Illinois 2023-2024 Regular Session

Illinois House Bill HB4907 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	HB4907 ~~EnrolledLRB103~~ 38362 CES 68497 b HB4907 ~~Enrolled~~ LRB103 38362 CES 68497 b
2		-	HB4907 ~~Enrolled~~ LRB103 38362 CES 68497 b
	1	+	HB4907 EngrossedLRB103 38362 CES 68497 b HB4907 Engrossed LRB103 38362 CES 68497 b
	2	+	HB4907 Engrossed LRB103 38362 CES 68497 b
3	3		1 AN ACT concerning health.
4	4		2 Be it enacted by the People of the State of Illinois,
5	5		3 represented in the General Assembly:
6		-	4 Section 5. The Hospital Licensing Act is amended by
7		-	5 changing Section 4.5 as follows:
8		-	6 (210 ILCS 85/4.5)
9		-	7 Sec. 4.5. Hospital with multiple locations; single
10		-	8 license.
11		-	9 (a) A hospital located in a county with fewer than
12		-	10 3,000,000 inhabitants may apply to the Department for approval
13		-	11 to conduct its operations from more than one location within
14		-	12 the county under a single license. At the time of the
15		-	13 application to operate under a single license, a hospital
16		-	14 located in a county with fewer than 125,000 inhabitants may
17		-	15 apply to the Department for approval to conduct its operations
18		-	16 from more than one location within contiguous counties in
19		-	17 which both facilities are located, provided that the second
20		-	18 county has fewer than 235,000 35,000 inhabitants.
21		-	19 (b) The facilities or buildings at those locations must be
22		-	20 owned or operated together by a single corporation or other
23		-	21 legal entity serving as the licensee and must share:
24		-	22 (1) a single board of directors with responsibility
25		-	23 for governance, including financial oversight and the
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34		-	1 authority to designate or remove the chief executive
35		-	2 officer;
36		-	3 (2) a single medical staff accountable to the board of
37		-	4 directors and governed by a single set of medical staff
38		-	5 bylaws, rules, and regulations with responsibility for the
39		-	6 quality of the medical services; and
40		-	7 (3) a single chief executive officer, accountable to
41		-	8 the board of directors, with management responsibility.
42		-	9 (c) Each hospital building or facility that is located on
43		-	10 a site geographically separate from the campus or premises of
44		-	11 another hospital building or facility operated by the licensee
45		-	12 must, at a minimum, individually comply with the Department's
46		-	13 hospital licensing requirements for emergency services.
47		-	14 (d) The hospital shall submit to the Department a
48		-	15 comprehensive plan in relation to the waiver or waivers
49		-	16 requested describing the services and operations of each
50		-	17 facility or building and how common services or operations
51		-	18 will be coordinated between the various locations. With the
52		-	19 exception of items required by subsection (c), the Department
53		-	20 is authorized to waive compliance with the hospital licensing
54		-	21 requirements for specific buildings or facilities, provided
55		-	22 that the hospital has documented which other building or
56		-	23 facility under its single license provides that service or
57		-	24 operation, and that doing so would not endanger the public's
58		-	25 health, safety, or welfare. Nothing in this Section relieves a
59		-	26 hospital from the requirements of the Health Facilities
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70		-	1 Planning Act.
71		-	2 (Source: P.A. 102-887, eff. 5-17-22.)
72		-	3 Section 10. The Illinois Public Aid Code is amended by
73		-	4 changing Section 5-5.2 as follows:
74		-	5 (305 ILCS 5/5-5.2)
75		-	6 Sec. 5-5.2. Payment.
76		-	7 (a) All nursing facilities that are grouped pursuant to
77		-	8 Section 5-5.1 of this Act shall receive the same rate of
78		-	9 payment for similar services.
79		-	10 (b) It shall be a matter of State policy that the Illinois
80		-	11 Department shall utilize a uniform billing cycle throughout
81		-	12 the State for the long-term care providers.
82		-	13 (c) (Blank).
83		-	14 (c-1) Notwithstanding any other provisions of this Code,
84		-	15 the methodologies for reimbursement of nursing services as
85		-	16 provided under this Article shall no longer be applicable for
86		-	17 bills payable for nursing services rendered on or after a new
87		-	18 reimbursement system based on the Patient Driven Payment Model
88		-	19 (PDPM) has been fully operationalized, which shall take effect
89		-	20 for services provided on or after the implementation of the
90		-	21 PDPM reimbursement system begins. For the purposes of Public
91		-	22 Act 102-1035, the implementation date of the PDPM
92		-	23 reimbursement system and all related provisions shall be July
93		-	24 1, 2022 if the following conditions are met: (i) the Centers
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104		-	1 for Medicare and Medicaid Services has approved corresponding
105		-	2 changes in the reimbursement system and bed assessment; and
106		-	3 (ii) the Department has filed rules to implement these changes
107		-	4 no later than June 1, 2022. Failure of the Department to file
108		-	5 rules to implement the changes provided in Public Act 102-1035
109		-	6 no later than June 1, 2022 shall result in the implementation
110		-	7 date being delayed to October 1, 2022.
