103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3466 Introduced 2/8/2024, by Sen. Ram Villivalam 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 to increase compensation for certified nursing assistants (CNA), removes language requiring the Department of Healthcare and Family Services to establish, by rule, payments to nursing facilities equal to Medicaid's share of the tenure wage increments for all reported CNA employee hours compensated. Instead provides that, based on the schedule set forth in the amendatory Act, the Department shall pay to each facility Medicaid's share of the facility's estimated CNA hours performed by employees and agency workers, estimated overtime hours, and benefits and taxes paid to and on behalf of CNA workers at the beginning of each quarter. Provides that moneys paid by the Department to each facility and moneys paid by each facility to workers and agencies or on behalf of workers and agencies shall be reconciled at the end of each quarter. Sets for a schedule concerning the calculation of tenure compensation which shall include: (i) compensation for regular CNA hours; (ii) overtime calculated at time and a half; and (iii) benefits and taxes at 25%. Provides that estimates of overtime shall be calculated at time and a half and benefits and taxes at 25%. Requires the Department to pay the facility for qualifying promotions estimated at the beginning of each quarter and reconciled at the end of the quarter. LRB103 39082 KTG 69220 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3466 Introduced 2/8/2024, by Sen. Ram Villivalam 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 to increase compensation for certified nursing assistants (CNA), removes language requiring the Department of Healthcare and Family Services to establish, by rule, payments to nursing facilities equal to Medicaid's share of the tenure wage increments for all reported CNA employee hours compensated. Instead provides that, based on the schedule set forth in the amendatory Act, the Department shall pay to each facility Medicaid's share of the facility's estimated CNA hours performed by employees and agency workers, estimated overtime hours, and benefits and taxes paid to and on behalf of CNA workers at the beginning of each quarter. Provides that moneys paid by the Department to each facility and moneys paid by each facility to workers and agencies or on behalf of workers and agencies shall be reconciled at the end of each quarter. Sets for a schedule concerning the calculation of tenure compensation which shall include: (i) compensation for regular CNA hours; (ii) overtime calculated at time and a half; and (iii) benefits and taxes at 25%. Provides that estimates of overtime shall be calculated at time and a half and benefits and taxes at 25%. Requires the Department to pay the facility for qualifying promotions estimated at the beginning of each quarter and reconciled at the end of the quarter. LRB103 39082 KTG 69220 b LRB103 39082 KTG 69220 b A BILL FOR
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3466 Introduced 2/8/2024, by Sen. Ram Villivalam 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 a provision concerning payments to nursing facilities to increase compensation for certified nursing assistants (CNA), removes language requiring the Department of Healthcare and Family Services to establish, by rule, payments to nursing facilities equal to Medicaid's share of the tenure wage increments for all reported CNA employee hours compensated. Instead provides that, based on the schedule set forth in the amendatory Act, the Department shall pay to each facility Medicaid's share of the facility's estimated CNA hours performed by employees and agency workers, estimated overtime hours, and benefits and taxes paid to and on behalf of CNA workers at the beginning of each quarter. Provides that moneys paid by the Department to each facility and moneys paid by each facility to workers and agencies or on behalf of workers and agencies shall be reconciled at the end of each quarter. Sets for a schedule concerning the calculation of tenure compensation which shall include: (i) compensation for regular CNA hours; (ii) overtime calculated at time and a half; and (iii) benefits and taxes at 25%. Provides that estimates of overtime shall be calculated at time and a half and benefits and taxes at 25%. Requires the Department to pay the facility for qualifying promotions estimated at the beginning of each quarter and reconciled at the end of the quarter.
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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 SB3466 Introduced 2/8/2024, by Sen. Ram Villivalam 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 a provision concerning payments to nursing facilities to increase compensation for certified nursing assistants (CNA), removes language requiring the Department of Healthcare and Family Services to establish, by rule, payments to nursing facilities equal to Medicaid's share of the tenure wage increments for all reported CNA employee hours compensated. Instead provides that, based on the schedule set forth in the amendatory Act, the Department shall pay to each facility Medicaid's share of the facility's estimated CNA hours performed by employees and agency workers, estimated overtime hours, and benefits and taxes paid to and on behalf of CNA workers at the beginning of each quarter. Provides that moneys paid by the Department to each facility and moneys paid by each facility to workers and agencies or on behalf of workers and agencies shall be reconciled at the end of each quarter. Sets for a schedule concerning the calculation of tenure compensation which shall include: (i) compensation for regular CNA hours; (ii) overtime calculated at time and a half; and (iii) benefits and taxes at 25%. Provides that estimates of overtime shall be calculated at time and a half and benefits and taxes at 25%. Requires the Department to pay the facility for qualifying promotions estimated at the beginning of each quarter and reconciled at the end of the quarter.
