Illinois 2023-2024 Regular Session

Illinois House Bill HB3125 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3125 Introduced , by Rep. Elizabeth "Lisa" Hernandez SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023 (rather than July 1, 2014), the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities shall be the rate in effect on June 30, 2014 increased by 8.17%. Effective July 1, 2023. LRB103 29884 KTG 56295 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3125 Introduced , by Rep. Elizabeth "Lisa" Hernandez SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2 305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023 (rather than July 1, 2014), the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities shall be the rate in effect on June 30, 2014 increased by 8.17%. Effective July 1, 2023. LRB103 29884 KTG 56295 b LRB103 29884 KTG 56295 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3125 Introduced , by Rep. Elizabeth "Lisa" Hernandez SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2 305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2
4	4	305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2
5	5	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023 (rather than July 1, 2014), the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities shall be the rate in effect on June 30, 2014 increased by 8.17%. Effective July 1, 2023.
6	6	LRB103 29884 KTG 56295 b LRB103 29884 KTG 56295 b
7	7	LRB103 29884 KTG 56295 b
8	8	A BILL FOR
9	9	HB3125LRB103 29884 KTG 56295 b HB3125 LRB103 29884 KTG 56295 b
10	10	HB3125 LRB103 29884 KTG 56295 b
11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Public Aid Code is amended by
15	15	5 changing Section 5-5.2 as follows:
16	16	6 (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
17	17	7 Sec. 5-5.2. Payment.
18	18	8 (a) All nursing facilities that are grouped pursuant to
19	19	9 Section 5-5.1 of this Act shall receive the same rate of
20	20	10 payment for similar services.
21	21	11 (b) It shall be a matter of State policy that the Illinois
22	22	12 Department shall utilize a uniform billing cycle throughout
23	23	13 the State for the long-term care providers.
24	24	14 (c) (Blank).
25	25	15 (c-1) Notwithstanding any other provisions of this Code,
26	26	16 the methodologies for reimbursement of nursing services as
27	27	17 provided under this Article shall no longer be applicable for
28	28	18 bills payable for nursing services rendered on or after a new
29	29	19 reimbursement system based on the Patient Driven Payment Model
30	30	20 (PDPM) has been fully operationalized, which shall take effect
31	31	21 for services provided on or after the implementation of the
32	32	22 PDPM reimbursement system begins. For the purposes of this
33	33	23 amendatory Act of the 102nd General Assembly, the
34	34
35	35
36	36
37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3125 Introduced , by Rep. Elizabeth "Lisa" Hernandez SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2 305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2
39	39	305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2
40	40	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023 (rather than July 1, 2014), the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities shall be the rate in effect on June 30, 2014 increased by 8.17%. Effective July 1, 2023.
41	41	LRB103 29884 KTG 56295 b LRB103 29884 KTG 56295 b
42	42	LRB103 29884 KTG 56295 b
43	43	A BILL FOR
44	44
45	45
46	46
47	47
48	48
49	49	305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2
50	50
51	51
52	52
53	53	LRB103 29884 KTG 56295 b
54	54
55	55
56	56
57	57
58	58
59	59
60	60
61	61
62	62
63	63	HB3125 LRB103 29884 KTG 56295 b
64	64
65	65
66	66	HB3125- 2 -LRB103 29884 KTG 56295 b HB3125 - 2 - LRB103 29884 KTG 56295 b
67	67	HB3125 - 2 - LRB103 29884 KTG 56295 b
68	68	1 implementation date of the PDPM reimbursement system and all
69	69	2 related provisions shall be July 1, 2022 if the following
70	70	3 conditions are met: (i) the Centers for Medicare and Medicaid
71	71	4 Services has approved corresponding changes in the
72	72	5 reimbursement system and bed assessment; and (ii) the
73	73	6 Department has filed rules to implement these changes no later
74	74	7 than June 1, 2022. Failure of the Department to file rules to
75	75	8 implement the changes provided in this amendatory Act of the
76	76	9 102nd General Assembly no later than June 1, 2022 shall result
77	77	10 in the implementation date being delayed to October 1, 2022.
