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| Public Act 098-0727 | ||||
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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 5-5.2 as follows:
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(305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
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Sec. 5-5.2. Payment.
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(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.
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(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.
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(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. | ||
(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 on | ||
January 1, 2014 shall be the quotient of the paragraph (1) | ||
divided by the sum calculated under subparagraph (D) of | ||
paragraph (2). | ||
(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) Notwithstanding any other provision of this Code, the | ||
Department shall by rule develop a reimbursement methodology | ||
reflective of the intensity of care and services requirements | ||
of low need residents in the lowest RUG IV groupers and | ||
corresponding regulations. Only that portion of the RUGs | ||
Reimbursement System spending pool described in subsection | ||
(d-1) attributed to the groupers as of July 1, 2013 for which | ||
the methodology in this Section is developed may be diverted | ||
for this purpose. The Department shall submit the rules no | ||
later than January 1, 2014 for an implementation date no later | ||
than January 1, 2015. If the Department does not implement this | ||
reimbursement methodology by the required date, the nursing | ||
component per diem on January 1, 2015 for residents classified | ||
in RUG-IV groups PA1, PA2, BA1, and BA2 shall be the blended | ||
rate of the calculated RUG-IV nursing component per diem and | ||
the nursing component per diem in effect on July 1, 2012. This | ||
blended rate shall be applied only to nursing homes whose | ||
resident population is greater than or equal to 70% of the | ||
total residents served and whose RUG-IV nursing component per | ||
diem rate is less than the nursing component per diem in effect | ||
on July 1, 2012. This blended rate shall be in effect until the | ||
reimbursement methodology is implemented or until July 1, 2019, | ||
whichever is sooner. | ||
(e-1) Notwithstanding any other provision of this Article, | ||
rates established pursuant to this subsection shall not apply | ||
to any and all nursing facilities designated by the Department | ||
as "Institutions for Mental Disease" and shall be excluded from | ||
the RUGs Reimbursement System applicable to facilities not | ||
designated as "Institutions for the Mentally Diseased" by the | ||
Department. | ||
(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%. | ||
(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section | ||
6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff. | ||
7-22-13; revised 9-19-13.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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