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Illinois House Bill HB3271

Illinois 2025-2026 Regular Session

Illinois House Bill HB3271 Compare Versions

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11 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3271 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service starting July 1, 2025, reimbursement calculations and direct payment for services provided by facilities licensed under the ID/DD Community Care Act are the responsibility of the Department of Healthcare and Family Services instead of the Department of Human Services. Requires appropriations for the facilities licensed under the ID/DD Community Care Act to be shifted from the Department of Human Services to the Department of Healthcare and Family Services. Provides that nothing shall prohibit the Department of Healthcare and Family Services from paying more than the rates specified in the Code. Requires the Department of Healthcare and Family Services to work with the Department of Human Services to study and review the reimbursement calculations and direct payments for facilities licensed under the ID/DD Community Care Act and for facilities licensed under the MC/DD Act. Effective July 1, 2025. LRB104 10623 KTG 20699 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3271 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service starting July 1, 2025, reimbursement calculations and direct payment for services provided by facilities licensed under the ID/DD Community Care Act are the responsibility of the Department of Healthcare and Family Services instead of the Department of Human Services. Requires appropriations for the facilities licensed under the ID/DD Community Care Act to be shifted from the Department of Human Services to the Department of Healthcare and Family Services. Provides that nothing shall prohibit the Department of Healthcare and Family Services from paying more than the rates specified in the Code. Requires the Department of Healthcare and Family Services to work with the Department of Human Services to study and review the reimbursement calculations and direct payments for facilities licensed under the ID/DD Community Care Act and for facilities licensed under the MC/DD Act. Effective July 1, 2025. LRB104 10623 KTG 20699 b LRB104 10623 KTG 20699 b A BILL FOR
22 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3271 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
33 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
44 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
55 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service starting July 1, 2025, reimbursement calculations and direct payment for services provided by facilities licensed under the ID/DD Community Care Act are the responsibility of the Department of Healthcare and Family Services instead of the Department of Human Services. Requires appropriations for the facilities licensed under the ID/DD Community Care Act to be shifted from the Department of Human Services to the Department of Healthcare and Family Services. Provides that nothing shall prohibit the Department of Healthcare and Family Services from paying more than the rates specified in the Code. Requires the Department of Healthcare and Family Services to work with the Department of Human Services to study and review the reimbursement calculations and direct payments for facilities licensed under the ID/DD Community Care Act and for facilities licensed under the MC/DD Act. Effective July 1, 2025.
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1111 1 AN ACT concerning public aid.
1212 2 Be it enacted by the People of the State of Illinois,
1313 3 represented in the General Assembly:
1414 4 Section 5. The Illinois Public Aid Code is amended by
1515 5 changing Section 5-5.4 as follows:
1616 6 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
1717 7 Sec. 5-5.4. Standards of payment; Department of Healthcare
1818 8 and Family Services. The Department of Healthcare and Family
1919 9 Services shall develop standards of payment of nursing
2020 10 facility and ICF/DD services in facilities providing such
2121 11 services under this Article which:
2222 12 (1) Provide for the determination of a facility's payment
2323 13 for nursing facility or ICF/DD services on a prospective
2424 14 basis. The amount of the payment rate for all nursing
2525 15 facilities certified by the Department of Public Health under
2626 16 the ID/DD Community Care Act or the Nursing Home Care Act as
2727 17 Intermediate Care for the Developmentally Disabled facilities,
2828 18 Long Term Care for Under Age 22 facilities, Skilled Nursing
2929 19 facilities, or Intermediate Care facilities under the medical
3030 20 assistance program shall be prospectively established annually
3131 21 on the basis of historical, financial, and statistical data
3232 22 reflecting actual costs from prior years, which shall be
3333 23 applied to the current rate year and updated for inflation,
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3737 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3271 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
3838 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
3939 305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
4040 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service starting July 1, 2025, reimbursement calculations and direct payment for services provided by facilities licensed under the ID/DD Community Care Act are the responsibility of the Department of Healthcare and Family Services instead of the Department of Human Services. Requires appropriations for the facilities licensed under the ID/DD Community Care Act to be shifted from the Department of Human Services to the Department of Healthcare and Family Services. Provides that nothing shall prohibit the Department of Healthcare and Family Services from paying more than the rates specified in the Code. Requires the Department of Healthcare and Family Services to work with the Department of Human Services to study and review the reimbursement calculations and direct payments for facilities licensed under the ID/DD Community Care Act and for facilities licensed under the MC/DD Act. Effective July 1, 2025.