78	78	11 (d) The new nursing services reimbursement methodology
79	79	12 utilizing the Patient Driven Payment Model, which shall be
80	80	13 referred to as the PDPM reimbursement system, taking effect
81	81	14 July 1, 2022, upon federal approval by the Centers for
82	82	15 Medicare and Medicaid Services, shall be based on the
83	83	16 following:
84	84	17 (1) The methodology shall be resident-centered,
85	85	18 facility-specific, cost-based, and based on guidance from
86	86	19 the Centers for Medicare and Medicaid Services.
87	87	20 (2) Costs shall be annually rebased and case mix index
88	88	21 quarterly updated. The nursing services methodology will
89	89	22 be assigned to the Medicaid enrolled residents on record
90	90	23 as of 30 days prior to the beginning of the rate period in
91	91	24 the Department's Medicaid Management Information System
92	92	25 (MMIS) as present on the last day of the second quarter
93	93	26 preceding the rate period based upon the Assessment
94	94
95	95
96	96
97	97
98	98
99	99	HB3125 - 2 - LRB103 29884 KTG 56295 b
100	100
101	101
102	102	HB3125- 3 -LRB103 29884 KTG 56295 b HB3125 - 3 - LRB103 29884 KTG 56295 b
103	103	HB3125 - 3 - LRB103 29884 KTG 56295 b
104	104	1 Reference Date of the Minimum Data Set (MDS).
105	105	2 (3) Regional wage adjustors based on the Health
106	106	3 Service Areas (HSA) groupings and adjusters in effect on
107	107	4 April 30, 2012 shall be included, except no adjuster shall
108	108	5 be lower than 1.06.
109	109	6 (4) PDPM nursing case mix indices in effect on March
110	110	7 1, 2022 shall be assigned to each resident class at no less
111	111	8 than 0.7858 of the Centers for Medicare and Medicaid
112	112	9 Services PDPM unadjusted case mix values, in effect on
113	113	10 March 1, 2022.
114	114	11 (5) The pool of funds available for distribution by
115	115	12 case mix and the base facility rate shall be determined
116	116	13 using the formula contained in subsection (d-1).
117	117	14 (6) The Department shall establish a variable per diem
118	118	15 staffing add-on in accordance with the most recent
119	119	16 available federal staffing report, currently the Payroll
120	120	17 Based Journal, for the same period of time, and if
121	121	18 applicable adjusted for acuity using the same quarter's
122	122	19 MDS. The Department shall rely on Payroll Based Journals
123	123	20 provided to the Department of Public Health to make a
124	124	21 determination of non-submission. If the Department is
125	125	22 notified by a facility of missing or inaccurate Payroll
126	126	23 Based Journal data or an incorrect calculation of
127	127	24 staffing, the Department must make a correction as soon as
128	128	25 the error is verified for the applicable quarter.
129	129	26 Facilities with at least 70% of the staffing indicated
130	130
131	131
132	132
133	133
134	134
135	135	HB3125 - 3 - LRB103 29884 KTG 56295 b
136	136
137	137
138	138	HB3125- 4 -LRB103 29884 KTG 56295 b HB3125 - 4 - LRB103 29884 KTG 56295 b
139	139	HB3125 - 4 - LRB103 29884 KTG 56295 b
140	140	1 by the STRIVE study shall be paid a per diem add-on of $9,
141	141	2 increasing by equivalent steps for each whole percentage
142	142	3 point until the facilities reach a per diem of $14.88.
