Bill Text: IL SB3607 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Services to establish reimbursement rates that build toward livable wages for front-line personnel in residential and day programs and service coordination agencies serving persons with intellectual and developmental disabilities. Provides that for community-based providers serving persons with intellectual or developmental disabilities, subject to federal approval, the rates taking effect for services delivered on or after July 1, 2022 shall be increased sufficiently to: (i) provide a minimum $3.50 per hour wage increase over the wages in effect on June 30, 2022 for front-line personnel; and (ii) provide wages for all other residential non-executive direct care staff, excluding direct support personnel, at the U.S. Department of Labor's average wage as defined, by rule, by the Department. Amends the Illinois Public Aid Code. Provides that for ID/DD facilities and MC/DD facilities, the rates taking effect for services delivered on or after July 1, 2022, shall be increased sufficiently to: (i) provide a minimum $3.50 per hour wage increase over the wages in effect on June 30, 2022 for front-line personnel; and (ii) provide wages for all other residential non-executive direct care staff, excluding direct support personnel, at the U.S. Department of Labor's average wage as defined, by rule, by the Department. Requires the same increase for front-line personnel employed at community-based providers serving persons with intellectual or developmental disabilities. Amends the Illinois Administrative Procedure Act. Grants the Departments of Human Services and Healthcare and Family Services emergency rulemaking authority. Effective immediately.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced - Dead) 2022-03-31 - Added as Chief Co-Sponsor Sen. Ram Villivalam [SB3607 Detail]

Download: Illinois-2021-SB3607-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 SB3607 Introduced 1/19/2022, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED:
5 ILCS 100/5-45.21 new
20 ILCS 1705/55.5 new
20 ILCS 1705/74
305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
305 ILCS 5/5-5.4i
Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Services to establish reimbursement rates that build toward livable wages for front-line personnel in residential and day programs and service coordination agencies serving persons with intellectual and developmental disabilities. Provides that for community-based providers serving persons with intellectual or developmental disabilities, subject to federal approval, the rates taking effect for services delivered on or after July 1, 2022 shall be increased sufficiently to: (i) provide a minimum $3.50 per hour wage increase over the wages in effect on June 30, 2022 for front-line personnel; and (ii) provide wages for all other residential non-executive direct care staff, excluding direct support personnel, at the U.S. Department of Labor's average wage as defined, by rule, by the Department. Amends the Illinois Public Aid Code. Provides that for ID/DD facilities and MC/DD facilities, the rates taking effect for services delivered on or after July 1, 2022, shall be increased sufficiently to: (i) provide a minimum $3.50 per hour wage increase over the wages in effect on June 30, 2022 for front-line personnel; and (ii) provide wages for all other residential non-executive direct care staff, excluding direct support personnel, at the U.S. Department of Labor's average wage as defined, by rule, by the Department. Requires the same increase for front-line personnel employed at community-based providers serving persons with intellectual or developmental disabilities. Amends the Illinois Administrative Procedure Act. Grants the Departments of Human Services and Healthcare and Family Services emergency rulemaking authority. Effective immediately.
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A BILL FOR
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AN ACT concerning care for persons with developmental
disabilities.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. This Act may be referred to as the Community
Disability Living Wage Act.
Section 2. Findings.
(1) An estimated 27,000 children and adults with
intellectual and developmental disabilities are supported
in community-based settings in Illinois; direct support
persons (DSPs), are trained paraprofessional staff who are
engaged in activities of daily living and community
support; too many of these employees earn wages that place
them and their families below the poverty level.
(2) According to the most recent Illinois industry
surveys, the median DSP wage in Illinois is just $12.04
per hour, below the U.S. Department of Health and Human
Services poverty threshold of $12.60 for a family of 4 and
one out of every 4 DSP jobs in provider agencies are going
unfilled; low wages often compel DSPs to work many
overtime hours or hold down a second job to support their
families; research by the American Network of Community
Options and Resources (ANCOR), inclusive of Illinois,

