Illinois 2025-2026 Regular Session

Illinois House Bill HB1922 Compare Versions

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

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1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1922 Introduced , by Rep. Kevin John Olickal 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. Effective immediately. LRB104 09529 KTG 19592 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1922 Introduced , by Rep. Kevin John Olickal 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. Effective immediately. LRB104 09529 KTG 19592 b LRB104 09529 KTG 19592 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1922 Introduced , by Rep. Kevin John Olickal 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. Effective immediately.
6	6	LRB104 09529 KTG 19592 b LRB104 09529 KTG 19592 b
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8	8	A BILL FOR
9	9	HB1922LRB104 09529 KTG 19592 b HB1922 LRB104 09529 KTG 19592 b
10	10	HB1922 LRB104 09529 KTG 19592 b
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, the implementation date of the PDPM
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37	37	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1922 Introduced , by Rep. Kevin John Olickal 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. Effective immediately.
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42	42	LRB104 09529 KTG 19592 b
43	43	A BILL FOR
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68	68	1 reimbursement system and all related provisions shall be July
69	69	2 1, 2022 if the following conditions are met: (i) the Centers
70	70	3 for Medicare and Medicaid Services has approved corresponding
71	71	4 changes in the reimbursement system and bed assessment; and
72	72	5 (ii) the Department has filed rules to implement these changes
73	73	6 no later than June 1, 2022. Failure of the Department to file
74	74	7 rules to implement the changes provided in Public Act 102-1035
75	75	8 no later than June 1, 2022 shall result in the implementation
76	76	9 date being delayed to October 1, 2022.
77	77	10 (d) The new nursing services reimbursement methodology
78	78	11 utilizing the Patient Driven Payment Model, which shall be
79	79	12 referred to as the PDPM reimbursement system, taking effect
80	80	13 July 1, 2022, upon federal approval by the Centers for
81	81	14 Medicare and Medicaid Services, shall be based on the
82	82	15 following:
83	83	16 (1) The methodology shall be resident-centered,
84	84	17 facility-specific, cost-based, and based on guidance from
85	85	18 the Centers for Medicare and Medicaid Services.
86	86	19 (2) Costs shall be annually rebased and case mix index
87	87	20 quarterly updated. The nursing services methodology will
88	88	21 be assigned to the Medicaid enrolled residents on record
89	89	22 as of 30 days prior to the beginning of the rate period in
90	90	23 the Department's Medicaid Management Information System
91	91	24 (MMIS) as present on the last day of the second quarter
92	92	25 preceding the rate period based upon the Assessment
93	93	26 Reference Date of the Minimum Data Set (MDS).
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104	104	1 (3) Regional wage adjustors based on the Health
105	105	2 Service Areas (HSA) groupings and adjusters in effect on
106	106	3 April 30, 2012 shall be included, except no adjuster shall
107	107	4 be lower than 1.06.
108	108	5 (4) PDPM nursing case mix indices in effect on March
109	109	6 1, 2022 shall be assigned to each resident class at no less
110	110	7 than 0.7858 of the Centers for Medicare and Medicaid
111	111	8 Services PDPM unadjusted case mix values, in effect on
112	112	9 March 1, 2022.
113	113	10 (5) The pool of funds available for distribution by
114	114	11 case mix and the base facility rate shall be determined
115	115	12 using the formula contained in subsection (d-1).
116	116	13 (6) The Department shall establish a variable per diem
117	117	14 staffing add-on in accordance with the most recent
118	118	15 available federal staffing report, currently the Payroll
119	119	16 Based Journal, for the same period of time, and if
120	120	17 applicable adjusted for acuity using the same quarter's
121	121	18 MDS. The Department shall rely on Payroll Based Journals
122	122	19 provided to the Department of Public Health to make a
123	123	20 determination of non-submission. If the Department is
124	124	21 notified by a facility of missing or inaccurate Payroll
125	125	22 Based Journal data or an incorrect calculation of
126	126	23 staffing, the Department must make a correction as soon as
127	127	24 the error is verified for the applicable quarter.