143	143	4 Facilities with at least 80% of the staffing indicated by
144	144	5 the STRIVE study shall be paid a per diem add-on of $14.88,
145	145	6 increasing by equivalent steps for each whole percentage
146	146	7 point until the facilities reach a per diem add-on of
147	147	8 $23.80. Facilities with at least 92% of the staffing
148	148	9 indicated by the STRIVE study shall be paid a per diem
149	149	10 add-on of $23.80, increasing by equivalent steps for each
150	150	11 whole percentage point until the facilities reach a per
151	151	12 diem add-on of $29.75. Facilities with at least 100% of
152	152	13 the staffing indicated by the STRIVE study shall be paid a
153	153	14 per diem add-on of $29.75, increasing by equivalent steps
154	154	15 for each whole percentage point until the facilities reach
155	155	16 a per diem add-on of $35.70. Facilities with at least 110%
156	156	17 of the staffing indicated by the STRIVE study shall be
157	157	18 paid a per diem add-on of $35.70, increasing by equivalent
158	158	19 steps for each whole percentage point until the facilities
159	159	20 reach a per diem add-on of $38.68. Facilities with at
160	160	21 least 125% or higher of the staffing indicated by the
161	161	22 STRIVE study shall be paid a per diem add-on of $38.68.
162	162	23 Beginning April 1, 2023, no nursing facility's variable
163	163	24 staffing per diem add-on shall be reduced by more than 5%
164	164	25 in 2 consecutive quarters. For the quarters beginning July
165	165	26 1, 2022 and October 1, 2022, no facility's variable per
166	166
167	167
168	168
169	169
170	170
171	171	HB3125 - 4 - LRB103 29884 KTG 56295 b
172	172
173	173
174	174	HB3125- 5 -LRB103 29884 KTG 56295 b HB3125 - 5 - LRB103 29884 KTG 56295 b
175	175	HB3125 - 5 - LRB103 29884 KTG 56295 b
176	176	1 diem staffing add-on shall be calculated at a rate lower
177	177	2 than 85% of the staffing indicated by the STRIVE study. No
178	178	3 facility below 70% of the staffing indicated by the STRIVE
179	179	4 study shall receive a variable per diem staffing add-on
180	180	5 after December 31, 2022.
181	181	6 (7) For dates of services beginning July 1, 2022, the
182	182	7 PDPM nursing component per diem for each nursing facility
183	183	8 shall be the product of the facility's (i) statewide PDPM
184	184	9 nursing base per diem rate, $92.25, adjusted for the
185	185	10 facility average PDPM case mix index calculated quarterly
186	186	11 and (ii) the regional wage adjuster, and then add the
187	187	12 Medicaid access adjustment as defined in (e-3) of this
188	188	13 Section. Transition rates for services provided between
189	189	14 July 1, 2022 and October 1, 2023 shall be the greater of
190	190	15 the PDPM nursing component per diem or:
191	191	16 (A) for the quarter beginning July 1, 2022, the
192	192	17 RUG-IV nursing component per diem;
193	193	18 (B) for the quarter beginning October 1, 2022, the
194	194	19 sum of the RUG-IV nursing component per diem
195	195	20 multiplied by 0.80 and the PDPM nursing component per
196	196	21 diem multiplied by 0.20;
197	197	22 (C) for the quarter beginning January 1, 2023, the
198	198	23 sum of the RUG-IV nursing component per diem
199	199	24 multiplied by 0.60 and the PDPM nursing component per
200	200	25 diem multiplied by 0.40;
201	201	26 (D) for the quarter beginning April 1, 2023, the
202	202
203	203
204	204
205	205
206	206
207	207	HB3125 - 5 - LRB103 29884 KTG 56295 b
208	208
209	209
210	210	HB3125- 6 -LRB103 29884 KTG 56295 b HB3125 - 6 - LRB103 29884 KTG 56295 b
211	211	HB3125 - 6 - LRB103 29884 KTG 56295 b
212	212	1 sum of the RUG-IV nursing component per diem
213	213	2 multiplied by 0.40 and the PDPM nursing component per
214	214	3 diem multiplied by 0.60;
215	215	4 (E) for the quarter beginning July 1, 2023, the
216	216	5 sum of the RUG-IV nursing component per diem
217	217	6 multiplied by 0.20 and the PDPM nursing component per
218	218	7 diem multiplied by 0.80; or
219	219	8 (F) for the quarter beginning October 1, 2023 and
220	220	9 each subsequent quarter, the transition rate shall end
221	221	10 and a nursing facility shall be paid 100% of the PDPM
222	222	11 nursing component per diem.
223	223	12 (d-1) Calculation of base year Statewide RUG-IV nursing
224	224	13 base per diem rate.