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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 (7) For dates of services beginning July 1, 2022, the
8 PDPM nursing component per diem for each nursing facility
9 shall be the product of the facility's (i) statewide PDPM
10 nursing base per diem rate, $92.25, adjusted for the
11 facility average PDPM case mix index calculated quarterly
12 and (ii) the regional wage adjuster, and then add the
13 Medicaid access adjustment as defined in (e-3) of this
14 Section. Transition rates for services provided between
15 July 1, 2022 and October 1, 2023 shall be the greater of
16 the PDPM nursing component per diem or:
17 (A) for the quarter beginning July 1, 2022, the
18 RUG-IV nursing component per diem;
19 (B) for the quarter beginning October 1, 2022, the
20 sum of the RUG-IV nursing component per diem
21 multiplied by 0.80 and the PDPM nursing component per
22 diem multiplied by 0.20;
23 (C) for the quarter beginning January 1, 2023, the
24 sum of the RUG-IV nursing component per diem
25 multiplied by 0.60 and the PDPM nursing component per
26 diem multiplied by 0.40;
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1 (D) for the quarter beginning April 1, 2023, the
2 sum of the RUG-IV nursing component per diem
3 multiplied by 0.40 and the PDPM nursing component per
4 diem multiplied by 0.60;
5 (E) for the quarter beginning July 1, 2023, the
6 sum of the RUG-IV nursing component per diem
7 multiplied by 0.20 and the PDPM nursing component per
8 diem multiplied by 0.80; or
9 (F) for the quarter beginning October 1, 2023 and
10 each subsequent quarter, the transition rate shall end
11 and a nursing facility shall be paid 100% of the PDPM
12 nursing component per diem.
13 (d-1) Calculation of base year Statewide RUG-IV nursing
14 base per diem rate.
15 (1) Base rate spending pool shall be:
16 (A) The base year resident days which are
17 calculated by multiplying the number of Medicaid
18 residents in each nursing home as indicated in the MDS
19 data defined in paragraph (4) by 365.
20 (B) Each facility's nursing component per diem in
21 effect on July 1, 2012 shall be multiplied by
22 subsection (A).
23 (C) Thirteen million is added to the product of
24 subparagraph (A) and subparagraph (B) to adjust for
25 the exclusion of nursing homes defined in paragraph
26 (5).
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1 (2) For each nursing home with Medicaid residents as
2 indicated by the MDS data defined in paragraph (4),
3 weighted days adjusted for case mix and regional wage
4 adjustment shall be calculated. For each home this
5 calculation is the product of:
6 (A) Base year resident days as calculated in
7 subparagraph (A) of paragraph (1).
8 (B) The nursing home's regional wage adjustor
9 based on the Health Service Areas (HSA) groupings and
10 adjustors in effect on April 30, 2012.
11 (C) Facility weighted case mix which is the number
12 of Medicaid residents as indicated by the MDS data
13 defined in paragraph (4) multiplied by the associated
14 case weight for the RUG-IV 48 grouper model using
15 standard RUG-IV procedures for index maximization.
16 (D) The sum of the products calculated for each
17 nursing home in subparagraphs (A) through (C) above
18 shall be the base year case mix, rate adjusted
19 weighted days.
20 (3) The Statewide RUG-IV nursing base per diem rate:
21 (A) on January 1, 2014 shall be the quotient of the
22 paragraph (1) divided by the sum calculated under
23 subparagraph (D) of paragraph (2);
24 (B) on and after July 1, 2014 and until July 1,
25 2022, shall be the amount calculated under
26 subparagraph (A) of this paragraph (3) plus $1.76; and
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1 (C) beginning July 1, 2022 and thereafter, $7
2 shall be added to the amount calculated under
3 subparagraph (B) of this paragraph (3) of this
4 Section.
5 (4) Minimum Data Set (MDS) comprehensive assessments
6 for Medicaid residents on the last day of the quarter used
7 to establish the base rate.