128	128	25 Beginning October 1, 2024, the staffing percentage
129	129	26 used in the calculation of the per diem staffing add-on
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140	140	1 shall be its PDPM STRIVE Staffing Ratio which equals: its
141	141	2 Reported Total Nurse Staffing Hours Per Resident Per Day
142	142	3 as published in the most recent federal staffing report
143	143	4 (the Provider Information File), divided by the facility's
144	144	5 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
145	145	6 Staffing Target is equal to .82 times the facility's
146	146	7 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
147	147	8 Day. A facility's Illinois Adjusted Facility Case Mix
148	148	9 Hours Per Resident Per Day is equal to its Case-Mix Total
149	149	10 Nurse Staffing Hours Per Resident Per Day (as published in
150	150	11 the most recent federal staffing report) times 3.662
151	151	12 (which reflects the national resident days-weighted mean
152	152	13 Reported Total Nurse Staffing Hours Per Resident Per Day
153	153	14 as calculated using the January 2024 federal Provider
154	154	15 Information Files), divided by the national resident
155	155	16 days-weighted mean Reported Total Nurse Staffing Hours Per
156	156	17 Resident Per Day calculated using the most recent federal
157	157	18 Provider Information File.
158	158	19 (6.5) Beginning July 1, 2024, the paid per diem
159	159	20 staffing add-on shall be the paid per diem staffing add-on
160	160	21 in effect April 1, 2024. For dates beginning October 1,
161	161	22 2024 and through September 30, 2025, the denominator for
162	162	23 the staffing percentage shall be the lesser of the
163	163	24 facility's PDPM STRIVE Staffing Target and:
164	164	25 (A) For the quarter beginning October 1, 2024, the
165	165	26 sum of 20% of the facility's PDPM STRIVE Staffing
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176	176	1 Target and 80% of the facility's Case-Mix Total Nurse
177	177	2 Staffing Hours Per Resident Per Day (as published in
178	178	3 the January 2024 federal staffing report).
179	179	4 (B) For the quarter beginning January 1, 2025, the
180	180	5 sum of 40% of the facility's PDPM STRIVE Staffing
181	181	6 Target and 60% of the facility's Case-Mix Total Nurse
182	182	7 Staffing Hours Per Resident Per Day (as published in
183	183	8 the January 2024 federal staffing report).
184	184	9 (C) For the quarter beginning March 1, 2025, the
185	185	10 sum of 60% of the facility's PDPM STRIVE Staffing
186	186	11 Target and 40% of the facility's Case-Mix Total Nurse
187	187	12 Staffing Hours Per Resident Per Day (as published in
188	188	13 the January 2024 federal staffing report).
189	189	14 (D) For the quarter beginning July 1, 2025, the
190	190	15 sum of 80% of the facility's PDPM STRIVE Staffing
191	191	16 Target and 20% of the facility's Case-Mix Total Nurse
192	192	17 Staffing Hours Per Resident Per Day (as published in
193	193	18 the January 2024 federal staffing report).
194	194	19 Facilities with at least 70% of the staffing
195	195	20 indicated by the STRIVE study shall be paid a per diem
196	196	21 add-on of $9, increasing by equivalent steps for each
197	197	22 whole percentage point until the facilities reach a per
198	198	23 diem of $16.52. Facilities with at least 80% of the
199	199	24 staffing indicated by the STRIVE study shall be paid a per
200	200	25 diem add-on of $16.52, increasing by equivalent steps for
201	201	26 each whole percentage point until the facilities reach a
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212	212	1 per diem add-on of $25.77. Facilities with at least 92% of
213	213	2 the staffing indicated by the STRIVE study shall be paid a
214	214	3 per diem add-on of $25.77, increasing by equivalent steps
215	215	4 for each whole percentage point until the facilities reach
216	216	5 a per diem add-on of $30.98. Facilities with at least 100%
217	217	6 of the staffing indicated by the STRIVE study shall be
218	218	7 paid a per diem add-on of $30.98, increasing by equivalent
219	219	8 steps for each whole percentage point until the facilities
220	220	9 reach a per diem add-on of $36.44. Facilities with at
221	221	10 least 110% of the staffing indicated by the STRIVE study
222	222	11 shall be paid a per diem add-on of $36.44, increasing by
223	223	12 equivalent steps for each whole percentage point until the
224	224	13 facilities reach a per diem add-on of $38.68. Facilities
225	225	14 with at least 125% or higher of the staffing indicated by
226	226	15 the STRIVE study shall be paid a per diem add-on of $38.68.
