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Illinois House Bill HB5847

Illinois 2023-2024 Regular Session

Illinois House Bill HB5847 Compare Versions

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11 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5847 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning payments to nursing facilities, sets forth how to calculate each facility's variable per diem staffing add-on amount beginning October 1, 2024. Increases the per diem maximum amounts paid to facilities based on the STRIVE study. Effective October 1, 2024. LRB103 40684 KTG 73450 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5847 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning payments to nursing facilities, sets forth how to calculate each facility's variable per diem staffing add-on amount beginning October 1, 2024. Increases the per diem maximum amounts paid to facilities based on the STRIVE study. Effective October 1, 2024. LRB103 40684 KTG 73450 b LRB103 40684 KTG 73450 b A BILL FOR
22 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5847 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
33 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
44 305 ILCS 5/5-5.2
55 Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning payments to nursing facilities, sets forth how to calculate each facility's variable per diem staffing add-on amount beginning October 1, 2024. Increases the per diem maximum amounts paid to facilities based on the STRIVE study. Effective October 1, 2024.
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1111 1 AN ACT concerning public aid.
1212 2 Be it enacted by the People of the State of Illinois,
1313 3 represented in the General Assembly:
1414 4 Section 5. The Illinois Public Aid Code is amended by
1515 5 changing Section 5-5.2 as follows:
1616 6 (305 ILCS 5/5-5.2)
1717 7 Sec. 5-5.2. Payment.
1818 8 (a) All nursing facilities that are grouped pursuant to
1919 9 Section 5-5.1 of this Act shall receive the same rate of
2020 10 payment for similar services.
2121 11 (b) It shall be a matter of State policy that the Illinois
2222 12 Department shall utilize a uniform billing cycle throughout
2323 13 the State for the long-term care providers.
2424 14 (c) (Blank).
2525 15 (c-1) Notwithstanding any other provisions of this Code,
2626 16 the methodologies for reimbursement of nursing services as
2727 17 provided under this Article shall no longer be applicable for
2828 18 bills payable for nursing services rendered on or after a new
2929 19 reimbursement system based on the Patient Driven Payment Model
3030 20 (PDPM) has been fully operationalized, which shall take effect
3131 21 for services provided on or after the implementation of the
3232 22 PDPM reimbursement system begins. For the purposes of Public
3333 23 Act 102-1035 this amendatory Act of the 102nd General
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3737 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5847 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
3838 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
3939 305 ILCS 5/5-5.2
4040 Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning payments to nursing facilities, sets forth how to calculate each facility's variable per diem staffing add-on amount beginning October 1, 2024. Increases the per diem maximum amounts paid to facilities based on the STRIVE study. Effective October 1, 2024.
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6868 1 Assembly, the implementation date of the PDPM reimbursement
6969 2 system and all related provisions shall be July 1, 2022 if the
7070 3 following conditions are met: (i) the Centers for Medicare and
7171 4 Medicaid Services has approved corresponding changes in the
7272 5 reimbursement system and bed assessment; and (ii) the
7373 6 Department has filed rules to implement these changes no later
7474 7 than June 1, 2022. Failure of the Department to file rules to
7575 8 implement the changes provided in Public Act 102-1035 this
7676 9 amendatory Act of the 102nd General Assembly no later than
7777 10 June 1, 2022 shall result in the implementation date being
7878 11 delayed to October 1, 2022.
7979 12 (d) The new nursing services reimbursement methodology
8080 13 utilizing the Patient Driven Payment Model, which shall be
8181 14 referred to as the PDPM reimbursement system, taking effect
8282 15 July 1, 2022, upon federal approval by the Centers for
8383 16 Medicare and Medicaid Services, shall be based on the
8484 17 following:
8585 18 (1) The methodology shall be resident-centered,
8686 19 facility-specific, cost-based, and based on guidance from
8787 20 the Centers for Medicare and Medicaid Services.