225	225	14 (1) Base rate spending pool shall be:
226	226	15 (A) The base year resident days which are
227	227	16 calculated by multiplying the number of Medicaid
228	228	17 residents in each nursing home as indicated in the MDS
229	229	18 data defined in paragraph (4) by 365.
230	230	19 (B) Each facility's nursing component per diem in
231	231	20 effect on July 1, 2012 shall be multiplied by
232	232	21 subsection (A).
233	233	22 (C) Thirteen million is added to the product of
234	234	23 subparagraph (A) and subparagraph (B) to adjust for
235	235	24 the exclusion of nursing homes defined in paragraph
236	236	25 (5).
237	237	26 (2) For each nursing home with Medicaid residents as
238	238
239	239
240	240
241	241
242	242
243	243	HB3125 - 6 - LRB103 29884 KTG 56295 b
244	244
245	245
246	246	HB3125- 7 -LRB103 29884 KTG 56295 b HB3125 - 7 - LRB103 29884 KTG 56295 b
247	247	HB3125 - 7 - LRB103 29884 KTG 56295 b
248	248	1 indicated by the MDS data defined in paragraph (4),
249	249	2 weighted days adjusted for case mix and regional wage
250	250	3 adjustment shall be calculated. For each home this
251	251	4 calculation is the product of:
252	252	5 (A) Base year resident days as calculated in
253	253	6 subparagraph (A) of paragraph (1).
254	254	7 (B) The nursing home's regional wage adjustor
255	255	8 based on the Health Service Areas (HSA) groupings and
256	256	9 adjustors in effect on April 30, 2012.
257	257	10 (C) Facility weighted case mix which is the number
258	258	11 of Medicaid residents as indicated by the MDS data
259	259	12 defined in paragraph (4) multiplied by the associated
260	260	13 case weight for the RUG-IV 48 grouper model using
261	261	14 standard RUG-IV procedures for index maximization.
262	262	15 (D) The sum of the products calculated for each
263	263	16 nursing home in subparagraphs (A) through (C) above
264	264	17 shall be the base year case mix, rate adjusted
265	265	18 weighted days.
266	266	19 (3) The Statewide RUG-IV nursing base per diem rate:
267	267	20 (A) on January 1, 2014 shall be the quotient of the
268	268	21 paragraph (1) divided by the sum calculated under
269	269	22 subparagraph (D) of paragraph (2);
270	270	23 (B) on and after July 1, 2014 and until July 1,
271	271	24 2022, shall be the amount calculated under
272	272	25 subparagraph (A) of this paragraph (3) plus $1.76; and
273	273	26 (C) beginning July 1, 2022 and thereafter, $7
274	274
275	275
276	276
277	277
278	278
279	279	HB3125 - 7 - LRB103 29884 KTG 56295 b
280	280
281	281
282	282	HB3125- 8 -LRB103 29884 KTG 56295 b HB3125 - 8 - LRB103 29884 KTG 56295 b
283	283	HB3125 - 8 - LRB103 29884 KTG 56295 b
284	284	1 shall be added to the amount calculated under
285	285	2 subparagraph (B) of this paragraph (3) of this
286	286	3 Section.
287	287	4 (4) Minimum Data Set (MDS) comprehensive assessments
288	288	5 for Medicaid residents on the last day of the quarter used
289	289	6 to establish the base rate.
290	290	7 (5) Nursing facilities designated as of July 1, 2012
291	291	8 by the Department as "Institutions for Mental Disease"
292	292	9 shall be excluded from all calculations under this
293	293	10 subsection. The data from these facilities shall not be
294	294	11 used in the computations described in paragraphs (1)
295	295	12 through (4) above to establish the base rate.
296	296	13 (e) Beginning July 1, 2014, the Department shall allocate
297	297	14 funding in the amount up to $10,000,000 for per diem add-ons to
298	298	15 the RUGS methodology for dates of service on and after July 1,
299	299	16 2014:
300	300	17 (1) $0.63 for each resident who scores in I4200
301	301	18 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
302	302	19 (2) $2.67 for each resident who scores either a "1" or
303	303	20 "2" in any items S1200A through S1200I and also scores in
304	304	21 RUG groups PA1, PA2, BA1, or BA2.