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6868 1 except that the capital cost element for newly constructed
6969 2 facilities shall be based upon projected budgets. The annually
7070 3 established payment rate shall take effect on July 1 in 1984
7171 4 and subsequent years. No rate increase and no update for
7272 5 inflation shall be provided on or after July 1, 1994, unless
7373 6 specifically provided for in this Section. The changes made by
7474 7 Public Act 93-841 extending the duration of the prohibition
7575 8 against a rate increase or update for inflation are effective
7676 9 retroactive to July 1, 2004.
7777 10 For facilities licensed by the Department of Public Health
7878 11 under the Nursing Home Care Act as Intermediate Care for the
7979 12 Developmentally Disabled facilities or Long Term Care for
8080 13 Under Age 22 facilities, the rates taking effect on July 1,
8181 14 1998 shall include an increase of 3%. For facilities licensed
8282 15 by the Department of Public Health under the Nursing Home Care
8383 16 Act as Skilled Nursing facilities or Intermediate Care
8484 17 facilities, the rates taking effect on July 1, 1998 shall
8585 18 include an increase of 3% plus $1.10 per resident-day, as
8686 19 defined by the Department. For facilities licensed by the
8787 20 Department of Public Health under the Nursing Home Care Act as
8888 21 Intermediate Care Facilities for the Developmentally Disabled
8989 22 or Long Term Care for Under Age 22 facilities, the rates taking
9090 23 effect on January 1, 2006 shall include an increase of 3%. For
9191 24 facilities licensed by the Department of Public Health under
9292 25 the Nursing Home Care Act as Intermediate Care Facilities for
9393 26 the Developmentally Disabled or Long Term Care for Under Age
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104104 1 22 facilities, the rates taking effect on January 1, 2009
105105 2 shall include an increase sufficient to provide a $0.50 per
106106 3 hour wage increase for non-executive staff. For facilities
107107 4 licensed by the Department of Public Health under the ID/DD
108108 5 Community Care Act as ID/DD Facilities the rates taking effect
109109 6 within 30 days after July 6, 2017 (the effective date of Public
110110 7 Act 100-23) shall include an increase sufficient to provide a
111111 8 $0.75 per hour wage increase for non-executive staff. The
112112 9 Department shall adopt rules, including emergency rules under
113113 10 subsection (y) of Section 5-45 of the Illinois Administrative
114114 11 Procedure Act, to implement the provisions of this paragraph.
115115 12 For facilities licensed by the Department of Public Health
116116 13 under the ID/DD Community Care Act as ID/DD Facilities and
117117 14 under the MC/DD Act as MC/DD Facilities, the rates taking
118118 15 effect within 30 days after June 5, 2019 (the effective date of
119119 16 Public Act 101-10) shall include an increase sufficient to
120120 17 provide a $0.50 per hour wage increase for non-executive
121121 18 front-line personnel, including, but not limited to, direct
122122 19 support persons, aides, front-line supervisors, qualified
123123 20 intellectual disabilities professionals, nurses, and
124124 21 non-administrative support staff. The Department shall adopt
125125 22 rules, including emergency rules under subsection (bb) of
126126 23 Section 5-45 of the Illinois Administrative Procedure Act, to
127127 24 implement the provisions of this paragraph.
128128 25 For facilities licensed by the Department of Public Health
129129 26 under the Nursing Home Care Act as Intermediate Care for the
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140140 1 Developmentally Disabled facilities or Long Term Care for
141141 2 Under Age 22 facilities, the rates taking effect on July 1,
142142 3 1999 shall include an increase of 1.6% plus $3.00 per
143143 4 resident-day, as defined by the Department. For facilities
144144 5 licensed by the Department of Public Health under the Nursing
145145 6 Home Care Act as Skilled Nursing facilities or Intermediate
146146 7 Care facilities, the rates taking effect on July 1, 1999 shall
147147 8 include an increase of 1.6% and, for services provided on or
148148 9 after October 1, 1999, shall be increased by $4.00 per
149149 10 resident-day, as defined by the Department.
