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| [ Introduced ] | [ Engrossed ] | [ House Amendment 001 ] |
92_HB5567enr HB5567 Enrolled LRB9212442DJpk 1 AN ACT in relation to public aid. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Illinois Public Aid Code is amended by 5 changing Section 5-5.4 as follows: 6 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) 7 Sec. 5-5.4. Standards of Payment - Department of Public 8 Aid. The Department of Public Aid shall develop standards of 9 payment of skilled nursing and intermediate care services in 10 facilities providing such services under this Article which: 11 (1) ProvideProvidesfor the determination of a 12 facility's payment for skilled nursing and intermediate care 13 services on a prospective basis. The amount of the payment 14 rate for all nursing facilities certified under the medical 15 assistance program shall be prospectively established 16 annually on the basis of historical, financial, and 17 statistical data reflecting actual costs from prior years, 18 which shall be applied to the current rate year and updated 19 for inflation, except that the capital cost element for newly 20 constructed facilities shall be based upon projected budgets. 21 The annually established payment rate shall take effect on 22 July 1 in 1984 and subsequent years.Rate increases shall be23provided annually thereafter on July 1 in 1984 and on each24subsequent July 1 in the following years, except thatNo rate 25 increase and no update for inflation shall be provided on or 26 after July 1, 1994 and before July 1, 2002, unless 27 specifically provided for in this Section. 28 For facilities licensed by the Department of Public 29 Health under the Nursing Home Care Act as Intermediate Care 30 for the Developmentally Disabled facilities or Long Term Care 31 for Under Age 22 facilities, the rates taking effect on July HB5567 Enrolled -2- LRB9212442DJpk 1 1, 1998 shall include an increase of 3%. For facilities 2 licensed by the Department of Public Health under the Nursing 3 Home Care Act as Skilled Nursing facilities or Intermediate 4 Care facilities, the rates taking effect on July 1, 1998 5 shall include an increase of 3% plus $1.10 per resident-day, 6 as defined by the Department. 7 For facilities licensed by the Department of Public 8 Health under the Nursing Home Care Act as Intermediate Care 9 for the Developmentally Disabled facilities or Long Term Care 10 for Under Age 22 facilities, the rates taking effect on July 11 1, 1999 shall include an increase of 1.6% plus $3.00 per 12 resident-day, as defined by the Department. For facilities 13 licensed by the Department of Public Health under the Nursing 14 Home Care Act as Skilled Nursing facilities or Intermediate 15 Care facilities, the rates taking effect on July 1, 1999 16 shall include an increase of 1.6% and, for services provided 17 on or after October 1, 1999, shall be increased by $4.00 per 18 resident-day, as defined by the Department. 19 For facilities licensed by the Department of Public 20 Health under the Nursing Home Care Act as Intermediate Care 21 for the Developmentally Disabled facilities or Long Term Care 22 for Under Age 22 facilities, the rates taking effect on July 23 1, 2000 shall include an increase of 2.5% per resident-day, 24 as defined by the Department. For facilities licensed by the 25 Department of Public Health under the Nursing Home Care Act 26 as Skilled Nursing facilities or Intermediate Care 27 facilities, the rates taking effect on July 1, 2000 shall 28 include an increase of 2.5% per resident-day, as defined by 29 the Department. 30 For facilities licensed by the Department of Public 31 Health under the Nursing Home Care Act as skilled nursing 32 facilities or intermediate care facilities, a new payment 33 methodology must be implemented for the nursing component of 34 the rate effective July 1, 2003. The Department of Public Aid HB5567 Enrolled -3- LRB9212442DJpk 1 shall develop the new payment methodology using the Minimum 2 Data Set (MDS) as the instrument to collect information 3 concerning nursing home resident condition necessary to 4 compute the rate. The Department of Public Aid shall develop 5 the new payment methodology to meet the unique needs of 6 Illinois nursing home residents while remaining subject to 7 the appropriations provided by the General Assembly. A 8 transition period from the payment methodology in effect on 9 June 30, 2003 to the payment methodology in effect on July 1, 10 2003 shall be provided for a period not exceeding 2 years 11 after implementation of the new payment methodology as 12 follows: 13 (A) For a facility that would receive a lower 14 nursing component rate per patient day under the new 15 system than the facility received effective on the date 16 immediately preceding the date that the Department 17 implements the new payment methodology, the nursing 18 component rate per patient day for the facility shall be 19 held at the level in effect on the date immediately 20 preceding the date that the Department implements the new 21 payment methodology until a higher nursing component rate 22 of reimbursement is achieved by that facility. 