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reveals 56% of DSPs rely on public assistance to make ends
meet, creating additional expenditures for State
government; low wages are a consequence of the
historically low reimbursement rates paid by the State of
Illinois to community-based service providers.
(3) Starting wages at many provider agencies are below
$12 per hour, the scheduled State minimum wage rate as of
January 1, 2022.
(4) The lack of adequate wages for employees who
perform the challenging work of supporting persons with
intellectual and developmental disabilities results in
high employee turnover, which in turn negatively impacts
the quality of services provided, higher wages are proven
to reduce staff turnover, improving stability and quality
of services while reducing employer training costs.
(5) Rising wages in other sectors now mean, despite
the modest wage increase and strenuous efforts to recruit
new workers, agencies are experiencing staff vacancy rates
of up to 40%; excessive vacancies force employers to rely
more on overtime, leading to staff burnout and driving up
costs; for the fourth year in a row the federal court
monitor documented how this growing hiring crisis impedes
the ability of community disability agencies to expand to
accommodate persons newly approved for services as part of
the Ligas Consent Decree.
(6) A December 2020 report issued by an independent

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consulting group commissioned by the State to propose
changes to the State's reimbursement for community
disability agencies recommended that addressing DSP wages
was the number one priority for ensuring compliance with
the mandates of the Ligas Consent Decree, and further
recommended that wages for DSPs should be fixed at 150% of
the prevailing minimum wage plus additional funding for
benefits.
(7) The difference between 150% of the State minimum
wage on January 1, 2022 and the hourly DSP wage rate set by
the State amounts to $3.50 per hour.
(8) The General Assembly finds that in order to reduce
turnover, increase retention, fill vacancies, and ensure
DSPs are adequately compensated for the critically
important work they do, an increase in rates and
reimbursements to community-based service providers to
effectuate an increase in the hourly wage paid to DSPs is
needed.
Section 3. Purpose and intent. It is the purpose of this
Act to increase the wages of DSPs and other frontline staff in
community disability agencies beyond the poverty level and to
a level competitive with rival employers and above the State
minimum wage, in an effort to improve the lives of DSPs and the
lives of the vulnerable persons they support.
It is the intent of the General Assembly to ensure that all

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funds resulting from rate increases provided to community
disability agencies are allocated to front-line employee wages
in order to address the current workforce crisis which is the
primary obstacle to the availability of community-based
services for people with disabilities.
Section 5. The Illinois Administrative Procedure Act is
amended by adding Section 5-45.21 as follows:
(5 ILCS 100/5-45.21 new)
Sec. 5-45.21. Emergency rulemaking; Departments of Human
Services and Healthcare and Family Services. To provide for
the expeditious and timely implementation of changes made by
this amendatory Act of the 102nd General Assembly to Section
74 of the Mental Health and Developmental Disabilities
Administrative Act and to Sections 5-5.4 and 5-5.4i of the
Illinois Public Aid Code, emergency rules implementing the
changes made by this amendatory Act of the 102nd General
Assembly to Section 74 of the Mental Health and Developmental
Disabilities Administrative Act and to Sections 5-5.4 and
5-5.4i of the Illinois Public Aid Code may be adopted in
accordance with Section 5-45 by the respective Department. The
adoption of emergency rules authorized by Section 5-45 and
this Section is deemed to be necessary for the public
interest, safety, and welfare.
This Section is repealed one year after the effective date