150150 11 For facilities licensed by the Department of Public Health
151151 12 under the Nursing Home Care Act as Intermediate Care for the
152152 13 Developmentally Disabled facilities or Long Term Care for
153153 14 Under Age 22 facilities, the rates taking effect on July 1,
154154 15 2000 shall include an increase of 2.5% per resident-day, as
155155 16 defined by the Department. For facilities licensed by the
156156 17 Department of Public Health under the Nursing Home Care Act as
157157 18 Skilled Nursing facilities or Intermediate Care facilities,
158158 19 the rates taking effect on July 1, 2000 shall include an
159159 20 increase of 2.5% per resident-day, as defined by the
160160 21 Department.
161161 22 For facilities licensed by the Department of Public Health
162162 23 under the Nursing Home Care Act as skilled nursing facilities
163163 24 or intermediate care facilities, a new payment methodology
164164 25 must be implemented for the nursing component of the rate
165165 26 effective July 1, 2003. The Department of Public Aid (now
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176176 1 Healthcare and Family Services) shall develop the new payment
177177 2 methodology using the Minimum Data Set (MDS) as the instrument
178178 3 to collect information concerning nursing home resident
179179 4 condition necessary to compute the rate. The Department shall
180180 5 develop the new payment methodology to meet the unique needs
181181 6 of Illinois nursing home residents while remaining subject to
182182 7 the appropriations provided by the General Assembly. A
183183 8 transition period from the payment methodology in effect on
184184 9 June 30, 2003 to the payment methodology in effect on July 1,
185185 10 2003 shall be provided for a period not exceeding 3 years and
186186 11 184 days after implementation of the new payment methodology
187187 12 as follows:
188188 13 (A) For a facility that would receive a lower nursing
189189 14 component rate per patient day under the new system than
190190 15 the facility received effective on the date immediately
191191 16 preceding the date that the Department implements the new
192192 17 payment methodology, the nursing component rate per
193193 18 patient day for the facility shall be held at the level in
194194 19 effect on the date immediately preceding the date that the
195195 20 Department implements the new payment methodology until a
196196 21 higher nursing component rate of reimbursement is achieved
197197 22 by that facility.
198198 23 (B) For a facility that would receive a higher nursing
199199 24 component rate per patient day under the payment
200200 25 methodology in effect on July 1, 2003 than the facility
201201 26 received effective on the date immediately preceding the
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212212 1 date that the Department implements the new payment
213213 2 methodology, the nursing component rate per patient day
214214 3 for the facility shall be adjusted.
215215 4 (C) Notwithstanding paragraphs (A) and (B), the
216216 5 nursing component rate per patient day for the facility
217217 6 shall be adjusted subject to appropriations provided by
218218 7 the General Assembly.
219219 8 For facilities licensed by the Department of Public Health
220220 9 under the Nursing Home Care Act as Intermediate Care for the
221221 10 Developmentally Disabled facilities or Long Term Care for
222222 11 Under Age 22 facilities, the rates taking effect on March 1,
223223 12 2001 shall include a statewide increase of 7.85%, as defined
224224 13 by the Department.
225225 14 Notwithstanding any other provision of this Section, for
226226 15 facilities licensed by the Department of Public Health under
227227 16 the Nursing Home Care Act as skilled nursing facilities or
228228 17 intermediate care facilities, except facilities participating
229229 18 in the Department's demonstration program pursuant to the
230230 19 provisions of Title 77, Part 300, Subpart T of the Illinois
231231 20 Administrative Code, the numerator of the ratio used by the
232232 21 Department of Healthcare and Family Services to compute the
233233 22 rate payable under this Section using the Minimum Data Set
234234 23 (MDS) methodology shall incorporate the following annual
235235 24 amounts as the additional funds appropriated to the Department
236236 25 specifically to pay for rates based on the MDS nursing
237237 26 component methodology in excess of the funding in effect on
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248248 1 December 31, 2006:
249249 2 (i) For rates taking effect January 1, 2007,
250250 3 $60,000,000.
251251 4 (ii) For rates taking effect January 1, 2008,
252252 5 $110,000,000.
253253 6 (iii) For rates taking effect January 1, 2009,
254254 7 $194,000,000.
255255 8 (iv) For rates taking effect April 1, 2011, or the
256256 9 first day of the month that begins at least 45 days after
257257 10 February 16, 2011 (the effective date of Public Act
258258 11 96-1530), $416,500,000 or an amount as may be necessary to
259259 12 complete the transition to the MDS methodology for the
260260 13 nursing component of the rate. Increased payments under
261261 14 this item (iv) are not due and payable, however, until (i)
262262 15 the methodologies described in this paragraph are approved
263263 16 by the federal government in an appropriate State Plan
264264 17 amendment and (ii) the assessment imposed by Section 5B-2
265265 18 of this Code is determined to be a permissible tax under
266266 19 Title XIX of the Social Security Act.
