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
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
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.
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A BILL FOR
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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5-5.2 as follows:
6 (305 ILCS 5/5-5.2)
7 Sec. 5-5.2. Payment.
8 (a) All nursing facilities that are grouped pursuant to
9 Section 5-5.1 of this Act shall receive the same rate of
10 payment for similar services.
11 (b) It shall be a matter of State policy that the Illinois
12 Department shall utilize a uniform billing cycle throughout
13 the State for the long-term care providers.
14 (c) (Blank).
15 (c-1) Notwithstanding any other provisions of this Code,
16 the methodologies for reimbursement of nursing services as
17 provided under this Article shall no longer be applicable for
18 bills payable for nursing services rendered on or after a new
19 reimbursement system based on the Patient Driven Payment Model
20 (PDPM) has been fully operationalized, which shall take effect
21 for services provided on or after the implementation of the
22 PDPM reimbursement system begins. For the purposes of Public
23 Act 102-1035 this amendatory Act of the 102nd General
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
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.
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A BILL FOR
305 ILCS 5/5-5.2
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1 Assembly, the implementation date of the PDPM reimbursement
2 system and all related provisions shall be July 1, 2022 if the
3 following conditions are met: (i) the Centers for Medicare and
4 Medicaid Services has approved corresponding changes in the
5 reimbursement system and bed assessment; and (ii) the
6 Department has filed rules to implement these changes no later
7 than June 1, 2022. Failure of the Department to file rules to
8 implement the changes provided in Public Act 102-1035 this
9 amendatory Act of the 102nd General Assembly no later than
10 June 1, 2022 shall result in the implementation date being
11 delayed to October 1, 2022.
12 (d) The new nursing services reimbursement methodology
13 utilizing the Patient Driven Payment Model, which shall be
14 referred to as the PDPM reimbursement system, taking effect
15 July 1, 2022, upon federal approval by the Centers for
16 Medicare and Medicaid Services, shall be based on the
17 following:
18 (1) The methodology shall be resident-centered,
19 facility-specific, cost-based, and based on guidance from
20 the Centers for Medicare and Medicaid Services.
21 (2) Costs shall be annually rebased and case mix index
22 quarterly updated. The nursing services methodology will
23 be assigned to the Medicaid enrolled residents on record
24 as of 30 days prior to the beginning of the rate period in
25 the Department's Medicaid Management Information System
26 (MMIS) as present on the last day of the second quarter
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1 preceding the rate period based upon the Assessment
2 Reference Date of the Minimum Data Set (MDS).
3 (3) Regional wage adjustors based on the Health
4 Service Areas (HSA) groupings and adjusters in effect on
5 April 30, 2012 shall be included, except no adjuster shall
6 be lower than 1.06.
7 (4) PDPM nursing case mix indices in effect on March
8 1, 2022 shall be assigned to each resident class at no less
9 than 0.7858 of the Centers for Medicare and Medicaid
10 Services PDPM unadjusted case mix values, in effect on
11 March 1, 2022.
12 (5) The pool of funds available for distribution by
13 case mix and the base facility rate shall be determined
14 using the formula contained in subsection (d-1).
15 (6) The Department shall establish a variable per diem
16 staffing add-on in accordance with the most recent
17 available federal staffing report, currently the Payroll
18 Based Journal, for the same period of time, and if
19 applicable adjusted for acuity using the same quarter's
20 MDS. The Department shall rely on Payroll Based Journals
21 provided to the Department of Public Health to make a
22 determination of non-submission. If the Department is
23 notified by a facility of missing or inaccurate Payroll
24 Based Journal data or an incorrect calculation of
25 staffing, the Department must make a correction as soon as
26 the error is verified for the applicable quarter.
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1 Facilities with at least 70% of the staffing indicated
2 by the STRIVE study shall be paid a per diem add-on of $9,
3 increasing by equivalent steps for each whole percentage
4 point until the facilities reach a per diem of $14.88.