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of this amendatory Act of the 102nd General Assembly.
Section 10. The Mental Health and Developmental
Disabilities Administrative Act is amended by changing Section
74 and by adding Section 55.5 as follows:
(20 ILCS 1705/55.5 new)
Sec. 55.5. Increased wages for front-line personnel. As
used in this Section, "front-line personnel" means direct
support persons, aides, front-line supervisors, and
non-administrative support staff working in service settings
outlined in this Section.
The Department shall establish reimbursement rates that
build toward livable wages for front-line personnel in
residential and day programs and service coordination agencies
serving persons with intellectual and developmental
disabilities under Section 54 of this Act, including, but not
limited to, intermediate care for the developmentally disabled
facilities, medically complex for the developmentally disabled
facilities, community-integrated living arrangements,
community day services, employment, and other residential and
day programs for persons with intellectual and developmental
disabilities supported by State funds or funding under Title
XIX of the federal Social Security Act.
The Department shall increase rates and reimbursements so
that by July 1, 2022 direct support persons wages shall be

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increased by $3.50 per hour, and so that other front-line
personnel earn a commensurate wage.
(20 ILCS 1705/74)
Sec. 74. Rates and reimbursements.
(a) Within 30 days after July 6, 2017 (the effective date
of Public Act 100-23), the Department shall increase rates and
reimbursements to fund a minimum of a $0.75 per hour wage
increase for front-line personnel, including, but not limited
to, direct support persons, aides, front-line supervisors,
qualified intellectual disabilities professionals, nurses, and
non-administrative support staff working in community-based
provider organizations serving individuals with developmental
disabilities. The Department shall adopt rules, including
emergency rules under subsection (y) of Section 5-45 of the
Illinois Administrative Procedure Act, to implement the
provisions of this Section.
(b) Rates and reimbursements. Within 30 days after the
effective date of this amendatory Act of the 100th General
Assembly, the Department shall increase rates and
reimbursements to fund a minimum of a $0.50 per hour wage
increase for front-line personnel, including, but not limited
to, direct support persons, aides, front-line supervisors,
qualified intellectual disabilities professionals, nurses, and
non-administrative support staff working in community-based
provider organizations serving individuals with developmental

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disabilities. The Department shall adopt rules, including
emergency rules under subsection (bb) of Section 5-45 of the
Illinois Administrative Procedure Act, to implement the
provisions of this Section.
(c) Rates and reimbursements. Within 30 days after the
effective date of this amendatory Act of the 101st General
Assembly, subject to federal approval, the Department shall
increase rates and reimbursements in effect on June 30, 2019
for community-based providers for persons with Developmental
Disabilities by 3.5% The Department shall adopt rules,
including emergency rules under subsection (jj) of Section
5-45 of the Illinois Administrative Procedure Act, to
implement the provisions of this Section, including wage
increases for direct care staff.
(d) For community-based providers serving persons with
intellectual/developmental disabilities, subject to federal
approval of any relevant Waiver Amendment, the rates taking
effect for services delivered on or after January 1, 2022,
shall include an increase in the rate methodology sufficient
to provide a $1.50 per hour wage increase for direct support
personnel in residential settings and sufficient to provide
wages for all residential non-executive direct care staff,
excluding direct support personnel, at the federal Department
of Labor, Bureau of Labor Statistics' average wage as defined
in rule by the Department.
The establishment of and any changes to the rate

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methodologies for community-based services provided to persons
with intellectual/developmental disabilities are subject to
federal approval of any relevant Waiver Amendment and shall be
defined in rule by the Department. The Department shall adopt
rules, including emergency rules as authorized by Section 5-45
of the Illinois Administrative Procedure Act, to implement the
provisions of this subsection (d).
(e) For community-based providers serving persons with
intellectual or developmental disabilities, subject to federal
approval, the rates taking effect for services delivered on or
after July 1, 2022 shall be increased sufficiently to provide
a minimum $3.50 per hour wage increase over the wages in effect
on June 30, 2022 for front-line personnel, including, but not
limited to, direct support persons, aides, front-line
supervisors, and non-administrative support staff working in
community-based provider organizations serving individuals
with developmental disabilities, and sufficiently to provide
wages for all other residential non-executive direct care
staff, excluding direct support personnel, at the U.S.
Department of Labor, Bureau of Labor Statistics' average wage
as defined, by rule, by the Department. The Department shall
adopt rules, including emergency rules in accordance with the
Illinois Administrative Procedure Act, to implement the
provisions of this subsection.
(Source: P.A. 101-10, eff. 6-5-19; 102-16, eff. 6-17-21.)