267267 20 Notwithstanding any other provision of this Section, for
268268 21 facilities licensed by the Department of Public Health under
269269 22 the Nursing Home Care Act as skilled nursing facilities or
270270 23 intermediate care facilities, the support component of the
271271 24 rates taking effect on January 1, 2008 shall be computed using
272272 25 the most recent cost reports on file with the Department of
273273 26 Healthcare and Family Services no later than April 1, 2005,
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284284 1 updated for inflation to January 1, 2006.
285285 2 For facilities licensed by the Department of Public Health
286286 3 under the Nursing Home Care Act as Intermediate Care for the
287287 4 Developmentally Disabled facilities or Long Term Care for
288288 5 Under Age 22 facilities, the rates taking effect on April 1,
289289 6 2002 shall include a statewide increase of 2.0%, as defined by
290290 7 the Department. This increase terminates on July 1, 2002;
291291 8 beginning July 1, 2002 these rates are reduced to the level of
292292 9 the rates in effect on March 31, 2002, as defined by the
293293 10 Department.
294294 11 For facilities licensed by the Department of Public Health
295295 12 under the Nursing Home Care Act as skilled nursing facilities
296296 13 or intermediate care facilities, the rates taking effect on
297297 14 July 1, 2001 shall be computed using the most recent cost
298298 15 reports on file with the Department of Public Aid no later than
299299 16 April 1, 2000, updated for inflation to January 1, 2001. For
300300 17 rates effective July 1, 2001 only, rates shall be the greater
301301 18 of the rate computed for July 1, 2001 or the rate effective on
302302 19 June 30, 2001.
303303 20 Notwithstanding any other provision of this Section, for
304304 21 facilities licensed by the Department of Public Health under
305305 22 the Nursing Home Care Act as skilled nursing facilities or
306306 23 intermediate care facilities, the Illinois Department shall
307307 24 determine by rule the rates taking effect on July 1, 2002,
308308 25 which shall be 5.9% less than the rates in effect on June 30,
309309 26 2002.
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320320 1 Notwithstanding any other provision of this Section, for
321321 2 facilities licensed by the Department of Public Health under
322322 3 the Nursing Home Care Act as skilled nursing facilities or
323323 4 intermediate care facilities, if the payment methodologies
324324 5 required under Section 5A-12 and the waiver granted under 42
325325 6 CFR 433.68 are approved by the United States Centers for
326326 7 Medicare and Medicaid Services, the rates taking effect on
327327 8 July 1, 2004 shall be 3.0% greater than the rates in effect on
328328 9 June 30, 2004. These rates shall take effect only upon
329329 10 approval and implementation of the payment methodologies
330330 11 required under Section 5A-12.
331331 12 Notwithstanding any other provisions of this Section, for
332332 13 facilities licensed by the Department of Public Health under
333333 14 the Nursing Home Care Act as skilled nursing facilities or
334334 15 intermediate care facilities, the rates taking effect on
335335 16 January 1, 2005 shall be 3% more than the rates in effect on
336336 17 December 31, 2004.
337337 18 Notwithstanding any other provision of this Section, for
338338 19 facilities licensed by the Department of Public Health under
339339 20 the Nursing Home Care Act as skilled nursing facilities or
340340 21 intermediate care facilities, effective January 1, 2009, the
341341 22 per diem support component of the rates effective on January
342342 23 1, 2008, computed using the most recent cost reports on file
343343 24 with the Department of Healthcare and Family Services no later
344344 25 than April 1, 2005, updated for inflation to January 1, 2006,
345345 26 shall be increased to the amount that would have been derived
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356356 1 using standard Department of Healthcare and Family Services
357357 2 methods, procedures, and inflators.
