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Illinois Senate Bill SB1606

Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1606 Compare Versions

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11 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1606 Introduced 2/4/2025, by Sen. David Koehler SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that subject to federal approval, beginning on January 1, 2026, the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities and for facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall be the rate in effect on June 30, 2024 increased by the percent change in the Consumer Price Index-U from September 2016 to September 2025. Effective immediately. LRB104 10490 KTG 20565 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1606 Introduced 2/4/2025, by Sen. David Koehler 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. Provides that subject to federal approval, beginning on January 1, 2026, the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities and for facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall be the rate in effect on June 30, 2024 increased by the percent change in the Consumer Price Index-U from September 2016 to September 2025. Effective immediately. LRB104 10490 KTG 20565 b LRB104 10490 KTG 20565 b A BILL FOR
22 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1606 Introduced 2/4/2025, by Sen. David Koehler SYNOPSIS AS INTRODUCED:
33 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
44 305 ILCS 5/5-5.2
55 Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that subject to federal approval, beginning on January 1, 2026, the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities and for facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall be the rate in effect on June 30, 2024 increased by the percent change in the Consumer Price Index-U from September 2016 to September 2025. 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 SB1606 Introduced 2/4/2025, by Sen. David Koehler 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. Provides that subject to federal approval, beginning on January 1, 2026, the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities and for facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall be the rate in effect on June 30, 2024 increased by the percent change in the Consumer Price Index-U from September 2016 to September 2025. 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, the
398398 7 Medicaid Access Adjustment shall be increased to $4.75. This
399399 8 subsection shall be inoperative on and after January 1, 2028.
400400 9 (e-4) Subject to federal approval, on and after January 1,
401401 10 2024, the Department shall increase the rate add-on at
402402 11 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
403403 12 for ventilator services from $208 per day to $481 per day.
404404 13 Payment is subject to the criteria and requirements under 89
405405 14 Ill. Adm. Code 147.335.
406406 15 (f) (Blank).
407407 16 (g) Notwithstanding any other provision of this Code, on
408408 17 and after July 1, 2012, for facilities not designated by the
409409 18 Department of Healthcare and Family Services as "Institutions
410410 19 for Mental Disease", rates effective May 1, 2011 shall be
411411 20 adjusted as follows:
412412 21 (1) (Blank);
413413 22 (2) (Blank);
414414 23 (3) Facility rates for the capital and support
415415 24 components shall be reduced by 1.7%.
416416 25 (h) Notwithstanding any other provision of this Code, on
417417 26 and after July 1, 2012, nursing facilities designated by the
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428428 1 Department of Healthcare and Family Services as "Institutions
429429 2 for Mental Disease" and "Institutions for Mental Disease" that
430430 3 are facilities licensed under the Specialized Mental Health
431431 4 Rehabilitation Act of 2013 shall have the nursing,
432432 5 socio-developmental, capital, and support components of their
433433 6 reimbursement rate effective May 1, 2011 reduced in total by
434434 7 2.7%.
435435 8 (i) On and after July 1, 2014, the reimbursement rates for
436436 9 the support component of the nursing facility rate for
437437 10 facilities licensed under the Nursing Home Care Act as skilled
438438 11 or intermediate care facilities shall be the rate in effect on
439439 12 June 30, 2014 increased by 8.17%.
440440 13 (i-1) Subject to federal approval, on and after January 1,
441441 14 2024, the reimbursement rates for the support component of the
442442 15 nursing facility rate for facilities licensed under the
443443 16 Nursing Home Care Act as skilled or intermediate care
444444 17 facilities shall be the rate in effect on June 30, 2023
445445 18 increased by 12%.
446446 19 (i-2) Subject to federal approval, beginning on January 1,
447447 20 2026, the reimbursement rates for the support component of the
448448 21 nursing facility rate for facilities licensed under the
449449 22 Nursing Home Care Act as skilled or intermediate care
450450 23 facilities and for facilities licensed under the Specialized
451451 24 Mental Health Rehabilitation Act of 2013 shall be the rate in
452452 25 effect on June 30, 2024 increased by the percent change in the
453453 26 Consumer Price Index-U from September 2016 to September 2025.
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464464 1 As used in this subsection, "Consumer Price Index-U" means the
465465 2 index published by the Bureau of Labor Statistics of the
466466 3 United States Department of Labor that measures the average
467467 4 change in prices of goods and services purchased by all urban
468468 5 consumers, United States city average, all items, 1982-84 =
469469 6 100.
