates for
the support component of the nursing facility rate for
facilities licensed under the Nursing Home Care Act as skilled
or intermediate care facilities shall be the rate in effect on
June 30, 2014 increased by 8.17%.
    (j) Notwithstanding any other provision of law, subject to
federal approval, effective July 1, 2019, sufficient funds
shall be allocated for changes to rates for facilities
licensed under the Nursing Home Care Act as skilled nursing
facilities or intermediate care facilities for dates of
services on and after July 1, 2019: (i) to establish a per diem
add-on to the direct care per diem rate not to exceed
$70,000,000 annually in the aggregate taking into account
federal matching funds for the purpose of addressing the
facility's unique staffing needs, adjusted quarterly and
distributed by a weighted formula based on Medicaid bed days
on the last day of the second quarter preceding the quarter for
which the rate is being adjusted; and (ii) in an amount not to
exceed $170,000,000 annually in the aggregate taking into
account federal matching funds to permit the support component
of the nursing facility rate to be updated as follows:
        (1) 80%, or $136,000,000, of the funds shall be used
    to update each facility's rate in effect on June 30, 2019
    using the most recent cost reports on file, which have had
    a limited review conducted by the Department of Healthcare
    and Family Services and will not hold up enacting the rate
    increase, with the Department of Healthcare and Family
    Services and taking into account subsection (i).
        (2) After completing the calculation in paragraph (1),
    any facility whose rate is less than the rate in effect on
    June 30, 2019 shall have its rate restored to the rate in
    effect on June 30, 2019 from the 20% of the funds set
    aside.
        (3) The remainder of the 20%, or $34,000,000, shall be
    used to increase each facility's rate by an equal
    percentage.
    To implement item (i) in this subsection, facilities shall
file quarterly reports documenting compliance with its
annually approved staffing plan, which shall permit compliance
with Section 3-202.05 of the Nursing Home Care Act. A facility
that fails to meet the benchmarks and dates contained in the
plan may have its add-on adjusted in the quarter following the
quarterly review. Nothing in this Section shall limit the
ability of the facility to appeal a ruling of non-compliance
and a subsequent reduction to the add-on. Funds adjusted for
noncompliance shall be maintained in the Long-Term Care
Provider Fund and accounted for separately. At the end of each
fiscal year, these funds shall be made available to facilities
for special staffing projects.
    In order to provide for the expeditious and timely
implementation of the provisions of Public Act 101-10 this
amendatory Act of the 101st General Assembly, emergency rules
to implement any provision of Public Act 101-10 this
amendatory Act of the 101st General Assembly may be adopted in
accordance with this subsection by the agency charged with
administering that provision or initiative. The agency shall
simultaneously file emergency rules and permanent rules to
ensure that there is no interruption in administrative
guidance. The 150-day limitation of the effective period of
emergency rules does not apply to rules adopted under this
subsection, and the effective period may continue through June
30, 2021. The 24-month limitation on the adoption of emergency
rules does not apply to rules adopted under this subsection.
The adoption of emergency rules authorized by this subsection
is deemed to be necessary for the public interest, safety, and
welfare.
    (k) (j) During the first quarter of State Fiscal Year
2020, the Department of Healthcare of Family Services must
convene a technical advisory group consisting of members of
all trade associations representing Illinois skilled nursing
providers to discuss changes necessary with federal
implementation of Medicare's Patient-Driven Payment Model.
Implementation of Medicare's Patient-Driven Payment Model
shall, by September 1, 2020, end the collection of the MDS data
that is necessary to maintain the current RUG-IV Medicaid
payment methodology. The technical advisory group must
consider a revised reimbursement methodology that takes into
account transparency, accountability, actual staffing as
reported under the federally required Payroll Based Journal
system, changes to the minimum wage, adequacy in coverage of
the cost of care, and a quality component that rewards quality
improvements.
(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
revised 9-18-19.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 7/9/2021