227	227	16 No nursing facility's variable staffing per diem add-on
228	228	17 shall be reduced by more than 5% in 2 consecutive
229	229	18 quarters. For the quarters beginning July 1, 2022 and
230	230	19 October 1, 2022, no facility's variable per diem staffing
231	231	20 add-on shall be calculated at a rate lower than 85% of the
232	232	21 staffing indicated by the STRIVE study. No facility below
233	233	22 70% of the staffing indicated by the STRIVE study shall
234	234	23 receive a variable per diem staffing add-on after December
235	235	24 31, 2022.
236	236	25 (7) For dates of services beginning July 1, 2022, the
237	237	26 PDPM nursing component per diem for each nursing facility
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248	248	1 shall be the product of the facility's (i) statewide PDPM
249	249	2 nursing base per diem rate, $92.25, adjusted for the
250	250	3 facility average PDPM case mix index calculated quarterly
251	251	4 and (ii) the regional wage adjuster, and then add the
252	252	5 Medicaid access adjustment as defined in (e-3) of this
253	253	6 Section. Transition rates for services provided between
254	254	7 July 1, 2022 and October 1, 2023 shall be the greater of
255	255	8 the PDPM nursing component per diem or:
256	256	9 (A) for the quarter beginning July 1, 2022, the
257	257	10 RUG-IV nursing component per diem;
258	258	11 (B) for the quarter beginning October 1, 2022, the
259	259	12 sum of the RUG-IV nursing component per diem
260	260	13 multiplied by 0.80 and the PDPM nursing component per
261	261	14 diem multiplied by 0.20;
262	262	15 (C) for the quarter beginning January 1, 2023, the
263	263	16 sum of the RUG-IV nursing component per diem
264	264	17 multiplied by 0.60 and the PDPM nursing component per
265	265	18 diem multiplied by 0.40;
266	266	19 (D) for the quarter beginning April 1, 2023, the
267	267	20 sum of the RUG-IV nursing component per diem
268	268	21 multiplied by 0.40 and the PDPM nursing component per
269	269	22 diem multiplied by 0.60;
270	270	23 (E) for the quarter beginning July 1, 2023, the
271	271	24 sum of the RUG-IV nursing component per diem
272	272	25 multiplied by 0.20 and the PDPM nursing component per
273	273	26 diem multiplied by 0.80; or
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284	284	1 (F) for the quarter beginning October 1, 2023 and
285	285	2 each subsequent quarter, the transition rate shall end
286	286	3 and a nursing facility shall be paid 100% of the PDPM
287	287	4 nursing component per diem.
288	288	5 (d-1) Calculation of base year Statewide RUG-IV nursing
289	289	6 base per diem rate.
290	290	7 (1) Base rate spending pool shall be:
291	291	8 (A) The base year resident days which are
292	292	9 calculated by multiplying the number of Medicaid
293	293	10 residents in each nursing home as indicated in the MDS
294	294	11 data defined in paragraph (4) by 365.
295	295	12 (B) Each facility's nursing component per diem in
296	296	13 effect on July 1, 2012 shall be multiplied by
297	297	14 subsection (A).
298	298	15 (C) Thirteen million is added to the product of
299	299	16 subparagraph (A) and subparagraph (B) to adjust for
300	300	17 the exclusion of nursing homes defined in paragraph
301	301	18 (5).
302	302	19 (2) For each nursing home with Medicaid residents as
303	303	20 indicated by the MDS data defined in paragraph (4),
304	304	21 weighted days adjusted for case mix and regional wage
305	305	22 adjustment shall be calculated. For each home this
306	306	23 calculation is the product of:
307	307	24 (A) Base year resident days as calculated in
308	308	25 subparagraph (A) of paragraph (1).
309	309	26 (B) The nursing home's regional wage adjustor
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320	320	1 based on the Health Service Areas (HSA) groupings and
321	321	2 adjustors in effect on April 30, 2012.
322	322	3 (C) Facility weighted case mix which is the number
323	323	4 of Medicaid residents as indicated by the MDS data
324	324	5 defined in paragraph (4) multiplied by the associated
325	325	6 case weight for the RUG-IV 48 grouper model using
326	326	7 standard RUG-IV procedures for index maximization.
