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| Public Act 094-0964 |
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Public Aid Code is amended by | ||||
changing Section 5-5.4 as follows: | ||||
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
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Sec. 5-5.4. Standards of Payment - Department of Healthcare | ||||
and Family Services
Public Aid.
The Department of Healthcare | ||||
and Family Services
Public Aid shall develop standards of | ||||
payment of skilled
nursing and intermediate care services in | ||||
facilities providing such services
under this Article which:
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(1) Provide for the determination of a facility's payment
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for skilled nursing and intermediate care services on a | ||||
prospective basis.
The amount of the payment rate for all | ||||
nursing facilities certified by the
Department of Public Health | ||||
under the Nursing Home Care Act as Intermediate
Care for the | ||||
Developmentally Disabled facilities, Long Term Care for Under | ||||
Age
22 facilities, Skilled Nursing facilities, or Intermediate | ||||
Care facilities
under the
medical assistance program shall be | ||||
prospectively established annually on the
basis of historical, | ||||
financial, and statistical data reflecting actual costs
from | ||||
prior years, which shall be applied to the current rate year | ||||
and updated
for inflation, except that the capital cost element | ||||
for newly constructed
facilities shall be based upon projected | ||||
budgets. The annually established
payment rate shall take | ||||
effect on July 1 in 1984 and subsequent years. No rate
increase | ||||
and no
update for inflation shall be provided on or after July | ||||
1, 1994 and before
July 1, 2006, unless specifically provided | ||||
for in this
Section.
The changes made by this amendatory Act of | ||||
the 93rd General Assembly extending the duration of the | ||||
prohibition against a rate increase or update for inflation are | ||||
effective retroactive to July 1, 2004.
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For facilities licensed by the Department of Public Health | ||
under the Nursing
Home Care Act as Intermediate Care for the | ||
Developmentally Disabled facilities
or Long Term Care for Under | ||
Age 22 facilities, the rates taking effect on July
1, 1998 | ||
shall include an increase of 3%. For facilities licensed by the
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Department of Public Health under the Nursing Home Care Act as | ||
Skilled Nursing
facilities or Intermediate Care facilities, | ||
the rates taking effect on July 1,
1998 shall include an | ||
increase of 3% plus $1.10 per resident-day, as defined by
the | ||
Department. For facilities licensed by the Department of Public | ||
Health under the Nursing Home Care Act as Intermediate Care | ||
Facilities for the Developmentally Disabled or Long Term Care | ||
for Under Age 22 facilities, the rates taking effect on January | ||
1, 2006 shall include an increase of 3%.
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For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on July 1, 1999 | ||
shall include an increase of 1.6% plus $3.00 per
resident-day, | ||
as defined by the Department. For facilities licensed by the
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Department of Public Health under the Nursing Home Care Act as | ||
Skilled Nursing
facilities or Intermediate Care facilities, | ||
the rates taking effect on July 1,
1999 shall include an | ||
increase of 1.6% and, for services provided on or after
October | ||
1, 1999, shall be increased by $4.00 per resident-day, as | ||
defined by
the Department.
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For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on July 1, 2000 | ||
shall include an increase of 2.5% per resident-day,
as defined | ||
by the Department. For facilities licensed by the Department of
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Public Health under the Nursing Home Care Act as Skilled | ||
Nursing facilities or
Intermediate Care facilities, the rates | ||
taking effect on July 1, 2000 shall
include an increase of 2.5% | ||
per resident-day, as defined by the Department.
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For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as skilled nursing facilities | ||
or intermediate care
facilities, a new payment methodology must | ||
be implemented for the nursing
component of the rate effective | ||
July 1, 2003. The Department of Public Aid
(now Healthcare and | ||
Family Services) shall develop the new payment methodology | ||
using the Minimum Data Set
(MDS) as the instrument to collect | ||
information concerning nursing home
resident condition | ||
necessary to compute the rate. The Department of Public Aid
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shall develop the new payment methodology to meet the unique | ||
needs of
Illinois nursing home residents while remaining | ||
subject to the appropriations
provided by the General Assembly.
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A transition period from the payment methodology in effect on | ||
June 30, 2003
to the payment methodology in effect on July 1, | ||
2003 shall be provided for a
period not exceeding 3 years and | ||
184 days after implementation of the new payment
methodology as | ||
follows:
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(A) For a facility that would receive a lower
nursing | ||
component rate per patient day under the new system than | ||
the facility
received
effective on the date immediately | ||
preceding the date that the Department
implements the new | ||
payment methodology, the nursing component rate per | ||
patient
day for the facility
shall be held at
the level in | ||
effect on the date immediately preceding the date that the
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Department implements the new payment methodology until a | ||
higher nursing
component rate of
reimbursement is achieved | ||
by that
facility.
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(B) For a facility that would receive a higher nursing | ||
component rate per
patient day under the payment | ||
methodology in effect on July 1, 2003 than the
facility | ||
received effective on the date immediately preceding the | ||
date that the
Department implements the new payment | ||
methodology, the nursing component rate
per patient day for | ||
the facility shall be adjusted.
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(C) Notwithstanding paragraphs (A) and (B), the | ||
nursing component rate per
patient day for the facility | ||
shall be adjusted subject to appropriations
provided by the | ||
General Assembly.
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For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on March 1, 2001 | ||
shall include a statewide increase of 7.85%, as
defined by the | ||
Department.
