Illinois 2023-2024 Regular Session

Illinois Senate Bill SB3466 Compare Versions

Only one version of the bill is available at this time.

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1	1	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
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3466 Introduced 2/8/2024, by Sen. Ram Villivalam SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
4	4	305 ILCS 5/5-5.2
5	5	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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11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Public Aid Code is amended by
15	15	5 changing Section 5-5.2 as follows:
16	16	6 (305 ILCS 5/5-5.2)
17	17	7 Sec. 5-5.2. Payment.
18	18	8 (a) All nursing facilities that are grouped pursuant to
19	19	9 Section 5-5.1 of this Act shall receive the same rate of
20	20	10 payment for similar services.
21	21	11 (b) It shall be a matter of State policy that the Illinois
22	22	12 Department shall utilize a uniform billing cycle throughout
23	23	13 the State for the long-term care providers.
24	24	14 (c) (Blank).
25	25	15 (c-1) Notwithstanding any other provisions of this Code,
26	26	16 the methodologies for reimbursement of nursing services as
27	27	17 provided under this Article shall no longer be applicable for
28	28	18 bills payable for nursing services rendered on or after a new
29	29	19 reimbursement system based on the Patient Driven Payment Model
30	30	20 (PDPM) has been fully operationalized, which shall take effect
31	31	21 for services provided on or after the implementation of the
32	32	22 PDPM reimbursement system begins. For the purposes of Public
33	33	23 Act 102-1035 this amendatory Act of the 102nd General
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3466 Introduced 2/8/2024, by Sen. Ram Villivalam SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
39	39	305 ILCS 5/5-5.2
40	40	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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42	42	LRB103 39082 KTG 69220 b
43	43	A BILL FOR
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68	68	1 Assembly, the implementation date of the PDPM reimbursement
69	69	2 system and all related provisions shall be July 1, 2022 if the
70	70	3 following conditions are met: (i) the Centers for Medicare and
71	71	4 Medicaid Services has approved corresponding changes in the
72	72	5 reimbursement system and bed assessment; and (ii) the
73	73	6 Department has filed rules to implement these changes no later
74	74	7 than June 1, 2022. Failure of the Department to file rules to
75	75	8 implement the changes provided in Public Act 102-1035 this
76	76	9 amendatory Act of the 102nd General Assembly no later than
77	77	10 June 1, 2022 shall result in the implementation date being
78	78	11 delayed to October 1, 2022.
79	79	12 (d) The new nursing services reimbursement methodology
80	80	13 utilizing the Patient Driven Payment Model, which shall be
81	81	14 referred to as the PDPM reimbursement system, taking effect
82	82	15 July 1, 2022, upon federal approval by the Centers for
83	83	16 Medicare and Medicaid Services, shall be based on the
84	84	17 following:
85	85	18 (1) The methodology shall be resident-centered,
86	86	19 facility-specific, cost-based, and based on guidance from
87	87	20 the Centers for Medicare and Medicaid Services.
88	88	21 (2) Costs shall be annually rebased and case mix index
89	89	22 quarterly updated. The nursing services methodology will
90	90	23 be assigned to the Medicaid enrolled residents on record
91	91	24 as of 30 days prior to the beginning of the rate period in
92	92	25 the Department's Medicaid Management Information System
93	93	26 (MMIS) as present on the last day of the second quarter
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104	104	1 preceding the rate period based upon the Assessment
105	105	2 Reference Date of the Minimum Data Set (MDS).
106	106	3 (3) Regional wage adjustors based on the Health
107	107	4 Service Areas (HSA) groupings and adjusters in effect on
108	108	5 April 30, 2012 shall be included, except no adjuster shall
109	109	6 be lower than 1.06.
110	110	7 (4) PDPM nursing case mix indices in effect on March
111	111	8 1, 2022 shall be assigned to each resident class at no less
112	112	9 than 0.7858 of the Centers for Medicare and Medicaid
113	113	10 Services PDPM unadjusted case mix values, in effect on
114	114	11 March 1, 2022.
115	115	12 (5) The pool of funds available for distribution by
116	116	13 case mix and the base facility rate shall be determined
117	117	14 using the formula contained in subsection (d-1).
