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Illinois Senate Bill SB1509

Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1509 Compare Versions

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11 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1509 Introduced 2/4/2025, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning Medicaid Access Adjustment payments to nursing facilities, provides that, for dates of service beginning July 1, 2025, the Medicaid Access Adjustment shall be increased to $5.75. Effective immediately. LRB104 08190 KTG 18240 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1509 Introduced 2/4/2025, by Sen. Sara Feigenholtz 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 Medicaid Access Adjustment payments to nursing facilities, provides that, for dates of service beginning July 1, 2025, the Medicaid Access Adjustment shall be increased to $5.75. Effective immediately. LRB104 08190 KTG 18240 b LRB104 08190 KTG 18240 b A BILL FOR
22 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1509 Introduced 2/4/2025, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
33 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
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55 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning Medicaid Access Adjustment payments to nursing facilities, provides that, for dates of service beginning July 1, 2025, the Medicaid Access Adjustment shall be increased to $5.75. Effective immediately.
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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 5-5.2 as follows:
1616 6 (305 ILCS 5/5-5.2)
1717 7 Sec. 5-5.2. Payment.
1818 8 (a) All nursing facilities that are grouped pursuant to
1919 9 Section 5-5.1 of this Act shall receive the same rate of
2020 10 payment for similar services.
2121 11 (b) It shall be a matter of State policy that the Illinois
2222 12 Department shall utilize a uniform billing cycle throughout
2323 13 the State for the long-term care providers.
2424 14 (c) (Blank).
2525 15 (c-1) Notwithstanding any other provisions of this Code,
2626 16 the methodologies for reimbursement of nursing services as
2727 17 provided under this Article shall no longer be applicable for
2828 18 bills payable for nursing services rendered on or after a new
2929 19 reimbursement system based on the Patient Driven Payment Model
3030 20 (PDPM) has been fully operationalized, which shall take effect
3131 21 for services provided on or after the implementation of the
3232 22 PDPM reimbursement system begins. For the purposes of Public
3333 23 Act 102-1035, the implementation date of the PDPM
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3737 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1509 Introduced 2/4/2025, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
3838 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
3939 305 ILCS 5/5-5.2
4040 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning Medicaid Access Adjustment payments to nursing facilities, provides that, for dates of service beginning July 1, 2025, the Medicaid Access Adjustment shall be increased to $5.75. Effective immediately.
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6868 1 reimbursement system and all related provisions shall be July
6969 2 1, 2022 if the following conditions are met: (i) the Centers
7070 3 for Medicare and Medicaid Services has approved corresponding
7171 4 changes in the reimbursement system and bed assessment; and
7272 5 (ii) the Department has filed rules to implement these changes
7373 6 no later than June 1, 2022. Failure of the Department to file
7474 7 rules to implement the changes provided in Public Act 102-1035
7575 8 no later than June 1, 2022 shall result in the implementation
7676 9 date being delayed to October 1, 2022.
7777 10 (d) The new nursing services reimbursement methodology
7878 11 utilizing the Patient Driven Payment Model, which shall be
7979 12 referred to as the PDPM reimbursement system, taking effect
8080 13 July 1, 2022, upon federal approval by the Centers for
8181 14 Medicare and Medicaid Services, shall be based on the
8282 15 following:
8383 16 (1) The methodology shall be resident-centered,
8484 17 facility-specific, cost-based, and based on guidance from
8585 18 the Centers for Medicare and Medicaid Services.
8686 19 (2) Costs shall be annually rebased and case mix index
8787 20 quarterly updated. The nursing services methodology will
8888 21 be assigned to the Medicaid enrolled residents on record
8989 22 as of 30 days prior to the beginning of the rate period in
9090 23 the Department's Medicaid Management Information System
9191 24 (MMIS) as present on the last day of the second quarter
9292 25 preceding the rate period based upon the Assessment
9393 26 Reference Date of the Minimum Data Set (MDS).
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104104 1 (3) Regional wage adjustors based on the Health
105105 2 Service Areas (HSA) groupings and adjusters in effect on
106106 3 April 30, 2012 shall be included, except no adjuster shall
107107 4 be lower than 1.06.