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Section 15. The Illinois Public Aid Code is amended by
changing Sections 5-5.4 and 5-5.4i as follows:
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
Sec. 5-5.4. Standards of Payment - Department of
Healthcare and Family Services. The Department of Healthcare
and Family Services shall develop standards of payment of
nursing facility and ICF/DD services in facilities providing
such services under this Article which:
(1) Provide for the determination of a facility's payment
for nursing facility or ICF/DD services on a prospective
basis. The amount of the payment rate for all nursing
facilities certified by the Department of Public Health under
the ID/DD Community Care Act or the Nursing Home Care Act as
Intermediate Care for the Developmentally Disabled facilities,
Long Term Care for Under Age 22 facilities, Skilled Nursing
facilities, or Intermediate Care facilities under the medical
assistance program shall be prospectively established annually
on the basis of historical, financial, and statistical data
reflecting actual costs from prior years, which shall be
applied to the current rate year and updated for inflation,
except that the capital cost element for newly constructed
facilities shall be based upon projected budgets. The annually
established payment rate shall take effect on July 1 in 1984
and subsequent years. No rate increase and no update for
inflation shall be provided on or after July 1, 1994, unless

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specifically provided for in this Section. The changes made by
Public Act 93-841 extending the duration of the prohibition
against a rate increase or update for inflation are effective
retroactive to July 1, 2004.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for
Under Age 22 facilities, the rates taking effect on July 1,
1998 shall include an increase of 3%. For facilities licensed
by the Department of Public Health under the Nursing Home Care
Act as Skilled Nursing facilities or Intermediate Care
facilities, the rates taking effect on July 1, 1998 shall
include an increase of 3% plus $1.10 per resident-day, as
defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Intermediate Care Facilities for the Developmentally Disabled
or Long Term Care for Under Age 22 facilities, the rates taking
effect on January 1, 2006 shall include an increase of 3%. For
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as Intermediate Care Facilities for
the Developmentally Disabled or Long Term Care for Under Age
22 facilities, the rates taking effect on January 1, 2009
shall include an increase sufficient to provide a $0.50 per
hour wage increase for non-executive staff. For facilities
licensed by the Department of Public Health under the ID/DD
Community Care Act as ID/DD Facilities the rates taking effect

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within 30 days after July 6, 2017 (the effective date of Public
Act 100-23) shall include an increase sufficient to provide a
$0.75 per hour wage increase for non-executive staff. The
Department shall adopt rules, including emergency rules under
subsection (y) of Section 5-45 of the Illinois Administrative
Procedure Act, to implement the provisions of this paragraph.
For facilities licensed by the Department of Public Health
under the ID/DD Community Care Act as ID/DD Facilities and
under the MC/DD Act as MC/DD Facilities, the rates taking
effect within 30 days after the effective date of this
amendatory Act of the 100th General Assembly shall include an
increase sufficient to provide a $0.50 per hour wage increase
for non-executive front-line personnel, including, but not
limited to, direct support persons, aides, front-line
supervisors, qualified intellectual disabilities
professionals, nurses, and non-administrative support staff.
The Department shall adopt rules, including emergency rules
under subsection (bb) of Section 5-45 of the Illinois
Administrative Procedure Act, to implement the provisions of
this paragraph.
For facilities licensed by the Department of Public Health
under the ID/DD Community Care Act as ID/DD facilities and
under the MC/DD Act as MC/DD facilities, the rates taking
effect for services delivered on or after July 1, 2022, shall
be increased sufficiently to provide a minimum $3.50 per hour
wage increase over the wages in effect on June 30, 2022 for

