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91_HB3398
LRB9110559DJcd
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-5.4.
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 Section 5-5.4 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 no update for inflation shall be provided on or
27 after July 1, 1994 and before July 1, 2000, unless
28 specifically provided for in this Section.
29 For facilities licensed by the Department of Public
30 Health under the Nursing Home Care Act as Intermediate Care
31 for the Developmentally Disabled facilities or Long Term Care
-2- LRB9110559DJcd
1 for Under Age 22 facilities, the rates taking effect on July
2 1, 1998 shall include an increase of 3%. For facilities
3 licensed by the Department of Public Health under the Nursing
4 Home Care Act as Skilled Nursing facilities or Intermediate
5 Care facilities, the rates taking effect on July 1, 1998
6 shall include an increase of 3% plus $1.10 per resident-day,
7 as defined by the Department.
8 For facilities licensed by the Department of Public
9 Health under the Nursing Home Care Act as Intermediate Care
10 for the Developmentally Disabled facilities or Long Term Care
11 for Under Age 22 facilities, the rates taking effect on July
12 1, 1999 shall include an increase of 1.6% plus $3.00 per
13 resident-day, as defined by the Department. For facilities
14 licensed by the Department of Public Health under the Nursing
15 Home Care Act as Skilled Nursing facilities or Intermediate
16 Care facilities, the rates taking effect on July 1, 1999
17 shall include an increase of 1.6% and, for services provided
18 on or after October 1, 1999, shall be increased by $4.00 per
19 resident-day, as defined by the Department.
20 Rates established effective each July 1 shall govern
21 payment for services rendered throughout that fiscal year,
22 except that rates established on July 1, 1996 shall be
23 increased by 6.8% for services provided on or after January
24 1, 1997. Such rates will be based upon the rates calculated
25 for the year beginning July 1, 1990, and for subsequent years
26 thereafter shall be based on the facility cost reports for
27 the facility fiscal year ending at any point in time during
28 the previous calendar year, updated to the midpoint of the
29 rate year. The cost report shall be on file with the
30 Department no later than April 1 of the current rate year.
31 Should the cost report not be on file by April 1, the
32 Department shall base the rate on the latest cost report
33 filed by each skilled care facility and intermediate care
34 facility, updated to the midpoint of the current rate year.
-3- LRB9110559DJcd
1 In determining rates for services rendered on and after July
2 1, 1985, fixed time shall not be computed at less than zero.
3 The Department shall not make any alterations of regulations
4 which would reduce any component of the Medicaid rate to a
5 level below what that component would have been utilizing in
6 the rate effective on July 1, 1984.
7 (2) Shall take into account the actual costs incurred by
8 facilities in providing services for recipients of skilled
9 nursing and intermediate care services under the medical
10 assistance program.
11 (3) Shall take into account the medical and
12 psycho-social characteristics and needs of the patients.
13 (4) Shall take into account the actual costs incurred by
14 facilities in meeting licensing and certification standards
15 imposed and prescribed by the State of Illinois, any of its
16 political subdivisions or municipalities and by the United
17 States Department of Health, Education and Welfare pursuant
18 to Title XIX of the Social Security Act.
19 (5) Shall include a quality incentive of at least $0.50
20 per resident per day for those facilities using a nationally
21 recognized quality improvement program.
22 The Department of Public Aid shall develop precise
23 standards for payments to reimburse nursing facilities for
24 any utilization of appropriate rehabilitative personnel for
25 the provision of rehabilitative services which is authorized
26 by federal regulations, including reimbursement for services
27 provided by qualified therapists or qualified assistants, and
28 which is in accordance with accepted professional practices.
29 Reimbursement also may be made for utilization of other
30 supportive personnel under appropriate supervision.
31 (Source: P.A. 90-9, eff. 7-1-97; 90-588, eff. 7-1-98; 91-24,
32 eff. 7-1-99.)