Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1490 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 SB1490 Introduced 1/31/2025, by Sen. Mary Edly-Allen SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning PDPM STRIVE staffing ratio calculations for nursing facilities, provides that beginning January 1, 2025, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio which equals: its Reported Total Nurse Staffing Hours Per Resident Per Day as published in the most recent federal staffing report (the Provider Information file), divided by the facility's PDPM STRIVE Staffing Target. Provides that each facility's PDPM STRIVE Staffing Target is equal to .76 times the facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day. Provides that a facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day is equal to its Nursing Case-Mix (as published in the most recent federal Provider Information file) divided by 1.4627 times 3.79 (which is the Reported Total Nurse Staffing Hours Per Resident Per Day for the Nation as reported in the January 2024 State US Averages file). Effective July 1, 2025. LRB104 09237 KTG 19294 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1490 Introduced 1/31/2025, by Sen. Mary Edly-Allen SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning PDPM STRIVE staffing ratio calculations for nursing facilities, provides that beginning January 1, 2025, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio which equals: its Reported Total Nurse Staffing Hours Per Resident Per Day as published in the most recent federal staffing report (the Provider Information file), divided by the facility's PDPM STRIVE Staffing Target. Provides that each facility's PDPM STRIVE Staffing Target is equal to .76 times the facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day. Provides that a facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day is equal to its Nursing Case-Mix (as published in the most recent federal Provider Information file) divided by 1.4627 times 3.79 (which is the Reported Total Nurse Staffing Hours Per Resident Per Day for the Nation as reported in the January 2024 State US Averages file). Effective July 1, 2025. LRB104 09237 KTG 19294 b LRB104 09237 KTG 19294 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1490 Introduced 1/31/2025, by Sen. Mary Edly-Allen 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 provisions concerning PDPM STRIVE staffing ratio calculations for nursing facilities, provides that beginning January 1, 2025, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio which equals: its Reported Total Nurse Staffing Hours Per Resident Per Day as published in the most recent federal staffing report (the Provider Information file), divided by the facility's PDPM STRIVE Staffing Target. Provides that each facility's PDPM STRIVE Staffing Target is equal to .76 times the facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day. Provides that a facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day is equal to its Nursing Case-Mix (as published in the most recent federal Provider Information file) divided by 1.4627 times 3.79 (which is the Reported Total Nurse Staffing Hours Per Resident Per Day for the Nation as reported in the January 2024 State US Averages file). Effective July 1, 2025.
6	6	LRB104 09237 KTG 19294 b LRB104 09237 KTG 19294 b
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8	8	A BILL FOR
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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, the implementation date of the PDPM
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37	37	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1490 Introduced 1/31/2025, by Sen. Mary Edly-Allen 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 provisions concerning PDPM STRIVE staffing ratio calculations for nursing facilities, provides that beginning January 1, 2025, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio which equals: its Reported Total Nurse Staffing Hours Per Resident Per Day as published in the most recent federal staffing report (the Provider Information file), divided by the facility's PDPM STRIVE Staffing Target. Provides that each facility's PDPM STRIVE Staffing Target is equal to .76 times the facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day. Provides that a facility's Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day is equal to its Nursing Case-Mix (as published in the most recent federal Provider Information file) divided by 1.4627 times 3.79 (which is the Reported Total Nurse Staffing Hours Per Resident Per Day for the Nation as reported in the January 2024 State US Averages file). Effective July 1, 2025.
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43	43	A BILL FOR
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49	49	305 ILCS 5/5-5.2
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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 Provider Information file staffing
151	151	12 report) times 3.662 (which reflects the national resident
152	152	13 days-weighted mean Reported Total Nurse Staffing Hours Per
153	153	14 Resident Per Day as calculated using the January 2024
154	154	15 federal Provider Information Files), divided by the
155	155	16 national resident days-weighted mean Reported Total Nurse
156	156	17 Staffing Hours Per Resident Per Day calculated using the
157	157	18 most recent State US Averages file federal Provider
158	158	19 Information File.