8 (5) Nursing facilities designated as of July 1, 2012
9 by the Department as "Institutions for Mental Disease"
10 shall be excluded from all calculations under this
11 subsection. The data from these facilities shall not be
12 used in the computations described in paragraphs (1)
13 through (4) above to establish the base rate.
14 (e) Beginning July 1, 2014, the Department shall allocate
15 funding in the amount up to $10,000,000 for per diem add-ons to
16 the RUGS methodology for dates of service on and after July 1,
17 2014:
18 (1) $0.63 for each resident who scores in I4200
19 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
20 (2) $2.67 for each resident who scores either a "1" or
21 "2" in any items S1200A through S1200I and also scores in
22 RUG groups PA1, PA2, BA1, or BA2.
23 (e-1) (Blank).
24 (e-2) For dates of services beginning January 1, 2014 and
25 ending September 30, 2023, the RUG-IV nursing component per
26 diem for a nursing home shall be the product of the statewide
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1 RUG-IV nursing base per diem rate, the facility average case
2 mix index, and the regional wage adjustor. For dates of
3 service beginning July 1, 2022 and ending September 30, 2023,
4 the Medicaid access adjustment described in subsection (e-3)
5 shall be added to the product.
6 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
7 facility average PDPM case mix index calculated quarterly
8 shall be added to the statewide PDPM nursing per diem for all
9 facilities with annual Medicaid bed days of at least 70% of all
10 occupied bed days adjusted quarterly. For each new calendar
11 year and for the 6-month period beginning July 1, 2022, the
12 percentage of a facility's occupied bed days comprised of
13 Medicaid bed days shall be determined by the Department
14 quarterly. For dates of service beginning January 1, 2023, the
15 Medicaid Access Adjustment shall be increased to $4.75. This
16 subsection shall be inoperative on and after January 1, 2028.
17 (e-4) Subject to federal approval, on and after January 1,
18 2024, the Department shall increase the rate add-on at
19 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
20 for ventilator services from $208 per day to $481 per day.
21 Payment is subject to the criteria and requirements under 89
22 Ill. Adm. Code 147.335.
23 (f) (Blank).
24 (g) Notwithstanding any other provision of this Code, on
25 and after July 1, 2012, for facilities not designated by the
26 Department of Healthcare and Family Services as "Institutions
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1 for Mental Disease", rates effective May 1, 2011 shall be
2 adjusted as follows:
3 (1) (Blank);
4 (2) (Blank);
5 (3) Facility rates for the capital and support
6 components shall be reduced by 1.7%.
7 (h) Notwithstanding any other provision of this Code, on
8 and after July 1, 2012, nursing facilities designated by the
9 Department of Healthcare and Family Services as "Institutions
10 for Mental Disease" and "Institutions for Mental Disease" that
11 are facilities licensed under the Specialized Mental Health
12 Rehabilitation Act of 2013 shall have the nursing,
13 socio-developmental, capital, and support components of their
14 reimbursement rate effective May 1, 2011 reduced in total by
15 2.7%.
16 (i) On and after July 1, 2014, the reimbursement rates for
17 the support component of the nursing facility rate for
18 facilities licensed under the Nursing Home Care Act as skilled
19 or intermediate care facilities shall be the rate in effect on
20 June 30, 2014 increased by 8.17%.
21 (i-1) Subject to federal approval, on and after January 1,
22 2024, the reimbursement rates for the support component of the
23 nursing facility rate for facilities licensed under the
24 Nursing Home Care Act as skilled or intermediate care
25 facilities shall be the rate in effect on June 30, 2023
26 increased by 12%.
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1 (j) Notwithstanding any other provision of law, subject to
2 federal approval, effective July 1, 2019, sufficient funds
3 shall be allocated for changes to rates for facilities
4 licensed under the Nursing Home Care Act as skilled nursing
5 facilities or intermediate care facilities for dates of
6 services on and after July 1, 2019: (i) to establish, through
7 June 30, 2022 a per diem add-on to the direct care per diem
8 rate not to exceed $70,000,000 annually in the aggregate
9 taking into account federal matching funds for the purpose of
10 addressing the facility's unique staffing needs, adjusted
11 quarterly and distributed by a weighted formula based on
12 Medicaid bed days on the last day of the second quarter
13 preceding the quarter for which the rate is being adjusted.