108108 5 (4) PDPM nursing case mix indices in effect on March
109109 6 1, 2022 shall be assigned to each resident class at no less
110110 7 than 0.7858 of the Centers for Medicare and Medicaid
111111 8 Services PDPM unadjusted case mix values, in effect on
112112 9 March 1, 2022.
113113 10 (5) The pool of funds available for distribution by
114114 11 case mix and the base facility rate shall be determined
115115 12 using the formula contained in subsection (d-1).
116116 13 (6) The Department shall establish a variable per diem
117117 14 staffing add-on in accordance with the most recent
118118 15 available federal staffing report, currently the Payroll
119119 16 Based Journal, for the same period of time, and if
120120 17 applicable adjusted for acuity using the same quarter's
121121 18 MDS. The Department shall rely on Payroll Based Journals
122122 19 provided to the Department of Public Health to make a
123123 20 determination of non-submission. If the Department is
124124 21 notified by a facility of missing or inaccurate Payroll
125125 22 Based Journal data or an incorrect calculation of
126126 23 staffing, the Department must make a correction as soon as
127127 24 the error is verified for the applicable quarter.
128128 25 Beginning October 1, 2024, the staffing percentage
129129 26 used in the calculation of the per diem staffing add-on
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140140 1 shall be its PDPM STRIVE Staffing Ratio which equals: its
141141 2 Reported Total Nurse Staffing Hours Per Resident Per Day
142142 3 as published in the most recent federal staffing report
143143 4 (the Provider Information File), divided by the facility's
144144 5 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
145145 6 Staffing Target is equal to .82 times the facility's
146146 7 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
147147 8 Day. A facility's Illinois Adjusted Facility Case Mix
148148 9 Hours Per Resident Per Day is equal to its Case-Mix Total
149149 10 Nurse Staffing Hours Per Resident Per Day (as published in
150150 11 the most recent federal staffing report) times 3.662
151151 12 (which reflects the national resident days-weighted mean
152152 13 Reported Total Nurse Staffing Hours Per Resident Per Day
153153 14 as calculated using the January 2024 federal Provider
154154 15 Information Files), divided by the national resident
155155 16 days-weighted mean Reported Total Nurse Staffing Hours Per
156156 17 Resident Per Day calculated using the most recent federal
157157 18 Provider Information File.
158158 19 (6.5) Beginning July 1, 2024, the paid per diem
159159 20 staffing add-on shall be the paid per diem staffing add-on
160160 21 in effect April 1, 2024. For dates beginning October 1,
161161 22 2024 and through September 30, 2025, the denominator for
162162 23 the staffing percentage shall be the lesser of the
163163 24 facility's PDPM STRIVE Staffing Target and:
164164 25 (A) For the quarter beginning October 1, 2024, the
165165 26 sum of 20% of the facility's PDPM STRIVE Staffing
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176176 1 Target and 80% of the facility's Case-Mix Total Nurse
177177 2 Staffing Hours Per Resident Per Day (as published in
178178 3 the January 2024 federal staffing report).
179179 4 (B) For the quarter beginning January 1, 2025, the
180180 5 sum of 40% of the facility's PDPM STRIVE Staffing
181181 6 Target and 60% of the facility's Case-Mix Total Nurse
182182 7 Staffing Hours Per Resident Per Day (as published in
183183 8 the January 2024 federal staffing report).
184184 9 (C) For the quarter beginning March 1, 2025, the
185185 10 sum of 60% of the facility's PDPM STRIVE Staffing
186186 11 Target and 40% of the facility's Case-Mix Total Nurse
187187 12 Staffing Hours Per Resident Per Day (as published in
188188 13 the January 2024 federal staffing report).
189189 14 (D) For the quarter beginning July 1, 2025, the
190190 15 sum of 80% of the facility's PDPM STRIVE Staffing
191191 16 Target and 20% of the facility's Case-Mix Total Nurse
192192 17 Staffing Hours Per Resident Per Day (as published in
193193 18 the January 2024 federal staffing report).