159	159	20 Beginning July 1, 2025, the staffing percentage used
160	160	21 in the calculation of the per diem staffing add-on shall
161	161	22 be its PDPM STRIVE Staffing Ratio which equals: its
162	162	23 Reported Total Nurse Staffing Hours Per Resident Per Day
163	163	24 as published in the most recent federal staffing report
164	164	25 (the Provider Information file), divided by the facility's
165	165	26 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
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176	176	1 Staffing Target is equal to .76 times the facility's
177	177	2 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
178	178	3 Day. A facility's Illinois Adjusted Facility Case-Mix
179	179	4 Hours Per Resident Per Day is equal to its Nursing
180	180	5 Case-Mix (as published in the most recent federal Provider
181	181	6 Information file) divided by 1.4627 times 3.79 (which is
182	182	7 the Reported Total Nurse Staffing Hours Per Resident Per
183	183	8 Day for the Nation as reported in the January 2024 State US
184	184	9 Averages file).
185	185	10 (6.5) Beginning July 1, 2024, the paid per diem
186	186	11 staffing add-on shall be the paid per diem staffing add-on
187	187	12 in effect April 1, 2024. For dates beginning October 1,
188	188	13 2024 and through September 30, 2025, the denominator for
189	189	14 the staffing percentage shall be the lesser of the
190	190	15 facility's PDPM STRIVE Staffing Target and:
191	191	16 (A) For the quarter beginning October 1, 2024, the
192	192	17 sum of 20% of the facility's PDPM STRIVE Staffing
193	193	18 Target and 80% of the facility's Case-Mix Total Nurse
194	194	19 Staffing Hours Per Resident Per Day (as published in
195	195	20 the January 2024 federal staffing report).
196	196	21 (B) For the quarter beginning January 1, 2025, the
197	197	22 sum of 40% of the facility's PDPM STRIVE Staffing
198	198	23 Target and 60% of the facility's Case-Mix Total Nurse
199	199	24 Staffing Hours Per Resident Per Day (as published in
200	200	25 the January 2024 federal staffing report).
201	201	26 (C) For the quarter beginning March 1, 2025, the
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212	212	1 sum of 60% of the facility's PDPM STRIVE Staffing
213	213	2 Target and 40% of the facility's Case-Mix Total Nurse
214	214	3 Staffing Hours Per Resident Per Day (as published in
215	215	4 the January 2024 federal staffing report).
216	216	5 (D) For the quarter beginning July 1, 2025, the
217	217	6 sum of 80% of the facility's PDPM STRIVE Staffing
218	218	7 Target and 20% of the facility's Case-Mix Total Nurse
219	219	8 Staffing Hours Per Resident Per Day (as published in
220	220	9 the January 2024 federal staffing report).
221	221	10 Facilities with at least 70% of the staffing
222	222	11 indicated by the STRIVE study shall be paid a per diem
223	223	12 add-on of $9, increasing by equivalent steps for each
224	224	13 whole percentage point until the facilities reach a per
225	225	14 diem of $16.52. Facilities with at least 80% of the
226	226	15 staffing indicated by the STRIVE study shall be paid a per
227	227	16 diem add-on of $16.52, increasing by equivalent steps for
228	228	17 each whole percentage point until the facilities reach a
229	229	18 per diem add-on of $25.77. Facilities with at least 92% of
230	230	19 the staffing indicated by the STRIVE study shall be paid a
231	231	20 per diem add-on of $25.77, increasing by equivalent steps
232	232	21 for each whole percentage point until the facilities reach
233	233	22 a per diem add-on of $30.98. Facilities with at least 100%
234	234	23 of the staffing indicated by the STRIVE study shall be
235	235	24 paid a per diem add-on of $30.98, increasing by equivalent
236	236	25 steps for each whole percentage point until the facilities
237	237	26 reach a per diem add-on of $36.44. Facilities with at
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248	248	1 least 110% of the staffing indicated by the STRIVE study
249	249	2 shall be paid a per diem add-on of $36.44, increasing by
250	250	3 equivalent steps for each whole percentage point until the
251	251	4 facilities reach a per diem add-on of $38.68. Facilities
252	252	5 with at least 125% or higher of the staffing indicated by
253	253	6 the STRIVE study shall be paid a per diem add-on of $38.68.