358358 3 Notwithstanding any other provisions of this Section, for
359359 4 facilities licensed by the Department of Public Health under
360360 5 the Nursing Home Care Act as intermediate care facilities that
361361 6 are federally defined as Institutions for Mental Disease, or
362362 7 facilities licensed by the Department of Public Health under
363363 8 the Specialized Mental Health Rehabilitation Act of 2013, a
364364 9 socio-development component rate equal to 6.6% of the
365365 10 facility's nursing component rate as of January 1, 2006 shall
366366 11 be established and paid effective July 1, 2006. The
367367 12 socio-development component of the rate shall be increased by
368368 13 a factor of 2.53 on the first day of the month that begins at
369369 14 least 45 days after January 11, 2008 (the effective date of
370370 15 Public Act 95-707). As of August 1, 2008, the
371371 16 socio-development component rate shall be equal to 6.6% of the
372372 17 facility's nursing component rate as of January 1, 2006,
373373 18 multiplied by a factor of 3.53. For services provided on or
374374 19 after April 1, 2011, or the first day of the month that begins
375375 20 at least 45 days after February 16, 2011 (the effective date of
376376 21 Public Act 96-1530), whichever is later, the Illinois
377377 22 Department may by rule adjust these socio-development
378378 23 component rates, and may use different adjustment
379379 24 methodologies for those facilities participating, and those
380380 25 not participating, in the Illinois Department's demonstration
381381 26 program pursuant to the provisions of Title 77, Part 300,
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392392 1 Subpart T of the Illinois Administrative Code, but in no case
393393 2 may such rates be diminished below those in effect on August 1,
394394 3 2008.
395395 4 For facilities licensed by the Department of Public Health
396396 5 under the Nursing Home Care Act as Intermediate Care for the
397397 6 Developmentally Disabled facilities or as long-term care
398398 7 facilities for residents under 22 years of age, the rates
399399 8 taking effect on July 1, 2003 shall include a statewide
400400 9 increase of 4%, as defined by the Department.
401401 10 For facilities licensed by the Department of Public Health
402402 11 under the Nursing Home Care Act as Intermediate Care for the
403403 12 Developmentally Disabled facilities or Long Term Care for
404404 13 Under Age 22 facilities, the rates taking effect on the first
405405 14 day of the month that begins at least 45 days after January 11,
406406 15 2008 (the effective date of Public Act 95-707) shall include a
407407 16 statewide increase of 2.5%, as defined by the Department.
408408 17 Notwithstanding any other provision of this Section, for
409409 18 facilities licensed by the Department of Public Health under
410410 19 the Nursing Home Care Act as skilled nursing facilities or
411411 20 intermediate care facilities, effective January 1, 2005,
412412 21 facility rates shall be increased by the difference between
413413 22 (i) a facility's per diem property, liability, and malpractice
414414 23 insurance costs as reported in the cost report filed with the
415415 24 Department of Public Aid and used to establish rates effective
416416 25 July 1, 2001 and (ii) those same costs as reported in the
417417 26 facility's 2002 cost report. These costs shall be passed
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428428 1 through to the facility without caps or limitations, except
429429 2 for adjustments required under normal auditing procedures.
430430 3 Rates established effective each July 1 shall govern
431431 4 payment for services rendered throughout that fiscal year,
432432 5 except that rates established on July 1, 1996 shall be
433433 6 increased by 6.8% for services provided on or after January 1,
434434 7 1997. Such rates will be based upon the rates calculated for
435435 8 the year beginning July 1, 1990, and for subsequent years
436436 9 thereafter until June 30, 2001 shall be based on the facility
437437 10 cost reports for the facility fiscal year ending at any point
438438 11 in time during the previous calendar year, updated to the
439439 12 midpoint of the rate year. The cost report shall be on file
440440 13 with the Department no later than April 1 of the current rate
441441 14 year. Should the cost report not be on file by April 1, the
442442 15 Department shall base the rate on the latest cost report filed
443443 16 by each skilled care facility and intermediate care facility,
444444 17 updated to the midpoint of the current rate year. In
445445 18 determining rates for services rendered on and after July 1,
446446 19 1985, fixed time shall not be computed at less than zero. The
447447 20 Department shall not make any alterations of regulations which
448448 21 would reduce any component of the Medicaid rate to a level
449449 22 below what that component would have been utilizing in the
450450 23 rate effective on July 1, 1984.
451451 24 (2) Shall take into account the actual costs incurred by
452452 25 facilities in providing services for recipients of skilled
453453 26 nursing and intermediate care services under the medical
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464464 1 assistance program.
465465 2 (3) Shall take into account the medical and psycho-social
466466 3 characteristics and needs of the patients.
467467 4 (4) Shall take into account the actual costs incurred by
468468 5 facilities in meeting licensing and certification standards
469469 6 imposed and prescribed by the State of Illinois, any of its
470470 7 political subdivisions or municipalities and by the U.S.