305	305	22 (e-1) (Blank).
306	306	23 (e-2) For dates of services beginning January 1, 2014 and
307	307	24 ending September 30, 2023, the RUG-IV nursing component per
308	308	25 diem for a nursing home shall be the product of the statewide
309	309	26 RUG-IV nursing base per diem rate, the facility average case
310	310
311	311
312	312
313	313
314	314
315	315	HB3125 - 8 - LRB103 29884 KTG 56295 b
316	316
317	317
318	318	HB3125- 9 -LRB103 29884 KTG 56295 b HB3125 - 9 - LRB103 29884 KTG 56295 b
319	319	HB3125 - 9 - LRB103 29884 KTG 56295 b
320	320	1 mix index, and the regional wage adjustor. For dates of
321	321	2 service beginning July 1, 2022 and ending September 30, 2023,
322	322	3 the Medicaid access adjustment described in subsection (e-3)
323	323	4 shall be added to the product.
324	324	5 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
325	325	6 facility average PDPM case mix index calculated quarterly
326	326	7 shall be added to the statewide PDPM nursing per diem for all
327	327	8 facilities with annual Medicaid bed days of at least 70% of all
328	328	9 occupied bed days adjusted quarterly. For each new calendar
329	329	10 year and for the 6-month period beginning July 1, 2022, the
330	330	11 percentage of a facility's occupied bed days comprised of
331	331	12 Medicaid bed days shall be determined by the Department
332	332	13 quarterly. For dates of service beginning January 1, 2023, the
333	333	14 Medicaid Access Adjustment shall be increased to $4.75. This
334	334	15 subsection shall be inoperative on and after January 1, 2028.
335	335	16 (f) (Blank).
336	336	17 (g) Notwithstanding any other provision of this Code, on
337	337	18 and after July 1, 2012, for facilities not designated by the
338	338	19 Department of Healthcare and Family Services as "Institutions
339	339	20 for Mental Disease", rates effective May 1, 2011 shall be
340	340	21 adjusted as follows:
341	341	22 (1) (Blank);
342	342	23 (2) (Blank);
343	343	24 (3) Facility rates for the capital and support
344	344	25 components shall be reduced by 1.7%.
345	345	26 (h) Notwithstanding any other provision of this Code, on
346	346
347	347
348	348
349	349
350	350
351	351	HB3125 - 9 - LRB103 29884 KTG 56295 b
352	352
353	353
354	354	HB3125- 10 -LRB103 29884 KTG 56295 b HB3125 - 10 - LRB103 29884 KTG 56295 b
355	355	HB3125 - 10 - LRB103 29884 KTG 56295 b
356	356	1 and after July 1, 2012, nursing facilities designated by the
357	357	2 Department of Healthcare and Family Services as "Institutions
358	358	3 for Mental Disease" and "Institutions for Mental Disease" that
359	359	4 are facilities licensed under the Specialized Mental Health
360	360	5 Rehabilitation Act of 2013 shall have the nursing,
361	361	6 socio-developmental, capital, and support components of their
362	362	7 reimbursement rate effective May 1, 2011 reduced in total by
363	363	8 2.7%.
364	364	9 (i) On and after July 1, 2023 2014, the reimbursement
365	365	10 rates for the support component of the nursing facility rate
366	366	11 for facilities licensed under the Nursing Home Care Act as
367	367	12 skilled or intermediate care facilities shall be the rate in
368	368	13 effect on June 30, 2014 increased by 8.17%.
369	369	14 (j) Notwithstanding any other provision of law, subject to
370	370	15 federal approval, effective July 1, 2019, sufficient funds
371	371	16 shall be allocated for changes to rates for facilities
372	372	17 licensed under the Nursing Home Care Act as skilled nursing
373	373	18 facilities or intermediate care facilities for dates of
374	374	19 services on and after July 1, 2019: (i) to establish, through
375	375	20 June 30, 2022 a per diem add-on to the direct care per diem
376	376	21 rate not to exceed $70,000,000 annually in the aggregate
377	377	22 taking into account federal matching funds for the purpose of
378	378	23 addressing the facility's unique staffing needs, adjusted
379	379	24 quarterly and distributed by a weighted formula based on
380	380	25 Medicaid bed days on the last day of the second quarter
381	381	26 preceding the quarter for which the rate is being adjusted.