111		-	8 (d) The new nursing services reimbursement methodology
112		-	9 utilizing the Patient Driven Payment Model, which shall be
113		-	10 referred to as the PDPM reimbursement system, taking effect
114		-	11 July 1, 2022, upon federal approval by the Centers for
115		-	12 Medicare and Medicaid Services, shall be based on the
116		-	13 following:
117		-	14 (1) The methodology shall be resident-centered,
118		-	15 facility-specific, cost-based, and based on guidance from
119		-	16 the Centers for Medicare and Medicaid Services.
120		-	17 (2) Costs shall be annually rebased and case mix index
121		-	18 quarterly updated. The nursing services methodology will
122		-	19 be assigned to the Medicaid enrolled residents on record
123		-	20 as of 30 days prior to the beginning of the rate period in
124		-	21 the Department's Medicaid Management Information System
125		-	22 (MMIS) as present on the last day of the second quarter
126		-	23 preceding the rate period based upon the Assessment
127		-	24 Reference Date of the Minimum Data Set (MDS).
128		-	25 (3) Regional wage adjustors based on the Health
129		-	26 Service Areas (HSA) groupings and adjusters in effect on
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140		-	1 April 30, 2012 shall be included, except no adjuster shall
141		-	2 be lower than 1.06.
142		-	3 (4) PDPM nursing case mix indices in effect on March
143		-	4 1, 2022 shall be assigned to each resident class at no less
144		-	5 than 0.7858 of the Centers for Medicare and Medicaid
145		-	6 Services PDPM unadjusted case mix values, in effect on
146		-	7 March 1, 2022.
147		-	8 (5) The pool of funds available for distribution by
148		-	9 case mix and the base facility rate shall be determined
149		-	10 using the formula contained in subsection (d-1).
150		-	11 (6) The Department shall establish a variable per diem
151		-	12 staffing add-on in accordance with the most recent
152		-	13 available federal staffing report, currently the Payroll
153		-	14 Based Journal, for the same period of time, and if
154		-	15 applicable adjusted for acuity using the same quarter's
155		-	16 MDS. The Department shall rely on Payroll Based Journals
156		-	17 provided to the Department of Public Health to make a
157		-	18 determination of non-submission. If the Department is
158		-	19 notified by a facility of missing or inaccurate Payroll
159		-	20 Based Journal data or an incorrect calculation of
160		-	21 staffing, the Department must make a correction as soon as
161		-	22 the error is verified for the applicable quarter.
162		-	23 Beginning October 1, 2024, the staffing percentage
163		-	24 used in the calculation of the per diem staffing add-on
164		-	25 shall be its PDPM STRIVE Staffing Ratio which equals: its
165		-	26 Reported Total Nurse Staffing Hours Per Resident Per Day
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176		-	1 as published in the most recent federal staffing report
177		-	2 (the Provider Information File), divided by the facility's
178		-	3 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
179		-	4 Staffing Target is equal to .82 times the facility's
180		-	5 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
181		-	6 Day. A facility's Illinois Adjusted Facility Case Mix
182		-	7 Hours Per Resident Per Day is equal to its Case-Mix Total
183		-	8 Nurse Staffing Hours Per Resident Per Day (as published in
184		-	9 the most recent federal Provider Information file staffing
185		-	10 report) times 3.662 (which reflects the national resident
186		-	11 days-weighted mean Reported Total Nurse Staffing Hours Per
187		-	12 Resident Per Day as calculated using the January 2024
188		-	13 federal Provider Information Files), divided by the
189		-	14 national resident days-weighted mean Reported Total Nurse
190		-	15 Staffing Hours Per Resident Per Day calculated using the
191		-	16 most recent State US Averages file federal Provider
192		-	17 Information File.