14 Beginning July 1, 2022, the annual $70,000,000 described in
15 the preceding sentence shall be dedicated to the variable per
16 diem add-on for staffing under paragraph (6) of subsection
17 (d); and (ii) in an amount not to exceed $170,000,000 annually
18 in the aggregate taking into account federal matching funds to
19 permit the support component of the nursing facility rate to
20 be updated as follows:
21 (1) 80%, or $136,000,000, of the funds shall be used
22 to update each facility's rate in effect on June 30, 2019
23 using the most recent cost reports on file, which have had
24 a limited review conducted by the Department of Healthcare
25 and Family Services and will not hold up enacting the rate
26 increase, with the Department of Healthcare and Family
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1 Services.
2 (2) After completing the calculation in paragraph (1),
3 any facility whose rate is less than the rate in effect on
4 June 30, 2019 shall have its rate restored to the rate in
5 effect on June 30, 2019 from the 20% of the funds set
6 aside.
7 (3) The remainder of the 20%, or $34,000,000, shall be
8 used to increase each facility's rate by an equal
9 percentage.
10 (k) During the first quarter of State Fiscal Year 2020,
11 the Department of Healthcare of Family Services must convene a
12 technical advisory group consisting of members of all trade
13 associations representing Illinois skilled nursing providers
14 to discuss changes necessary with federal implementation of
15 Medicare's Patient-Driven Payment Model. Implementation of
16 Medicare's Patient-Driven Payment Model shall, by September 1,
17 2020, end the collection of the MDS data that is necessary to
18 maintain the current RUG-IV Medicaid payment methodology. The
19 technical advisory group must consider a revised reimbursement
20 methodology that takes into account transparency,
21 accountability, actual staffing as reported under the
22 federally required Payroll Based Journal system, changes to
23 the minimum wage, adequacy in coverage of the cost of care, and
24 a quality component that rewards quality improvements.
25 (l) The Department shall establish per diem add-on
26 payments to improve the quality of care delivered by
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1 facilities, including:
2 (1) Incentive payments determined by facility
3 performance on specified quality measures in an initial
4 amount of $70,000,000. Nothing in this subsection shall be
5 construed to limit the quality of care payments in the
6 aggregate statewide to $70,000,000, and, if quality of
7 care has improved across nursing facilities, the
8 Department shall adjust those add-on payments accordingly.
9 The quality payment methodology described in this
10 subsection must be used for at least State Fiscal Year
11 2023. Beginning with the quarter starting July 1, 2023,
12 the Department may add, remove, or change quality metrics
13 and make associated changes to the quality payment
14 methodology as outlined in subparagraph (E). Facilities
15 designated by the Centers for Medicare and Medicaid
16 Services as a special focus facility or a hospital-based
17 nursing home do not qualify for quality payments.
18 (A) Each quality pool must be distributed by
19 assigning a quality weighted score for each nursing
20 home which is calculated by multiplying the nursing
21 home's quality base period Medicaid days by the
22 nursing home's star rating weight in that period.
23 (B) Star rating weights are assigned based on the
24 nursing home's star rating for the LTS quality star
25 rating. As used in this subparagraph, "LTS quality
26 star rating" means the long-term stay quality rating
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1 for each nursing facility, as assigned by the Centers
2 for Medicare and Medicaid Services under the Five-Star
3 Quality Rating System. The rating is a number ranging
4 from 0 (lowest) to 5 (highest).
5 (i) Zero-star or one-star rating has a weight
6 of 0.
7 (ii) Two-star rating has a weight of 0.75.
8 (iii) Three-star rating has a weight of 1.5.
9 (iv) Four-star rating has a weight of 2.5.
10 (v) Five-star rating has a weight of 3.5.
11 (C) Each nursing home's quality weight score is
12 divided by the sum of all quality weight scores for
13 qualifying nursing homes to determine the proportion
14 of the quality pool to be paid to the nursing home.