8888 21 (2) Costs shall be annually rebased and case mix index
8989 22 quarterly updated. The nursing services methodology will
9090 23 be assigned to the Medicaid enrolled residents on record
9191 24 as of 30 days prior to the beginning of the rate period in
9292 25 the Department's Medicaid Management Information System
9393 26 (MMIS) as present on the last day of the second quarter
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104104 1 preceding the rate period based upon the Assessment
105105 2 Reference Date of the Minimum Data Set (MDS).
106106 3 (3) Regional wage adjustors based on the Health
107107 4 Service Areas (HSA) groupings and adjusters in effect on
108108 5 April 30, 2012 shall be included, except no adjuster shall
109109 6 be lower than 1.06.
110110 7 (4) PDPM nursing case mix indices in effect on March
111111 8 1, 2022 shall be assigned to each resident class at no less
112112 9 than 0.7858 of the Centers for Medicare and Medicaid
113113 10 Services PDPM unadjusted case mix values, in effect on
114114 11 March 1, 2022.
115115 12 (5) The pool of funds available for distribution by
116116 13 case mix and the base facility rate shall be determined
117117 14 using the formula contained in subsection (d-1).
118118 15 (6) The Department shall establish a variable per diem
119119 16 staffing add-on in accordance with the most recent
120120 17 available federal staffing report, currently the Payroll
121121 18 Based Journal, for the same period of time, and if
122122 19 applicable adjusted for acuity using the same quarter's
123123 20 MDS. The Department shall rely on Payroll Based Journals
124124 21 provided to the Department of Public Health to make a
125125 22 determination of non-submission. If the Department is
126126 23 notified by a facility of missing or inaccurate Payroll
127127 24 Based Journal data or an incorrect calculation of
128128 25 staffing, the Department must make a correction as soon as
129129 26 the error is verified for the applicable quarter.
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140140 1 Beginning October 1, 2024, the staffing percentage
141141 2 used in the calculation of the per diem staffing add-on
142142 3 shall be its PDPM STRIVE Staffing Ratio which equals: its
143143 4 Reported Total Nurse Staffing Hours Per Resident Per Day
144144 5 as published in the most recent federal staffing report
145145 6 (the Provider Information File), divided by the facility's
146146 7 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
147147 8 Staffing Target is equal to .82 times the facility's
148148 9 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
149149 10 Day. A facility's Illinois Adjusted Facility Case Mix
150150 11 Hours Per Resident Per Day is equal to its Case-Mix Total
151151 12 Nurse Staffing Hours Per Resident Per Day (as published in
152152 13 the most recent federal staffing report) times 3.662
153153 14 (which reflects the national resident days-weighted mean
154154 15 Reported Total Nurse Staffing Hours Per Resident Per Day
155155 16 as calculated using the January 2024 federal Provider
156156 17 Information Files), divided by the national resident
157157 18 days-weighted mean Reported Total Nurse Staffing Hours Per
158158 19 Resident Per Day calculated using the most recent federal
159159 20 Provider Information File. Facilities with at least 70% of
160160 21 the staffing indicated by the STRIVE study shall be paid a
161161 22 per diem add-on of $9, increasing by equivalent steps for
162162 23 each whole percentage point until the facilities reach a
163163 24 per diem of $16.52 $14.88. Facilities with at least 80% of
164164 25 the staffing indicated by the STRIVE study shall be paid a
165165 26 per diem add-on of $16.52 $14.88, increasing by equivalent
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176176 1 steps for each whole percentage point until the facilities
177177 2 reach a per diem add-on of $25.77 $23.80. Facilities with
178178 3 at least 92% of the staffing indicated by the STRIVE study
179179 4 shall be paid a per diem add-on of $25.77 $23.80,