194194 19 Facilities with at least 70% of the staffing
195195 20 indicated by the STRIVE study shall be paid a per diem
196196 21 add-on of $9, increasing by equivalent steps for each
197197 22 whole percentage point until the facilities reach a per
198198 23 diem of $16.52. Facilities with at least 80% of the
199199 24 staffing indicated by the STRIVE study shall be paid a per
200200 25 diem add-on of $16.52, increasing by equivalent steps for
201201 26 each whole percentage point until the facilities reach a
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212212 1 per diem add-on of $25.77. Facilities with at least 92% of
213213 2 the staffing indicated by the STRIVE study shall be paid a
214214 3 per diem add-on of $25.77, increasing by equivalent steps
215215 4 for each whole percentage point until the facilities reach
216216 5 a per diem add-on of $30.98. Facilities with at least 100%
217217 6 of the staffing indicated by the STRIVE study shall be
218218 7 paid a per diem add-on of $30.98, increasing by equivalent
219219 8 steps for each whole percentage point until the facilities
220220 9 reach a per diem add-on of $36.44. Facilities with at
221221 10 least 110% of the staffing indicated by the STRIVE study
222222 11 shall be paid a per diem add-on of $36.44, increasing by
223223 12 equivalent steps for each whole percentage point until the
224224 13 facilities reach a per diem add-on of $38.68. Facilities
225225 14 with at least 125% or higher of the staffing indicated by
226226 15 the STRIVE study shall be paid a per diem add-on of $38.68.
227227 16 No nursing facility's variable staffing per diem add-on
228228 17 shall be reduced by more than 5% in 2 consecutive
229229 18 quarters. For the quarters beginning July 1, 2022 and
230230 19 October 1, 2022, no facility's variable per diem staffing
231231 20 add-on shall be calculated at a rate lower than 85% of the
232232 21 staffing indicated by the STRIVE study. No facility below
233233 22 70% of the staffing indicated by the STRIVE study shall
234234 23 receive a variable per diem staffing add-on after December
235235 24 31, 2022.
236236 25 (7) For dates of services beginning July 1, 2022, the
237237 26 PDPM nursing component per diem for each nursing facility
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248248 1 shall be the product of the facility's (i) statewide PDPM
249249 2 nursing base per diem rate, $92.25, adjusted for the
250250 3 facility average PDPM case mix index calculated quarterly
251251 4 and (ii) the regional wage adjuster, and then add the
252252 5 Medicaid access adjustment as defined in (e-3) of this
253253 6 Section. Transition rates for services provided between
254254 7 July 1, 2022 and October 1, 2023 shall be the greater of
255255 8 the PDPM nursing component per diem or:
256256 9 (A) for the quarter beginning July 1, 2022, the
257257 10 RUG-IV nursing component per diem;
258258 11 (B) for the quarter beginning October 1, 2022, the
259259 12 sum of the RUG-IV nursing component per diem
260260 13 multiplied by 0.80 and the PDPM nursing component per
261261 14 diem multiplied by 0.20;
262262 15 (C) for the quarter beginning January 1, 2023, the
263263 16 sum of the RUG-IV nursing component per diem
264264 17 multiplied by 0.60 and the PDPM nursing component per
265265 18 diem multiplied by 0.40;
266266 19 (D) for the quarter beginning April 1, 2023, the
267267 20 sum of the RUG-IV nursing component per diem
268268 21 multiplied by 0.40 and the PDPM nursing component per
269269 22 diem multiplied by 0.60;
270270 23 (E) for the quarter beginning July 1, 2023, the
271271 24 sum of the RUG-IV nursing component per diem
272272 25 multiplied by 0.20 and the PDPM nursing component per
273273 26 diem multiplied by 0.80; or
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284284 1 (F) for the quarter beginning October 1, 2023 and
285285 2 each subsequent quarter, the transition rate shall end
286286 3 and a nursing facility shall be paid 100% of the PDPM
287287 4 nursing component per diem.
288288 5 (d-1) Calculation of base year Statewide RUG-IV nursing
289289 6 base per diem rate.
