IL
Illinois Senate Bill SB3380

Illinois 2023-2024 Regular Session

Illinois Senate Bill SB3380 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3380 Introduced 2/8/2024, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions requiring the Department of Healthcare and Family Services to make certain per diem add-on payments to nursing facilities that meet specified staffing levels indicated by the STRIVE study, provides that whenever the federal Centers for Medicare and Medicaid Services no longer updates the STRIVE study, the Department of Healthcare and Family Services shall use the last quarter STRIVE numbers for add-on calculations and shall not decrease the payment amounts until a replacement staff time measurement study is incorporated by law. LRB103 38150 KTG 68283 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3380 Introduced 2/8/2024, by Sen. Sara Feigenholtz 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 provisions requiring the Department of Healthcare and Family Services to make certain per diem add-on payments to nursing facilities that meet specified staffing levels indicated by the STRIVE study, provides that whenever the federal Centers for Medicare and Medicaid Services no longer updates the STRIVE study, the Department of Healthcare and Family Services shall use the last quarter STRIVE numbers for add-on calculations and shall not decrease the payment amounts until a replacement staff time measurement study is incorporated by law. LRB103 38150 KTG 68283 b LRB103 38150 KTG 68283 b A BILL FOR
22 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3380 Introduced 2/8/2024, by Sen. Sara Feigenholtz 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 provisions requiring the Department of Healthcare and Family Services to make certain per diem add-on payments to nursing facilities that meet specified staffing levels indicated by the STRIVE study, provides that whenever the federal Centers for Medicare and Medicaid Services no longer updates the STRIVE study, the Department of Healthcare and Family Services shall use the last quarter STRIVE numbers for add-on calculations and shall not decrease the payment amounts until a replacement staff time measurement study is incorporated by law.
66 LRB103 38150 KTG 68283 b LRB103 38150 KTG 68283 b
77 LRB103 38150 KTG 68283 b
88 A BILL FOR
99 SB3380LRB103 38150 KTG 68283 b SB3380 LRB103 38150 KTG 68283 b
1010 SB3380 LRB103 38150 KTG 68283 b
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
3434
3535
3636
3737 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3380 Introduced 2/8/2024, by Sen. Sara Feigenholtz 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 provisions requiring the Department of Healthcare and Family Services to make certain per diem add-on payments to nursing facilities that meet specified staffing levels indicated by the STRIVE study, provides that whenever the federal Centers for Medicare and Medicaid Services no longer updates the STRIVE study, the Department of Healthcare and Family Services shall use the last quarter STRIVE numbers for add-on calculations and shall not decrease the payment amounts until a replacement staff time measurement study is incorporated by law.
4141 LRB103 38150 KTG 68283 b LRB103 38150 KTG 68283 b
4242 LRB103 38150 KTG 68283 b
4343 A BILL FOR
4444
4545
4646
4747
4848
4949 305 ILCS 5/5-5.2
5050
5151
5252
5353 LRB103 38150 KTG 68283 b
5454
5555
5656
5757
5858
5959
6060
6161
6262
6363 SB3380 LRB103 38150 KTG 68283 b
6464
6565
6666 SB3380- 2 -LRB103 38150 KTG 68283 b SB3380 - 2 - LRB103 38150 KTG 68283 b
6767 SB3380 - 2 - LRB103 38150 KTG 68283 b
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
9494
9595
9696
9797
9898
9999 SB3380 - 2 - LRB103 38150 KTG 68283 b
100100
101101
102102 SB3380- 3 -LRB103 38150 KTG 68283 b SB3380 - 3 - LRB103 38150 KTG 68283 b
103103 SB3380 - 3 - LRB103 38150 KTG 68283 b
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.
130130
131131
132132
133133
134134
135135 SB3380 - 3 - LRB103 38150 KTG 68283 b
136136
137137
138138 SB3380- 4 -LRB103 38150 KTG 68283 b SB3380 - 4 - LRB103 38150 KTG 68283 b
139139 SB3380 - 4 - LRB103 38150 KTG 68283 b
140140 1 Facilities with at least 70% of the staffing indicated
141141 2 by the STRIVE study shall be paid a per diem add-on of $9,
142142 3 increasing by equivalent steps for each whole percentage
143143 4 point until the facilities reach a per diem of $14.88.