254	254	7 No nursing facility's variable staffing per diem add-on
255	255	8 shall be reduced by more than 5% in 2 consecutive
256	256	9 quarters. For the quarters beginning July 1, 2022 and
257	257	10 October 1, 2022, no facility's variable per diem staffing
258	258	11 add-on shall be calculated at a rate lower than 85% of the
259	259	12 staffing indicated by the STRIVE study. No facility below
260	260	13 70% of the staffing indicated by the STRIVE study shall
261	261	14 receive a variable per diem staffing add-on after December
262	262	15 31, 2022.
263	263	16 (7) For dates of services beginning July 1, 2022, the
264	264	17 PDPM nursing component per diem for each nursing facility
265	265	18 shall be the product of the facility's (i) statewide PDPM
266	266	19 nursing base per diem rate, $92.25, adjusted for the
267	267	20 facility average PDPM case mix index calculated quarterly
268	268	21 and (ii) the regional wage adjuster, and then add the
269	269	22 Medicaid access adjustment as defined in (e-3) of this
270	270	23 Section. Transition rates for services provided between
271	271	24 July 1, 2022 and October 1, 2023 shall be the greater of
272	272	25 the PDPM nursing component per diem or:
273	273	26 (A) for the quarter beginning July 1, 2022, the
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284	284	1 RUG-IV nursing component per diem;
285	285	2 (B) for the quarter beginning October 1, 2022, the
286	286	3 sum of the RUG-IV nursing component per diem
287	287	4 multiplied by 0.80 and the PDPM nursing component per
288	288	5 diem multiplied by 0.20;
289	289	6 (C) for the quarter beginning January 1, 2023, the
290	290	7 sum of the RUG-IV nursing component per diem
291	291	8 multiplied by 0.60 and the PDPM nursing component per
292	292	9 diem multiplied by 0.40;
293	293	10 (D) for the quarter beginning April 1, 2023, the
294	294	11 sum of the RUG-IV nursing component per diem
295	295	12 multiplied by 0.40 and the PDPM nursing component per
296	296	13 diem multiplied by 0.60;
297	297	14 (E) for the quarter beginning July 1, 2023, the
298	298	15 sum of the RUG-IV nursing component per diem
299	299	16 multiplied by 0.20 and the PDPM nursing component per
300	300	17 diem multiplied by 0.80; or
301	301	18 (F) for the quarter beginning October 1, 2023 and
302	302	19 each subsequent quarter, the transition rate shall end
303	303	20 and a nursing facility shall be paid 100% of the PDPM
304	304	21 nursing component per diem.
305	305	22 (d-1) Calculation of base year Statewide RUG-IV nursing
306	306	23 base per diem rate.
307	307	24 (1) Base rate spending pool shall be:
308	308	25 (A) The base year resident days which are
309	309	26 calculated by multiplying the number of Medicaid
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320	320	1 residents in each nursing home as indicated in the MDS
321	321	2 data defined in paragraph (4) by 365.
322	322	3 (B) Each facility's nursing component per diem in
323	323	4 effect on July 1, 2012 shall be multiplied by
324	324	5 subsection (A).
325	325	6 (C) Thirteen million is added to the product of
326	326	7 subparagraph (A) and subparagraph (B) to adjust for
327	327	8 the exclusion of nursing homes defined in paragraph
328	328	9 (5).
329	329	10 (2) For each nursing home with Medicaid residents as
330	330	11 indicated by the MDS data defined in paragraph (4),
331	331	12 weighted days adjusted for case mix and regional wage
332	332	13 adjustment shall be calculated. For each home this
333	333	14 calculation is the product of:
334	334	15 (A) Base year resident days as calculated in
335	335	16 subparagraph (A) of paragraph (1).