471471 8 Department of Health and Human Services pursuant to Title XIX
472472 9 of the Social Security Act.
473473 10 The Department of Healthcare and Family Services shall
474474 11 develop precise standards for payments to reimburse nursing
475475 12 facilities for any utilization of appropriate rehabilitative
476476 13 personnel for the provision of rehabilitative services which
477477 14 is authorized by federal regulations, including reimbursement
478478 15 for services provided by qualified therapists or qualified
479479 16 assistants, and which is in accordance with accepted
480480 17 professional practices. Reimbursement also may be made for
481481 18 utilization of other supportive personnel under appropriate
482482 19 supervision.
483483 20 The Department shall develop enhanced payments to offset
484484 21 the additional costs incurred by a facility serving
485485 22 exceptional need residents and shall allocate at least
486486 23 $4,000,000 of the funds collected from the assessment
487487 24 established by Section 5B-2 of this Code for such payments.
488488 25 For the purpose of this Section, "exceptional needs" means,
489489 26 but need not be limited to, ventilator care and traumatic
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500500 1 brain injury care. The enhanced payments for exceptional need
501501 2 residents under this paragraph are not due and payable,
502502 3 however, until (i) the methodologies described in this
503503 4 paragraph are approved by the federal government in an
504504 5 appropriate State Plan amendment and (ii) the assessment
505505 6 imposed by Section 5B-2 of this Code is determined to be a
506506 7 permissible tax under Title XIX of the Social Security Act.
507507 8 Beginning January 1, 2014 the methodologies for
508508 9 reimbursement of nursing facility services as provided under
509509 10 this Section 5-5.4 shall no longer be applicable for services
510510 11 provided on or after January 1, 2014.
511511 12 No payment increase under this Section for the MDS
512512 13 methodology, exceptional care residents, or the
513513 14 socio-development component rate established by Public Act
514514 15 96-1530 of the 96th General Assembly and funded by the
515515 16 assessment imposed under Section 5B-2 of this Code shall be
516516 17 due and payable until after the Department notifies the
517517 18 long-term care providers, in writing, that the payment
518518 19 methodologies to long-term care providers required under this
519519 20 Section have been approved by the Centers for Medicare and
520520 21 Medicaid Services of the U.S. Department of Health and Human
521521 22 Services and the waivers under 42 CFR 433.68 for the
522522 23 assessment imposed by this Section, if necessary, have been
523523 24 granted by the Centers for Medicare and Medicaid Services of
524524 25 the U.S. Department of Health and Human Services. Upon
525525 26 notification to the Department of approval of the payment
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536536 1 methodologies required under this Section and the waivers
537537 2 granted under 42 CFR 433.68, all increased payments otherwise
538538 3 due under this Section prior to the date of notification shall
539539 4 be due and payable within 90 days of the date federal approval
540540 5 is received.
541541 6 On and after July 1, 2012, the Department shall reduce any
542542 7 rate of reimbursement for services or other payments or alter
543543 8 any methodologies authorized by this Code to reduce any rate
544544 9 of reimbursement for services or other payments in accordance
545545 10 with Section 5-5e.
546546 11 For facilities licensed by the Department of Public Health
547547 12 under the ID/DD Community Care Act as ID/DD Facilities and
548548 13 under the MC/DD Act as MC/DD Facilities, subject to federal
549549 14 approval, the rates taking effect for services delivered on or
550550 15 after August 1, 2019 shall be increased by 3.5% over the rates
551551 16 in effect on June 30, 2019. The Department shall adopt rules,
552552 17 including emergency rules under subsection (ii) of Section
553553 18 5-45 of the Illinois Administrative Procedure Act, to
554554 19 implement the provisions of this Section, including wage
555555 20 increases for direct care staff.
556556 21 For facilities licensed by the Department of Public Health
557557 22 under the ID/DD Community Care Act as ID/DD Facilities and
558558 23 under the MC/DD Act as MC/DD Facilities, subject to federal
559559 24 approval, the rates taking effect on the latter of the
560560 25 approval date of the State Plan Amendment for these facilities
561561 26 or the Waiver Amendment for the home and community-based
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572572 1 services settings shall include an increase sufficient to
573573 2 provide a $0.26 per hour wage increase to the base wage for
574574 3 non-executive staff. The Department shall adopt rules,
575575 4 including emergency rules as authorized by Section 5-45 of the
576576 5 Illinois Administrative Procedure Act, to implement the
577577 6 provisions of this Section, including wage increases for
578578 7 direct care staff.