144144 5 Facilities with at least 80% of the staffing indicated by
145145 6 the STRIVE study shall be paid a per diem add-on of $14.88,
146146 7 increasing by equivalent steps for each whole percentage
147147 8 point until the facilities reach a per diem add-on of
148148 9 $23.80. Facilities with at least 92% of the staffing
149149 10 indicated by the STRIVE study shall be paid a per diem
150150 11 add-on of $23.80, increasing by equivalent steps for each
151151 12 whole percentage point until the facilities reach a per
152152 13 diem add-on of $29.75. Facilities with at least 100% of
153153 14 the staffing indicated by the STRIVE study shall be paid a
154154 15 per diem add-on of $29.75, increasing by equivalent steps
155155 16 for each whole percentage point until the facilities reach
156156 17 a per diem add-on of $35.70. Facilities with at least 110%
157157 18 of the staffing indicated by the STRIVE study shall be
158158 19 paid a per diem add-on of $35.70, increasing by equivalent
159159 20 steps for each whole percentage point until the facilities
160160 21 reach a per diem add-on of $38.68. Facilities with at
161161 22 least 125% or higher of the staffing indicated by the
162162 23 STRIVE study shall be paid a per diem add-on of $38.68.
163163 24 Beginning April 1, 2023, no nursing facility's variable
164164 25 staffing per diem add-on shall be reduced by more than 5%
165165 26 in 2 consecutive quarters. For the quarters beginning July
166166
167167
168168
169169
170170
171171 SB3380 - 4 - LRB103 38150 KTG 68283 b
172172
173173
174174 SB3380- 5 -LRB103 38150 KTG 68283 b SB3380 - 5 - LRB103 38150 KTG 68283 b
175175 SB3380 - 5 - LRB103 38150 KTG 68283 b
176176 1 1, 2022 and October 1, 2022, no facility's variable per
177177 2 diem staffing add-on shall be calculated at a rate lower
178178 3 than 85% of the staffing indicated by the STRIVE study. No
179179 4 facility below 70% of the staffing indicated by the STRIVE
180180 5 study shall receive a variable per diem staffing add-on
181181 6 after December 31, 2022.
182182 7 Whenever the federal Centers for Medicare and Medicaid
183183 8 Services no longer updates the STRIVE study, the
184184 9 Department shall use the last quarter STRIVE numbers for
185185 10 add-on calculations and shall not decrease the payment
186186 11 amounts until a replacement staff time measurement study
187187 12 is incorporated into this Section by law.
188188 13 (7) For dates of services beginning July 1, 2022, the
189189 14 PDPM nursing component per diem for each nursing facility
190190 15 shall be the product of the facility's (i) statewide PDPM
191191 16 nursing base per diem rate, $92.25, adjusted for the
192192 17 facility average PDPM case mix index calculated quarterly
193193 18 and (ii) the regional wage adjuster, and then add the
194194 19 Medicaid access adjustment as defined in (e-3) of this
195195 20 Section. Transition rates for services provided between
196196 21 July 1, 2022 and October 1, 2023 shall be the greater of
197197 22 the PDPM nursing component per diem or:
198198 23 (A) for the quarter beginning July 1, 2022, the
199199 24 RUG-IV nursing component per diem;
200200 25 (B) for the quarter beginning October 1, 2022, the
201201 26 sum of the RUG-IV nursing component per diem
202202
203203
204204
205205
206206
207207 SB3380 - 5 - LRB103 38150 KTG 68283 b
208208
209209
210210 SB3380- 6 -LRB103 38150 KTG 68283 b SB3380 - 6 - LRB103 38150 KTG 68283 b
211211 SB3380 - 6 - LRB103 38150 KTG 68283 b
212212 1 multiplied by 0.80 and the PDPM nursing component per
213213 2 diem multiplied by 0.20;
214214 3 (C) for the quarter beginning January 1, 2023, the
215215 4 sum of the RUG-IV nursing component per diem
216216 5 multiplied by 0.60 and the PDPM nursing component per
217217 6 diem multiplied by 0.40;
218218 7 (D) for the quarter beginning April 1, 2023, the
219219 8 sum of the RUG-IV nursing component per diem
220220 9 multiplied by 0.40 and the PDPM nursing component per
221221 10 diem multiplied by 0.60;
222222 11 (E) for the quarter beginning July 1, 2023, the
223223 12 sum of the RUG-IV nursing component per diem
224224 13 multiplied by 0.20 and the PDPM nursing component per
225225 14 diem multiplied by 0.80; or
226226 15 (F) for the quarter beginning October 1, 2023 and
227227 16 each subsequent quarter, the transition rate shall end
228228 17 and a nursing facility shall be paid 100% of the PDPM
229229 18 nursing component per diem.