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front-line personnel, including, but not limited to, direct
support persons, aides, front-line supervisors, and
non-administrative support staff working in community-based
provider organizations serving individuals with developmental
disabilities, and sufficiently to provide wages for all other
residential non-executive direct care staff, excluding direct
support personnel, at the U.S. Department of Labor, Bureau of
Labor Statistics' average wage as defined, by rule, by the
Department. The Department shall adopt rules, including
emergency rules in accordance with the Illinois Administrative
Procedure Act, to implement the provisions of this paragraph.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for
Under Age 22 facilities, the rates taking effect on July 1,
1999 shall include an increase of 1.6% plus $3.00 per
resident-day, as defined by the Department. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Skilled Nursing facilities or Intermediate
Care facilities, the rates taking effect on July 1, 1999 shall
include an increase of 1.6% and, for services provided on or
after October 1, 1999, shall be increased by $4.00 per
resident-day, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for

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Under Age 22 facilities, the rates taking effect on July 1,
2000 shall include an increase of 2.5% per resident-day, as
defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 2000 shall include an
increase of 2.5% per resident-day, as defined by the
Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, a new payment methodology
must be implemented for the nursing component of the rate
effective July 1, 2003. The Department of Public Aid (now
Healthcare and Family Services) shall develop the new payment
methodology using the Minimum Data Set (MDS) as the instrument
to collect information concerning nursing home resident
condition necessary to compute the rate. The Department shall
develop the new payment methodology to meet the unique needs
of Illinois nursing home residents while remaining subject to
the appropriations provided by the General Assembly. A
transition period from the payment methodology in effect on
June 30, 2003 to the payment methodology in effect on July 1,
2003 shall be provided for a period not exceeding 3 years and
184 days after implementation of the new payment methodology
as follows:
(A) For a facility that would receive a lower nursing

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component rate per patient day under the new system than
the facility received effective on the date immediately
preceding the date that the Department implements the new
payment methodology, the nursing component rate per
patient day for the facility shall be held at the level in
effect on the date immediately preceding the date that the
Department implements the new payment methodology until a
higher nursing component rate of reimbursement is achieved
by that facility.
(B) For a facility that would receive a higher nursing
component rate per patient day under the payment
methodology in effect on July 1, 2003 than the facility
received effective on the date immediately preceding the
date that the Department implements the new payment
methodology, the nursing component rate per patient day
for the facility shall be adjusted.
(C) Notwithstanding paragraphs (A) and (B), the
nursing component rate per patient day for the facility
shall be adjusted subject to appropriations provided by
the General Assembly.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for
Under Age 22 facilities, the rates taking effect on March 1,
2001 shall include a statewide increase of 7.85%, as defined
by the Department.

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Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, except facilities participating
in the Department's demonstration program pursuant to the
provisions of Title 77, Part 300, Subpart T of the Illinois
Administrative Code, the numerator of the ratio used by the
Department of Healthcare and Family Services to compute the
rate payable under this Section using the Minimum Data Set
(MDS) methodology shall incorporate the following annual
amounts as the additional funds appropriated to the Department
specifically to pay for rates based on the MDS nursing
component methodology in excess of the funding in effect on
December 31, 2006:
(i) For rates taking effect January 1, 2007,
$60,000,000.
(ii) For rates taking effect January 1, 2008,
$110,000,000.
(iii) For rates taking effect January 1, 2009,
$194,000,000.
(iv) For rates taking effect April 1, 2011, or the
first day of the month that begins at least 45 days after
the effective date of this amendatory Act of the 96th
General Assembly, $416,500,000 or an amount as may be
necessary to complete the transition to the MDS
methodology for the nursing component of the rate.