579579 8 For facilities licensed by the Department of Public Health
580580 9 under the ID/DD Community Care Act as ID/DD Facilities and
581581 10 under the MC/DD Act as MC/DD Facilities, subject to federal
582582 11 approval of the State Plan Amendment and the Waiver Amendment
583583 12 for the home and community-based services settings, the rates
584584 13 taking effect for the services delivered on or after July 1,
585585 14 2020 shall include an increase sufficient to provide a $1.00
586586 15 per hour wage increase for non-executive staff. For services
587587 16 delivered on or after January 1, 2021, subject to federal
588588 17 approval of the State Plan Amendment and the Waiver Amendment
589589 18 for the home and community-based services settings, shall
590590 19 include an increase sufficient to provide a $0.50 per hour
591591 20 increase for non-executive staff. The Department shall adopt
592592 21 rules, including emergency rules as authorized by Section 5-45
593593 22 of the Illinois Administrative Procedure Act, to implement the
594594 23 provisions of this Section, including wage increases for
595595 24 direct care staff.
596596 25 For facilities licensed by the Department of Public Health
597597 26 under the ID/DD Community Care Act as ID/DD Facilities and
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608608 1 under the MC/DD Act as MC/DD Facilities, subject to federal
609609 2 approval of the State Plan Amendment, the rates taking effect
610610 3 for the residential services delivered on or after July 1,
611611 4 2021, shall include an increase sufficient to provide a $0.50
612612 5 per hour increase for aides in the rate methodology. For
613613 6 facilities licensed by the Department of Public Health under
614614 7 the ID/DD Community Care Act as ID/DD Facilities and under the
615615 8 MC/DD Act as MC/DD Facilities, subject to federal approval of
616616 9 the State Plan Amendment, the rates taking effect for the
617617 10 residential services delivered on or after January 1, 2022
618618 11 shall include an increase sufficient to provide a $1.00 per
619619 12 hour increase for aides in the rate methodology. In addition,
620620 13 for residential services delivered on or after January 1, 2022
621621 14 such rates shall include an increase sufficient to provide
622622 15 wages for all residential non-executive direct care staff,
623623 16 excluding aides, at the federal Department of Labor, Bureau of
624624 17 Labor Statistics' average wage as defined in rule by the
625625 18 Department. The Department shall adopt rules, including
626626 19 emergency rules as authorized by Section 5-45 of the Illinois
627627 20 Administrative Procedure Act, to implement the provisions of
628628 21 this Section.
629629 22 For facilities licensed by the Department of Public Health
630630 23 under the ID/DD Community Care Act as ID/DD facilities and
631631 24 under the MC/DD Act as MC/DD facilities, subject to federal
632632 25 approval of the State Plan Amendment, the rates taking effect
633633 26 for services delivered on or after January 1, 2023, shall
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644644 1 include a $1.00 per hour wage increase for all direct support
645645 2 personnel and all other frontline personnel who are not
646646 3 subject to the Bureau of Labor Statistics' average wage
647647 4 increases, who work in residential and community day services
648648 5 settings, with at least $0.50 of those funds to be provided as
649649 6 a direct increase to all aide base wages, with the remaining
650650 7 $0.50 to be used flexibly for base wage increases to the rate
651651 8 methodology for aides. In addition, for residential services
652652 9 delivered on or after January 1, 2023 the rates shall include
653653 10 an increase sufficient to provide wages for all residential
654654 11 non-executive direct care staff, excluding aides, at the
655655 12 federal Department of Labor, Bureau of Labor Statistics'
656656 13 average wage as determined by the Department. Also, for
657657 14 services delivered on or after January 1, 2023, the rates will
658658 15 include adjustments to employment-related expenses as defined
659659 16 in rule by the Department. The Department shall adopt rules,
660660 17 including emergency rules as authorized by Section 5-45 of the
661661 18 Illinois Administrative Procedure Act, to implement the
662662 19 provisions of this Section.