290290 7 (1) Base rate spending pool shall be:
291291 8 (A) The base year resident days which are
292292 9 calculated by multiplying the number of Medicaid
293293 10 residents in each nursing home as indicated in the MDS
294294 11 data defined in paragraph (4) by 365.
295295 12 (B) Each facility's nursing component per diem in
296296 13 effect on July 1, 2012 shall be multiplied by
297297 14 subsection (A).
298298 15 (C) Thirteen million is added to the product of
299299 16 subparagraph (A) and subparagraph (B) to adjust for
300300 17 the exclusion of nursing homes defined in paragraph
301301 18 (5).
302302 19 (2) For each nursing home with Medicaid residents as
303303 20 indicated by the MDS data defined in paragraph (4),
304304 21 weighted days adjusted for case mix and regional wage
305305 22 adjustment shall be calculated. For each home this
306306 23 calculation is the product of:
307307 24 (A) Base year resident days as calculated in
308308 25 subparagraph (A) of paragraph (1).
309309 26 (B) The nursing home's regional wage adjustor
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320320 1 based on the Health Service Areas (HSA) groupings and
321321 2 adjustors in effect on April 30, 2012.
322322 3 (C) Facility weighted case mix which is the number
323323 4 of Medicaid residents as indicated by the MDS data
324324 5 defined in paragraph (4) multiplied by the associated
325325 6 case weight for the RUG-IV 48 grouper model using
326326 7 standard RUG-IV procedures for index maximization.
327327 8 (D) The sum of the products calculated for each
328328 9 nursing home in subparagraphs (A) through (C) above
329329 10 shall be the base year case mix, rate adjusted
330330 11 weighted days.
331331 12 (3) The Statewide RUG-IV nursing base per diem rate:
332332 13 (A) on January 1, 2014 shall be the quotient of the
333333 14 paragraph (1) divided by the sum calculated under
334334 15 subparagraph (D) of paragraph (2);
335335 16 (B) on and after July 1, 2014 and until July 1,
336336 17 2022, shall be the amount calculated under
337337 18 subparagraph (A) of this paragraph (3) plus $1.76; and
338338 19 (C) beginning July 1, 2022 and thereafter, $7
339339 20 shall be added to the amount calculated under
340340 21 subparagraph (B) of this paragraph (3) of this
341341 22 Section.
342342 23 (4) Minimum Data Set (MDS) comprehensive assessments
343343 24 for Medicaid residents on the last day of the quarter used
344344 25 to establish the base rate.
345345 26 (5) Nursing facilities designated as of July 1, 2012
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356356 1 by the Department as "Institutions for Mental Disease"
357357 2 shall be excluded from all calculations under this
358358 3 subsection. The data from these facilities shall not be
359359 4 used in the computations described in paragraphs (1)
360360 5 through (4) above to establish the base rate.
361361 6 (e) Beginning July 1, 2014, the Department shall allocate
362362 7 funding in the amount up to $10,000,000 for per diem add-ons to
363363 8 the RUGS methodology for dates of service on and after July 1,
364364 9 2014:
365365 10 (1) $0.63 for each resident who scores in I4200
366366 11 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
367367 12 (2) $2.67 for each resident who scores either a "1" or
368368 13 "2" in any items S1200A through S1200I and also scores in
369369 14 RUG groups PA1, PA2, BA1, or BA2.
370370 15 (e-1) (Blank).
371371 16 (e-2) For dates of services beginning January 1, 2014 and
372372 17 ending September 30, 2023, the RUG-IV nursing component per
373373 18 diem for a nursing home shall be the product of the statewide
374374 19 RUG-IV nursing base per diem rate, the facility average case
375375 20 mix index, and the regional wage adjustor. For dates of
376376 21 service beginning July 1, 2022 and ending September 30, 2023,
377377 22 the Medicaid access adjustment described in subsection (e-3)
378378 23 shall be added to the product.