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Increased payments under this item (iv) are not due and
payable, however, until (i) the methodologies described in
this paragraph are approved by the federal government in
an appropriate State Plan amendment and (ii) the
assessment imposed by Section 5B-2 of this Code is
determined to be a permissible tax under Title XIX of the
Social Security Act.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the support component of the
rates taking effect on January 1, 2008 shall be computed using
the most recent cost reports on file with the Department of
Healthcare and Family Services no later than April 1, 2005,
updated for inflation to January 1, 2006.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for
Under Age 22 facilities, the rates taking effect on April 1,
2002 shall include a statewide increase of 2.0%, as defined by
the Department. This increase terminates on July 1, 2002;
beginning July 1, 2002 these rates are reduced to the level of
the rates in effect on March 31, 2002, as defined by the
Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities

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or intermediate care facilities, the rates taking effect on
July 1, 2001 shall be computed using the most recent cost
reports on file with the Department of Public Aid no later than
April 1, 2000, updated for inflation to January 1, 2001. For
rates effective July 1, 2001 only, rates shall be the greater
of the rate computed for July 1, 2001 or the rate effective on
June 30, 2001.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall
determine by rule the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, if the payment methodologies
required under Section 5A-12 and the waiver granted under 42
CFR 433.68 are approved by the United States Centers for
Medicare and Medicaid Services, the rates taking effect on
July 1, 2004 shall be 3.0% greater than the rates in effect on
June 30, 2004. These rates shall take effect only upon
approval and implementation of the payment methodologies
required under Section 5A-12.
Notwithstanding any other provisions of this Section, for

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facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the rates taking effect on
January 1, 2005 shall be 3% more than the rates in effect on
December 31, 2004.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2009, the
per diem support component of the rates effective on January
1, 2008, computed using the most recent cost reports on file
with the Department of Healthcare and Family Services no later
than April 1, 2005, updated for inflation to January 1, 2006,
shall be increased to the amount that would have been derived
using standard Department of Healthcare and Family Services
methods, procedures, and inflators.
Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as intermediate care facilities that
are federally defined as Institutions for Mental Disease, or
facilities licensed by the Department of Public Health under
the Specialized Mental Health Rehabilitation Act of 2013, a
socio-development component rate equal to 6.6% of the
facility's nursing component rate as of January 1, 2006 shall
be established and paid effective July 1, 2006. The
socio-development component of the rate shall be increased by

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a factor of 2.53 on the first day of the month that begins at
least 45 days after January 11, 2008 (the effective date of
Public Act 95-707). As of August 1, 2008, the
socio-development component rate shall be equal to 6.6% of the
facility's nursing component rate as of January 1, 2006,
multiplied by a factor of 3.53. For services provided on or
after April 1, 2011, or the first day of the month that begins
at least 45 days after the effective date of this amendatory
Act of the 96th General Assembly, whichever is later, the
Illinois Department may by rule adjust these socio-development
component rates, and may use different adjustment
methodologies for those facilities participating, and those
not participating, in the Illinois Department's demonstration
program pursuant to the provisions of Title 77, Part 300,
Subpart T of the Illinois Administrative Code, but in no case
may such rates be diminished below those in effect on August 1,
2008.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or as long-term care
facilities for residents under 22 years of age, the rates
taking effect on July 1, 2003 shall include a statewide
increase of 4%, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for

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Under Age 22 facilities, the rates taking effect on the first
day of the month that begins at least 45 days after the
effective date of this amendatory Act of the 95th General
Assembly shall include a statewide increase of 2.5%, as
defined by the Department.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2005,
facility rates shall be increased by the difference between
(i) a facility's per diem property, liability, and malpractice
insurance costs as reported in the cost report filed with the
Department of Public Aid and used to establish rates effective
July 1, 2001 and (ii) those same costs as reported in the
facility's 2002 cost report. These costs shall be passed
through to the facility without caps or limitations, except
for adjustments required under normal auditing procedures.
Rates established effective each July 1 shall govern
payment for services rendered throughout that fiscal year,
except that rates established on July 1, 1996 shall be
increased by 6.8% for services provided on or after January 1,
1997. Such rates will be based upon the rates calculated for
the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the