180180 5 increasing by equivalent steps for each whole percentage
181181 6 point until the facilities reach a per diem add-on of
182182 7 $30.98 $29.75. Facilities with at least 100% of the
183183 8 staffing indicated by the STRIVE study shall be paid a per
184184 9 diem add-on of $30.98 $29.75, increasing by equivalent
185185 10 steps for each whole percentage point until the facilities
186186 11 reach a per diem add-on of $36.44 $35.70. Facilities with
187187 12 at least 110% of the staffing indicated by the STRIVE
188188 13 study shall be paid a per diem add-on of $36.44 $35.70,
189189 14 increasing by equivalent steps for each whole percentage
190190 15 point until the facilities reach a per diem add-on of
191191 16 $38.68. Facilities with at least 125% or higher of the
192192 17 staffing indicated by the STRIVE study shall be paid a per
193193 18 diem add-on of $38.68. No Beginning April 1, 2023, no
194194 19 nursing facility's variable staffing per diem add-on shall
195195 20 be reduced by more than 5% in 2 consecutive quarters. For
196196 21 the quarters beginning July 1, 2022 and October 1, 2022,
197197 22 no facility's variable per diem staffing add-on shall be
198198 23 calculated at a rate lower than 85% of the staffing
199199 24 indicated by the STRIVE study. No facility below 70% of
200200 25 the staffing indicated by the STRIVE study shall receive a
201201 26 variable per diem staffing add-on after December 31, 2022.
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212212 1 (7) For dates of services beginning July 1, 2022, the
213213 2 PDPM nursing component per diem for each nursing facility
214214 3 shall be the product of the facility's (i) statewide PDPM
215215 4 nursing base per diem rate, $92.25, adjusted for the
216216 5 facility average PDPM case mix index calculated quarterly
217217 6 and (ii) the regional wage adjuster, and then add the
218218 7 Medicaid access adjustment as defined in (e-3) of this
219219 8 Section. Transition rates for services provided between
220220 9 July 1, 2022 and October 1, 2023 shall be the greater of
221221 10 the PDPM nursing component per diem or:
222222 11 (A) for the quarter beginning July 1, 2022, the
223223 12 RUG-IV nursing component per diem;
224224 13 (B) for the quarter beginning October 1, 2022, the
225225 14 sum of the RUG-IV nursing component per diem
226226 15 multiplied by 0.80 and the PDPM nursing component per
227227 16 diem multiplied by 0.20;
228228 17 (C) for the quarter beginning January 1, 2023, the
229229 18 sum of the RUG-IV nursing component per diem
230230 19 multiplied by 0.60 and the PDPM nursing component per
231231 20 diem multiplied by 0.40;
232232 21 (D) for the quarter beginning April 1, 2023, the
233233 22 sum of the RUG-IV nursing component per diem
234234 23 multiplied by 0.40 and the PDPM nursing component per
235235 24 diem multiplied by 0.60;
236236 25 (E) for the quarter beginning July 1, 2023, the
237237 26 sum of the RUG-IV nursing component per diem
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248248 1 multiplied by 0.20 and the PDPM nursing component per
249249 2 diem multiplied by 0.80; or
250250 3 (F) for the quarter beginning October 1, 2023 and
251251 4 each subsequent quarter, the transition rate shall end
252252 5 and a nursing facility shall be paid 100% of the PDPM
253253 6 nursing component per diem.
254254 7 (d-1) Calculation of base year Statewide RUG-IV nursing
255255 8 base per diem rate.
256256 9 (1) Base rate spending pool shall be:
257257 10 (A) The base year resident days which are
258258 11 calculated by multiplying the number of Medicaid
259259 12 residents in each nursing home as indicated in the MDS
260260 13 data defined in paragraph (4) by 365.
261261 14 (B) Each facility's nursing component per diem in
262262 15 effect on July 1, 2012 shall be multiplied by
263263 16 subsection (A).
264264 17 (C) Thirteen million is added to the product of
265265 18 subparagraph (A) and subparagraph (B) to adjust for
266266 19 the exclusion of nursing homes defined in paragraph
267267 20 (5).
