Bill Text: IL HB5646 | 2015-2016 | 99th General Assembly | Introduced

---

Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning payments to nursing facilities, provides that the Department of Healthcare and Family Services may contract with a third-party vendor to perform onsite and desk reviews to determine the accuracy of resident assessment information transmitted in the Minimum Data Set that is relevant to the determination of reimbursement rates.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2016-04-08 - Rule 19(a) / Re-referred to Rules Committee [HB5646 Detail]

Download: Illinois-2015-HB5646-Introduced.html

---

99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 HB5646 Introduced , by Rep. Patricia R. Bellock SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2
Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning payments to nursing facilities, provides that the Department of Healthcare and Family Services may contract with a third-party vendor to perform onsite and desk reviews to determine the accuracy of resident assessment information transmitted in the Minimum Data Set that is relevant to the determination of reimbursement rates.
LRB099 19841 KTG 44240 b
FISCAL NOTE ACT MAY APPLY
A BILL FOR
HB5646 LRB099 19841 KTG 44240 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5.2 as follows:
(305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
Sec. 5-5.2. Payment.
(a) All nursing facilities that are grouped pursuant to
Section 5-5.1 of this Act shall receive the same rate of
payment for similar services.
(b) It shall be a matter of State policy that the Illinois
Department shall utilize a uniform billing cycle throughout the
State for the long-term care providers.
(c) Notwithstanding any other provisions of this Code, the
methodologies for reimbursement of nursing services as
provided under this Article shall no longer be applicable for
bills payable for nursing services rendered on or after a new
reimbursement system based on the Resource Utilization Groups
(RUGs) has been fully operationalized, which shall take effect
for services provided on or after January 1, 2014.
(d) The new nursing services reimbursement methodology
utilizing RUG-IV 48 grouper model, which shall be referred to
as the RUGs reimbursement system, taking effect January 1,

HB5646 - 2 - LRB099 19841 KTG 44240 b
2014, shall be based on the following:
(1) The methodology shall be resident-driven,
facility-specific, and cost-based.
(2) Costs shall be annually rebased and case mix index
quarterly updated. The nursing services methodology will
be assigned to the Medicaid enrolled residents on record as
of 30 days prior to the beginning of the rate period in the
Department's Medicaid Management Information System (MMIS)
as present on the last day of the second quarter preceding
the rate period based upon the Assessment Reference Date of
the Minimum Data Set (MDS).
(3) Regional wage adjustors based on the Health Service
Areas (HSA) groupings and adjusters in effect on April 30,
2012 shall be included.
(4) Case mix index shall be assigned to each resident
class based on the Centers for Medicare and Medicaid
Services staff time measurement study in effect on July 1,
2013, utilizing an index maximization approach.
(5) The pool of funds available for distribution by
case mix and the base facility rate shall be determined
using the formula contained in subsection (d-1).
(d-1) Calculation of base year Statewide RUG-IV nursing
base per diem rate.
(1) Base rate spending pool shall be:
(A) The base year resident days which are
calculated by multiplying the number of Medicaid

HB5646 - 3 - LRB099 19841 KTG 44240 b
residents in each nursing home as indicated in the MDS
data defined in paragraph (4) by 365.
(B) Each facility's nursing component per diem in
effect on July 1, 2012 shall be multiplied by
subsection (A).
(C) Thirteen million is added to the product of
subparagraph (A) and subparagraph (B) to adjust for the
exclusion of nursing homes defined in paragraph (5).
(2) For each nursing home with Medicaid residents as
indicated by the MDS data defined in paragraph (4),
weighted days adjusted for case mix and regional wage
adjustment shall be calculated. For each home this
calculation is the product of:
(A) Base year resident days as calculated in
subparagraph (A) of paragraph (1).
(B) The nursing home's regional wage adjustor
based on the Health Service Areas (HSA) groupings and
adjustors in effect on April 30, 2012.
(C) Facility weighted case mix which is the number
of Medicaid residents as indicated by the MDS data
defined in paragraph (4) multiplied by the associated
case weight for the RUG-IV 48 grouper model using
standard RUG-IV procedures for index maximization.
(D) The sum of the products calculated for each
nursing home in subparagraphs (A) through (C) above
shall be the base year case mix, rate adjusted weighted

