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90_SB1420
305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
305 ILCS 5/5-5.21
Amends the "Medical Assistance" Article of the Public Aid
Code. With respect to standards of payment to long-term care
providers, provides that after June 30, 1998 the payment
rates shall include an update for inflation and shall be
based on the most recent cost reports on file with the
Department no later than April 1 of the current rate year.
With respect to the reimbursement methodology for long-term
care providers, provides that (i) beginning not later than
July 1, 1999 the nursing component of the reimbursement rate
shall be calculated according to a Resource Utilization
Grouping System (RUGS) model and (ii) beginning not later
than July 1, 2000 the capital, support, and nursing
components of the reimbursement rate shall be calculated
according to a methodology that is entirely cost-based.
Effective immediately.
LRB9009801DJcd
LRB9009801DJcd
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Sections 5-5.4 and 5-5.21.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Sections 5-5.4 and 5-5.21 as follows:
7 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
8 Sec. 5-5.4. Standards of Payment - Department of Public
9 Aid. The Department of Public Aid shall develop standards of
10 payment of skilled nursing and intermediate care services in
11 facilities providing such services under this Article which:
12 (1) Provides for the determination of a facility's
13 payment for skilled nursing and intermediate care services on
14 a prospective basis. The amount of the payment rate for all
15 nursing facilities certified under the medical assistance
16 program shall be prospectively established annually on the
17 basis of historical, financial, and statistical data
18 reflecting actual costs from prior years, which shall be
19 applied to the current rate year and updated for inflation,
20 except that the capital cost element for newly constructed
21 facilities shall be based upon projected budgets. The
22 annually established payment rate shall take effect on July 1
23 in 1984 and subsequent years. Rate increases shall be
24 provided annually thereafter on July 1 in 1984 and on each
25 subsequent July 1 in the following years, except that no rate
26 increase and, except as otherwise provided in this Section,
27 no update for inflation shall be provided on or after July 1,
28 1994. Rates established effective each July 1 shall govern
29 payment for services rendered throughout that fiscal year,
30 except that rates established on July 1, 1996 shall be
31 increased by 6.8% for services provided on or after January
-2- LRB9009801DJcd
1 1, 1997. Such rates will be based upon the rates calculated
2 for the year beginning July 1, 1990, and for subsequent years
3 thereafter shall be based on the facility cost reports for
4 the facility fiscal year ending at any point in time during
5 the previous calendar year, updated to the midpoint of the
6 rate year. The cost report shall be on file with the
7 Department no later than April 1 of the current rate year.
8 Should the cost report not be on file by April 1, the
9 Department shall base the rate on the latest cost report
10 filed by each skilled care facility and intermediate care
11 facility, updated to the midpoint of the current rate year.
12 After June 30, 1998 the rates shall include an update for
13 inflation and shall be based on the most recent cost reports
14 on file with the Department no later than April 1 of the
15 current rate year. In determining rates for services
16 rendered on and after July 1, 1985, fixed time shall not be
17 computed at less than zero. The Department shall not make
18 any alterations of regulations which would reduce any
19 component of the Medicaid rate to a level below what that
20 component would have been utilizing in the rate effective on
21 July 1, 1984.
22 (2) Shall take into account the actual costs incurred by
23 facilities in providing services for recipients of skilled
24 nursing and intermediate care services under the medical
25 assistance program.
26 (3) Shall take into account the medical and
27 psycho-social characteristics and needs of the patients.
28 (4) Shall take into account the actual costs incurred by
29 facilities in meeting, licensing and certification standards
30 imposed and prescribed by the State of Illinois, any of its
31 political subdivisions or municipalities and by the United
32 States Department of Health, Education and Welfare pursuant
33 to Title XIX of the Social Security Act.
34 The Department of Public Aid shall develop precise
-3- LRB9009801DJcd
1 standards for payments to reimburse nursing facilities for
2 any utilization of appropriate rehabilitative personnel for
3 the provision of rehabilitative services which is authorized
4 by federal regulations, including reimbursement for services
5 provided by qualified therapists or qualified assistants, and
6 which is in accordance with accepted professional practices.
7 Reimbursement also may be made for utilization of other
8 supportive personnel under appropriate supervision.
9 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 90-9,
10 eff. 7-1-97.)
11 (305 ILCS 5/5-5.21)
12 Sec. 5-5.21. Reimbursement methodology. The Department
13 shall form a workgroup comprised of representatives of the
14 Department, the Illinois Department of Public Health, and
15 members of the long-term care provider community to implement
16 a reimbursement methodology based upon the federally mandated
17 resident assessment instrument. No later than January 1,
18 1997, the Illinois Department in conjunction with the work
19 group will recommend to the Governor a methodology for
20 determining payment rates for services in nursing facilities
21 based upon the federally mandated resident assessment
22 instrument. No later than June 30, 1997, the Illinois
23 Department shall implement a methodology for determining
24 payment rates for services in nursing facilities based upon
25 federal requirements.
26 Beginning not later than July 1, 1999 the nursing
27 component of the reimbursement rate shall be calculated
28 according to a Resource Utilization Grouping System (RUGS)
29 model.
30 Beginning not later than July 1, 2000 the capital,
31 support, and nursing components of the reimbursement rate
32 shall be calculated according to a methodology that is
33 entirely cost-based.
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1 (Source: P.A. 89-415, eff. 1-1-96.)
2 Section 99. Effective date. This Act takes effect upon
3 becoming law.