268268 21 (2) For each nursing home with Medicaid residents as
269269 22 indicated by the MDS data defined in paragraph (4),
270270 23 weighted days adjusted for case mix and regional wage
271271 24 adjustment shall be calculated. For each home this
272272 25 calculation is the product of:
273273 26 (A) Base year resident days as calculated in
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284284 1 subparagraph (A) of paragraph (1).
285285 2 (B) The nursing home's regional wage adjustor
286286 3 based on the Health Service Areas (HSA) groupings and
287287 4 adjustors in effect on April 30, 2012.
288288 5 (C) Facility weighted case mix which is the number
289289 6 of Medicaid residents as indicated by the MDS data
290290 7 defined in paragraph (4) multiplied by the associated
291291 8 case weight for the RUG-IV 48 grouper model using
292292 9 standard RUG-IV procedures for index maximization.
293293 10 (D) The sum of the products calculated for each
294294 11 nursing home in subparagraphs (A) through (C) above
295295 12 shall be the base year case mix, rate adjusted
296296 13 weighted days.
297297 14 (3) The Statewide RUG-IV nursing base per diem rate:
298298 15 (A) on January 1, 2014 shall be the quotient of the
299299 16 paragraph (1) divided by the sum calculated under
300300 17 subparagraph (D) of paragraph (2);
301301 18 (B) on and after July 1, 2014 and until July 1,
302302 19 2022, shall be the amount calculated under
303303 20 subparagraph (A) of this paragraph (3) plus $1.76; and
304304 21 (C) beginning July 1, 2022 and thereafter, $7
305305 22 shall be added to the amount calculated under
306306 23 subparagraph (B) of this paragraph (3) of this
307307 24 Section.
308308 25 (4) Minimum Data Set (MDS) comprehensive assessments
309309 26 for Medicaid residents on the last day of the quarter used
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320320 1 to establish the base rate.
321321 2 (5) Nursing facilities designated as of July 1, 2012
322322 3 by the Department as "Institutions for Mental Disease"
323323 4 shall be excluded from all calculations under this
324324 5 subsection. The data from these facilities shall not be
325325 6 used in the computations described in paragraphs (1)
326326 7 through (4) above to establish the base rate.
327327 8 (e) Beginning July 1, 2014, the Department shall allocate
328328 9 funding in the amount up to $10,000,000 for per diem add-ons to
329329 10 the RUGS methodology for dates of service on and after July 1,
330330 11 2014:
331331 12 (1) $0.63 for each resident who scores in I4200
332332 13 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
333333 14 (2) $2.67 for each resident who scores either a "1" or
334334 15 "2" in any items S1200A through S1200I and also scores in
335335 16 RUG groups PA1, PA2, BA1, or BA2.
336336 17 (e-1) (Blank).
337337 18 (e-2) For dates of services beginning January 1, 2014 and
338338 19 ending September 30, 2023, the RUG-IV nursing component per
339339 20 diem for a nursing home shall be the product of the statewide
340340 21 RUG-IV nursing base per diem rate, the facility average case
341341 22 mix index, and the regional wage adjustor. For dates of
342342 23 service beginning July 1, 2022 and ending September 30, 2023,
343343 24 the Medicaid access adjustment described in subsection (e-3)
344344 25 shall be added to the product.
345345 26 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
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356356 1 facility average PDPM case mix index calculated quarterly
357357 2 shall be added to the statewide PDPM nursing per diem for all
358358 3 facilities with annual Medicaid bed days of at least 70% of all
359359 4 occupied bed days adjusted quarterly. For each new calendar
360360 5 year and for the 6-month period beginning July 1, 2022, the
361361 6 percentage of a facility's occupied bed days comprised of
362362 7 Medicaid bed days shall be determined by the Department
363363 8 quarterly. For dates of service beginning January 1, 2023, the
364364 9 Medicaid Access Adjustment shall be increased to $4.75. This
365365 10 subsection shall be inoperative on and after January 1, 2028.