336	336	17 (B) The nursing home's regional wage adjustor
337	337	18 based on the Health Service Areas (HSA) groupings and
338	338	19 adjustors in effect on April 30, 2012.
339	339	20 (C) Facility weighted case mix which is the number
340	340	21 of Medicaid residents as indicated by the MDS data
341	341	22 defined in paragraph (4) multiplied by the associated
342	342	23 case weight for the RUG-IV 48 grouper model using
343	343	24 standard RUG-IV procedures for index maximization.
344	344	25 (D) The sum of the products calculated for each
345	345	26 nursing home in subparagraphs (A) through (C) above
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356	356	1 shall be the base year case mix, rate adjusted
357	357	2 weighted days.
358	358	3 (3) The Statewide RUG-IV nursing base per diem rate:
359	359	4 (A) on January 1, 2014 shall be the quotient of the
360	360	5 paragraph (1) divided by the sum calculated under
361	361	6 subparagraph (D) of paragraph (2);
362	362	7 (B) on and after July 1, 2014 and until July 1,
363	363	8 2022, shall be the amount calculated under
364	364	9 subparagraph (A) of this paragraph (3) plus $1.76; and
365	365	10 (C) beginning July 1, 2022 and thereafter, $7
366	366	11 shall be added to the amount calculated under
367	367	12 subparagraph (B) of this paragraph (3) of this
368	368	13 Section.
369	369	14 (4) Minimum Data Set (MDS) comprehensive assessments
370	370	15 for Medicaid residents on the last day of the quarter used
371	371	16 to establish the base rate.
372	372	17 (5) Nursing facilities designated as of July 1, 2012
373	373	18 by the Department as "Institutions for Mental Disease"
374	374	19 shall be excluded from all calculations under this
375	375	20 subsection. The data from these facilities shall not be
376	376	21 used in the computations described in paragraphs (1)
377	377	22 through (4) above to establish the base rate.
378	378	23 (e) Beginning July 1, 2014, the Department shall allocate
379	379	24 funding in the amount up to $10,000,000 for per diem add-ons to
380	380	25 the RUGS methodology for dates of service on and after July 1,
381	381	26 2014:
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392	392	1 (1) $0.63 for each resident who scores in I4200
393	393	2 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
394	394	3 (2) $2.67 for each resident who scores either a "1" or
395	395	4 "2" in any items S1200A through S1200I and also scores in
396	396	5 RUG groups PA1, PA2, BA1, or BA2.
397	397	6 (e-1) (Blank).
398	398	7 (e-2) For dates of services beginning January 1, 2014 and
399	399	8 ending September 30, 2023, the RUG-IV nursing component per
400	400	9 diem for a nursing home shall be the product of the statewide
401	401	10 RUG-IV nursing base per diem rate, the facility average case
402	402	11 mix index, and the regional wage adjustor. For dates of
403	403	12 service beginning July 1, 2022 and ending September 30, 2023,
404	404	13 the Medicaid access adjustment described in subsection (e-3)
405	405	14 shall be added to the product.
406	406	15 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
407	407	16 facility average PDPM case mix index calculated quarterly
408	408	17 shall be added to the statewide PDPM nursing per diem for all
409	409	18 facilities with annual Medicaid bed days of at least 70% of all
410	410	19 occupied bed days adjusted quarterly. For each new calendar
411	411	20 year and for the 6-month period beginning July 1, 2022, the
412	412	21 percentage of a facility's occupied bed days comprised of
413	413	22 Medicaid bed days shall be determined by the Department
414	414	23 quarterly. For dates of service beginning January 1, 2023, the
415	415	24 Medicaid Access Adjustment shall be increased to $4.75. This
416	416	25 subsection shall be inoperative on and after January 1, 2028.