230230 19 (d-1) Calculation of base year Statewide RUG-IV nursing
231231 20 base per diem rate.
232232 21 (1) Base rate spending pool shall be:
233233 22 (A) The base year resident days which are
234234 23 calculated by multiplying the number of Medicaid
235235 24 residents in each nursing home as indicated in the MDS
236236 25 data defined in paragraph (4) by 365.
237237 26 (B) Each facility's nursing component per diem in
238238
239239
240240
241241
242242
243243 SB3380 - 6 - LRB103 38150 KTG 68283 b
244244
245245
246246 SB3380- 7 -LRB103 38150 KTG 68283 b SB3380 - 7 - LRB103 38150 KTG 68283 b
247247 SB3380 - 7 - LRB103 38150 KTG 68283 b
248248 1 effect on July 1, 2012 shall be multiplied by
249249 2 subsection (A).
250250 3 (C) Thirteen million is added to the product of
251251 4 subparagraph (A) and subparagraph (B) to adjust for
252252 5 the exclusion of nursing homes defined in paragraph
253253 6 (5).
254254 7 (2) For each nursing home with Medicaid residents as
255255 8 indicated by the MDS data defined in paragraph (4),
256256 9 weighted days adjusted for case mix and regional wage
257257 10 adjustment shall be calculated. For each home this
258258 11 calculation is the product of:
259259 12 (A) Base year resident days as calculated in
260260 13 subparagraph (A) of paragraph (1).
261261 14 (B) The nursing home's regional wage adjustor
262262 15 based on the Health Service Areas (HSA) groupings and
263263 16 adjustors in effect on April 30, 2012.
264264 17 (C) Facility weighted case mix which is the number
265265 18 of Medicaid residents as indicated by the MDS data
266266 19 defined in paragraph (4) multiplied by the associated
267267 20 case weight for the RUG-IV 48 grouper model using
268268 21 standard RUG-IV procedures for index maximization.
269269 22 (D) The sum of the products calculated for each
270270 23 nursing home in subparagraphs (A) through (C) above
271271 24 shall be the base year case mix, rate adjusted
272272 25 weighted days.
273273 26 (3) The Statewide RUG-IV nursing base per diem rate:
274274
275275
276276
277277
278278
279279 SB3380 - 7 - LRB103 38150 KTG 68283 b
280280
281281
282282 SB3380- 8 -LRB103 38150 KTG 68283 b SB3380 - 8 - LRB103 38150 KTG 68283 b
283283 SB3380 - 8 - LRB103 38150 KTG 68283 b
284284 1 (A) on January 1, 2014 shall be the quotient of the
285285 2 paragraph (1) divided by the sum calculated under
286286 3 subparagraph (D) of paragraph (2);
287287 4 (B) on and after July 1, 2014 and until July 1,
288288 5 2022, shall be the amount calculated under
289289 6 subparagraph (A) of this paragraph (3) plus $1.76; and
290290 7 (C) beginning July 1, 2022 and thereafter, $7
291291 8 shall be added to the amount calculated under
292292 9 subparagraph (B) of this paragraph (3) of this
293293 10 Section.