366366 11 (e-4) Subject to federal approval, on and after January 1,
367367 12 2024, the Department shall increase the rate add-on at
368368 13 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
369369 14 for ventilator services from $208 per day to $481 per day.
370370 15 Payment is subject to the criteria and requirements under 89
371371 16 Ill. Adm. Code 147.335.
372372 17 (f) (Blank).
373373 18 (g) Notwithstanding any other provision of this Code, on
374374 19 and after July 1, 2012, for facilities not designated by the
375375 20 Department of Healthcare and Family Services as "Institutions
376376 21 for Mental Disease", rates effective May 1, 2011 shall be
377377 22 adjusted as follows:
378378 23 (1) (Blank);
379379 24 (2) (Blank);
380380 25 (3) Facility rates for the capital and support
381381 26 components shall be reduced by 1.7%.
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392392 1 (h) Notwithstanding any other provision of this Code, on
393393 2 and after July 1, 2012, nursing facilities designated by the
394394 3 Department of Healthcare and Family Services as "Institutions
395395 4 for Mental Disease" and "Institutions for Mental Disease" that
396396 5 are facilities licensed under the Specialized Mental Health
397397 6 Rehabilitation Act of 2013 shall have the nursing,
398398 7 socio-developmental, capital, and support components of their
399399 8 reimbursement rate effective May 1, 2011 reduced in total by
400400 9 2.7%.
401401 10 (i) On and after July 1, 2014, the reimbursement rates for
402402 11 the support component of the nursing facility rate for
403403 12 facilities licensed under the Nursing Home Care Act as skilled
404404 13 or intermediate care facilities shall be the rate in effect on
405405 14 June 30, 2014 increased by 8.17%.
406406 15 (i-1) Subject to federal approval, on and after January 1,
407407 16 2024, the reimbursement rates for the support component of the
408408 17 nursing facility rate for facilities licensed under the
409409 18 Nursing Home Care Act as skilled or intermediate care
410410 19 facilities shall be the rate in effect on June 30, 2023
411411 20 increased by 12%.
412412 21 (j) Notwithstanding any other provision of law, subject to
413413 22 federal approval, effective July 1, 2019, sufficient funds
414414 23 shall be allocated for changes to rates for facilities
415415 24 licensed under the Nursing Home Care Act as skilled nursing
416416 25 facilities or intermediate care facilities for dates of
417417 26 services on and after July 1, 2019: (i) to establish, through
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428428 1 June 30, 2022 a per diem add-on to the direct care per diem
429429 2 rate not to exceed $70,000,000 annually in the aggregate
430430 3 taking into account federal matching funds for the purpose of
431431 4 addressing the facility's unique staffing needs, adjusted
432432 5 quarterly and distributed by a weighted formula based on
433433 6 Medicaid bed days on the last day of the second quarter
434434 7 preceding the quarter for which the rate is being adjusted.
435435 8 Beginning July 1, 2022, the annual $70,000,000 described in
436436 9 the preceding sentence shall be dedicated to the variable per
437437 10 diem add-on for staffing under paragraph (6) of subsection
438438 11 (d); and (ii) in an amount not to exceed $170,000,000 annually
439439 12 in the aggregate taking into account federal matching funds to
440440 13 permit the support component of the nursing facility rate to
441441 14 be updated as follows:
442442 15 (1) 80%, or $136,000,000, of the funds shall be used
443443 16 to update each facility's rate in effect on June 30, 2019
444444 17 using the most recent cost reports on file, which have had
445445 18 a limited review conducted by the Department of Healthcare
446446 19 and Family Services and will not hold up enacting the rate
447447 20 increase, with the Department of Healthcare and Family
448448 21 Services.