417	417	26 (e-4) Subject to federal approval, on and after January 1,
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428	428	1 2024, the Department shall increase the rate add-on at
429	429	2 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
430	430	3 for ventilator services from $208 per day to $481 per day.
431	431	4 Payment is subject to the criteria and requirements under 89
432	432	5 Ill. Adm. Code 147.335.
433	433	6 (f) (Blank).
434	434	7 (g) Notwithstanding any other provision of this Code, on
435	435	8 and after July 1, 2012, for facilities not designated by the
436	436	9 Department of Healthcare and Family Services as "Institutions
437	437	10 for Mental Disease", rates effective May 1, 2011 shall be
438	438	11 adjusted as follows:
439	439	12 (1) (Blank);
440	440	13 (2) (Blank);
441	441	14 (3) Facility rates for the capital and support
442	442	15 components shall be reduced by 1.7%.
443	443	16 (h) Notwithstanding any other provision of this Code, on
444	444	17 and after July 1, 2012, nursing facilities designated by the
445	445	18 Department of Healthcare and Family Services as "Institutions
446	446	19 for Mental Disease" and "Institutions for Mental Disease" that
447	447	20 are facilities licensed under the Specialized Mental Health
448	448	21 Rehabilitation Act of 2013 shall have the nursing,
449	449	22 socio-developmental, capital, and support components of their
450	450	23 reimbursement rate effective May 1, 2011 reduced in total by
451	451	24 2.7%.
452	452	25 (i) On and after July 1, 2014, the reimbursement rates for
453	453	26 the support component of the nursing facility rate for
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464	464	1 facilities licensed under the Nursing Home Care Act as skilled
465	465	2 or intermediate care facilities shall be the rate in effect on
466	466	3 June 30, 2014 increased by 8.17%.
467	467	4 (i-1) Subject to federal approval, on and after January 1,
468	468	5 2024, the reimbursement rates for the support component of the
469	469	6 nursing facility rate for facilities licensed under the
470	470	7 Nursing Home Care Act as skilled or intermediate care
471	471	8 facilities shall be the rate in effect on June 30, 2023
472	472	9 increased by 12%.
473	473	10 (j) Notwithstanding any other provision of law, subject to
474	474	11 federal approval, effective July 1, 2019, sufficient funds
475	475	12 shall be allocated for changes to rates for facilities
476	476	13 licensed under the Nursing Home Care Act as skilled nursing
477	477	14 facilities or intermediate care facilities for dates of
478	478	15 services on and after July 1, 2019: (i) to establish, through
479	479	16 June 30, 2022 a per diem add-on to the direct care per diem
480	480	17 rate not to exceed $70,000,000 annually in the aggregate
481	481	18 taking into account federal matching funds for the purpose of
482	482	19 addressing the facility's unique staffing needs, adjusted
483	483	20 quarterly and distributed by a weighted formula based on
484	484	21 Medicaid bed days on the last day of the second quarter
485	485	22 preceding the quarter for which the rate is being adjusted.
486	486	23 Beginning July 1, 2022, the annual $70,000,000 described in
487	487	24 the preceding sentence shall be dedicated to the variable per
488	488	25 diem add-on for staffing under paragraph (6) of subsection
489	489	26 (d); and (ii) in an amount not to exceed $170,000,000 annually
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500	500	1 in the aggregate taking into account federal matching funds to
501	501	2 permit the support component of the nursing facility rate to
502	502	3 be updated as follows:
503	503	4 (1) 80%, or $136,000,000, of the funds shall be used
504	504	5 to update each facility's rate in effect on June 30, 2019
505	505	6 using the most recent cost reports on file, which have had
506	506	7 a limited review conducted by the Department of Healthcare
507	507	8 and Family Services and will not hold up enacting the rate
508	508	9 increase, with the Department of Healthcare and Family
509	509	10 Services.
510	510	11 (2) After completing the calculation in paragraph (1),
511	511	12 any facility whose rate is less than the rate in effect on
512	512	13 June 30, 2019 shall have its rate restored to the rate in
513	513	14 effect on June 30, 2019 from the 20% of the funds set
514	514	15 aside.