5 Facilities with at least 80% of the staffing indicated by
6 the STRIVE study shall be paid a per diem add-on of $14.88,
7 increasing by equivalent steps for each whole percentage
8 point until the facilities reach a per diem add-on of
9 $23.80. Facilities with at least 92% of the staffing
10 indicated by the STRIVE study shall be paid a per diem
11 add-on of $23.80, increasing by equivalent steps for each
12 whole percentage point until the facilities reach a per
13 diem add-on of $29.75. Facilities with at least 100% of
14 the staffing indicated by the STRIVE study shall be paid a
15 per diem add-on of $29.75, increasing by equivalent steps
16 for each whole percentage point until the facilities reach
17 a per diem add-on of $35.70. Facilities with at least 110%
18 of the staffing indicated by the STRIVE study shall be
19 paid a per diem add-on of $35.70, increasing by equivalent
20 steps for each whole percentage point until the facilities
21 reach a per diem add-on of $38.68. Facilities with at
22 least 125% or higher of the staffing indicated by the
23 STRIVE study shall be paid a per diem add-on of $38.68.
24 Beginning April 1, 2023, no nursing facility's variable
25 staffing per diem add-on shall be reduced by more than 5%
26 in 2 consecutive quarters. For the quarters beginning July
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1 1, 2022 and October 1, 2022, no facility's variable per
2 diem staffing add-on shall be calculated at a rate lower
3 than 85% of the staffing indicated by the STRIVE study. No
4 facility below 70% of the staffing indicated by the STRIVE
5 study shall receive a variable per diem staffing add-on
6 after December 31, 2022.
7 Whenever the federal Centers for Medicare and Medicaid
8 Services no longer updates the STRIVE study, the
9 Department shall use the last quarter STRIVE numbers for
10 add-on calculations and shall not decrease the payment
11 amounts until a replacement staff time measurement study
12 is incorporated into this Section by law.
13 (7) For dates of services beginning July 1, 2022, the
14 PDPM nursing component per diem for each nursing facility
15 shall be the product of the facility's (i) statewide PDPM
16 nursing base per diem rate, $92.25, adjusted for the
17 facility average PDPM case mix index calculated quarterly
18 and (ii) the regional wage adjuster, and then add the
19 Medicaid access adjustment as defined in (e-3) of this
20 Section. Transition rates for services provided between
21 July 1, 2022 and October 1, 2023 shall be the greater of
22 the PDPM nursing component per diem or:
23 (A) for the quarter beginning July 1, 2022, the
24 RUG-IV nursing component per diem;
25 (B) for the quarter beginning October 1, 2022, the
26 sum of the RUG-IV nursing component per diem
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1 multiplied by 0.80 and the PDPM nursing component per
2 diem multiplied by 0.20;
3 (C) for the quarter beginning January 1, 2023, the
4 sum of the RUG-IV nursing component per diem
5 multiplied by 0.60 and the PDPM nursing component per
6 diem multiplied by 0.40;
7 (D) for the quarter beginning April 1, 2023, the
8 sum of the RUG-IV nursing component per diem
9 multiplied by 0.40 and the PDPM nursing component per
10 diem multiplied by 0.60;
11 (E) for the quarter beginning July 1, 2023, the
12 sum of the RUG-IV nursing component per diem
13 multiplied by 0.20 and the PDPM nursing component per
14 diem multiplied by 0.80; or
15 (F) for the quarter beginning October 1, 2023 and
16 each subsequent quarter, the transition rate shall end
17 and a nursing facility shall be paid 100% of the PDPM
18 nursing component per diem.
19 (d-1) Calculation of base year Statewide RUG-IV nursing
20 base per diem rate.
21 (1) Base rate spending pool shall be:
22 (A) The base year resident days which are
23 calculated by multiplying the number of Medicaid
24 residents in each nursing home as indicated in the MDS
25 data defined in paragraph (4) by 365.
26 (B) Each facility's nursing component per diem in
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1 effect on July 1, 2012 shall be multiplied by
2 subsection (A).
3 (C) Thirteen million is added to the product of
4 subparagraph (A) and subparagraph (B) to adjust for
5 the exclusion of nursing homes defined in paragraph
6 (5).