193		-	18 Beginning January 1, 2025, the staffing percentage
194		-	19 used in the calculation of the per diem staffing add-on
195		-	20 shall be its PDPM STRIVE Staffing Ratio which equals: its
196		-	21 Reported Total Nurse Staffing Hours Per Resident Per Day
197		-	22 as published in the most recent federal staffing report
198		-	23 (the Provider Information File), divided by the facility's
199		-	24 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
200		-	25 Staffing Target is equal to .7122 times the facility's
201		-	26 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
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212		-	1 Day. A facility's Illinois Adjusted Facility Case Mix
213		-	2 Hours Per Resident Per Day is equal to its Case-Mix Total
214		-	3 Nurse Staffing Hours Per Resident Per Day (as published in
215		-	4 the most recent federal staffing report Provider
216		-	5 Information file) times 3.79 (which is the Reported Total
217		-	6 Nurse Staffing Hours Per Resident Per Day for the Nation
218		-	7 as reported the January 2024 State US Averages file),
219		-	8 divided by the Reported Total Nurse Staffing Hours Per
220		-	9 Resident Per Day for the Nation as reported in the most
221		-	10 recent State US Averages file.
222		-	11 (6.5) Beginning July 1, 2024, the paid per diem
223		-	12 staffing add-on shall be the paid per diem staffing add-on
224		-	13 in effect April 1, 2024. For dates beginning October 1,
225		-	14 2024 and through September 30, 2025, the denominator for
226		-	15 the staffing percentage shall be the lesser of the
227		-	16 facility's PDPM STRIVE Staffing Target and:
228		-	17 (A) For the quarter beginning October 1, 2024, the
229		-	18 sum of 20% of the facility's PDPM STRIVE Staffing
230		-	19 Target and 80% of the facility's Case-Mix Total Nurse
231		-	20 Staffing Hours Per Resident Per Day (as published in
232		-	21 the January 2024 federal staffing report).
233		-	22 (B) For the quarter beginning January 1, 2025, the
234		-	23 sum of 40% of the facility's PDPM STRIVE Staffing
235		-	24 Target and 60% of the facility's Case-Mix Total Nurse
236		-	25 Staffing Hours Per Resident Per Day (as published in
237		-	26 the January 2024 federal staffing report).
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248		-	1 (C) For the quarter beginning March 1, 2025, the
249		-	2 sum of 60% of the facility's PDPM STRIVE Staffing
250		-	3 Target and 40% of the facility's Case-Mix Total Nurse
251		-	4 Staffing Hours Per Resident Per Day (as published in
252		-	5 the January 2024 federal staffing report).
253		-	6 (D) For the quarter beginning July 1, 2025, the
254		-	7 sum of 80% of the facility's PDPM STRIVE Staffing
255		-	8 Target and 20% of the facility's Case-Mix Total Nurse
256		-	9 Staffing Hours Per Resident Per Day (as published in
257		-	10 the January 2024 federal staffing report).
258		-	11 Facilities with at least 70% of the staffing
259		-	12 indicated by the STRIVE study shall be paid a per diem
260		-	13 add-on of $9, increasing by equivalent steps for each
261		-	14 whole percentage point until the facilities reach a per
262		-	15 diem of $16.52. Facilities with at least 80% of the
263		-	16 staffing indicated by the STRIVE study shall be paid a per
264		-	17 diem add-on of $16.52, increasing by equivalent steps for
265		-	18 each whole percentage point until the facilities reach a
266		-	19 per diem add-on of $25.77. Facilities with at least 92% of
267		-	20 the staffing indicated by the STRIVE study shall be paid a
268		-	21 per diem add-on of $25.77, increasing by equivalent steps
269		-	22 for each whole percentage point until the facilities reach
270		-	23 a per diem add-on of $30.98. Facilities with at least 100%
271		-	24 of the staffing indicated by the STRIVE study shall be
272		-	25 paid a per diem add-on of $30.98, increasing by equivalent
273		-	26 steps for each whole percentage point until the facilities
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284		-	1 reach a per diem add-on of $36.44. Facilities with at
285		-	2 least 110% of the staffing indicated by the STRIVE study
286		-	3 shall be paid a per diem add-on of $36.44, increasing by
287		-	4 equivalent steps for each whole percentage point until the
288		-	5 facilities reach a per diem add-on of $38.68. Facilities
289		-	6 with at least 125% or higher of the staffing indicated by
290		-	7 the STRIVE study shall be paid a per diem add-on of $38.68.
291		-	8 No nursing facility's variable staffing per diem add-on
292		-	9 shall be reduced by more than 5% in 2 consecutive
293		-	10 quarters. For the quarters beginning July 1, 2022 and
294		-	11 October 1, 2022, no facility's variable per diem staffing
295		-	12 add-on shall be calculated at a rate lower than 85% of the
296		-	13 staffing indicated by the STRIVE study. No facility below
297		-	14 70% of the staffing indicated by the STRIVE study shall
298		-	15 receive a variable per diem staffing add-on after December
299		-	16 31, 2022.