118	118	15 (6) The Department shall establish a variable per diem
119	119	16 staffing add-on in accordance with the most recent
120	120	17 available federal staffing report, currently the Payroll
121	121	18 Based Journal, for the same period of time, and if
122	122	19 applicable adjusted for acuity using the same quarter's
123	123	20 MDS. The Department shall rely on Payroll Based Journals
124	124	21 provided to the Department of Public Health to make a
125	125	22 determination of non-submission. If the Department is
126	126	23 notified by a facility of missing or inaccurate Payroll
127	127	24 Based Journal data or an incorrect calculation of
128	128	25 staffing, the Department must make a correction as soon as
129	129	26 the error is verified for the applicable quarter.
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140	140	1 Facilities with at least 70% of the staffing indicated
141	141	2 by the STRIVE study shall be paid a per diem add-on of $9,
142	142	3 increasing by equivalent steps for each whole percentage
143	143	4 point until the facilities reach a per diem of $14.88.
144	144	5 Facilities with at least 80% of the staffing indicated by
145	145	6 the STRIVE study shall be paid a per diem add-on of $14.88,
146	146	7 increasing by equivalent steps for each whole percentage
147	147	8 point until the facilities reach a per diem add-on of
148	148	9 $23.80. Facilities with at least 92% of the staffing
149	149	10 indicated by the STRIVE study shall be paid a per diem
150	150	11 add-on of $23.80, increasing by equivalent steps for each
151	151	12 whole percentage point until the facilities reach a per
152	152	13 diem add-on of $29.75. Facilities with at least 100% of
153	153	14 the staffing indicated by the STRIVE study shall be paid a
154	154	15 per diem add-on of $29.75, increasing by equivalent steps
155	155	16 for each whole percentage point until the facilities reach
156	156	17 a per diem add-on of $35.70. Facilities with at least 110%
157	157	18 of the staffing indicated by the STRIVE study shall be
158	158	19 paid a per diem add-on of $35.70, increasing by equivalent
159	159	20 steps for each whole percentage point until the facilities
160	160	21 reach a per diem add-on of $38.68. Facilities with at
161	161	22 least 125% or higher of the staffing indicated by the
162	162	23 STRIVE study shall be paid a per diem add-on of $38.68.
163	163	24 Beginning April 1, 2023, no nursing facility's variable
164	164	25 staffing per diem add-on shall be reduced by more than 5%
165	165	26 in 2 consecutive quarters. For the quarters beginning July
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176	176	1 1, 2022 and October 1, 2022, no facility's variable per
177	177	2 diem staffing add-on shall be calculated at a rate lower
178	178	3 than 85% of the staffing indicated by the STRIVE study. No
179	179	4 facility below 70% of the staffing indicated by the STRIVE
180	180	5 study shall receive a variable per diem staffing add-on
181	181	6 after December 31, 2022.
182	182	7 (7) For dates of services beginning July 1, 2022, the
183	183	8 PDPM nursing component per diem for each nursing facility
184	184	9 shall be the product of the facility's (i) statewide PDPM
185	185	10 nursing base per diem rate, $92.25, adjusted for the
186	186	11 facility average PDPM case mix index calculated quarterly
187	187	12 and (ii) the regional wage adjuster, and then add the
188	188	13 Medicaid access adjustment as defined in (e-3) of this
189	189	14 Section. Transition rates for services provided between
190	190	15 July 1, 2022 and October 1, 2023 shall be the greater of
191	191	16 the PDPM nursing component per diem or:
192	192	17 (A) for the quarter beginning July 1, 2022, the
193	193	18 RUG-IV nursing component per diem;
194	194	19 (B) for the quarter beginning October 1, 2022, the
195	195	20 sum of the RUG-IV nursing component per diem
196	196	21 multiplied by 0.80 and the PDPM nursing component per
197	197	22 diem multiplied by 0.20;
198	198	23 (C) for the quarter beginning January 1, 2023, the
199	199	24 sum of the RUG-IV nursing component per diem
200	200	25 multiplied by 0.60 and the PDPM nursing component per
201	201	26 diem multiplied by 0.40;
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212	212	1 (D) for the quarter beginning April 1, 2023, the
213	213	2 sum of the RUG-IV nursing component per diem
214	214	3 multiplied by 0.40 and the PDPM nursing component per
215	215	4 diem multiplied by 0.60;
216	216	5 (E) for the quarter beginning July 1, 2023, the
217	217	6 sum of the RUG-IV nursing component per diem
218	218	7 multiplied by 0.20 and the PDPM nursing component per
219	219	8 diem multiplied by 0.80; or
220	220	9 (F) for the quarter beginning October 1, 2023 and
221	221	10 each subsequent quarter, the transition rate shall end
222	222	11 and a nursing facility shall be paid 100% of the PDPM
223	223	12 nursing component per diem.