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midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report filed
by each skilled care facility and intermediate care facility,
updated to the midpoint of the current rate year. In
determining rates for services rendered on and after July 1,
1985, fixed time shall not be computed at less than zero. The
Department shall not make any alterations of regulations which
would reduce any component of the Medicaid rate to a level
below what that component would have been utilizing in the
rate effective on July 1, 1984.
(2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled
nursing and intermediate care services under the medical
assistance program.
(3) Shall take into account the medical and psycho-social
characteristics and needs of the patients.
(4) Shall take into account the actual costs incurred by
facilities in meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
The Department of Healthcare and Family Services shall
develop precise standards for payments to reimburse nursing

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facilities for any utilization of appropriate rehabilitative
personnel for the provision of rehabilitative services which
is authorized by federal regulations, including reimbursement
for services provided by qualified therapists or qualified
assistants, and which is in accordance with accepted
professional practices. Reimbursement also may be made for
utilization of other supportive personnel under appropriate
supervision.
The Department shall develop enhanced payments to offset
the additional costs incurred by a facility serving
exceptional need residents and shall allocate at least
$4,000,000 of the funds collected from the assessment
established by Section 5B-2 of this Code for such payments.
For the purpose of this Section, "exceptional needs" means,
but need not be limited to, ventilator care and traumatic
brain injury care. The enhanced payments for exceptional need
residents under this paragraph are not due and payable,
however, until (i) the methodologies described in this
paragraph are approved by the federal government in an
appropriate State Plan amendment and (ii) the assessment
imposed by Section 5B-2 of this Code is determined to be a
permissible tax under Title XIX of the Social Security Act.
Beginning January 1, 2014 the methodologies for
reimbursement of nursing facility services as provided under
this Section 5-5.4 shall no longer be applicable for services
provided on or after January 1, 2014.

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No payment increase under this Section for the MDS
methodology, exceptional care residents, or the
socio-development component rate established by Public Act
96-1530 of the 96th General Assembly and funded by the
assessment imposed under Section 5B-2 of this Code shall be
due and payable until after the Department notifies the
long-term care providers, in writing, that the payment
methodologies to long-term care providers required under this
Section have been approved by the Centers for Medicare and
Medicaid Services of the U.S. Department of Health and Human
Services and the waivers under 42 CFR 433.68 for the
assessment imposed by this Section, if necessary, have been
granted by the Centers for Medicare and Medicaid Services of
the U.S. Department of Health and Human Services. Upon
notification to the Department of approval of the payment
methodologies required under this Section and the waivers
granted under 42 CFR 433.68, all increased payments otherwise
due under this Section prior to the date of notification shall
be due and payable within 90 days of the date federal approval
is received.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
For facilities licensed by the Department of Public Health

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under the ID/DD Community Care Act as ID/DD Facilities and
under the MC/DD Act as MC/DD Facilities, subject to federal
approval, the rates taking effect for services delivered on or
after August 1, 2019 shall be increased by 3.5% over the rates
in effect on June 30, 2019. The Department shall adopt rules,
including emergency rules under subsection (ii) of Section
5-45 of the Illinois Administrative Procedure Act, to
implement the provisions of this Section, including wage
increases for direct care staff.
For facilities licensed by the Department of Public Health
under the ID/DD Community Care Act as ID/DD Facilities and
under the MC/DD Act as MC/DD Facilities, subject to federal
approval, the rates taking effect on the latter of the
approval date of the State Plan Amendment for these facilities
or the Waiver Amendment for the home and community-based
services settings shall include an increase sufficient to
provide a $0.26 per hour wage increase to the base wage for
non-executive staff. The Department shall adopt rules,
including emergency rules as authorized by Section 5-45 of the
Illinois Administrative Procedure Act, to implement the
provisions of this Section, including wage increases for
direct care staff.
For facilities licensed by the Department of Public Health
under the ID/DD Community Care Act as ID/DD Facilities and
under the MC/DD Act as MC/DD Facilities, subject to federal
approval of the State Plan Amendment and the Waiver Amendment