379379 24 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
380380 25 facility average PDPM case mix index calculated quarterly
381381 26 shall be added to the statewide PDPM nursing per diem for all
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392392 1 facilities with annual Medicaid bed days of at least 70% of all
393393 2 occupied bed days adjusted quarterly. For each new calendar
394394 3 year and for the 6-month period beginning July 1, 2022, the
395395 4 percentage of a facility's occupied bed days comprised of
396396 5 Medicaid bed days shall be determined by the Department
397397 6 quarterly. For dates of service beginning January 1, 2023
398398 7 through June 30, 2025, the Medicaid Access Adjustment shall be
399399 8 increased to $4.75. For dates of service beginning July 1,
400400 9 2025, the Medicaid Access Adjustment shall be increased to
401401 10 $5.75. This subsection shall be inoperative on and after
402402 11 January 1, 2028.
403403 12 (e-4) Subject to federal approval, on and after January 1,
404404 13 2024, the Department shall increase the rate add-on at
405405 14 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
406406 15 for ventilator services from $208 per day to $481 per day.
407407 16 Payment is subject to the criteria and requirements under 89
408408 17 Ill. Adm. Code 147.335.
409409 18 (f) (Blank).
410410 19 (g) Notwithstanding any other provision of this Code, on
411411 20 and after July 1, 2012, for facilities not designated by the
412412 21 Department of Healthcare and Family Services as "Institutions
413413 22 for Mental Disease", rates effective May 1, 2011 shall be
414414 23 adjusted as follows:
415415 24 (1) (Blank);
416416 25 (2) (Blank);
417417 26 (3) Facility rates for the capital and support
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428428 1 components shall be reduced by 1.7%.
429429 2 (h) Notwithstanding any other provision of this Code, on
430430 3 and after July 1, 2012, nursing facilities designated by the
431431 4 Department of Healthcare and Family Services as "Institutions
432432 5 for Mental Disease" and "Institutions for Mental Disease" that
433433 6 are facilities licensed under the Specialized Mental Health
434434 7 Rehabilitation Act of 2013 shall have the nursing,
435435 8 socio-developmental, capital, and support components of their
436436 9 reimbursement rate effective May 1, 2011 reduced in total by
437437 10 2.7%.
438438 11 (i) On and after July 1, 2014, the reimbursement rates for
439439 12 the support component of the nursing facility rate for
440440 13 facilities licensed under the Nursing Home Care Act as skilled
441441 14 or intermediate care facilities shall be the rate in effect on
442442 15 June 30, 2014 increased by 8.17%.
443443 16 (i-1) Subject to federal approval, on and after January 1,
444444 17 2024, the reimbursement rates for the support component of the
445445 18 nursing facility rate for facilities licensed under the
446446 19 Nursing Home Care Act as skilled or intermediate care
447447 20 facilities shall be the rate in effect on June 30, 2023
448448 21 increased by 12%.
449449 22 (j) Notwithstanding any other provision of law, subject to
450450 23 federal approval, effective July 1, 2019, sufficient funds
451451 24 shall be allocated for changes to rates for facilities
452452 25 licensed under the Nursing Home Care Act as skilled nursing
453453 26 facilities or intermediate care facilities for dates of
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464464 1 services on and after July 1, 2019: (i) to establish, through
465465 2 June 30, 2022 a per diem add-on to the direct care per diem
466466 3 rate not to exceed $70,000,000 annually in the aggregate
467467 4 taking into account federal matching funds for the purpose of
468468 5 addressing the facility's unique staffing needs, adjusted
469469 6 quarterly and distributed by a weighted formula based on
470470 7 Medicaid bed days on the last day of the second quarter
471471 8 preceding the quarter for which the rate is being adjusted.
472472 9 Beginning July 1, 2022, the annual $70,000,000 described in
473473 10 the preceding sentence shall be dedicated to the variable per
474474 11 diem add-on for staffing under paragraph (6) of subsection
475475 12 (d); and (ii) in an amount not to exceed $170,000,000 annually
476476 13 in the aggregate taking into account federal matching funds to
477477 14 permit the support component of the nursing facility rate to
478478 15 be updated as follows:
479479 16 (1) 80%, or $136,000,000, of the funds shall be used
480480 17 to update each facility's rate in effect on June 30, 2019
481481 18 using the most recent cost reports on file, which have had
482482 19 a limited review conducted by the Department of Healthcare
483483 20 and Family Services and will not hold up enacting the rate
484484 21 increase, with the Department of Healthcare and Family
485485 22 Services.