224	224	13 (d-1) Calculation of base year Statewide RUG-IV nursing
225	225	14 base per diem rate.
226	226	15 (1) Base rate spending pool shall be:
227	227	16 (A) The base year resident days which are
228	228	17 calculated by multiplying the number of Medicaid
229	229	18 residents in each nursing home as indicated in the MDS
230	230	19 data defined in paragraph (4) by 365.
231	231	20 (B) Each facility's nursing component per diem in
232	232	21 effect on July 1, 2012 shall be multiplied by
233	233	22 subsection (A).
234	234	23 (C) Thirteen million is added to the product of
235	235	24 subparagraph (A) and subparagraph (B) to adjust for
236	236	25 the exclusion of nursing homes defined in paragraph
237	237	26 (5).
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248	248	1 (2) For each nursing home with Medicaid residents as
249	249	2 indicated by the MDS data defined in paragraph (4),
250	250	3 weighted days adjusted for case mix and regional wage
251	251	4 adjustment shall be calculated. For each home this
252	252	5 calculation is the product of:
253	253	6 (A) Base year resident days as calculated in
254	254	7 subparagraph (A) of paragraph (1).
255	255	8 (B) The nursing home's regional wage adjustor
256	256	9 based on the Health Service Areas (HSA) groupings and
257	257	10 adjustors in effect on April 30, 2012.
258	258	11 (C) Facility weighted case mix which is the number
259	259	12 of Medicaid residents as indicated by the MDS data
260	260	13 defined in paragraph (4) multiplied by the associated
261	261	14 case weight for the RUG-IV 48 grouper model using
262	262	15 standard RUG-IV procedures for index maximization.
263	263	16 (D) The sum of the products calculated for each
264	264	17 nursing home in subparagraphs (A) through (C) above
265	265	18 shall be the base year case mix, rate adjusted
266	266	19 weighted days.
267	267	20 (3) The Statewide RUG-IV nursing base per diem rate:
268	268	21 (A) on January 1, 2014 shall be the quotient of the
269	269	22 paragraph (1) divided by the sum calculated under
270	270	23 subparagraph (D) of paragraph (2);
271	271	24 (B) on and after July 1, 2014 and until July 1,
272	272	25 2022, shall be the amount calculated under
273	273	26 subparagraph (A) of this paragraph (3) plus $1.76; and
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284	284	1 (C) beginning July 1, 2022 and thereafter, $7
285	285	2 shall be added to the amount calculated under
286	286	3 subparagraph (B) of this paragraph (3) of this
287	287	4 Section.
288	288	5 (4) Minimum Data Set (MDS) comprehensive assessments
289	289	6 for Medicaid residents on the last day of the quarter used
290	290	7 to establish the base rate.
291	291	8 (5) Nursing facilities designated as of July 1, 2012
292	292	9 by the Department as "Institutions for Mental Disease"
293	293	10 shall be excluded from all calculations under this
294	294	11 subsection. The data from these facilities shall not be
295	295	12 used in the computations described in paragraphs (1)
296	296	13 through (4) above to establish the base rate.
297	297	14 (e) Beginning July 1, 2014, the Department shall allocate
298	298	15 funding in the amount up to $10,000,000 for per diem add-ons to
299	299	16 the RUGS methodology for dates of service on and after July 1,
300	300	17 2014:
301	301	18 (1) $0.63 for each resident who scores in I4200
302	302	19 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
303	303	20 (2) $2.67 for each resident who scores either a "1" or
304	304	21 "2" in any items S1200A through S1200I and also scores in
305	305	22 RUG groups PA1, PA2, BA1, or BA2.
306	306	23 (e-1) (Blank).
307	307	24 (e-2) For dates of services beginning January 1, 2014 and
308	308	25 ending September 30, 2023, the RUG-IV nursing component per
309	309	26 diem for a nursing home shall be the product of the statewide
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320	320	1 RUG-IV nursing base per diem rate, the facility average case
321	321	2 mix index, and the regional wage adjustor. For dates of
322	322	3 service beginning July 1, 2022 and ending September 30, 2023,
323	323	4 the Medicaid access adjustment described in subsection (e-3)
324	324	5 shall be added to the product.