300		-	17 (7) For dates of services beginning July 1, 2022, the
301		-	18 PDPM nursing component per diem for each nursing facility
302		-	19 shall be the product of the facility's (i) statewide PDPM
303		-	20 nursing base per diem rate, $92.25, adjusted for the
304		-	21 facility average PDPM case mix index calculated quarterly
305		-	22 and (ii) the regional wage adjuster, and then add the
306		-	23 Medicaid access adjustment as defined in (e-3) of this
307		-	24 Section. Transition rates for services provided between
308		-	25 July 1, 2022 and October 1, 2023 shall be the greater of
309		-	26 the PDPM nursing component per diem or:
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320		-	1 (A) for the quarter beginning July 1, 2022, the
321		-	2 RUG-IV nursing component per diem;
322		-	3 (B) for the quarter beginning October 1, 2022, the
323		-	4 sum of the RUG-IV nursing component per diem
324		-	5 multiplied by 0.80 and the PDPM nursing component per
325		-	6 diem multiplied by 0.20;
326		-	7 (C) for the quarter beginning January 1, 2023, the
327		-	8 sum of the RUG-IV nursing component per diem
328		-	9 multiplied by 0.60 and the PDPM nursing component per
329		-	10 diem multiplied by 0.40;
330		-	11 (D) for the quarter beginning April 1, 2023, the
331		-	12 sum of the RUG-IV nursing component per diem
332		-	13 multiplied by 0.40 and the PDPM nursing component per
333		-	14 diem multiplied by 0.60;
334		-	15 (E) for the quarter beginning July 1, 2023, the
335		-	16 sum of the RUG-IV nursing component per diem
336		-	17 multiplied by 0.20 and the PDPM nursing component per
337		-	18 diem multiplied by 0.80; or
338		-	19 (F) for the quarter beginning October 1, 2023 and
339		-	20 each subsequent quarter, the transition rate shall end
340		-	21 and a nursing facility shall be paid 100% of the PDPM
341		-	22 nursing component per diem.
342		-	23 (d-1) Calculation of base year Statewide RUG-IV nursing
343		-	24 base per diem rate.
344		-	25 (1) Base rate spending pool shall be:
345		-	26 (A) The base year resident days which are
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356		-	1 calculated by multiplying the number of Medicaid
357		-	2 residents in each nursing home as indicated in the MDS
358		-	3 data defined in paragraph (4) by 365.
359		-	4 (B) Each facility's nursing component per diem in
360		-	5 effect on July 1, 2012 shall be multiplied by
361		-	6 subsection (A).
362		-	7 (C) Thirteen million is added to the product of
363		-	8 subparagraph (A) and subparagraph (B) to adjust for
364		-	9 the exclusion of nursing homes defined in paragraph
365		-	10 (5).
366		-	11 (2) For each nursing home with Medicaid residents as
367		-	12 indicated by the MDS data defined in paragraph (4),
368		-	13 weighted days adjusted for case mix and regional wage
369		-	14 adjustment shall be calculated. For each home this
370		-	15 calculation is the product of:
371		-	16 (A) Base year resident days as calculated in
372		-	17 subparagraph (A) of paragraph (1).
373		-	18 (B) The nursing home's regional wage adjustor
374		-	19 based on the Health Service Areas (HSA) groupings and
375		-	20 adjustors in effect on April 30, 2012.
376		-	21 (C) Facility weighted case mix which is the number
377		-	22 of Medicaid residents as indicated by the MDS data
378		-	23 defined in paragraph (4) multiplied by the associated
379		-	24 case weight for the RUG-IV 48 grouper model using
380		-	25 standard RUG-IV procedures for index maximization.
381		-	26 (D) The sum of the products calculated for each
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392		-	1 nursing home in subparagraphs (A) through (C) above
393		-	2 shall be the base year case mix, rate adjusted
394		-	3 weighted days.
395		-	4 (3) The Statewide RUG-IV nursing base per diem rate:
396		-	5 (A) on January 1, 2014 shall be the quotient of the
397		-	6 paragraph (1) divided by the sum calculated under
398		-	7 subparagraph (D) of paragraph (2);
399		-	8 (B) on and after July 1, 2014 and until July 1,
400		-	9 2022, shall be the amount calculated under
401		-	10 subparagraph (A) of this paragraph (3) plus $1.76; and
402		-	11 (C) beginning July 1, 2022 and thereafter, $7
403		-	12 shall be added to the amount calculated under
404		-	13 subparagraph (B) of this paragraph (3) of this
405		-	14 Section.
406		-	15 (4) Minimum Data Set (MDS) comprehensive assessments
407		-	16 for Medicaid residents on the last day of the quarter used
408		-	17 to establish the base rate.
409		-	18 (5) Nursing facilities designated as of July 1, 2012
410		-	19 by the Department as "Institutions for Mental Disease"
411		-	20 shall be excluded from all calculations under this
412		-	21 subsection. The data from these facilities shall not be
413		-	22 used in the computations described in paragraphs (1)
414		-	23 through (4) above to establish the base rate.