7 (2) For each nursing home with Medicaid residents as
8 indicated by the MDS data defined in paragraph (4),
9 weighted days adjusted for case mix and regional wage
10 adjustment shall be calculated. For each home this
11 calculation is the product of:
12 (A) Base year resident days as calculated in
13 subparagraph (A) of paragraph (1).
14 (B) The nursing home's regional wage adjustor
15 based on the Health Service Areas (HSA) groupings and
16 adjustors in effect on April 30, 2012.
17 (C) Facility weighted case mix which is the number
18 of Medicaid residents as indicated by the MDS data
19 defined in paragraph (4) multiplied by the associated
20 case weight for the RUG-IV 48 grouper model using
21 standard RUG-IV procedures for index maximization.
22 (D) The sum of the products calculated for each
23 nursing home in subparagraphs (A) through (C) above
24 shall be the base year case mix, rate adjusted
25 weighted days.
26 (3) The Statewide RUG-IV nursing base per diem rate:
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1 (A) on January 1, 2014 shall be the quotient of the
2 paragraph (1) divided by the sum calculated under
3 subparagraph (D) of paragraph (2);
4 (B) on and after July 1, 2014 and until July 1,
5 2022, shall be the amount calculated under
6 subparagraph (A) of this paragraph (3) plus $1.76; and
7 (C) beginning July 1, 2022 and thereafter, $7
8 shall be added to the amount calculated under
9 subparagraph (B) of this paragraph (3) of this
10 Section.
11 (4) Minimum Data Set (MDS) comprehensive assessments
12 for Medicaid residents on the last day of the quarter used
13 to establish the base rate.
14 (5) Nursing facilities designated as of July 1, 2012
15 by the Department as "Institutions for Mental Disease"
16 shall be excluded from all calculations under this
17 subsection. The data from these facilities shall not be
18 used in the computations described in paragraphs (1)
19 through (4) above to establish the base rate.
20 (e) Beginning July 1, 2014, the Department shall allocate
21 funding in the amount up to $10,000,000 for per diem add-ons to
22 the RUGS methodology for dates of service on and after July 1,
23 2014:
24 (1) $0.63 for each resident who scores in I4200
25 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
26 (2) $2.67 for each resident who scores either a "1" or
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1 "2" in any items S1200A through S1200I and also scores in
2 RUG groups PA1, PA2, BA1, or BA2.
3 (e-1) (Blank).
4 (e-2) For dates of services beginning January 1, 2014 and
5 ending September 30, 2023, the RUG-IV nursing component per
6 diem for a nursing home shall be the product of the statewide
7 RUG-IV nursing base per diem rate, the facility average case
8 mix index, and the regional wage adjustor. For dates of
9 service beginning July 1, 2022 and ending September 30, 2023,
10 the Medicaid access adjustment described in subsection (e-3)
11 shall be added to the product.
12 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
13 facility average PDPM case mix index calculated quarterly
14 shall be added to the statewide PDPM nursing per diem for all
15 facilities with annual Medicaid bed days of at least 70% of all
16 occupied bed days adjusted quarterly. For each new calendar
17 year and for the 6-month period beginning July 1, 2022, the
18 percentage of a facility's occupied bed days comprised of
19 Medicaid bed days shall be determined by the Department
20 quarterly. For dates of service beginning January 1, 2023, the
21 Medicaid Access Adjustment shall be increased to $4.75. This
22 subsection shall be inoperative on and after January 1, 2028.
23 (e-4) Subject to federal approval, on and after January 1,
24 2024, the Department shall increase the rate add-on at
25 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
26 for ventilator services from $208 per day to $481 per day.
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1 Payment is subject to the criteria and requirements under 89
2 Ill. Adm. Code 147.335.
3 (f) (Blank).
4 (g) Notwithstanding any other provision of this Code, on
5 and after July 1, 2012, for facilities not designated by the
6 Department of Healthcare and Family Services as "Institutions
7 for Mental Disease", rates effective May 1, 2011 shall be
8 adjusted as follows:
9 (1) (Blank);
10 (2) (Blank);
11 (3) Facility rates for the capital and support
12 components shall be reduced by 1.7%.