515	515	16 (3) The remainder of the 20%, or $34,000,000, shall be
516	516	17 used to increase each facility's rate by an equal
517	517	18 percentage.
518	518	19 (k) During the first quarter of State Fiscal Year 2020,
519	519	20 the Department of Healthcare of Family Services must convene a
520	520	21 technical advisory group consisting of members of all trade
521	521	22 associations representing Illinois skilled nursing providers
522	522	23 to discuss changes necessary with federal implementation of
523	523	24 Medicare's Patient-Driven Payment Model. Implementation of
524	524	25 Medicare's Patient-Driven Payment Model shall, by September 1,
525	525	26 2020, end the collection of the MDS data that is necessary to
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536	536	1 maintain the current RUG-IV Medicaid payment methodology. The
537	537	2 technical advisory group must consider a revised reimbursement
538	538	3 methodology that takes into account transparency,
539	539	4 accountability, actual staffing as reported under the
540	540	5 federally required Payroll Based Journal system, changes to
541	541	6 the minimum wage, adequacy in coverage of the cost of care, and
542	542	7 a quality component that rewards quality improvements.
543	543	8 (l) The Department shall establish per diem add-on
544	544	9 payments to improve the quality of care delivered by
545	545	10 facilities, including:
546	546	11 (1) Incentive payments determined by facility
547	547	12 performance on specified quality measures in an initial
548	548	13 amount of $70,000,000. Nothing in this subsection shall be
549	549	14 construed to limit the quality of care payments in the
550	550	15 aggregate statewide to $70,000,000, and, if quality of
551	551	16 care has improved across nursing facilities, the
552	552	17 Department shall adjust those add-on payments accordingly.
553	553	18 The quality payment methodology described in this
554	554	19 subsection must be used for at least State Fiscal Year
555	555	20 2023. Beginning with the quarter starting July 1, 2023,
556	556	21 the Department may add, remove, or change quality metrics
557	557	22 and make associated changes to the quality payment
558	558	23 methodology as outlined in subparagraph (E). Facilities
559	559	24 designated by the Centers for Medicare and Medicaid
560	560	25 Services as a special focus facility or a hospital-based
561	561	26 nursing home do not qualify for quality payments.
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572	572	1 (A) Each quality pool must be distributed by
573	573	2 assigning a quality weighted score for each nursing
574	574	3 home which is calculated by multiplying the nursing
575	575	4 home's quality base period Medicaid days by the
576	576	5 nursing home's star rating weight in that period.
577	577	6 (B) Star rating weights are assigned based on the
578	578	7 nursing home's star rating for the LTS quality star
579	579	8 rating. As used in this subparagraph, "LTS quality
580	580	9 star rating" means the long-term stay quality rating
581	581	10 for each nursing facility, as assigned by the Centers
582	582	11 for Medicare and Medicaid Services under the Five-Star
583	583	12 Quality Rating System. The rating is a number ranging
584	584	13 from 0 (lowest) to 5 (highest).
585	585	14 (i) Zero-star or one-star rating has a weight
586	586	15 of 0.
587	587	16 (ii) Two-star rating has a weight of 0.75.
588	588	17 (iii) Three-star rating has a weight of 1.5.
589	589	18 (iv) Four-star rating has a weight of 2.5.
590	590	19 (v) Five-star rating has a weight of 3.5.
591	591	20 (C) Each nursing home's quality weight score is
592	592	21 divided by the sum of all quality weight scores for
593	593	22 qualifying nursing homes to determine the proportion
594	594	23 of the quality pool to be paid to the nursing home.