325	325	6 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
326	326	7 facility average PDPM case mix index calculated quarterly
327	327	8 shall be added to the statewide PDPM nursing per diem for all
328	328	9 facilities with annual Medicaid bed days of at least 70% of all
329	329	10 occupied bed days adjusted quarterly. For each new calendar
330	330	11 year and for the 6-month period beginning July 1, 2022, the
331	331	12 percentage of a facility's occupied bed days comprised of
332	332	13 Medicaid bed days shall be determined by the Department
333	333	14 quarterly. For dates of service beginning January 1, 2023, the
334	334	15 Medicaid Access Adjustment shall be increased to $4.75. This
335	335	16 subsection shall be inoperative on and after January 1, 2028.
336	336	17 (e-4) Subject to federal approval, on and after January 1,
337	337	18 2024, the Department shall increase the rate add-on at
338	338	19 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
339	339	20 for ventilator services from $208 per day to $481 per day.
340	340	21 Payment is subject to the criteria and requirements under 89
341	341	22 Ill. Adm. Code 147.335.
342	342	23 (f) (Blank).
343	343	24 (g) Notwithstanding any other provision of this Code, on
344	344	25 and after July 1, 2012, for facilities not designated by the
345	345	26 Department of Healthcare and Family Services as "Institutions
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356	356	1 for Mental Disease", rates effective May 1, 2011 shall be
357	357	2 adjusted as follows:
358	358	3 (1) (Blank);
359	359	4 (2) (Blank);
360	360	5 (3) Facility rates for the capital and support
361	361	6 components shall be reduced by 1.7%.
362	362	7 (h) Notwithstanding any other provision of this Code, on
363	363	8 and after July 1, 2012, nursing facilities designated by the
364	364	9 Department of Healthcare and Family Services as "Institutions
365	365	10 for Mental Disease" and "Institutions for Mental Disease" that
366	366	11 are facilities licensed under the Specialized Mental Health
367	367	12 Rehabilitation Act of 2013 shall have the nursing,
368	368	13 socio-developmental, capital, and support components of their
369	369	14 reimbursement rate effective May 1, 2011 reduced in total by
370	370	15 2.7%.
371	371	16 (i) On and after July 1, 2014, the reimbursement rates for
372	372	17 the support component of the nursing facility rate for
373	373	18 facilities licensed under the Nursing Home Care Act as skilled
374	374	19 or intermediate care facilities shall be the rate in effect on
375	375	20 June 30, 2014 increased by 8.17%.
376	376	21 (i-1) Subject to federal approval, on and after January 1,
377	377	22 2024, the reimbursement rates for the support component of the
378	378	23 nursing facility rate for facilities licensed under the
379	379	24 Nursing Home Care Act as skilled or intermediate care
380	380	25 facilities shall be the rate in effect on June 30, 2023
381	381	26 increased by 12%.
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392	392	1 (j) Notwithstanding any other provision of law, subject to
393	393	2 federal approval, effective July 1, 2019, sufficient funds
394	394	3 shall be allocated for changes to rates for facilities
395	395	4 licensed under the Nursing Home Care Act as skilled nursing
396	396	5 facilities or intermediate care facilities for dates of
397	397	6 services on and after July 1, 2019: (i) to establish, through
398	398	7 June 30, 2022 a per diem add-on to the direct care per diem
399	399	8 rate not to exceed $70,000,000 annually in the aggregate
400	400	9 taking into account federal matching funds for the purpose of
401	401	10 addressing the facility's unique staffing needs, adjusted
402	402	11 quarterly and distributed by a weighted formula based on
403	403	12 Medicaid bed days on the last day of the second quarter
404	404	13 preceding the quarter for which the rate is being adjusted.
405	405	14 Beginning July 1, 2022, the annual $70,000,000 described in
406	406	15 the preceding sentence shall be dedicated to the variable per
407	407	16 diem add-on for staffing under paragraph (6) of subsection
408	408	17 (d); and (ii) in an amount not to exceed $170,000,000 annually
409	409	18 in the aggregate taking into account federal matching funds to
410	410	19 permit the support component of the nursing facility rate to
411	411	20 be updated as follows:
412	412	21 (1) 80%, or $136,000,000, of the funds shall be used
413	413	22 to update each facility's rate in effect on June 30, 2019
414	414	23 using the most recent cost reports on file, which have had
415	415	24 a limited review conducted by the Department of Healthcare
416	416	25 and Family Services and will not hold up enacting the rate
417	417	26 increase, with the Department of Healthcare and Family
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428	428	1 Services.