486486 23 (2) After completing the calculation in paragraph (1),
487487 24 any facility whose rate is less than the rate in effect on
488488 25 June 30, 2019 shall have its rate restored to the rate in
489489 26 effect on June 30, 2019 from the 20% of the funds set
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500500 1 aside.
501501 2 (3) The remainder of the 20%, or $34,000,000, shall be
502502 3 used to increase each facility's rate by an equal
503503 4 percentage.
504504 5 (k) During the first quarter of State Fiscal Year 2020,
505505 6 the Department of Healthcare of Family Services must convene a
506506 7 technical advisory group consisting of members of all trade
507507 8 associations representing Illinois skilled nursing providers
508508 9 to discuss changes necessary with federal implementation of
509509 10 Medicare's Patient-Driven Payment Model. Implementation of
510510 11 Medicare's Patient-Driven Payment Model shall, by September 1,
511511 12 2020, end the collection of the MDS data that is necessary to
512512 13 maintain the current RUG-IV Medicaid payment methodology. The
513513 14 technical advisory group must consider a revised reimbursement
514514 15 methodology that takes into account transparency,
515515 16 accountability, actual staffing as reported under the
516516 17 federally required Payroll Based Journal system, changes to
517517 18 the minimum wage, adequacy in coverage of the cost of care, and
518518 19 a quality component that rewards quality improvements.
519519 20 (l) The Department shall establish per diem add-on
520520 21 payments to improve the quality of care delivered by
521521 22 facilities, including:
522522 23 (1) Incentive payments determined by facility
523523 24 performance on specified quality measures in an initial
524524 25 amount of $70,000,000. Nothing in this subsection shall be
525525 26 construed to limit the quality of care payments in the
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536536 1 aggregate statewide to $70,000,000, and, if quality of
537537 2 care has improved across nursing facilities, the
538538 3 Department shall adjust those add-on payments accordingly.
539539 4 The quality payment methodology described in this
540540 5 subsection must be used for at least State Fiscal Year
541541 6 2023. Beginning with the quarter starting July 1, 2023,
542542 7 the Department may add, remove, or change quality metrics
543543 8 and make associated changes to the quality payment
544544 9 methodology as outlined in subparagraph (E). Facilities
545545 10 designated by the Centers for Medicare and Medicaid
546546 11 Services as a special focus facility or a hospital-based
547547 12 nursing home do not qualify for quality payments.
548548 13 (A) Each quality pool must be distributed by
549549 14 assigning a quality weighted score for each nursing
550550 15 home which is calculated by multiplying the nursing
551551 16 home's quality base period Medicaid days by the
552552 17 nursing home's star rating weight in that period.
553553 18 (B) Star rating weights are assigned based on the
554554 19 nursing home's star rating for the LTS quality star
555555 20 rating. As used in this subparagraph, "LTS quality
556556 21 star rating" means the long-term stay quality rating
557557 22 for each nursing facility, as assigned by the Centers
558558 23 for Medicare and Medicaid Services under the Five-Star
559559 24 Quality Rating System. The rating is a number ranging
560560 25 from 0 (lowest) to 5 (highest).
561561 26 (i) Zero-star or one-star rating has a weight
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572572 1 of 0.
573573 2 (ii) Two-star rating has a weight of 0.75.
574574 3 (iii) Three-star rating has a weight of 1.5.
575575 4 (iv) Four-star rating has a weight of 2.5.
576576 5 (v) Five-star rating has a weight of 3.5.
577577 6 (C) Each nursing home's quality weight score is
578578 7 divided by the sum of all quality weight scores for
579579 8 qualifying nursing homes to determine the proportion
580580 9 of the quality pool to be paid to the nursing home.