294294 11 (4) Minimum Data Set (MDS) comprehensive assessments
295295 12 for Medicaid residents on the last day of the quarter used
296296 13 to establish the base rate.
297297 14 (5) Nursing facilities designated as of July 1, 2012
298298 15 by the Department as "Institutions for Mental Disease"
299299 16 shall be excluded from all calculations under this
300300 17 subsection. The data from these facilities shall not be
301301 18 used in the computations described in paragraphs (1)
302302 19 through (4) above to establish the base rate.
303303 20 (e) Beginning July 1, 2014, the Department shall allocate
304304 21 funding in the amount up to $10,000,000 for per diem add-ons to
305305 22 the RUGS methodology for dates of service on and after July 1,
306306 23 2014:
307307 24 (1) $0.63 for each resident who scores in I4200
308308 25 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
309309 26 (2) $2.67 for each resident who scores either a "1" or
310310
311311
312312
313313
314314
315315 SB3380 - 8 - LRB103 38150 KTG 68283 b
316316
317317
318318 SB3380- 9 -LRB103 38150 KTG 68283 b SB3380 - 9 - LRB103 38150 KTG 68283 b
319319 SB3380 - 9 - LRB103 38150 KTG 68283 b
320320 1 "2" in any items S1200A through S1200I and also scores in
321321 2 RUG groups PA1, PA2, BA1, or BA2.
322322 3 (e-1) (Blank).
323323 4 (e-2) For dates of services beginning January 1, 2014 and
324324 5 ending September 30, 2023, the RUG-IV nursing component per
325325 6 diem for a nursing home shall be the product of the statewide
326326 7 RUG-IV nursing base per diem rate, the facility average case
327327 8 mix index, and the regional wage adjustor. For dates of
328328 9 service beginning July 1, 2022 and ending September 30, 2023,
329329 10 the Medicaid access adjustment described in subsection (e-3)
330330 11 shall be added to the product.
331331 12 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
332332 13 facility average PDPM case mix index calculated quarterly
333333 14 shall be added to the statewide PDPM nursing per diem for all
334334 15 facilities with annual Medicaid bed days of at least 70% of all
335335 16 occupied bed days adjusted quarterly. For each new calendar
336336 17 year and for the 6-month period beginning July 1, 2022, the
337337 18 percentage of a facility's occupied bed days comprised of
338338 19 Medicaid bed days shall be determined by the Department
339339 20 quarterly. For dates of service beginning January 1, 2023, the
340340 21 Medicaid Access Adjustment shall be increased to $4.75. This
341341 22 subsection shall be inoperative on and after January 1, 2028.
342342 23 (e-4) Subject to federal approval, on and after January 1,
343343 24 2024, the Department shall increase the rate add-on at
344344 25 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
345345 26 for ventilator services from $208 per day to $481 per day.
346346
347347
348348
349349
350350
351351 SB3380 - 9 - LRB103 38150 KTG 68283 b
352352
353353
354354 SB3380- 10 -LRB103 38150 KTG 68283 b SB3380 - 10 - LRB103 38150 KTG 68283 b
355355 SB3380 - 10 - LRB103 38150 KTG 68283 b
356356 1 Payment is subject to the criteria and requirements under 89
357357 2 Ill. Adm. Code 147.335.
358358 3 (f) (Blank).
359359 4 (g) Notwithstanding any other provision of this Code, on
360360 5 and after July 1, 2012, for facilities not designated by the
361361 6 Department of Healthcare and Family Services as "Institutions
362362 7 for Mental Disease", rates effective May 1, 2011 shall be
363363 8 adjusted as follows:
364364 9 (1) (Blank);
365365 10 (2) (Blank);
366366 11 (3) Facility rates for the capital and support
367367 12 components shall be reduced by 1.7%.