663663 20 For facilities licensed by the Department of Public Health
664664 21 under the ID/DD Community Care Act as ID/DD facilities and
665665 22 under the MC/DD Act as MC/DD facilities, subject to federal
666666 23 approval of the State Plan Amendment, the rates taking effect
667667 24 for services delivered on or after January 1, 2024 shall
668668 25 include a $2.50 per hour wage increase for all direct support
669669 26 personnel and all other frontline personnel who are not
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680680 1 subject to the Bureau of Labor Statistics' average wage
681681 2 increases and who work in residential and community day
682682 3 services settings. At least $1.25 of the per hour wage
683683 4 increase shall be provided as a direct increase to all aide
684684 5 base wages, and the remaining $1.25 of the per hour wage
685685 6 increase shall be used flexibly for base wage increases to the
686686 7 rate methodology for aides. In addition, for residential
687687 8 services delivered on or after January 1, 2024, the rates
688688 9 shall include an increase sufficient to provide wages for all
689689 10 residential non-executive direct care staff, excluding aides,
690690 11 at the federal Department of Labor, Bureau of Labor
691691 12 Statistics' average wage as determined by the Department.
692692 13 Also, for services delivered on or after January 1, 2024, the
693693 14 rates will include adjustments to employment-related expenses
694694 15 as defined in rule by the Department. The Department shall
695695 16 adopt rules, including emergency rules as authorized by
696696 17 Section 5-45 of the Illinois Administrative Procedure Act, to
697697 18 implement the provisions of this Section.
698698 19 For facilities licensed by the Department of Public Health
699699 20 under the ID/DD Community Care Act as ID/DD facilities and
700700 21 under the MC/DD Act as MC/DD facilities, subject to federal
701701 22 approval of a State Plan Amendment, the rates taking effect
702702 23 for services delivered on or after January 1, 2025 shall
703703 24 include a $1.00 per hour wage increase for all direct support
704704 25 personnel and all other frontline personnel who are not
705705 26 subject to the Bureau of Labor Statistics' average wage
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716716 1 increases and who work in residential and community day
717717 2 services settings, with at least $0.75 of those funds to be
718718 3 provided as a direct increase to all aide base wages and the
719719 4 remaining $0.25 to be used flexibly for base wage increases to
720720 5 the rate methodology for aides. These increases shall not be
721721 6 used by facilities for operational and administrative
722722 7 expenses. In addition, for residential services delivered on
723723 8 or after January 1, 2025, the rates shall include an increase
724724 9 sufficient to provide wages for all residential non-executive
725725 10 direct care staff, excluding aides, at the federal Department
726726 11 of Labor, Bureau of Labor Statistics' average wage as
727727 12 determined by the Department. Also, for services delivered on
728728 13 or after January 1, 2025, the rates will include adjustments
729729 14 to employment-related expenses as defined in rule by the
730730 15 Department. The Department shall adopt rules, including
731731 16 emergency rules as authorized by Section 5-45 of the Illinois
732732 17 Administrative Procedure Act, to implement the provisions of
733733 18 this Section.
734734 19 Notwithstanding any other provision of this Section to the
735735 20 contrary, any regional wage adjuster for facilities located
736736 21 outside of the counties of Cook, DuPage, Kane, Lake, McHenry,
737737 22 and Will shall be no lower than 1.00, and any regional wage
738738 23 adjuster for facilities located within the counties of Cook,
739739 24 DuPage, Kane, Lake, McHenry, and Will shall be no lower than
740740 25 1.15.
741741 26 (5) For dates of service starting July 1, 2025,
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752752 1 reimbursement calculations and direct payment for services
753753 2 provided by facilities licensed under the ID/DD Community Care
754754 3 Act are the responsibility of the Department of Healthcare and
755755 4 Family Services instead of the Department of Human Services.
756756 5 Appropriations for the facilities licensed under the ID/DD
757757 6 Community Care Act must be shifted from the Department of
758758 7 Human Services to the Department of Healthcare and Family
759759 8 Services. Nothing in this Section shall prohibit the
760760 9 Department of Healthcare and Family Services from paying more
761761 10 than the rates specified in this Section. The rates in this
762762 11 Section must be interpreted as a minimum amount.
763763 12 (6) Beginning on the effective date of this amendatory Act
764764 13 of the 104th General Assembly, the Department of Healthcare
765765 14 and Family Services shall work with the Department of Human
766766 15 Services to study and review the reimbursement calculations
767767 16 and direct payments for facilities licensed under the ID/DD
768768 17 Community Care Act and for facilities licensed under the MC/DD
769769 18 Act. This work shall include requesting any cost reports and
770770 19 rate information directly from the facilities as needed.
771771 20 (Source: P.A. 102-16, eff. 6-17-21; 102-699, eff. 4-19-22;
772772 21 103-8, eff. 6-7-23; 103-588, eff. 7-1-24.)
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