HB5646 - 4 - LRB099 19841 KTG 44240 b
days.
(3) The Statewide RUG-IV nursing base per diem rate:
(A) on January 1, 2014 shall be the quotient of the
paragraph (1) divided by the sum calculated under
subparagraph (D) of paragraph (2); and
(B) on and after July 1, 2014, shall be the amount
calculated under subparagraph (A) of this paragraph
(3) plus $1.76.
(4) Minimum Data Set (MDS) comprehensive assessments
for Medicaid residents on the last day of the quarter used
to establish the base rate.
(5) Nursing facilities designated as of July 1, 2012 by
the Department as "Institutions for Mental Disease" shall
be excluded from all calculations under this subsection.
The data from these facilities shall not be used in the
computations described in paragraphs (1) through (4) above
to establish the base rate.
(e) Beginning July 1, 2014, the Department shall allocate
funding in the amount up to $10,000,000 for per diem add-ons to
the RUGS methodology for dates of service on and after July 1,
2014:
(1) $0.63 for each resident who scores in I4200
Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
(2) $2.67 for each resident who scores either a "1" or
"2" in any items S1200A through S1200I and also scores in
RUG groups PA1, PA2, BA1, or BA2.

HB5646 - 5 - LRB099 19841 KTG 44240 b
(e-1) (Blank).
(e-2) For dates of services beginning January 1, 2014, the
RUG-IV nursing component per diem for a nursing home shall be
the product of the statewide RUG-IV nursing base per diem rate,
the facility average case mix index, and the regional wage
adjustor. Transition rates for services provided between
January 1, 2014 and December 31, 2014 shall be as follows:
(1) The transition RUG-IV per diem nursing rate for
nursing homes whose rate calculated in this subsection
(e-2) is greater than the nursing component rate in effect
July 1, 2012 shall be paid the sum of:
(A) The nursing component rate in effect July 1,
2012; plus
(B) The difference of the RUG-IV nursing component
per diem calculated for the current quarter minus the
nursing component rate in effect July 1, 2012
multiplied by 0.88.
(2) The transition RUG-IV per diem nursing rate for
nursing homes whose rate calculated in this subsection
(e-2) is less than the nursing component rate in effect
July 1, 2012 shall be paid the sum of:
(A) The nursing component rate in effect July 1,
2012; plus
(B) The difference of the RUG-IV nursing component
per diem calculated for the current quarter minus the
nursing component rate in effect July 1, 2012

HB5646 - 6 - LRB099 19841 KTG 44240 b
multiplied by 0.13.
(f) Notwithstanding any other provision of this Code, on
and after July 1, 2012, reimbursement rates associated with the
nursing or support components of the current nursing facility
rate methodology shall not increase beyond the level effective
May 1, 2011 until a new reimbursement system based on the RUGs
IV 48 grouper model has been fully operationalized.
(g) Notwithstanding any other provision of this Code, on
and after July 1, 2012, for facilities not designated by the
Department of Healthcare and Family Services as "Institutions
for Mental Disease", rates effective May 1, 2011 shall be
adjusted as follows:
(1) Individual nursing rates for residents classified
in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
ending March 31, 2012 shall be reduced by 10%;
(2) Individual nursing rates for residents classified
in all other RUG IV groups shall be reduced by 1.0%;
(3) Facility rates for the capital and support
components shall be reduced by 1.7%.
(h) Notwithstanding any other provision of this Code, on
and after July 1, 2012, nursing facilities designated by the
Department of Healthcare and Family Services as "Institutions
for Mental Disease" and "Institutions for Mental Disease" that
are facilities licensed under the Specialized Mental Health
Rehabilitation Act of 2013 shall have the nursing,
socio-developmental, capital, and support components of their

HB5646 - 7 - LRB099 19841 KTG 44240 b
reimbursement rate effective May 1, 2011 reduced in total by
2.7%.
(i) On and after July 1, 2014, 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 shall be the rate in effect on
June 30, 2014 increased by 8.17%.
(j) The Department may contract with a third-party vendor
to perform onsite and desk reviews to determine the accuracy of
resident assessment information transmitted in the MDS that is
relevant to the determination of reimbursement rates.
(Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13;
98-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff.
6-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78,
eff. 7-20-15.)