581581 10 (D) The quality pool is no less than $70,000,000
582582 11 annually or $17,500,000 per quarter. The Department
583583 12 shall publish on its website the estimated payments
584584 13 and the associated weights for each facility 45 days
585585 14 prior to when the initial payments for the quarter are
586586 15 to be paid. The Department shall assign each facility
587587 16 the most recent and applicable quarter's STAR value
588588 17 unless the facility notifies the Department within 15
589589 18 days of an issue and the facility provides reasonable
590590 19 evidence demonstrating its timely compliance with
591591 20 federal data submission requirements for the quarter
592592 21 of record. If such evidence cannot be provided to the
593593 22 Department, the STAR rating assigned to the facility
594594 23 shall be reduced by one from the prior quarter.
595595 24 (E) The Department shall review quality metrics
596596 25 used for payment of the quality pool and make
597597 26 recommendations for any associated changes to the
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608608 1 methodology for distributing quality pool payments in
609609 2 consultation with associations representing long-term
610610 3 care providers, consumer advocates, organizations
611611 4 representing workers of long-term care facilities, and
612612 5 payors. The Department may establish, by rule, changes
613613 6 to the methodology for distributing quality pool
614614 7 payments.
615615 8 (F) The Department shall disburse quality pool
616616 9 payments from the Long-Term Care Provider Fund on a
617617 10 monthly basis in amounts proportional to the total
618618 11 quality pool payment determined for the quarter.
619619 12 (G) The Department shall publish any changes in
620620 13 the methodology for distributing quality pool payments
621621 14 prior to the beginning of the measurement period or
622622 15 quality base period for any metric added to the
623623 16 distribution's methodology.
624624 17 (2) Payments based on CNA tenure, promotion, and CNA
625625 18 training for the purpose of increasing CNA compensation.
626626 19 It is the intent of this subsection that payments made in
627627 20 accordance with this paragraph be directly incorporated
628628 21 into increased compensation for CNAs. As used in this
629629 22 paragraph, "CNA" means a certified nursing assistant as
630630 23 that term is described in Section 3-206 of the Nursing
631631 24 Home Care Act, Section 3-206 of the ID/DD Community Care
632632 25 Act, and Section 3-206 of the MC/DD Act. The Department
633633 26 shall establish, by rule, payments to nursing facilities
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644644 1 equal to Medicaid's share of the tenure wage increments
645645 2 specified in this paragraph for all reported CNA employee
646646 3 hours compensated according to a posted schedule
647647 4 consisting of increments at least as large as those
648648 5 specified in this paragraph. The increments are as
649649 6 follows: an additional $1.50 per hour for CNAs with at
650650 7 least one and less than 2 years' experience plus another
651651 8 $1 per hour for each additional year of experience up to a
652652 9 maximum of $6.50 for CNAs with at least 6 years of
653653 10 experience. For purposes of this paragraph, Medicaid's
654654 11 share shall be the ratio determined by paid Medicaid bed
655655 12 days divided by total bed days for the applicable time
656656 13 period used in the calculation. In addition, and additive
657657 14 to any tenure increments paid as specified in this
658658 15 paragraph, the Department shall establish, by rule,
659659 16 payments supporting Medicaid's share of the
660660 17 promotion-based wage increments for CNA employee hours
661661 18 compensated for that promotion with at least a $1.50
662662 19 hourly increase. Medicaid's share shall be established as
663663 20 it is for the tenure increments described in this
664664 21 paragraph. Qualifying promotions shall be defined by the
665665 22 Department in rules for an expected 10-15% subset of CNAs
666666 23 assigned intermediate, specialized, or added roles such as
667667 24 CNA trainers, CNA scheduling "captains", and CNA
668668 25 specialists for resident conditions like dementia or
669669 26 memory care or behavioral health.
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680680 1 (m) The Department shall work with nursing facility
681681 2 industry representatives to design policies and procedures to
682682 3 permit facilities to address the integrity of data from
683683 4 federal reporting sites used by the Department in setting
684684 5 facility rates.
685685 6 (Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
686686 7 102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
687687 8 Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
688688 9 Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
689689 10 7-1-24.)
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