415		-	24 (e) Beginning July 1, 2014, the Department shall allocate
416		-	25 funding in the amount up to $10,000,000 for per diem add-ons to
417		-	26 the RUGS methodology for dates of service on and after July 1,
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428		-	1 2014:
429		-	2 (1) $0.63 for each resident who scores in I4200
430		-	3 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
431		-	4 (2) $2.67 for each resident who scores either a "1" or
432		-	5 "2" in any items S1200A through S1200I and also scores in
433		-	6 RUG groups PA1, PA2, BA1, or BA2.
434		-	7 (e-1) (Blank).
435		-	8 (e-2) For dates of services beginning January 1, 2014 and
436		-	9 ending September 30, 2023, the RUG-IV nursing component per
437		-	10 diem for a nursing home shall be the product of the statewide
438		-	11 RUG-IV nursing base per diem rate, the facility average case
439		-	12 mix index, and the regional wage adjustor. For dates of
440		-	13 service beginning July 1, 2022 and ending September 30, 2023,
441		-	14 the Medicaid access adjustment described in subsection (e-3)
442		-	15 shall be added to the product.
443		-	16 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
444		-	17 facility average PDPM case mix index calculated quarterly
445		-	18 shall be added to the statewide PDPM nursing per diem for all
446		-	19 facilities with annual Medicaid bed days of at least 70% of all
447		-	20 occupied bed days adjusted quarterly. For each new calendar
448		-	21 year and for the 6-month period beginning July 1, 2022, the
449		-	22 percentage of a facility's occupied bed days comprised of
450		-	23 Medicaid bed days shall be determined by the Department
451		-	24 quarterly. For dates of service beginning January 1, 2023, the
452		-	25 Medicaid Access Adjustment shall be increased to $4.75. This
453		-	26 subsection shall be inoperative on and after January 1, 2028.
454		-
455		-
456		-
457		-
458		-
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460		-
461		-
462		-	HB4907 Enrolled- 14 -LRB103 38362 CES 68497 b HB4907 Enrolled - 14 - LRB103 38362 CES 68497 b
463		-	HB4907 Enrolled - 14 - LRB103 38362 CES 68497 b
464		-	1 (e-4) Subject to federal approval, on and after January 1,
465		-	2 2024, the Department shall increase the rate add-on at
466		-	3 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
467		-	4 for ventilator services from $208 per day to $481 per day.
468		-	5 Payment is subject to the criteria and requirements under 89
469		-	6 Ill. Adm. Code 147.335.
470		-	7 (f) (Blank).
471		-	8 (g) Notwithstanding any other provision of this Code, on
472		-	9 and after July 1, 2012, for facilities not designated by the
473		-	10 Department of Healthcare and Family Services as "Institutions
474		-	11 for Mental Disease", rates effective May 1, 2011 shall be
475		-	12 adjusted as follows:
476		-	13 (1) (Blank);
477		-	14 (2) (Blank);
478		-	15 (3) Facility rates for the capital and support
479		-	16 components shall be reduced by 1.7%.
480		-	17 (h) Notwithstanding any other provision of this Code, on
481		-	18 and after July 1, 2012, nursing facilities designated by the
482		-	19 Department of Healthcare and Family Services as "Institutions
483		-	20 for Mental Disease" and "Institutions for Mental Disease" that
484		-	21 are facilities licensed under the Specialized Mental Health
485		-	22 Rehabilitation Act of 2013 shall have the nursing,
486		-	23 socio-developmental, capital, and support components of their
487		-	24 reimbursement rate effective May 1, 2011 reduced in total by
488		-	25 2.7%.
489		-	26 (i) On and after July 1, 2014, the reimbursement rates for
490		-
491		-
492		-
493		-
494		-
495		-	HB4907 Enrolled - 14 - LRB103 38362 CES 68497 b
496		-
497		-
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499		-	HB4907 Enrolled - 15 - LRB103 38362 CES 68497 b
500		-	1 the support component of the nursing facility rate for
501		-	2 facilities licensed under the Nursing Home Care Act as skilled
502		-	3 or intermediate care facilities shall be the rate in effect on
503		-	4 June 30, 2014 increased by 8.17%.
504		-	5 (i-1) Subject to federal approval, on and after January 1,
505		-	6 2024, the reimbursement rates for the support component of the
506		-	7 nursing facility rate for facilities licensed under the
507		-	8 Nursing Home Care Act as skilled or intermediate care
508		-	9 facilities shall be the rate in effect on June 30, 2023
509		-	10 increased by 12%.