327	327	8 (D) The sum of the products calculated for each
328	328	9 nursing home in subparagraphs (A) through (C) above
329	329	10 shall be the base year case mix, rate adjusted
330	330	11 weighted days.
331	331	12 (3) The Statewide RUG-IV nursing base per diem rate:
332	332	13 (A) on January 1, 2014 shall be the quotient of the
333	333	14 paragraph (1) divided by the sum calculated under
334	334	15 subparagraph (D) of paragraph (2);
335	335	16 (B) on and after July 1, 2014 and until July 1,
336	336	17 2022, shall be the amount calculated under
337	337	18 subparagraph (A) of this paragraph (3) plus $1.76; and
338	338	19 (C) beginning July 1, 2022 and thereafter, $7
339	339	20 shall be added to the amount calculated under
340	340	21 subparagraph (B) of this paragraph (3) of this
341	341	22 Section.
342	342	23 (4) Minimum Data Set (MDS) comprehensive assessments
343	343	24 for Medicaid residents on the last day of the quarter used
344	344	25 to establish the base rate.
345	345	26 (5) Nursing facilities designated as of July 1, 2012
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356	356	1 by the Department as "Institutions for Mental Disease"
357	357	2 shall be excluded from all calculations under this
358	358	3 subsection. The data from these facilities shall not be
359	359	4 used in the computations described in paragraphs (1)
360	360	5 through (4) above to establish the base rate.
361	361	6 (e) Beginning July 1, 2014, the Department shall allocate
362	362	7 funding in the amount up to $10,000,000 for per diem add-ons to
363	363	8 the RUGS methodology for dates of service on and after July 1,
364	364	9 2014:
365	365	10 (1) $0.63 for each resident who scores in I4200
366	366	11 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
367	367	12 (2) $2.67 for each resident who scores either a "1" or
368	368	13 "2" in any items S1200A through S1200I and also scores in
369	369	14 RUG groups PA1, PA2, BA1, or BA2.
370	370	15 (e-1) (Blank).
371	371	16 (e-2) For dates of services beginning January 1, 2014 and
372	372	17 ending September 30, 2023, the RUG-IV nursing component per
373	373	18 diem for a nursing home shall be the product of the statewide
374	374	19 RUG-IV nursing base per diem rate, the facility average case
375	375	20 mix index, and the regional wage adjustor. For dates of
376	376	21 service beginning July 1, 2022 and ending September 30, 2023,
377	377	22 the Medicaid access adjustment described in subsection (e-3)
378	378	23 shall be added to the product.
379	379	24 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
380	380	25 facility average PDPM case mix index calculated quarterly
381	381	26 shall be added to the statewide PDPM nursing per diem for all
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392	392	1 facilities with annual Medicaid bed days of at least 70% of all
393	393	2 occupied bed days adjusted quarterly. For each new calendar
394	394	3 year and for the 6-month period beginning July 1, 2022, the
395	395	4 percentage of a facility's occupied bed days comprised of
396	396	5 Medicaid bed days shall be determined by the Department
397	397	6 quarterly. For dates of service beginning January 1, 2023, the
398	398	7 Medicaid Access Adjustment shall be increased to $4.75. This
399	399	8 subsection shall be inoperative on and after January 1, 2028.
400	400	9 (e-4) Subject to federal approval, on and after January 1,
401	401	10 2024, the Department shall increase the rate add-on at
402	402	11 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
403	403	12 for ventilator services from $208 per day to $481 per day.
404	404	13 Payment is subject to the criteria and requirements under 89
405	405	14 Ill. Adm. Code 147.335.
406	406	15 (f) (Blank).
407	407	16 (g) Notwithstanding any other provision of this Code, on
408	408	17 and after July 1, 2012, for facilities not designated by the
409	409	18 Department of Healthcare and Family Services as "Institutions
410	410	19 for Mental Disease", rates effective May 1, 2011 shall be
411	411	20 adjusted as follows:
412	412	21 (1) (Blank);
413	413	22 (2) (Blank);
414	414	23 (3) Facility rates for the capital and support
415	415	24 components shall be reduced by 1.7%.