595	595	24 (D) The quality pool is no less than $70,000,000
596	596	25 annually or $17,500,000 per quarter. The Department
597	597	26 shall publish on its website the estimated payments
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608	608	1 and the associated weights for each facility 45 days
609	609	2 prior to when the initial payments for the quarter are
610	610	3 to be paid. The Department shall assign each facility
611	611	4 the most recent and applicable quarter's STAR value
612	612	5 unless the facility notifies the Department within 15
613	613	6 days of an issue and the facility provides reasonable
614	614	7 evidence demonstrating its timely compliance with
615	615	8 federal data submission requirements for the quarter
616	616	9 of record. If such evidence cannot be provided to the
617	617	10 Department, the STAR rating assigned to the facility
618	618	11 shall be reduced by one from the prior quarter.
619	619	12 (E) The Department shall review quality metrics
620	620	13 used for payment of the quality pool and make
621	621	14 recommendations for any associated changes to the
622	622	15 methodology for distributing quality pool payments in
623	623	16 consultation with associations representing long-term
624	624	17 care providers, consumer advocates, organizations
625	625	18 representing workers of long-term care facilities, and
626	626	19 payors. The Department may establish, by rule, changes
627	627	20 to the methodology for distributing quality pool
628	628	21 payments.
629	629	22 (F) The Department shall disburse quality pool
630	630	23 payments from the Long-Term Care Provider Fund on a
631	631	24 monthly basis in amounts proportional to the total
632	632	25 quality pool payment determined for the quarter.
633	633	26 (G) The Department shall publish any changes in
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644	644	1 the methodology for distributing quality pool payments
645	645	2 prior to the beginning of the measurement period or
646	646	3 quality base period for any metric added to the
647	647	4 distribution's methodology.
648	648	5 (2) Payments based on CNA tenure, promotion, and CNA
649	649	6 training for the purpose of increasing CNA compensation.
650	650	7 It is the intent of this subsection that payments made in
651	651	8 accordance with this paragraph be directly incorporated
652	652	9 into increased compensation for CNAs. As used in this
653	653	10 paragraph, "CNA" means a certified nursing assistant as
654	654	11 that term is described in Section 3-206 of the Nursing
655	655	12 Home Care Act, Section 3-206 of the ID/DD Community Care
656	656	13 Act, and Section 3-206 of the MC/DD Act. The Department
657	657	14 shall establish, by rule, payments to nursing facilities
658	658	15 equal to Medicaid's share of the tenure wage increments
659	659	16 specified in this paragraph for all reported CNA employee
660	660	17 hours compensated according to a posted schedule
661	661	18 consisting of increments at least as large as those
662	662	19 specified in this paragraph. The increments are as
663	663	20 follows: an additional $1.50 per hour for CNAs with at
664	664	21 least one and less than 2 years' experience plus another
665	665	22 $1 per hour for each additional year of experience up to a
666	666	23 maximum of $6.50 for CNAs with at least 6 years of
667	667	24 experience. For purposes of this paragraph, Medicaid's
668	668	25 share shall be the ratio determined by paid Medicaid bed
669	669	26 days divided by total bed days for the applicable time
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680	680	1 period used in the calculation. In addition, and additive
681	681	2 to any tenure increments paid as specified in this
682	682	3 paragraph, the Department shall establish, by rule,
683	683	4 payments supporting Medicaid's share of the
684	684	5 promotion-based wage increments for CNA employee hours
685	685	6 compensated for that promotion with at least a $1.50
686	686	7 hourly increase. Medicaid's share shall be established as
687	687	8 it is for the tenure increments described in this
688	688	9 paragraph. Qualifying promotions shall be defined by the
689	689	10 Department in rules for an expected 10-15% subset of CNAs
690	690	11 assigned intermediate, specialized, or added roles such as
691	691	12 CNA trainers, CNA scheduling "captains", and CNA
692	692	13 specialists for resident conditions like dementia or
693	693	14 memory care or behavioral health.
694	694	15 (m) The Department shall work with nursing facility
695	695	16 industry representatives to design policies and procedures to
696	696	17 permit facilities to address the integrity of data from
697	697	18 federal reporting sites used by the Department in setting
698	698	19 facility rates.
699	699	20 (Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
700	700	21 102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
701	701	22 Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
702	702	23 Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
703	703	24 7-1-24.)
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