382	382
383	383
384	384
385	385
386	386
387	387	HB3125 - 10 - LRB103 29884 KTG 56295 b
388	388
389	389
390	390	HB3125- 11 -LRB103 29884 KTG 56295 b HB3125 - 11 - LRB103 29884 KTG 56295 b
391	391	HB3125 - 11 - LRB103 29884 KTG 56295 b
392	392	1 Beginning July 1, 2022, the annual $70,000,000 described in
393	393	2 the preceding sentence shall be dedicated to the variable per
394	394	3 diem add-on for staffing under paragraph (6) of subsection
395	395	4 (d); and (ii) in an amount not to exceed $170,000,000 annually
396	396	5 in the aggregate taking into account federal matching funds to
397	397	6 permit the support component of the nursing facility rate to
398	398	7 be updated as follows:
399	399	8 (1) 80%, or $136,000,000, of the funds shall be used
400	400	9 to update each facility's rate in effect on June 30, 2019
401	401	10 using the most recent cost reports on file, which have had
402	402	11 a limited review conducted by the Department of Healthcare
403	403	12 and Family Services and will not hold up enacting the rate
404	404	13 increase, with the Department of Healthcare and Family
405	405	14 Services.
406	406	15 (2) After completing the calculation in paragraph (1),
407	407	16 any facility whose rate is less than the rate in effect on
408	408	17 June 30, 2019 shall have its rate restored to the rate in
409	409	18 effect on June 30, 2019 from the 20% of the funds set
410	410	19 aside.
411	411	20 (3) The remainder of the 20%, or $34,000,000, shall be
412	412	21 used to increase each facility's rate by an equal
413	413	22 percentage.
414	414	23 (k) During the first quarter of State Fiscal Year 2020,
415	415	24 the Department of Healthcare of Family Services must convene a
416	416	25 technical advisory group consisting of members of all trade
417	417	26 associations representing Illinois skilled nursing providers
418	418
419	419
420	420
421	421
422	422
423	423	HB3125 - 11 - LRB103 29884 KTG 56295 b
424	424
425	425
426	426	HB3125- 12 -LRB103 29884 KTG 56295 b HB3125 - 12 - LRB103 29884 KTG 56295 b
427	427	HB3125 - 12 - LRB103 29884 KTG 56295 b
428	428	1 to discuss changes necessary with federal implementation of
429	429	2 Medicare's Patient-Driven Payment Model. Implementation of
430	430	3 Medicare's Patient-Driven Payment Model shall, by September 1,
431	431	4 2020, end the collection of the MDS data that is necessary to
432	432	5 maintain the current RUG-IV Medicaid payment methodology. The
433	433	6 technical advisory group must consider a revised reimbursement
434	434	7 methodology that takes into account transparency,
435	435	8 accountability, actual staffing as reported under the
436	436	9 federally required Payroll Based Journal system, changes to
437	437	10 the minimum wage, adequacy in coverage of the cost of care, and
438	438	11 a quality component that rewards quality improvements.
439	439	12 (l) The Department shall establish per diem add-on
440	440	13 payments to improve the quality of care delivered by
441	441	14 facilities, including:
442	442	15 (1) Incentive payments determined by facility
443	443	16 performance on specified quality measures in an initial
444	444	17 amount of $70,000,000. Nothing in this subsection shall be
445	445	18 construed to limit the quality of care payments in the
446	446	19 aggregate statewide to $70,000,000, and, if quality of
447	447	20 care has improved across nursing facilities, the
448	448	21 Department shall adjust those add-on payments accordingly.