416	416	25 (h) Notwithstanding any other provision of this Code, on
417	417	26 and after July 1, 2012, nursing facilities designated by the
418	418
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428	428	1 Department of Healthcare and Family Services as "Institutions
429	429	2 for Mental Disease" and "Institutions for Mental Disease" that
430	430	3 are facilities licensed under the Specialized Mental Health
431	431	4 Rehabilitation Act of 2013 shall have the nursing,
432	432	5 socio-developmental, capital, and support components of their
433	433	6 reimbursement rate effective May 1, 2011 reduced in total by
434	434	7 2.7%.
435	435	8 (i) On and after July 1, 2014, the reimbursement rates for
436	436	9 the support component of the nursing facility rate for
437	437	10 facilities licensed under the Nursing Home Care Act as skilled
438	438	11 or intermediate care facilities shall be the rate in effect on
439	439	12 June 30, 2014 increased by 8.17%.
440	440	13 (i-1) Subject to federal approval, on and after January 1,
441	441	14 2024, the reimbursement rates for the support component of the
442	442	15 nursing facility rate for facilities licensed under the
443	443	16 Nursing Home Care Act as skilled or intermediate care
444	444	17 facilities shall be the rate in effect on June 30, 2023
445	445	18 increased by 12%.
446	446	19 (j) Notwithstanding any other provision of law, subject to
447	447	20 federal approval, effective July 1, 2019, sufficient funds
448	448	21 shall be allocated for changes to rates for facilities
449	449	22 licensed under the Nursing Home Care Act as skilled nursing
450	450	23 facilities or intermediate care facilities for dates of
451	451	24 services on and after July 1, 2019: (i) to establish, through
452	452	25 June 30, 2022 a per diem add-on to the direct care per diem
453	453	26 rate not to exceed $70,000,000 annually in the aggregate
454	454
455	455
456	456
457	457
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464	464	1 taking into account federal matching funds for the purpose of
465	465	2 addressing the facility's unique staffing needs, adjusted
466	466	3 quarterly and distributed by a weighted formula based on
467	467	4 Medicaid bed days on the last day of the second quarter
468	468	5 preceding the quarter for which the rate is being adjusted.
469	469	6 Beginning July 1, 2022, the annual $70,000,000 described in
470	470	7 the preceding sentence shall be dedicated to the variable per
471	471	8 diem add-on for staffing under paragraph (6) of subsection
472	472	9 (d); and (ii) in an amount not to exceed $170,000,000 annually
473	473	10 in the aggregate taking into account federal matching funds to
474	474	11 permit the support component of the nursing facility rate to
475	475	12 be updated as follows:
476	476	13 (1) 80%, or $136,000,000, of the funds shall be used
477	477	14 to update each facility's rate in effect on June 30, 2019
478	478	15 using the most recent cost reports on file, which have had
479	479	16 a limited review conducted by the Department of Healthcare
480	480	17 and Family Services and will not hold up enacting the rate
481	481	18 increase, with the Department of Healthcare and Family
482	482	19 Services.
483	483	20 (2) After completing the calculation in paragraph (1),
484	484	21 any facility whose rate is less than the rate in effect on
485	485	22 June 30, 2019 shall have its rate restored to the rate in
486	486	23 effect on June 30, 2019 from the 20% of the funds set
487	487	24 aside.
488	488	25 (3) The remainder of the 20%, or $34,000,000, shall be
489	489	26 used to increase each facility's rate by an equal
490	490
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500	500	1 percentage.
501	501	2 (k) During the first quarter of State Fiscal Year 2020,
502	502	3 the Department of Healthcare of Family Services must convene a
503	503	4 technical advisory group consisting of members of all trade
504	504	5 associations representing Illinois skilled nursing providers
505	505	6 to discuss changes necessary with federal implementation of
506	506	7 Medicare's Patient-Driven Payment Model. Implementation of
507	507	8 Medicare's Patient-Driven Payment Model shall, by September 1,
508	508	9 2020, end the collection of the MDS data that is necessary to
509	509	10 maintain the current RUG-IV Medicaid payment methodology. The
510	510	11 technical advisory group must consider a revised reimbursement
511	511	12 methodology that takes into account transparency,
512	512	13 accountability, actual staffing as reported under the
513	513	14 federally required Payroll Based Journal system, changes to
514	514	15 the minimum wage, adequacy in coverage of the cost of care, and
515	515	16 a quality component that rewards quality improvements.