510		-	11 (j) Notwithstanding any other provision of law, subject to
511		-	12 federal approval, effective July 1, 2019, sufficient funds
512		-	13 shall be allocated for changes to rates for facilities
513		-	14 licensed under the Nursing Home Care Act as skilled nursing
514		-	15 facilities or intermediate care facilities for dates of
515		-	16 services on and after July 1, 2019: (i) to establish, through
516		-	17 June 30, 2022 a per diem add-on to the direct care per diem
517		-	18 rate not to exceed $70,000,000 annually in the aggregate
518		-	19 taking into account federal matching funds for the purpose of
519		-	20 addressing the facility's unique staffing needs, adjusted
520		-	21 quarterly and distributed by a weighted formula based on
521		-	22 Medicaid bed days on the last day of the second quarter
522		-	23 preceding the quarter for which the rate is being adjusted.
523		-	24 Beginning July 1, 2022, the annual $70,000,000 described in
524		-	25 the preceding sentence shall be dedicated to the variable per
525		-	26 diem add-on for staffing under paragraph (6) of subsection
526		-
527		-
528		-
529		-
530		-
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532		-
533		-
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535		-	HB4907 Enrolled - 16 - LRB103 38362 CES 68497 b
536		-	1 (d); and (ii) in an amount not to exceed $170,000,000 annually
537		-	2 in the aggregate taking into account federal matching funds to
538		-	3 permit the support component of the nursing facility rate to
539		-	4 be updated as follows:
540		-	5 (1) 80%, or $136,000,000, of the funds shall be used
541		-	6 to update each facility's rate in effect on June 30, 2019
542		-	7 using the most recent cost reports on file, which have had
543		-	8 a limited review conducted by the Department of Healthcare
544		-	9 and Family Services and will not hold up enacting the rate
545		-	10 increase, with the Department of Healthcare and Family
546		-	11 Services.
547		-	12 (2) After completing the calculation in paragraph (1),
548		-	13 any facility whose rate is less than the rate in effect on
549		-	14 June 30, 2019 shall have its rate restored to the rate in
550		-	15 effect on June 30, 2019 from the 20% of the funds set
551		-	16 aside.
552		-	17 (3) The remainder of the 20%, or $34,000,000, shall be
553		-	18 used to increase each facility's rate by an equal
554		-	19 percentage.
555		-	20 (k) During the first quarter of State Fiscal Year 2020,
556		-	21 the Department of Healthcare of Family Services must convene a
557		-	22 technical advisory group consisting of members of all trade
558		-	23 associations representing Illinois skilled nursing providers
559		-	24 to discuss changes necessary with federal implementation of
560		-	25 Medicare's Patient-Driven Payment Model. Implementation of
561		-	26 Medicare's Patient-Driven Payment Model shall, by September 1,
562		-
563		-
564		-
565		-
566		-
567		-	HB4907 Enrolled - 16 - LRB103 38362 CES 68497 b
568		-
569		-
570		-	HB4907 Enrolled- 17 -LRB103 38362 CES 68497 b HB4907 Enrolled - 17 - LRB103 38362 CES 68497 b
571		-	HB4907 Enrolled - 17 - LRB103 38362 CES 68497 b
572		-	1 2020, end the collection of the MDS data that is necessary to
573		-	2 maintain the current RUG-IV Medicaid payment methodology. The
574		-	3 technical advisory group must consider a revised reimbursement
575		-	4 methodology that takes into account transparency,
576		-	5 accountability, actual staffing as reported under the
577		-	6 federally required Payroll Based Journal system, changes to
578		-	7 the minimum wage, adequacy in coverage of the cost of care, and
579		-	8 a quality component that rewards quality improvements.
580		-	9 (l) The Department shall establish per diem add-on
581		-	10 payments to improve the quality of care delivered by
582		-	11 facilities, including:
583		-	12 (1) Incentive payments determined by facility
584		-	13 performance on specified quality measures in an initial
585		-	14 amount of $70,000,000. Nothing in this subsection shall be
586		-	15 construed to limit the quality of care payments in the
587		-	16 aggregate statewide to $70,000,000, and, if quality of
588		-	17 care has improved across nursing facilities, the
589		-	18 Department shall adjust those add-on payments accordingly.
590		-	19 The quality payment methodology described in this
591		-	20 subsection must be used for at least State Fiscal Year
592		-	21 2023. Beginning with the quarter starting July 1, 2023,
593		-	22 the Department may add, remove, or change quality metrics
594		-	23 and make associated changes to the quality payment
595		-	24 methodology as outlined in subparagraph (E). Facilities
596		-	25 designated by the Centers for Medicare and Medicaid
597		-	26 Services as a special focus facility or a hospital-based
598		-
599		-
600		-
601		-
602		-
603		-	HB4907 Enrolled - 17 - LRB103 38362 CES 68497 b
604		-
605		-
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607		-	HB4907 Enrolled - 18 - LRB103 38362 CES 68497 b
608		-	1 nursing home do not qualify for quality payments.