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For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on April 1, 2002 | ||
shall include a statewide increase of 2.0%, as
defined by the | ||
Department.
This increase terminates on July 1, 2002;
beginning | ||
July 1, 2002 these rates are reduced to the level of the rates
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in effect on March 31, 2002, as defined by the Department.
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For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as skilled nursing facilities | ||
or intermediate care
facilities, the rates taking effect on | ||
July 1, 2001 shall be computed using the most recent cost | ||
reports
on file with the Department of Public Aid no later than | ||
April 1, 2000,
updated for inflation to January 1, 2001. For | ||
rates effective July 1, 2001
only, rates shall be the greater | ||
of the rate computed for July 1, 2001
or the rate effective on | ||
June 30, 2001.
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Notwithstanding any other provision of this Section, for | ||
facilities
licensed by the Department of Public Health under | ||
the Nursing Home Care Act
as skilled nursing facilities or | ||
intermediate care facilities, the Illinois
Department shall | ||
determine by rule the rates taking effect on July 1, 2002,
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which shall be 5.9% less than the rates in effect on June 30, | ||
2002.
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Notwithstanding any other provision of this Section, for | ||
facilities
licensed by the Department of Public Health under | ||
the Nursing Home Care Act as
skilled nursing
facilities or | ||
intermediate care facilities, if the payment methodologies | ||
required under Section 5A-12 and the waiver granted under 42 | ||
CFR 433.68 are approved by the United States Centers for | ||
Medicare and Medicaid Services, the rates taking effect on July | ||
1, 2004 shall be 3.0% greater than the rates in effect on June | ||
30, 2004. These rates shall take
effect only upon approval and
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implementation of the payment methodologies required under | ||
Section 5A-12.
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Notwithstanding any other provisions of this Section, for | ||
facilities licensed by the Department of Public Health under | ||
the Nursing Home Care Act as skilled nursing facilities or | ||
intermediate care facilities, the rates taking effect on | ||
January 1, 2005 shall be 3% more than the rates in effect on | ||
December 31, 2004.
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For facilities
licensed
by the
Department of Public Health | ||
under the Nursing Home Care Act as Intermediate
Care for
the | ||
Developmentally Disabled facilities or as long-term care | ||
facilities for
residents under 22 years of age, the rates | ||
taking effect on July 1,
2003 shall
include a statewide | ||
increase of 4%, as defined by the Department.
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Notwithstanding any other provision of this Section, for | ||
facilities licensed by the Department of Public Health under | ||
the Nursing Home Care Act as skilled nursing facilities or | ||
intermediate care facilities, effective January 1, 2005, | ||
facility rates shall be increased by the difference between (i) | ||
a facility's per diem property, liability, and malpractice | ||
insurance costs as reported in the cost report filed with the | ||
Department of Public Aid and used to establish rates effective | ||
July 1, 2001 and (ii) those same costs as reported in the | ||
facility's 2002 cost report. These costs shall be passed | ||
through to the facility without caps or limitations, except for | ||
adjustments required under normal auditing procedures.
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Rates established effective each July 1 shall govern | ||
payment
for services rendered throughout that fiscal year, | ||
except that rates
established on July 1, 1996 shall be | ||
increased by 6.8% for services
provided on or after January 1, | ||
1997. Such rates will be based
upon the rates calculated for | ||
the year beginning July 1, 1990, and for
subsequent years | ||
thereafter until June 30, 2001 shall be based on the
facility | ||
cost reports
for the facility fiscal year ending at any point | ||
in time during the previous
calendar year, updated to the | ||
midpoint of the rate year. The cost report
shall be on file | ||
with the Department no later than April 1 of the current
rate | ||
year. Should the cost report not be on file by April 1, the | ||
Department
shall base the rate on the latest cost report filed | ||
by each skilled care
facility and intermediate care facility, | ||
updated to the midpoint of the
current rate year. In | ||
determining rates for services rendered on and after
July 1, | ||
1985, fixed time shall not be computed at less than zero. The
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Department shall not make any alterations of regulations which | ||
would reduce
any component of the Medicaid rate to a level | ||
below what that component would
have been utilizing in the rate | ||
effective on July 1, 1984.
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(2) Shall take into account the actual costs incurred by | ||
facilities
in providing services for recipients of skilled | ||
nursing and intermediate
care services under the medical | ||
assistance program.
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(3) Shall take into account the medical and psycho-social
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characteristics and needs of the patients.
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(4) Shall take into account the actual costs incurred by | ||
facilities in
meeting licensing and certification standards | ||
imposed and prescribed by the
State of Illinois, any of its | ||
political subdivisions or municipalities and by
the U.S. | ||
Department of Health and Human Services pursuant to Title XIX | ||
of the
Social Security Act.
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The Department of Healthcare and Family Services
Public Aid
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shall develop precise standards for
payments to reimburse | ||
nursing facilities for any utilization of
appropriate | ||
rehabilitative personnel for the provision of rehabilitative
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services which is authorized by federal regulations, including
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reimbursement for services provided by qualified therapists or | ||
qualified
assistants, and which is in accordance with accepted | ||
professional
practices. Reimbursement also may be made for | ||
utilization of other
supportive personnel under appropriate | ||
supervision.
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(Source: P.A. 93-20, eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, | ||
eff. 2-3-04; 93-841, eff. 7-30-04; 93-1087, eff. 2-28-05; | ||
94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, eff. 11-21-05; | ||
revised 12-15-05.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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