449	449	22 The quality payment methodology described in this
450	450	23 subsection must be used for at least State Fiscal Year
451	451	24 2023. Beginning with the quarter starting July 1, 2023,
452	452	25 the Department may add, remove, or change quality metrics
453	453	26 and make associated changes to the quality payment
454	454
455	455
456	456
457	457
458	458
459	459	HB3125 - 12 - LRB103 29884 KTG 56295 b
460	460
461	461
462	462	HB3125- 13 -LRB103 29884 KTG 56295 b HB3125 - 13 - LRB103 29884 KTG 56295 b
463	463	HB3125 - 13 - LRB103 29884 KTG 56295 b
464	464	1 methodology as outlined in subparagraph (E). Facilities
465	465	2 designated by the Centers for Medicare and Medicaid
466	466	3 Services as a special focus facility or a hospital-based
467	467	4 nursing home do not qualify for quality payments.
468	468	5 (A) Each quality pool must be distributed by
469	469	6 assigning a quality weighted score for each nursing
470	470	7 home which is calculated by multiplying the nursing
471	471	8 home's quality base period Medicaid days by the
472	472	9 nursing home's star rating weight in that period.
473	473	10 (B) Star rating weights are assigned based on the
474	474	11 nursing home's star rating for the LTS quality star
475	475	12 rating. As used in this subparagraph, "LTS quality
476	476	13 star rating" means the long-term stay quality rating
477	477	14 for each nursing facility, as assigned by the Centers
478	478	15 for Medicare and Medicaid Services under the Five-Star
479	479	16 Quality Rating System. The rating is a number ranging
480	480	17 from 0 (lowest) to 5 (highest).
481	481	18 (i) Zero-star or one-star rating has a weight
482	482	19 of 0.
483	483	20 (ii) Two-star rating has a weight of 0.75.
484	484	21 (iii) Three-star rating has a weight of 1.5.
485	485	22 (iv) Four-star rating has a weight of 2.5.
486	486	23 (v) Five-star rating has a weight of 3.5.
487	487	24 (C) Each nursing home's quality weight score is
488	488	25 divided by the sum of all quality weight scores for
489	489	26 qualifying nursing homes to determine the proportion
490	490
491	491
492	492
493	493
494	494
495	495	HB3125 - 13 - LRB103 29884 KTG 56295 b
496	496
497	497
498	498	HB3125- 14 -LRB103 29884 KTG 56295 b HB3125 - 14 - LRB103 29884 KTG 56295 b
499	499	HB3125 - 14 - LRB103 29884 KTG 56295 b
500	500	1 of the quality pool to be paid to the nursing home.
501	501	2 (D) The quality pool is no less than $70,000,000
502	502	3 annually or $17,500,000 per quarter. The Department
503	503	4 shall publish on its website the estimated payments
504	504	5 and the associated weights for each facility 45 days
505	505	6 prior to when the initial payments for the quarter are
506	506	7 to be paid. The Department shall assign each facility
507	507	8 the most recent and applicable quarter's STAR value
508	508	9 unless the facility notifies the Department within 15
509	509	10 days of an issue and the facility provides reasonable
510	510	11 evidence demonstrating its timely compliance with
511	511	12 federal data submission requirements for the quarter
512	512	13 of record. If such evidence cannot be provided to the
513	513	14 Department, the STAR rating assigned to the facility
514	514	15 shall be reduced by one from the prior quarter.
515	515	16 (E) The Department shall review quality metrics
516	516	17 used for payment of the quality pool and make
517	517	18 recommendations for any associated changes to the
518	518	19 methodology for distributing quality pool payments in
519	519	20 consultation with associations representing long-term
520	520	21 care providers, consumer advocates, organizations
521	521	22 representing workers of long-term care facilities, and
522	522	23 payors. The Department may establish, by rule, changes
523	523	24 to the methodology for distributing quality pool
524	524	25 payments.
525	525	26 (F) The Department shall disburse quality pool
526	526
527	527
528	528
529	529
530	530
531	531	HB3125 - 14 - LRB103 29884 KTG 56295 b
532	532
533	533
534	534	HB3125- 15 -LRB103 29884 KTG 56295 b HB3125 - 15 - LRB103 29884 KTG 56295 b
535	535	HB3125 - 15 - LRB103 29884 KTG 56295 b
536	536	1 payments from the Long-Term Care Provider Fund on a
537	537	2 monthly basis in amounts proportional to the total
538	538	3 quality pool payment determined for the quarter.