368368 13 (h) Notwithstanding any other provision of this Code, on
369369 14 and after July 1, 2012, nursing facilities designated by the
370370 15 Department of Healthcare and Family Services as "Institutions
371371 16 for Mental Disease" and "Institutions for Mental Disease" that
372372 17 are facilities licensed under the Specialized Mental Health
373373 18 Rehabilitation Act of 2013 shall have the nursing,
374374 19 socio-developmental, capital, and support components of their
375375 20 reimbursement rate effective May 1, 2011 reduced in total by
376376 21 2.7%.
377377 22 (i) On and after July 1, 2014, the reimbursement rates for
378378 23 the support component of the nursing facility rate for
379379 24 facilities licensed under the Nursing Home Care Act as skilled
380380 25 or intermediate care facilities shall be the rate in effect on
381381 26 June 30, 2014 increased by 8.17%.
382382
383383
384384
385385
386386
387387 SB3380 - 10 - LRB103 38150 KTG 68283 b
388388
389389
390390 SB3380- 11 -LRB103 38150 KTG 68283 b SB3380 - 11 - LRB103 38150 KTG 68283 b
391391 SB3380 - 11 - LRB103 38150 KTG 68283 b
392392 1 (i-1) Subject to federal approval, on and after January 1,
393393 2 2024, the reimbursement rates for the support component of the
394394 3 nursing facility rate for facilities licensed under the
395395 4 Nursing Home Care Act as skilled or intermediate care
396396 5 facilities shall be the rate in effect on June 30, 2023
397397 6 increased by 12%.
398398 7 (j) Notwithstanding any other provision of law, subject to
399399 8 federal approval, effective July 1, 2019, sufficient funds
400400 9 shall be allocated for changes to rates for facilities
401401 10 licensed under the Nursing Home Care Act as skilled nursing
402402 11 facilities or intermediate care facilities for dates of
403403 12 services on and after July 1, 2019: (i) to establish, through
404404 13 June 30, 2022 a per diem add-on to the direct care per diem
405405 14 rate not to exceed $70,000,000 annually in the aggregate
406406 15 taking into account federal matching funds for the purpose of
407407 16 addressing the facility's unique staffing needs, adjusted
408408 17 quarterly and distributed by a weighted formula based on
409409 18 Medicaid bed days on the last day of the second quarter
410410 19 preceding the quarter for which the rate is being adjusted.
411411 20 Beginning July 1, 2022, the annual $70,000,000 described in
412412 21 the preceding sentence shall be dedicated to the variable per
413413 22 diem add-on for staffing under paragraph (6) of subsection
414414 23 (d); and (ii) in an amount not to exceed $170,000,000 annually
415415 24 in the aggregate taking into account federal matching funds to
416416 25 permit the support component of the nursing facility rate to
417417 26 be updated as follows:
418418
419419
420420
421421
422422
423423 SB3380 - 11 - LRB103 38150 KTG 68283 b
424424
425425
426426 SB3380- 12 -LRB103 38150 KTG 68283 b SB3380 - 12 - LRB103 38150 KTG 68283 b
427427 SB3380 - 12 - LRB103 38150 KTG 68283 b
428428 1 (1) 80%, or $136,000,000, of the funds shall be used
429429 2 to update each facility's rate in effect on June 30, 2019
430430 3 using the most recent cost reports on file, which have had
431431 4 a limited review conducted by the Department of Healthcare
432432 5 and Family Services and will not hold up enacting the rate
433433 6 increase, with the Department of Healthcare and Family
434434 7 Services.
435435 8 (2) After completing the calculation in paragraph (1),
436436 9 any facility whose rate is less than the rate in effect on
437437 10 June 30, 2019 shall have its rate restored to the rate in
438438 11 effect on June 30, 2019 from the 20% of the funds set
439439 12 aside.
440440 13 (3) The remainder of the 20%, or $34,000,000, shall be
441441 14 used to increase each facility's rate by an equal
442442 15 percentage.