516	516	17 (l) The Department shall establish per diem add-on
517	517	18 payments to improve the quality of care delivered by
518	518	19 facilities, including:
519	519	20 (1) Incentive payments determined by facility
520	520	21 performance on specified quality measures in an initial
521	521	22 amount of $70,000,000. Nothing in this subsection shall be
522	522	23 construed to limit the quality of care payments in the
523	523	24 aggregate statewide to $70,000,000, and, if quality of
524	524	25 care has improved across nursing facilities, the
525	525	26 Department shall adjust those add-on payments accordingly.
526	526
527	527
528	528
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536	536	1 The quality payment methodology described in this
537	537	2 subsection must be used for at least State Fiscal Year
538	538	3 2023. Beginning with the quarter starting July 1, 2023,
539	539	4 the Department may add, remove, or change quality metrics
540	540	5 and make associated changes to the quality payment
541	541	6 methodology as outlined in subparagraph (E). Facilities
542	542	7 designated by the Centers for Medicare and Medicaid
543	543	8 Services as a special focus facility or a hospital-based
544	544	9 nursing home do not qualify for quality payments.
545	545	10 (A) Each quality pool must be distributed by
546	546	11 assigning a quality weighted score for each nursing
547	547	12 home which is calculated by multiplying the nursing
548	548	13 home's quality base period Medicaid days by the
549	549	14 nursing home's star rating weight in that period.
550	550	15 (B) Star rating weights are assigned based on the
551	551	16 nursing home's star rating for the LTS quality star
552	552	17 rating. As used in this subparagraph, "LTS quality
553	553	18 star rating" means the long-term stay quality rating
554	554	19 for each nursing facility, as assigned by the Centers
555	555	20 for Medicare and Medicaid Services under the Five-Star
556	556	21 Quality Rating System. The rating is a number ranging
557	557	22 from 0 (lowest) to 5 (highest).
558	558	23 (i) Zero-star or one-star rating has a weight
559	559	24 of 0.
560	560	25 (ii) Two-star rating has a weight of 0.75.
561	561	26 (iii) Three-star rating has a weight of 1.5.
562	562
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572	572	1 (iv) Four-star rating has a weight of 2.5.
573	573	2 (v) Five-star rating has a weight of 3.5.
574	574	3 (C) Each nursing home's quality weight score is
575	575	4 divided by the sum of all quality weight scores for
576	576	5 qualifying nursing homes to determine the proportion
577	577	6 of the quality pool to be paid to the nursing home.
578	578	7 (D) The quality pool is no less than $70,000,000
579	579	8 annually or $17,500,000 per quarter. The Department
580	580	9 shall publish on its website the estimated payments
581	581	10 and the associated weights for each facility 45 days
582	582	11 prior to when the initial payments for the quarter are
583	583	12 to be paid. The Department shall assign each facility
584	584	13 the most recent and applicable quarter's STAR value
585	585	14 unless the facility notifies the Department within 15
586	586	15 days of an issue and the facility provides reasonable
587	587	16 evidence demonstrating its timely compliance with
588	588	17 federal data submission requirements for the quarter
589	589	18 of record. If such evidence cannot be provided to the
590	590	19 Department, the STAR rating assigned to the facility
591	591	20 shall be reduced by one from the prior quarter.
592	592	21 (E) The Department shall review quality metrics
593	593	22 used for payment of the quality pool and make
594	594	23 recommendations for any associated changes to the
595	595	24 methodology for distributing quality pool payments in
596	596	25 consultation with associations representing long-term
597	597	26 care providers, consumer advocates, organizations
598	598
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608	608	1 representing workers of long-term care facilities, and
609	609	2 payors. The Department may establish, by rule, changes
610	610	3 to the methodology for distributing quality pool
611	611	4 payments.
612	612	5 (F) The Department shall disburse quality pool
613	613	6 payments from the Long-Term Care Provider Fund on a
614	614	7 monthly basis in amounts proportional to the total
615	615	8 quality pool payment determined for the quarter.