539	539	4 (G) The Department shall publish any changes in
540	540	5 the methodology for distributing quality pool payments
541	541	6 prior to the beginning of the measurement period or
542	542	7 quality base period for any metric added to the
543	543	8 distribution's methodology.
544	544	9 (2) Payments based on CNA tenure, promotion, and CNA
545	545	10 training for the purpose of increasing CNA compensation.
546	546	11 It is the intent of this subsection that payments made in
547	547	12 accordance with this paragraph be directly incorporated
548	548	13 into increased compensation for CNAs. As used in this
549	549	14 paragraph, "CNA" means a certified nursing assistant as
550	550	15 that term is described in Section 3-206 of the Nursing
551	551	16 Home Care Act, Section 3-206 of the ID/DD Community Care
552	552	17 Act, and Section 3-206 of the MC/DD Act. The Department
553	553	18 shall establish, by rule, payments to nursing facilities
554	554	19 equal to Medicaid's share of the tenure wage increments
555	555	20 specified in this paragraph for all reported CNA employee
556	556	21 hours compensated according to a posted schedule
557	557	22 consisting of increments at least as large as those
558	558	23 specified in this paragraph. The increments are as
559	559	24 follows: an additional $1.50 per hour for CNAs with at
560	560	25 least one and less than 2 years' experience plus another
561	561	26 $1 per hour for each additional year of experience up to a
562	562
563	563
564	564
565	565
566	566
567	567	HB3125 - 15 - LRB103 29884 KTG 56295 b
568	568
569	569
570	570	HB3125- 16 -LRB103 29884 KTG 56295 b HB3125 - 16 - LRB103 29884 KTG 56295 b
571	571	HB3125 - 16 - LRB103 29884 KTG 56295 b
572	572	1 maximum of $6.50 for CNAs with at least 6 years of
573	573	2 experience. For purposes of this paragraph, Medicaid's
574	574	3 share shall be the ratio determined by paid Medicaid bed
575	575	4 days divided by total bed days for the applicable time
576	576	5 period used in the calculation. In addition, and additive
577	577	6 to any tenure increments paid as specified in this
578	578	7 paragraph, the Department shall establish, by rule,
579	579	8 payments supporting Medicaid's share of the
580	580	9 promotion-based wage increments for CNA employee hours
581	581	10 compensated for that promotion with at least a $1.50
582	582	11 hourly increase. Medicaid's share shall be established as
583	583	12 it is for the tenure increments described in this
584	584	13 paragraph. Qualifying promotions shall be defined by the
585	585	14 Department in rules for an expected 10-15% subset of CNAs
586	586	15 assigned intermediate, specialized, or added roles such as
587	587	16 CNA trainers, CNA scheduling "captains", and CNA
588	588	17 specialists for resident conditions like dementia or
589	589	18 memory care or behavioral health.
590	590	19 (m) The Department shall work with nursing facility
591	591	20 industry representatives to design policies and procedures to
592	592	21 permit facilities to address the integrity of data from
593	593	22 federal reporting sites used by the Department in setting
594	594	23 facility rates.
595	595	24 (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
596	596	25 102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff.
597	597	26 5-31-22; 102-1118, eff. 1-18-23.)
598	598
599	599
600	600
601	601
602	602
603	603	HB3125 - 16 - LRB103 29884 KTG 56295 b
604	604
605	605
606	606	HB3125- 17 -LRB103 29884 KTG 56295 b HB3125 - 17 - LRB103 29884 KTG 56295 b
607	607	HB3125 - 17 - LRB103 29884 KTG 56295 b
608	608	1 Section 99. Effective date. This Act takes effect July 1,
609	609	2 2023.
610	610
611	611
612	612
613	613
614	614
615	615	HB3125 - 17 - LRB103 29884 KTG 56295 b