429	429	2 (2) After completing the calculation in paragraph (1),
430	430	3 any facility whose rate is less than the rate in effect on
431	431	4 June 30, 2019 shall have its rate restored to the rate in
432	432	5 effect on June 30, 2019 from the 20% of the funds set
433	433	6 aside.
434	434	7 (3) The remainder of the 20%, or $34,000,000, shall be
435	435	8 used to increase each facility's rate by an equal
436	436	9 percentage.
437	437	10 (k) During the first quarter of State Fiscal Year 2020,
438	438	11 the Department of Healthcare of Family Services must convene a
439	439	12 technical advisory group consisting of members of all trade
440	440	13 associations representing Illinois skilled nursing providers
441	441	14 to discuss changes necessary with federal implementation of
442	442	15 Medicare's Patient-Driven Payment Model. Implementation of
443	443	16 Medicare's Patient-Driven Payment Model shall, by September 1,
444	444	17 2020, end the collection of the MDS data that is necessary to
445	445	18 maintain the current RUG-IV Medicaid payment methodology. The
446	446	19 technical advisory group must consider a revised reimbursement
447	447	20 methodology that takes into account transparency,
448	448	21 accountability, actual staffing as reported under the
449	449	22 federally required Payroll Based Journal system, changes to
450	450	23 the minimum wage, adequacy in coverage of the cost of care, and
451	451	24 a quality component that rewards quality improvements.
452	452	25 (l) The Department shall establish per diem add-on
453	453	26 payments to improve the quality of care delivered by
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464	464	1 facilities, including:
465	465	2 (1) Incentive payments determined by facility
466	466	3 performance on specified quality measures in an initial
467	467	4 amount of $70,000,000. Nothing in this subsection shall be
468	468	5 construed to limit the quality of care payments in the
469	469	6 aggregate statewide to $70,000,000, and, if quality of
470	470	7 care has improved across nursing facilities, the
471	471	8 Department shall adjust those add-on payments accordingly.
472	472	9 The quality payment methodology described in this
473	473	10 subsection must be used for at least State Fiscal Year
474	474	11 2023. Beginning with the quarter starting July 1, 2023,
475	475	12 the Department may add, remove, or change quality metrics
476	476	13 and make associated changes to the quality payment
477	477	14 methodology as outlined in subparagraph (E). Facilities
478	478	15 designated by the Centers for Medicare and Medicaid
479	479	16 Services as a special focus facility or a hospital-based
480	480	17 nursing home do not qualify for quality payments.
481	481	18 (A) Each quality pool must be distributed by
482	482	19 assigning a quality weighted score for each nursing
483	483	20 home which is calculated by multiplying the nursing
484	484	21 home's quality base period Medicaid days by the
485	485	22 nursing home's star rating weight in that period.
486	486	23 (B) Star rating weights are assigned based on the
487	487	24 nursing home's star rating for the LTS quality star
488	488	25 rating. As used in this subparagraph, "LTS quality
489	489	26 star rating" means the long-term stay quality rating
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500	500	1 for each nursing facility, as assigned by the Centers
501	501	2 for Medicare and Medicaid Services under the Five-Star
502	502	3 Quality Rating System. The rating is a number ranging
503	503	4 from 0 (lowest) to 5 (highest).
504	504	5 (i) Zero-star or one-star rating has a weight
505	505	6 of 0.
506	506	7 (ii) Two-star rating has a weight of 0.75.
507	507	8 (iii) Three-star rating has a weight of 1.5.
508	508	9 (iv) Four-star rating has a weight of 2.5.
509	509	10 (v) Five-star rating has a weight of 3.5.
510	510	11 (C) Each nursing home's quality weight score is
511	511	12 divided by the sum of all quality weight scores for
512	512	13 qualifying nursing homes to determine the proportion
513	513	14 of the quality pool to be paid to the nursing home.
514	514	15 (D) The quality pool is no less than $70,000,000
515	515	16 annually or $17,500,000 per quarter. The Department
516	516	17 shall publish on its website the estimated payments
517	517	18 and the associated weights for each facility 45 days
518	518	19 prior to when the initial payments for the quarter are
519	519	20 to be paid. The Department shall assign each facility
520	520	21 the most recent and applicable quarter's STAR value
521	521	22 unless the facility notifies the Department within 15
522	522	23 days of an issue and the facility provides reasonable
523	523	24 evidence demonstrating its timely compliance with
524	524	25 federal data submission requirements for the quarter
525	525	26 of record. If such evidence cannot be provided to the
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536	536	1 Department, the STAR rating assigned to the facility
537	537	2 shall be reduced by one from the prior quarter.