616	616	9 (G) The Department shall publish any changes in
617	617	10 the methodology for distributing quality pool payments
618	618	11 prior to the beginning of the measurement period or
619	619	12 quality base period for any metric added to the
620	620	13 distribution's methodology.
621	621	14 (2) Payments based on CNA tenure, promotion, and CNA
622	622	15 training for the purpose of increasing CNA compensation.
623	623	16 It is the intent of this subsection that payments made in
624	624	17 accordance with this paragraph be directly incorporated
625	625	18 into increased compensation for CNAs. As used in this
626	626	19 paragraph, "CNA" means a certified nursing assistant as
627	627	20 that term is described in Section 3-206 of the Nursing
628	628	21 Home Care Act, Section 3-206 of the ID/DD Community Care
629	629	22 Act, and Section 3-206 of the MC/DD Act. Based on the
630	630	23 schedule in this paragraph, the Department shall pay to
631	631	24 each facility Medicaid's share of the facility's estimated
632	632	25 CNA hours performed by employees and agency workers,
633	633	26 estimated overtime hours, and benefits and taxes paid to
634	634
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644	644	1 and on behalf of CNA workers at the beginning of each
645	645	2 quarter. The Department shall establish, by rule, payments
646	646	3 to nursing facilities equal to Medicaid's share of the
647	647	4 tenure wage increments specified in this paragraph for all
648	648	5 reported CNA employee hours compensated according to a
649	649	6 posted schedule consisting of increments at least as large
650	650	7 as those specified in this paragraph. The increments are
651	651	8 as follows: an additional $1.50 per hour for CNAs with at
652	652	9 least one and less than 2 years' experience plus another
653	653	10 $1 per hour for each additional year of experience up to a
654	654	11 maximum of $6.50 for CNAs with at least 6 years of
655	655	12 experience. For purposes of this paragraph, Medicaid's
656	656	13 share shall be the ratio determined by paid Medicaid bed
657	657	14 days divided by total bed days for the applicable time
658	658	15 period used in the calculation. Moneys paid by the
659	659	16 Department to each facility and moneys paid by each
660	660	17 facility to workers and agencies or on behalf of workers
661	661	18 and agencies shall be reconciled at the end of each
662	662	19 quarter.
663	663	20 Calculation of tenure compensation shall include the
664	664	21 following:
665	665	22 (A) compensation for regular CNA hours: an
666	666	23 additional $1.50 per hour for CNAs with at least one
667	667	24 and less than 2 years' experience plus another $1 per
668	668	25 hour for each additional year of experience up to a
669	669	26 maximum of $6.50 for CNAs with at least 6 years of
670	670
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680	680	1 experience;
681	681	2 (B) overtime calculated at time and a half; and
682	682	3 (C) benefits and taxes at 25%.
683	683	4 In addition, and additive to any tenure increments
684	684	5 paid as specified in this paragraph, the Department shall
685	685	6 establish, by rule, payments supporting Medicaid's share
686	686	7 of the promotion-based wage increments for CNA employee
687	687	8 hours compensated for that promotion with at least a $1.50
688	688	9 hourly increase. Medicaid's share shall be established as
689	689	10 it is for the tenure increments described in this
690	690	11 paragraph. Estimates of overtime shall be calculated at
691	691	12 time and a half and benefits and taxes at 25%. The
692	692	13 Department shall pay the facility for qualifying
693	693	14 promotions estimated at the beginning of each quarter and
694	694	15 reconciled at the end of the quarter. Qualifying
695	695	16 promotions shall be defined by the Department in rules for
696	696	17 an expected 10-15% subset of CNAs assigned intermediate,
697	697	18 specialized, or added roles such as CNA trainers, CNA
698	698	19 scheduling "captains", and CNA specialists for resident
699	699	20 conditions like dementia or memory care or behavioral
700	700	21 health.
701	701	22 (m) The Department shall work with nursing facility
702	702	23 industry representatives to design policies and procedures to
703	703	24 permit facilities to address the integrity of data from
704	704	25 federal reporting sites used by the Department in setting
705	705	26 facility rates.
706	706
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716	716	1 (Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
717	717	2 102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
718	718	3 Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
719	719	4 Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
720	720	5 7-1-24.)
721	721
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