443443 16 (k) During the first quarter of State Fiscal Year 2020,
444444 17 the Department of Healthcare of Family Services must convene a
445445 18 technical advisory group consisting of members of all trade
446446 19 associations representing Illinois skilled nursing providers
447447 20 to discuss changes necessary with federal implementation of
448448 21 Medicare's Patient-Driven Payment Model. Implementation of
449449 22 Medicare's Patient-Driven Payment Model shall, by September 1,
450450 23 2020, end the collection of the MDS data that is necessary to
451451 24 maintain the current RUG-IV Medicaid payment methodology. The
452452 25 technical advisory group must consider a revised reimbursement
453453 26 methodology that takes into account transparency,
454454
455455
456456
457457
458458
459459 SB3380 - 12 - LRB103 38150 KTG 68283 b
460460
461461
462462 SB3380- 13 -LRB103 38150 KTG 68283 b SB3380 - 13 - LRB103 38150 KTG 68283 b
463463 SB3380 - 13 - LRB103 38150 KTG 68283 b
464464 1 accountability, actual staffing as reported under the
465465 2 federally required Payroll Based Journal system, changes to
466466 3 the minimum wage, adequacy in coverage of the cost of care, and
467467 4 a quality component that rewards quality improvements.
468468 5 (l) The Department shall establish per diem add-on
469469 6 payments to improve the quality of care delivered by
470470 7 facilities, including:
471471 8 (1) Incentive payments determined by facility
472472 9 performance on specified quality measures in an initial
473473 10 amount of $70,000,000. Nothing in this subsection shall be
474474 11 construed to limit the quality of care payments in the
475475 12 aggregate statewide to $70,000,000, and, if quality of
476476 13 care has improved across nursing facilities, the
477477 14 Department shall adjust those add-on payments accordingly.
478478 15 The quality payment methodology described in this
479479 16 subsection must be used for at least State Fiscal Year
480480 17 2023. Beginning with the quarter starting July 1, 2023,
481481 18 the Department may add, remove, or change quality metrics
482482 19 and make associated changes to the quality payment
483483 20 methodology as outlined in subparagraph (E). Facilities
484484 21 designated by the Centers for Medicare and Medicaid
485485 22 Services as a special focus facility or a hospital-based
486486 23 nursing home do not qualify for quality payments.
487487 24 (A) Each quality pool must be distributed by
488488 25 assigning a quality weighted score for each nursing
489489 26 home which is calculated by multiplying the nursing
490490
491491
492492
493493
494494
495495 SB3380 - 13 - LRB103 38150 KTG 68283 b
496496
497497
498498 SB3380- 14 -LRB103 38150 KTG 68283 b SB3380 - 14 - LRB103 38150 KTG 68283 b
499499 SB3380 - 14 - LRB103 38150 KTG 68283 b
500500 1 home's quality base period Medicaid days by the
501501 2 nursing home's star rating weight in that period.
502502 3 (B) Star rating weights are assigned based on the
503503 4 nursing home's star rating for the LTS quality star
504504 5 rating. As used in this subparagraph, "LTS quality
505505 6 star rating" means the long-term stay quality rating
506506 7 for each nursing facility, as assigned by the Centers
507507 8 for Medicare and Medicaid Services under the Five-Star
508508 9 Quality Rating System. The rating is a number ranging
509509 10 from 0 (lowest) to 5 (highest).
510510 11 (i) Zero-star or one-star rating has a weight
511511 12 of 0.
512512 13 (ii) Two-star rating has a weight of 0.75.
513513 14 (iii) Three-star rating has a weight of 1.5.
514514 15 (iv) Four-star rating has a weight of 2.5.
515515 16 (v) Five-star rating has a weight of 3.5.
516516 17 (C) Each nursing home's quality weight score is
517517 18 divided by the sum of all quality weight scores for
518518 19 qualifying nursing homes to determine the proportion
519519 20 of the quality pool to be paid to the nursing home.