15 (D) The quality pool is no less than $70,000,000
16 annually or $17,500,000 per quarter. The Department
17 shall publish on its website the estimated payments
18 and the associated weights for each facility 45 days
19 prior to when the initial payments for the quarter are
20 to be paid. The Department shall assign each facility
21 the most recent and applicable quarter's STAR value
22 unless the facility notifies the Department within 15
23 days of an issue and the facility provides reasonable
24 evidence demonstrating its timely compliance with
25 federal data submission requirements for the quarter
26 of record. If such evidence cannot be provided to the
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1 Department, the STAR rating assigned to the facility
2 shall be reduced by one from the prior quarter.
3 (E) The Department shall review quality metrics
4 used for payment of the quality pool and make
5 recommendations for any associated changes to the
6 methodology for distributing quality pool payments in
7 consultation with associations representing long-term
8 care providers, consumer advocates, organizations
9 representing workers of long-term care facilities, and
10 payors. The Department may establish, by rule, changes
11 to the methodology for distributing quality pool
12 payments.
13 (F) The Department shall disburse quality pool
14 payments from the Long-Term Care Provider Fund on a
15 monthly basis in amounts proportional to the total
16 quality pool payment determined for the quarter.
17 (G) The Department shall publish any changes in
18 the methodology for distributing quality pool payments
19 prior to the beginning of the measurement period or
20 quality base period for any metric added to the
21 distribution's methodology.
22 (2) Payments based on CNA tenure, promotion, and CNA
23 training for the purpose of increasing CNA compensation.
24 It is the intent of this subsection that payments made in
25 accordance with this paragraph be directly incorporated
26 into increased compensation for CNAs. As used in this
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1 paragraph, "CNA" means a certified nursing assistant as
2 that term is described in Section 3-206 of the Nursing
3 Home Care Act, Section 3-206 of the ID/DD Community Care
4 Act, and Section 3-206 of the MC/DD Act. The Department
5 shall establish, by rule, payments to nursing facilities
6 equal to Medicaid's share of the tenure wage increments
7 specified in this paragraph for all reported CNA employee
8 hours compensated according to a posted schedule
9 consisting of increments at least as large as those
10 specified in this paragraph. The increments are as
11 follows: an additional $1.50 per hour for CNAs with at
12 least one and less than 2 years' experience plus another
13 $1 per hour for each additional year of experience up to a
14 maximum of $6.50 for CNAs with at least 6 years of
15 experience.
16 Based on the schedule in this paragraph, the
17 Department shall pay to each facility Medicaid's share of
18 the facility's estimated CNA hours performed by employees
19 and agency workers, estimated overtime hours, and benefits
20 and taxes paid to and on behalf of CNA workers at the
21 beginning of each quarter. For purposes of this paragraph,
22 Medicaid's share shall be the ratio determined by paid
23 Medicaid bed days divided by total bed days for the
24 applicable time period used in the calculation. Moneys
25 paid by the Department to each facility and moneys paid by
26 each facility to workers and agencies or on behalf of
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1 workers and agencies shall be reconciled at the end of
2 each quarter.
3 Calculation of tenure compensation shall include the
4 following:
5 (A) compensation for regular CNA hours: an
6 additional $1.50 per hour for CNAs with at least one
7 and less than 2 years' experience plus another $1 per
8 hour for each additional year of experience up to a
9 maximum of $6.50 for CNAs with at least 6 years of
10 experience;
11 (B) overtime calculated at time and a half; and
12 (C) benefits and taxes at 25%.
13 In addition, and additive to any tenure increments
14 paid as specified in this paragraph, the Department shall
15 establish, by rule, payments supporting Medicaid's share
16 of the promotion-based wage increments for CNA employee
17 hours compensated for that promotion with at least a $1.50
18 hourly increase. Medicaid's share shall be established as
19 it is for the tenure increments described in this
20 paragraph. Estimates of overtime shall be calculated at
21 time and a half and benefits and taxes at 25%. The
22 Department shall pay the facility for qualifying
23 promotions estimated at the beginning of each quarter and
24 reconciled at the end of the quarter. Qualifying
25 promotions shall be defined by the Department in rules for
26 an expected 10-15% subset of CNAs assigned intermediate,
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