470470 7 (j) Notwithstanding any other provision of law, subject to
471471 8 federal approval, effective July 1, 2019, sufficient funds
472472 9 shall be allocated for changes to rates for facilities
473473 10 licensed under the Nursing Home Care Act as skilled nursing
474474 11 facilities or intermediate care facilities for dates of
475475 12 services on and after July 1, 2019: (i) to establish, through
476476 13 June 30, 2022 a per diem add-on to the direct care per diem
477477 14 rate not to exceed $70,000,000 annually in the aggregate
478478 15 taking into account federal matching funds for the purpose of
479479 16 addressing the facility's unique staffing needs, adjusted
480480 17 quarterly and distributed by a weighted formula based on
481481 18 Medicaid bed days on the last day of the second quarter
482482 19 preceding the quarter for which the rate is being adjusted.
483483 20 Beginning July 1, 2022, the annual $70,000,000 described in
484484 21 the preceding sentence shall be dedicated to the variable per
485485 22 diem add-on for staffing under paragraph (6) of subsection
486486 23 (d); and (ii) in an amount not to exceed $170,000,000 annually
487487 24 in the aggregate taking into account federal matching funds to
488488 25 permit the support component of the nursing facility rate to
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500500 1 (1) 80%, or $136,000,000, of the funds shall be used
501501 2 to update each facility's rate in effect on June 30, 2019
502502 3 using the most recent cost reports on file, which have had
503503 4 a limited review conducted by the Department of Healthcare
504504 5 and Family Services and will not hold up enacting the rate
505505 6 increase, with the Department of Healthcare and Family
506506 7 Services.
507507 8 (2) After completing the calculation in paragraph (1),
508508 9 any facility whose rate is less than the rate in effect on
509509 10 June 30, 2019 shall have its rate restored to the rate in
510510 11 effect on June 30, 2019 from the 20% of the funds set
511511 12 aside.
512512 13 (3) The remainder of the 20%, or $34,000,000, shall be
513513 14 used to increase each facility's rate by an equal
514514 15 percentage.
515515 16 (k) During the first quarter of State Fiscal Year 2020,
516516 17 the Department of Healthcare of Family Services must convene a
517517 18 technical advisory group consisting of members of all trade
518518 19 associations representing Illinois skilled nursing providers
519519 20 to discuss changes necessary with federal implementation of
520520 21 Medicare's Patient-Driven Payment Model. Implementation of
521521 22 Medicare's Patient-Driven Payment Model shall, by September 1,
522522 23 2020, end the collection of the MDS data that is necessary to
523523 24 maintain the current RUG-IV Medicaid payment methodology. The
524524 25 technical advisory group must consider a revised reimbursement
525525 26 methodology that takes into account transparency,
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536536 1 accountability, actual staffing as reported under the
537537 2 federally required Payroll Based Journal system, changes to
538538 3 the minimum wage, adequacy in coverage of the cost of care, and
539539 4 a quality component that rewards quality improvements.
540540 5 (l) The Department shall establish per diem add-on
541541 6 payments to improve the quality of care delivered by
542542 7 facilities, including:
543543 8 (1) Incentive payments determined by facility
544544 9 performance on specified quality measures in an initial
545545 10 amount of $70,000,000. Nothing in this subsection shall be
546546 11 construed to limit the quality of care payments in the
547547 12 aggregate statewide to $70,000,000, and, if quality of
548548 13 care has improved across nursing facilities, the
549549 14 Department shall adjust those add-on payments accordingly.
550550 15 The quality payment methodology described in this
551551 16 subsection must be used for at least State Fiscal Year
552552 17 2023. Beginning with the quarter starting July 1, 2023,
553553 18 the Department may add, remove, or change quality metrics
554554 19 and make associated changes to the quality payment
555555 20 methodology as outlined in subparagraph (E). Facilities
556556 21 designated by the Centers for Medicare and Medicaid
557557 22 Services as a special focus facility or a hospital-based
558558 23 nursing home do not qualify for quality payments.
559559 24 (A) Each quality pool must be distributed by
560560 25 assigning a quality weighted score for each nursing
561561 26 home which is calculated by multiplying the nursing
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572572 1 home's quality base period Medicaid days by the
573573 2 nursing home's star rating weight in that period.
574574 3 (B) Star rating weights are assigned based on the
575575 4 nursing home's star rating for the LTS quality star
576576 5 rating. As used in this subparagraph, "LTS quality
577577 6 star rating" means the long-term stay quality rating
578578 7 for each nursing facility, as assigned by the Centers
579579 8 for Medicare and Medicaid Services under the Five-Star
580580 9 Quality Rating System. The rating is a number ranging
581581 10 from 0 (lowest) to 5 (highest).
582582 11 (i) Zero-star or one-star rating has a weight
583583 12 of 0.