520520 21 (D) The quality pool is no less than $70,000,000
521521 22 annually or $17,500,000 per quarter. The Department
522522 23 shall publish on its website the estimated payments
523523 24 and the associated weights for each facility 45 days
524524 25 prior to when the initial payments for the quarter are
525525 26 to be paid. The Department shall assign each facility
526526
527527
528528
529529
530530
531531 SB3380 - 14 - LRB103 38150 KTG 68283 b
532532
533533
534534 SB3380- 15 -LRB103 38150 KTG 68283 b SB3380 - 15 - LRB103 38150 KTG 68283 b
535535 SB3380 - 15 - LRB103 38150 KTG 68283 b
536536 1 the most recent and applicable quarter's STAR value
537537 2 unless the facility notifies the Department within 15
538538 3 days of an issue and the facility provides reasonable
539539 4 evidence demonstrating its timely compliance with
540540 5 federal data submission requirements for the quarter
541541 6 of record. If such evidence cannot be provided to the
542542 7 Department, the STAR rating assigned to the facility
543543 8 shall be reduced by one from the prior quarter.
544544 9 (E) The Department shall review quality metrics
545545 10 used for payment of the quality pool and make
546546 11 recommendations for any associated changes to the
547547 12 methodology for distributing quality pool payments in
548548 13 consultation with associations representing long-term
549549 14 care providers, consumer advocates, organizations
550550 15 representing workers of long-term care facilities, and
551551 16 payors. The Department may establish, by rule, changes
552552 17 to the methodology for distributing quality pool
553553 18 payments.
554554 19 (F) The Department shall disburse quality pool
555555 20 payments from the Long-Term Care Provider Fund on a
556556 21 monthly basis in amounts proportional to the total
557557 22 quality pool payment determined for the quarter.
558558 23 (G) The Department shall publish any changes in
559559 24 the methodology for distributing quality pool payments
560560 25 prior to the beginning of the measurement period or
561561 26 quality base period for any metric added to the
562562
563563
564564
565565
566566
567567 SB3380 - 15 - LRB103 38150 KTG 68283 b
568568
569569
570570 SB3380- 16 -LRB103 38150 KTG 68283 b SB3380 - 16 - LRB103 38150 KTG 68283 b
571571 SB3380 - 16 - LRB103 38150 KTG 68283 b
572572 1 distribution's methodology.
573573 2 (2) Payments based on CNA tenure, promotion, and CNA
574574 3 training for the purpose of increasing CNA compensation.
575575 4 It is the intent of this subsection that payments made in
576576 5 accordance with this paragraph be directly incorporated
577577 6 into increased compensation for CNAs. As used in this
578578 7 paragraph, "CNA" means a certified nursing assistant as
579579 8 that term is described in Section 3-206 of the Nursing
580580 9 Home Care Act, Section 3-206 of the ID/DD Community Care
581581 10 Act, and Section 3-206 of the MC/DD Act. The Department
582582 11 shall establish, by rule, payments to nursing facilities
583583 12 equal to Medicaid's share of the tenure wage increments
584584 13 specified in this paragraph for all reported CNA employee
585585 14 hours compensated according to a posted schedule
586586 15 consisting of increments at least as large as those
587587 16 specified in this paragraph. The increments are as
588588 17 follows: an additional $1.50 per hour for CNAs with at
589589 18 least one and less than 2 years' experience plus another
590590 19 $1 per hour for each additional year of experience up to a
591591 20 maximum of $6.50 for CNAs with at least 6 years of
592592 21 experience. For purposes of this paragraph, Medicaid's
593593 22 share shall be the ratio determined by paid Medicaid bed
594594 23 days divided by total bed days for the applicable time
595595 24 period used in the calculation. In addition, and additive
596596 25 to any tenure increments paid as specified in this
597597 26 paragraph, the Department shall establish, by rule,
598598
599599
600600
601601
602602
603603 SB3380 - 16 - LRB103 38150 KTG 68283 b
604604
605605
606606 SB3380- 17 -LRB103 38150 KTG 68283 b SB3380 - 17 - LRB103 38150 KTG 68283 b
607607 SB3380 - 17 - LRB103 38150 KTG 68283 b
608608
609609
610610
611611
612612
613613 SB3380 - 17 - LRB103 38150 KTG 68283 b