449449 22 (2) After completing the calculation in paragraph (1),
450450 23 any facility whose rate is less than the rate in effect on
451451 24 June 30, 2019 shall have its rate restored to the rate in
452452 25 effect on June 30, 2019 from the 20% of the funds set
453453 26 aside.
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464464 1 (3) The remainder of the 20%, or $34,000,000, shall be
465465 2 used to increase each facility's rate by an equal
466466 3 percentage.
467467 4 (k) During the first quarter of State Fiscal Year 2020,
468468 5 the Department of Healthcare of Family Services must convene a
469469 6 technical advisory group consisting of members of all trade
470470 7 associations representing Illinois skilled nursing providers
471471 8 to discuss changes necessary with federal implementation of
472472 9 Medicare's Patient-Driven Payment Model. Implementation of
473473 10 Medicare's Patient-Driven Payment Model shall, by September 1,
474474 11 2020, end the collection of the MDS data that is necessary to
475475 12 maintain the current RUG-IV Medicaid payment methodology. The
476476 13 technical advisory group must consider a revised reimbursement
477477 14 methodology that takes into account transparency,
478478 15 accountability, actual staffing as reported under the
479479 16 federally required Payroll Based Journal system, changes to
480480 17 the minimum wage, adequacy in coverage of the cost of care, and
481481 18 a quality component that rewards quality improvements.
482482 19 (l) The Department shall establish per diem add-on
483483 20 payments to improve the quality of care delivered by
484484 21 facilities, including:
485485 22 (1) Incentive payments determined by facility
486486 23 performance on specified quality measures in an initial
487487 24 amount of $70,000,000. Nothing in this subsection shall be
488488 25 construed to limit the quality of care payments in the
489489 26 aggregate statewide to $70,000,000, and, if quality of
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500500 1 care has improved across nursing facilities, the
501501 2 Department shall adjust those add-on payments accordingly.
502502 3 The quality payment methodology described in this
503503 4 subsection must be used for at least State Fiscal Year
504504 5 2023. Beginning with the quarter starting July 1, 2023,
505505 6 the Department may add, remove, or change quality metrics
506506 7 and make associated changes to the quality payment
507507 8 methodology as outlined in subparagraph (E). Facilities
508508 9 designated by the Centers for Medicare and Medicaid
509509 10 Services as a special focus facility or a hospital-based
510510 11 nursing home do not qualify for quality payments.
511511 12 (A) Each quality pool must be distributed by
512512 13 assigning a quality weighted score for each nursing
513513 14 home which is calculated by multiplying the nursing
514514 15 home's quality base period Medicaid days by the
515515 16 nursing home's star rating weight in that period.
516516 17 (B) Star rating weights are assigned based on the
517517 18 nursing home's star rating for the LTS quality star
518518 19 rating. As used in this subparagraph, "LTS quality
519519 20 star rating" means the long-term stay quality rating
520520 21 for each nursing facility, as assigned by the Centers
521521 22 for Medicare and Medicaid Services under the Five-Star
522522 23 Quality Rating System. The rating is a number ranging
523523 24 from 0 (lowest) to 5 (highest).
524524 25 (i) Zero-star or one-star rating has a weight
525525 26 of 0.
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536536 1 (ii) Two-star rating has a weight of 0.75.
537537 2 (iii) Three-star rating has a weight of 1.5.
538538 3 (iv) Four-star rating has a weight of 2.5.
539539 4 (v) Five-star rating has a weight of 3.5.
540540 5 (C) Each nursing home's quality weight score is
541541 6 divided by the sum of all quality weight scores for
542542 7 qualifying nursing homes to determine the proportion
543543 8 of the quality pool to be paid to the nursing home.