13 (h) Notwithstanding any other provision of this Code, on
14 and after July 1, 2012, nursing facilities designated by the
15 Department of Healthcare and Family Services as "Institutions
16 for Mental Disease" and "Institutions for Mental Disease" that
17 are facilities licensed under the Specialized Mental Health
18 Rehabilitation Act of 2013 shall have the nursing,
19 socio-developmental, capital, and support components of their
20 reimbursement rate effective May 1, 2011 reduced in total by
21 2.7%.
22 (i) On and after July 1, 2014, the reimbursement rates for
23 the support component of the nursing facility rate for
24 facilities licensed under the Nursing Home Care Act as skilled
25 or intermediate care facilities shall be the rate in effect on
26 June 30, 2014 increased by 8.17%.
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1 (i-1) Subject to federal approval, on and after January 1,
2 2024, the reimbursement rates for the support component of the
3 nursing facility rate for facilities licensed under the
4 Nursing Home Care Act as skilled or intermediate care
5 facilities shall be the rate in effect on June 30, 2023
6 increased by 12%.
7 (j) Notwithstanding any other provision of law, subject to
8 federal approval, effective July 1, 2019, sufficient funds
9 shall be allocated for changes to rates for facilities
10 licensed under the Nursing Home Care Act as skilled nursing
11 facilities or intermediate care facilities for dates of
12 services on and after July 1, 2019: (i) to establish, through
13 June 30, 2022 a per diem add-on to the direct care per diem
14 rate not to exceed $70,000,000 annually in the aggregate
15 taking into account federal matching funds for the purpose of
16 addressing the facility's unique staffing needs, adjusted
17 quarterly and distributed by a weighted formula based on
18 Medicaid bed days on the last day of the second quarter
19 preceding the quarter for which the rate is being adjusted.
20 Beginning July 1, 2022, the annual $70,000,000 described in
21 the preceding sentence shall be dedicated to the variable per
22 diem add-on for staffing under paragraph (6) of subsection
23 (d); and (ii) in an amount not to exceed $170,000,000 annually
24 in the aggregate taking into account federal matching funds to
25 permit the support component of the nursing facility rate to
26 be updated as follows:
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1 (1) 80%, or $136,000,000, of the funds shall be used
2 to update each facility's rate in effect on June 30, 2019
3 using the most recent cost reports on file, which have had
4 a limited review conducted by the Department of Healthcare
5 and Family Services and will not hold up enacting the rate
6 increase, with the Department of Healthcare and Family
7 Services.
8 (2) After completing the calculation in paragraph (1),
9 any facility whose rate is less than the rate in effect on
10 June 30, 2019 shall have its rate restored to the rate in
11 effect on June 30, 2019 from the 20% of the funds set
12 aside.
13 (3) The remainder of the 20%, or $34,000,000, shall be
14 used to increase each facility's rate by an equal
15 percentage.
16 (k) During the first quarter of State Fiscal Year 2020,
17 the Department of Healthcare of Family Services must convene a
18 technical advisory group consisting of members of all trade
19 associations representing Illinois skilled nursing providers
20 to discuss changes necessary with federal implementation of
21 Medicare's Patient-Driven Payment Model. Implementation of
22 Medicare's Patient-Driven Payment Model shall, by September 1,
23 2020, end the collection of the MDS data that is necessary to
24 maintain the current RUG-IV Medicaid payment methodology. The
25 technical advisory group must consider a revised reimbursement
26 methodology that takes into account transparency,
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1 accountability, actual staffing as reported under the
2 federally required Payroll Based Journal system, changes to
3 the minimum wage, adequacy in coverage of the cost of care, and
4 a quality component that rewards quality improvements.
5 (l) The Department shall establish per diem add-on
6 payments to improve the quality of care delivered by
7 facilities, including:
8 (1) Incentive payments determined by facility
9 performance on specified quality measures in an initial
10 amount of $70,000,000. Nothing in this subsection shall be
11 construed to limit the quality of care payments in the
12 aggregate statewide to $70,000,000, and, if quality of
13 care has improved across nursing facilities, the
14 Department shall adjust those add-on payments accordingly.
15 The quality payment methodology described in this
16 subsection must be used for at least State Fiscal Year
17 2023. Beginning with the quarter starting July 1, 2023,
18 the Department may add, remove, or change quality metrics
19 and make associated changes to the quality payment
20 methodology as outlined in subparagraph (E). Facilities
21 designated by the Centers for Medicare and Medicaid
22 Services as a special focus facility or a hospital-based
23 nursing home do not qualify for quality payments.