609		-	2 (A) Each quality pool must be distributed by
610		-	3 assigning a quality weighted score for each nursing
611		-	4 home which is calculated by multiplying the nursing
612		-	5 home's quality base period Medicaid days by the
613		-	6 nursing home's star rating weight in that period.
614		-	7 (B) Star rating weights are assigned based on the
615		-	8 nursing home's star rating for the LTS quality star
616		-	9 rating. As used in this subparagraph, "LTS quality
617		-	10 star rating" means the long-term stay quality rating
618		-	11 for each nursing facility, as assigned by the Centers
619		-	12 for Medicare and Medicaid Services under the Five-Star
620		-	13 Quality Rating System. The rating is a number ranging
621		-	14 from 0 (lowest) to 5 (highest).
622		-	15 (i) Zero-star or one-star rating has a weight
623		-	16 of 0.
624		-	17 (ii) Two-star rating has a weight of 0.75.
625		-	18 (iii) Three-star rating has a weight of 1.5.
626		-	19 (iv) Four-star rating has a weight of 2.5.
627		-	20 (v) Five-star rating has a weight of 3.5.
628		-	21 (C) Each nursing home's quality weight score is
629		-	22 divided by the sum of all quality weight scores for
630		-	23 qualifying nursing homes to determine the proportion
631		-	24 of the quality pool to be paid to the nursing home.
632		-	25 (D) The quality pool is no less than $70,000,000
633		-	26 annually or $17,500,000 per quarter. The Department
634		-
635		-
636		-
637		-
638		-
639		-	HB4907 Enrolled - 18 - LRB103 38362 CES 68497 b
640		-
641		-
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643		-	HB4907 Enrolled - 19 - LRB103 38362 CES 68497 b
644		-	1 shall publish on its website the estimated payments
645		-	2 and the associated weights for each facility 45 days
646		-	3 prior to when the initial payments for the quarter are
647		-	4 to be paid. The Department shall assign each facility
648		-	5 the most recent and applicable quarter's STAR value
649		-	6 unless the facility notifies the Department within 15
650		-	7 days of an issue and the facility provides reasonable
651		-	8 evidence demonstrating its timely compliance with
652		-	9 federal data submission requirements for the quarter
653		-	10 of record. If such evidence cannot be provided to the
654		-	11 Department, the STAR rating assigned to the facility
655		-	12 shall be reduced by one from the prior quarter.
656		-	13 (E) The Department shall review quality metrics
657		-	14 used for payment of the quality pool and make
658		-	15 recommendations for any associated changes to the
659		-	16 methodology for distributing quality pool payments in
660		-	17 consultation with associations representing long-term
661		-	18 care providers, consumer advocates, organizations
662		-	19 representing workers of long-term care facilities, and
663		-	20 payors. The Department may establish, by rule, changes
664		-	21 to the methodology for distributing quality pool
665		-	22 payments.
666		-	23 (F) The Department shall disburse quality pool
667		-	24 payments from the Long-Term Care Provider Fund on a
668		-	25 monthly basis in amounts proportional to the total
669		-	26 quality pool payment determined for the quarter.
670		-
671		-
672		-
673		-
674		-
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676		-
677		-
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679		-	HB4907 Enrolled - 20 - LRB103 38362 CES 68497 b
680		-	1 (G) The Department shall publish any changes in
681		-	2 the methodology for distributing quality pool payments
682		-	3 prior to the beginning of the measurement period or
683		-	4 quality base period for any metric added to the
684		-	5 distribution's methodology.
685		-	6 (2) Payments based on CNA tenure, promotion, and CNA
686		-	7 training for the purpose of increasing CNA compensation.