584584 13 (ii) Two-star rating has a weight of 0.75.
585585 14 (iii) Three-star rating has a weight of 1.5.
586586 15 (iv) Four-star rating has a weight of 2.5.
587587 16 (v) Five-star rating has a weight of 3.5.
588588 17 (C) Each nursing home's quality weight score is
589589 18 divided by the sum of all quality weight scores for
590590 19 qualifying nursing homes to determine the proportion
591591 20 of the quality pool to be paid to the nursing home.
592592 21 (D) The quality pool is no less than $70,000,000
593593 22 annually or $17,500,000 per quarter. The Department
594594 23 shall publish on its website the estimated payments
595595 24 and the associated weights for each facility 45 days
596596 25 prior to when the initial payments for the quarter are
597597 26 to be paid. The Department shall assign each facility
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608608 1 the most recent and applicable quarter's STAR value
609609 2 unless the facility notifies the Department within 15
610610 3 days of an issue and the facility provides reasonable
611611 4 evidence demonstrating its timely compliance with
612612 5 federal data submission requirements for the quarter
613613 6 of record. If such evidence cannot be provided to the
614614 7 Department, the STAR rating assigned to the facility
615615 8 shall be reduced by one from the prior quarter.
616616 9 (E) The Department shall review quality metrics
617617 10 used for payment of the quality pool and make
618618 11 recommendations for any associated changes to the
619619 12 methodology for distributing quality pool payments in
620620 13 consultation with associations representing long-term
621621 14 care providers, consumer advocates, organizations
622622 15 representing workers of long-term care facilities, and
623623 16 payors. The Department may establish, by rule, changes
624624 17 to the methodology for distributing quality pool
625625 18 payments.
626626 19 (F) The Department shall disburse quality pool
627627 20 payments from the Long-Term Care Provider Fund on a
628628 21 monthly basis in amounts proportional to the total
629629 22 quality pool payment determined for the quarter.
630630 23 (G) The Department shall publish any changes in
631631 24 the methodology for distributing quality pool payments
632632 25 prior to the beginning of the measurement period or
633633 26 quality base period for any metric added to the
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644644 1 distribution's methodology.
645645 2 (2) Payments based on CNA tenure, promotion, and CNA
646646 3 training for the purpose of increasing CNA compensation.
647647 4 It is the intent of this subsection that payments made in
648648 5 accordance with this paragraph be directly incorporated
649649 6 into increased compensation for CNAs. As used in this
650650 7 paragraph, "CNA" means a certified nursing assistant as
651651 8 that term is described in Section 3-206 of the Nursing
652652 9 Home Care Act, Section 3-206 of the ID/DD Community Care
653653 10 Act, and Section 3-206 of the MC/DD Act. The Department
654654 11 shall establish, by rule, payments to nursing facilities
655655 12 equal to Medicaid's share of the tenure wage increments
656656 13 specified in this paragraph for all reported CNA employee
657657 14 hours compensated according to a posted schedule
658658 15 consisting of increments at least as large as those
659659 16 specified in this paragraph. The increments are as
660660 17 follows: an additional $1.50 per hour for CNAs with at
661661 18 least one and less than 2 years' experience plus another
662662 19 $1 per hour for each additional year of experience up to a
663663 20 maximum of $6.50 for CNAs with at least 6 years of
664664 21 experience. For purposes of this paragraph, Medicaid's
665665 22 share shall be the ratio determined by paid Medicaid bed
666666 23 days divided by total bed days for the applicable time
667667 24 period used in the calculation. In addition, and additive
668668 25 to any tenure increments paid as specified in this
669669 26 paragraph, the Department shall establish, by rule,
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680680 1 payments supporting Medicaid's share of the
681681 2 promotion-based wage increments for CNA employee hours
682682 3 compensated for that promotion with at least a $1.50
683683 4 hourly increase. Medicaid's share shall be established as
684684 5 it is for the tenure increments described in this
685685 6 paragraph. Qualifying promotions shall be defined by the
686686 7 Department in rules for an expected 10-15% subset of CNAs
687687 8 assigned intermediate, specialized, or added roles such as
688688 9 CNA trainers, CNA scheduling "captains", and CNA
689689 10 specialists for resident conditions like dementia or
690690 11 memory care or behavioral health.
691691 12 (m) The Department shall work with nursing facility
692692 13 industry representatives to design policies and procedures to
693693 14 permit facilities to address the integrity of data from
694694 15 federal reporting sites used by the Department in setting
695695 16 facility rates.
696696 17 (Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
697697 18 102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
698698 19 Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
699699 20 Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
700700 21 7-1-24.)
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