23 (B) For a facility that would receive a higher 24 nursing component rate per patient day under the payment 25 methodology in effect on July 1, 2003 than the facility 26 received effective on the date immediately preceding the 27 date that the Department implements the new payment 28 methodology, the nursing component rate per patient day 29 for the facility shall be adjusted. 30 (C) Notwithstanding paragraphs (A) and (B), the 31 nursing component rate per patient day for the facility 32 shall be adjusted subject to appropriations provided by 33 the General Assembly. 34 For facilities licensed by the Department of Public HB5567 Enrolled -4- LRB9212442DJpk 1 Health under the Nursing Home Care Act as Intermediate Care 2 for the Developmentally Disabled facilities or Long Term Care 3 for Under Age 22 facilities, the rates taking effect on March 4 1, 2001 shall include a statewide increase of 7.85%, as 5 defined by the Department. 6 For facilities licensed by the Department of Public 7 Health under the Nursing Home Care Act as Intermediate Care 8 for the Developmentally Disabled facilities or Long Term Care 9 for Under Age 22 facilities, the rates taking effect on April 10 1, 2002 shall include a statewide increase of 2.0%, as 11 defined by the Department. 12 For facilities licensed by the Department of Public 13 Health under the Nursing Home Care Act as skilled nursing 14 facilities or intermediate care facilities, the rates taking 15 effect on July 1, 2001, and each subsequent year thereafter, 16 shall be computed using the most recent cost reports on file 17 with the Department of Public Aid no later than April 1, 2000 18 updated for inflation to January 1, 2001. For rates 19 effective July 1, 2001 only, rates shall be the greater of 20 the rate computed for July 1, 2001 or the rate effective on 21 June 30, 2001. 22 Rates established effective each July 1 shall govern 23 payment for services rendered throughout that fiscal year, 24 except that rates established on July 1, 1996 shall be 25 increased by 6.8% for services provided on or after January 26 1, 1997. Such rates will be based upon the rates calculated 27 for the year beginning July 1, 1990, and for subsequent years 28 thereafter until June 30, 2001 shall be based on the facility 29 cost reports for the facility fiscal year ending at any point 30 in time during the previous calendar year, updated to the 31 midpoint of the rate year. The cost report shall be on file 32 with the Department no later than April 1 of the current rate 33 year. Should the cost report not be on file by April 1, the 34 Department shall base the rate on the latest cost report HB5567 Enrolled -5- LRB9212442DJpk 1 filed by each skilled care facility and intermediate care 2 facility, updated to the midpoint of the current rate year. 3 In determining rates for services rendered on and after July 4 1, 1985, fixed time shall not be computed at less than zero. 5 The Department shall not make any alterations of regulations 6 which would reduce any component of the Medicaid rate to a 7 level below what that component would have been utilizing in 8 the rate effective on July 1, 1984. 9 (2) Shall take into account the actual costs incurred by 10 facilities in providing services for recipients of skilled 11 nursing and intermediate care services under the medical 12 assistance program. 13 (3) Shall take into account the medical and 14 psycho-social characteristics and needs of the patients. 15 (4) Shall take into account the actual costs incurred by 16 facilities in meeting licensing and certification standards 17 imposed and prescribed by the State of Illinois, any of its 18 political subdivisions or municipalities and by the U.S. 19 Department of Health and Human Services pursuant to Title XIX 20 of the Social Security Act. 21 The Department of Public Aid shall develop precise 22 standards for payments to reimburse nursing facilities for 23 any utilization of appropriate rehabilitative personnel for 24 the provision of rehabilitative services which is authorized 25 by federal regulations, including reimbursement for services 26 provided by qualified therapists or qualified assistants, and 27 which is in accordance with accepted professional practices. 28 Reimbursement also may be made for utilization of other 29 supportive personnel under appropriate supervision. 30 (Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10, 31 eff. 6-11-01; 92-31, eff. 6-28-01; revised 12-13-01.)