24 (A) Each quality pool must be distributed by
25 assigning a quality weighted score for each nursing
26 home which is calculated by multiplying the nursing
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1 home's quality base period Medicaid days by the
2 nursing home's star rating weight in that period.
3 (B) Star rating weights are assigned based on the
4 nursing home's star rating for the LTS quality star
5 rating. As used in this subparagraph, "LTS quality
6 star rating" means the long-term stay quality rating
7 for each nursing facility, as assigned by the Centers
8 for Medicare and Medicaid Services under the Five-Star
9 Quality Rating System. The rating is a number ranging
10 from 0 (lowest) to 5 (highest).
11 (i) Zero-star or one-star rating has a weight
12 of 0.
13 (ii) Two-star rating has a weight of 0.75.
14 (iii) Three-star rating has a weight of 1.5.
15 (iv) Four-star rating has a weight of 2.5.
16 (v) Five-star rating has a weight of 3.5.
17 (C) Each nursing home's quality weight score is
18 divided by the sum of all quality weight scores for
19 qualifying nursing homes to determine the proportion
20 of the quality pool to be paid to the nursing home.
21 (D) The quality pool is no less than $70,000,000
22 annually or $17,500,000 per quarter. The Department
23 shall publish on its website the estimated payments
24 and the associated weights for each facility 45 days
25 prior to when the initial payments for the quarter are
26 to be paid. The Department shall assign each facility
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1 the most recent and applicable quarter's STAR value
2 unless the facility notifies the Department within 15
3 days of an issue and the facility provides reasonable
4 evidence demonstrating its timely compliance with
5 federal data submission requirements for the quarter
6 of record. If such evidence cannot be provided to the
7 Department, the STAR rating assigned to the facility
8 shall be reduced by one from the prior quarter.
9 (E) The Department shall review quality metrics
10 used for payment of the quality pool and make
11 recommendations for any associated changes to the
12 methodology for distributing quality pool payments in
13 consultation with associations representing long-term
14 care providers, consumer advocates, organizations
15 representing workers of long-term care facilities, and
16 payors. The Department may establish, by rule, changes
17 to the methodology for distributing quality pool
18 payments.
19 (F) The Department shall disburse quality pool
20 payments from the Long-Term Care Provider Fund on a
21 monthly basis in amounts proportional to the total
22 quality pool payment determined for the quarter.
23 (G) The Department shall publish any changes in
24 the methodology for distributing quality pool payments
25 prior to the beginning of the measurement period or
26 quality base period for any metric added to the
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1 distribution's methodology.
2 (2) Payments based on CNA tenure, promotion, and CNA
3 training for the purpose of increasing CNA compensation.
4 It is the intent of this subsection that payments made in
5 accordance with this paragraph be directly incorporated
6 into increased compensation for CNAs. As used in this
7 paragraph, "CNA" means a certified nursing assistant as
8 that term is described in Section 3-206 of the Nursing
9 Home Care Act, Section 3-206 of the ID/DD Community Care
10 Act, and Section 3-206 of the MC/DD Act. The Department
11 shall establish, by rule, payments to nursing facilities
12 equal to Medicaid's share of the tenure wage increments
13 specified in this paragraph for all reported CNA employee
14 hours compensated according to a posted schedule
15 consisting of increments at least as large as those
16 specified in this paragraph. The increments are as
17 follows: an additional $1.50 per hour for CNAs with at
18 least one and less than 2 years' experience plus another
19 $1 per hour for each additional year of experience up to a
20 maximum of $6.50 for CNAs with at least 6 years of
21 experience. For purposes of this paragraph, Medicaid's
22 share shall be the ratio determined by paid Medicaid bed
23 days divided by total bed days for the applicable time
24 period used in the calculation. In addition, and additive
25 to any tenure increments paid as specified in this
26 paragraph, the Department shall establish, by rule,
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