538	538	3 (E) The Department shall review quality metrics
539	539	4 used for payment of the quality pool and make
540	540	5 recommendations for any associated changes to the
541	541	6 methodology for distributing quality pool payments in
542	542	7 consultation with associations representing long-term
543	543	8 care providers, consumer advocates, organizations
544	544	9 representing workers of long-term care facilities, and
545	545	10 payors. The Department may establish, by rule, changes
546	546	11 to the methodology for distributing quality pool
547	547	12 payments.
548	548	13 (F) The Department shall disburse quality pool
549	549	14 payments from the Long-Term Care Provider Fund on a
550	550	15 monthly basis in amounts proportional to the total
551	551	16 quality pool payment determined for the quarter.
552	552	17 (G) The Department shall publish any changes in
553	553	18 the methodology for distributing quality pool payments
554	554	19 prior to the beginning of the measurement period or
555	555	20 quality base period for any metric added to the
556	556	21 distribution's methodology.
557	557	22 (2) Payments based on CNA tenure, promotion, and CNA
558	558	23 training for the purpose of increasing CNA compensation.
559	559	24 It is the intent of this subsection that payments made in
560	560	25 accordance with this paragraph be directly incorporated
561	561	26 into increased compensation for CNAs. As used in this
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572	572	1 paragraph, "CNA" means a certified nursing assistant as
573	573	2 that term is described in Section 3-206 of the Nursing
574	574	3 Home Care Act, Section 3-206 of the ID/DD Community Care
575	575	4 Act, and Section 3-206 of the MC/DD Act. The Department
576	576	5 shall establish, by rule, payments to nursing facilities
577	577	6 equal to Medicaid's share of the tenure wage increments
578	578	7 specified in this paragraph for all reported CNA employee
579	579	8 hours compensated according to a posted schedule
580	580	9 consisting of increments at least as large as those
581	581	10 specified in this paragraph. The increments are as
582	582	11 follows: an additional $1.50 per hour for CNAs with at
583	583	12 least one and less than 2 years' experience plus another
584	584	13 $1 per hour for each additional year of experience up to a
585	585	14 maximum of $6.50 for CNAs with at least 6 years of
586	586	15 experience.
587	587	16 Based on the schedule in this paragraph, the
588	588	17 Department shall pay to each facility Medicaid's share of
589	589	18 the facility's estimated CNA hours performed by employees
590	590	19 and agency workers, estimated overtime hours, and benefits
591	591	20 and taxes paid to and on behalf of CNA workers at the
592	592	21 beginning of each quarter. For purposes of this paragraph,
593	593	22 Medicaid's share shall be the ratio determined by paid
594	594	23 Medicaid bed days divided by total bed days for the
595	595	24 applicable time period used in the calculation. Moneys
596	596	25 paid by the Department to each facility and moneys paid by
597	597	26 each facility to workers and agencies or on behalf of
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608	608	1 workers and agencies shall be reconciled at the end of
609	609	2 each quarter.
610	610	3 Calculation of tenure compensation shall include the
611	611	4 following:
612	612	5 (A) compensation for regular CNA hours: an
613	613	6 additional $1.50 per hour for CNAs with at least one
614	614	7 and less than 2 years' experience plus another $1 per
615	615	8 hour for each additional year of experience up to a
616	616	9 maximum of $6.50 for CNAs with at least 6 years of
617	617	10 experience;
618	618	11 (B) overtime calculated at time and a half; and
619	619	12 (C) benefits and taxes at 25%.
620	620	13 In addition, and additive to any tenure increments
621	621	14 paid as specified in this paragraph, the Department shall
622	622	15 establish, by rule, payments supporting Medicaid's share
623	623	16 of the promotion-based wage increments for CNA employee
624	624	17 hours compensated for that promotion with at least a $1.50
625	625	18 hourly increase. Medicaid's share shall be established as
626	626	19 it is for the tenure increments described in this
627	627	20 paragraph. Estimates of overtime shall be calculated at
628	628	21 time and a half and benefits and taxes at 25%. The
629	629	22 Department shall pay the facility for qualifying
630	630	23 promotions estimated at the beginning of each quarter and
631	631	24 reconciled at the end of the quarter. Qualifying
632	632	25 promotions shall be defined by the Department in rules for
633	633	26 an expected 10-15% subset of CNAs assigned intermediate,
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