687		-	8 It is the intent of this subsection that payments made in
688		-	9 accordance with this paragraph be directly incorporated
689		-	10 into increased compensation for CNAs. As used in this
690		-	11 paragraph, "CNA" means a certified nursing assistant as
691		-	12 that term is described in Section 3-206 of the Nursing
692		-	13 Home Care Act, Section 3-206 of the ID/DD Community Care
693		-	14 Act, and Section 3-206 of the MC/DD Act. The Department
694		-	15 shall establish, by rule, payments to nursing facilities
695		-	16 equal to Medicaid's share of the tenure wage increments
696		-	17 specified in this paragraph for all reported CNA employee
697		-	18 hours compensated according to a posted schedule
698		-	19 consisting of increments at least as large as those
699		-	20 specified in this paragraph. The increments are as
700		-	21 follows: an additional $1.50 per hour for CNAs with at
701		-	22 least one and less than 2 years' experience plus another
702		-	23 $1 per hour for each additional year of experience up to a
703		-	24 maximum of $6.50 for CNAs with at least 6 years of
704		-	25 experience. For purposes of this paragraph, Medicaid's
705		-	26 share shall be the ratio determined by paid Medicaid bed
706		-
707		-
708		-
709		-
710		-
711		-	HB4907 Enrolled - 20 - LRB103 38362 CES 68497 b
712		-
713		-
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715		-	HB4907 Enrolled - 21 - LRB103 38362 CES 68497 b
716		-	1 days divided by total bed days for the applicable time
717		-	2 period used in the calculation. In addition, and additive
718		-	3 to any tenure increments paid as specified in this
719		-	4 paragraph, the Department shall establish, by rule,
720		-	5 payments supporting Medicaid's share of the
721		-	6 promotion-based wage increments for CNA employee hours
722		-	7 compensated for that promotion with at least a $1.50
723		-	8 hourly increase. Medicaid's share shall be established as
724		-	9 it is for the tenure increments described in this
725		-	10 paragraph. Qualifying promotions shall be defined by the
726		-	11 Department in rules for an expected 10-15% subset of CNAs
727		-	12 assigned intermediate, specialized, or added roles such as
728		-	13 CNA trainers, CNA scheduling "captains", and CNA
729		-	14 specialists for resident conditions like dementia or
730		-	15 memory care or behavioral health.
731		-	16 (m) The Department shall work with nursing facility
732		-	17 industry representatives to design policies and procedures to
733		-	18 permit facilities to address the integrity of data from
734		-	19 federal reporting sites used by the Department in setting
735		-	20 facility rates.
736		-	21 (Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
737		-	22 102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
738		-	23 Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
739		-	24 Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
740		-	25 7-1-24.)
741		-
742		-
743		-
744		-
745		-
746		-	HB4907 Enrolled - 21 - LRB103 38362 CES 68497 b
747		-
748		-
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750		-	HB4907 Enrolled - 22 - LRB103 38362 CES 68497 b
751		-	1 Section 15. The Workforce Direct Care Expansion Act is
752		-	2 amended by changing Section 15 as follows:
753		-	3 (405 ILCS 162/15)
754		-	4 Sec. 15. Membership. The Task Force shall be chaired by
755		-	5 Illinois' Chief Behavioral Health Officer or the Officer's
756		-	6 designee. The chair of the Task Force may designate an a
757		-	7 nongovernmental entity or entities to provide pro bono
758		-	8 administrative support to the Task Force. Except as otherwise
759		-	9 provided in this Section, members of the Task Force shall be
760		-	10 appointed by the chair. The Task Force shall consist of at
761		-	11 least 15 members, including, but not limited to, the
762		-	12 following:
763		-	13 (1) community mental health and substance use
764		-	14 providers representing geographical regions across the
765		-	15 State;
766		-	16 (2) representatives of statewide associations that
767		-	17 represent behavioral health providers;
768		-	18 (3) representatives of advocacy organizations either
769		-	19 led by or consisting primarily of individuals with lived
770		-	20 experience;
771		-	21 (4) a representative from the Division of Mental
772		-	22 Health in the Department of Human Services;
773		-	23 (5) a representative from the Division of Substance
774		-	24 Use Prevention and Recovery in the Department of Human
775		-	25 Services;
776		-
777		-
778		-
779		-
780		-
781		-	HB4907 Enrolled - 22 - LRB103 38362 CES 68497 b
782		-
783		-
784		-	HB4907 Enrolled- 23 -LRB103 38362 CES 68497 b HB4907 Enrolled - 23 - LRB103 38362 CES 68497 b
785		-	HB4907 Enrolled - 23 - LRB103 38362 CES 68497 b
786		-	1 (6) a representative from the Department of Children
787		-	2 and Family Services;
788		-	3 (7) a representative from the Department of Public
789		-	4 Health;
790		-	5 (8) one member of the House of Representatives,
791		-	6 appointed by the Speaker of the House of Representatives;
792		-	7 (9) one member of the House of Representatives,
793		-	8 appointed by the Minority Leader of the House of
794		-	9 Representatives;
795		-	10 (10) one member of the Senate, appointed by the
796		-	11 President of the Senate; and
797		-	12 (11) one member of the Senate, appointed by the
798		-	13 Minority Leader of the Senate.
799		-	14 (Source: P.A. 103-690, eff. 7-19-24.)
800		-
801		-
802		-
803		-
804		-
805		-	HB4907 Enrolled - 23 - LRB103 38362 CES 68497 b
	9	+	HB4907 Engrossed LRB103 38362 CES 68497 b