544544 9 (D) The quality pool is no less than $70,000,000
545545 10 annually or $17,500,000 per quarter. The Department
546546 11 shall publish on its website the estimated payments
547547 12 and the associated weights for each facility 45 days
548548 13 prior to when the initial payments for the quarter are
549549 14 to be paid. The Department shall assign each facility
550550 15 the most recent and applicable quarter's STAR value
551551 16 unless the facility notifies the Department within 15
552552 17 days of an issue and the facility provides reasonable
553553 18 evidence demonstrating its timely compliance with
554554 19 federal data submission requirements for the quarter
555555 20 of record. If such evidence cannot be provided to the
556556 21 Department, the STAR rating assigned to the facility
557557 22 shall be reduced by one from the prior quarter.
558558 23 (E) The Department shall review quality metrics
559559 24 used for payment of the quality pool and make
560560 25 recommendations for any associated changes to the
561561 26 methodology for distributing quality pool payments in
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572572 1 consultation with associations representing long-term
573573 2 care providers, consumer advocates, organizations
574574 3 representing workers of long-term care facilities, and
575575 4 payors. The Department may establish, by rule, changes
576576 5 to the methodology for distributing quality pool
577577 6 payments.
578578 7 (F) The Department shall disburse quality pool
579579 8 payments from the Long-Term Care Provider Fund on a
580580 9 monthly basis in amounts proportional to the total
581581 10 quality pool payment determined for the quarter.
582582 11 (G) The Department shall publish any changes in
583583 12 the methodology for distributing quality pool payments
584584 13 prior to the beginning of the measurement period or
585585 14 quality base period for any metric added to the
586586 15 distribution's methodology.
587587 16 (2) Payments based on CNA tenure, promotion, and CNA
588588 17 training for the purpose of increasing CNA compensation.
589589 18 It is the intent of this subsection that payments made in
590590 19 accordance with this paragraph be directly incorporated
591591 20 into increased compensation for CNAs. As used in this
592592 21 paragraph, "CNA" means a certified nursing assistant as
593593 22 that term is described in Section 3-206 of the Nursing
594594 23 Home Care Act, Section 3-206 of the ID/DD Community Care
595595 24 Act, and Section 3-206 of the MC/DD Act. The Department
596596 25 shall establish, by rule, payments to nursing facilities
597597 26 equal to Medicaid's share of the tenure wage increments
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608608 1 specified in this paragraph for all reported CNA employee
609609 2 hours compensated according to a posted schedule
610610 3 consisting of increments at least as large as those
611611 4 specified in this paragraph. The increments are as
612612 5 follows: an additional $1.50 per hour for CNAs with at
613613 6 least one and less than 2 years' experience plus another
614614 7 $1 per hour for each additional year of experience up to a
615615 8 maximum of $6.50 for CNAs with at least 6 years of
616616 9 experience. For purposes of this paragraph, Medicaid's
617617 10 share shall be the ratio determined by paid Medicaid bed
618618 11 days divided by total bed days for the applicable time
619619 12 period used in the calculation. In addition, and additive
620620 13 to any tenure increments paid as specified in this
621621 14 paragraph, the Department shall establish, by rule,
622622 15 payments supporting Medicaid's share of the
623623 16 promotion-based wage increments for CNA employee hours
624624 17 compensated for that promotion with at least a $1.50
625625 18 hourly increase. Medicaid's share shall be established as
626626 19 it is for the tenure increments described in this
627627 20 paragraph. Qualifying promotions shall be defined by the
628628 21 Department in rules for an expected 10-15% subset of CNAs
629629 22 assigned intermediate, specialized, or added roles such as
630630 23 CNA trainers, CNA scheduling "captains", and CNA
631631 24 specialists for resident conditions like dementia or
632632 25 memory care or behavioral health.
633633 26 (m) The Department shall work with nursing facility
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644644 1 industry representatives to design policies and procedures to
645645 2 permit facilities to address the integrity of data from
646646 3 federal reporting sites used by the Department in setting
647647 4 facility rates.
648648 5 (Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
649649 6 102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
650650 7 Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
651651 8 Section 50-5, eff. 1-1-24; revised 12-15-23.)
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