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for the home and community-based services settings, the rates
taking effect for the services delivered on or after July 1,
2020 shall include an increase sufficient to provide a $1.00
per hour wage increase for non-executive staff. For services
delivered on or after January 1, 2021, subject to federal
approval of the State Plan Amendment and the Waiver Amendment
for the home and community-based services settings, shall
include an increase sufficient to provide a $0.50 per hour
increase for non-executive staff. The Department shall adopt
rules, including emergency rules as authorized by Section 5-45
of the Illinois Administrative Procedure Act, to implement the
provisions of this Section, including wage increases for
direct care staff.
For facilities licensed by the Department of Public Health
under the ID/DD Community Care Act as ID/DD Facilities and
under the MC/DD Act as MC/DD Facilities, subject to federal
approval of the State Plan Amendment, the rates taking effect
for the residential services delivered on or after July 1,
2021, shall include an increase sufficient to provide a $0.50
per hour increase for aides in the rate methodology. For
facilities licensed by the Department of Public Health under
the ID/DD Community Care Act as ID/DD Facilities and under the
MC/DD Act as MC/DD Facilities, subject to federal approval of
the State Plan Amendment, the rates taking effect for the
residential services delivered on or after January 1, 2022
shall include an increase sufficient to provide a $1.00 per

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hour increase for aides in the rate methodology. In addition,
for residential services delivered on or after January 1, 2022
such rates shall include an increase sufficient to provide
wages for all residential non-executive direct care staff,
excluding aides, at the federal Department of Labor, Bureau of
Labor Statistics' average wage as defined in rule by the
Department. The Department shall adopt rules, including
emergency rules as authorized by Section 5-45 of the Illinois
Administrative Procedure Act, to implement the provisions of
this Section.
For facilities licensed by the Department of Public Health
under the ID/DD Community Care Act as ID/DD facilities and
under the MC/DD Act as MC/DD facilities, subject to federal
approval, the rates taking effect for services delivered on or
after July 1, 2022, shall be increased sufficiently to provide
a minimum $3.50 per hour wage increase over the wages in effect
on June 30, 2022 for front-line personnel, including, but not
limited to, direct support persons, aides, front-line
supervisors, and non-administrative support staff working in
community-based provider organizations serving individuals
with developmental disabilities, and sufficiently to provide
wages for all other residential non-executive direct care
staff, excluding direct support personnel, at the U.S.
Department of Labor, Bureau of Labor Statistics' average wage
as defined, by rule, by the Department. The Department shall
adopt rules, including emergency rules in accordance with the

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Illinois Administrative Procedure Act, to implement the
provisions of this paragraph.
(Source: P.A. 101-10, eff. 6-5-19; 101-636, eff. 6-10-20;
102-16, eff. 6-17-21.)
(305 ILCS 5/5-5.4i)
Sec. 5-5.4i. Rates and reimbursements.
(a) Within 30 days after July 6, 2017 (the effective date
of Public Act 100-23), the Department shall increase rates and
reimbursements to fund a minimum of a $0.75 per hour wage
increase for front-line personnel, including, but not limited
to, direct support persons, aides, front-line supervisors,
qualified intellectual disabilities professionals, nurses, and
non-administrative support staff working in community-based
provider organizations serving individuals with developmental
disabilities. The Department shall adopt rules, including
emergency rules under subsection (y) of Section 5-45 of the
Illinois Administrative Procedure Act, to implement the
provisions of this Section.
(b) Within 30 days after June 4, 2018 (the effective date
of Public Act 100-587), the Department shall increase rates
and reimbursements to fund a minimum of a $0.50 per hour wage
increase for front-line personnel, including, but not limited
to, direct support persons, aides, front-line supervisors,
qualified intellectual disabilities professionals, nurses, and
non-administrative support staff working in community-based

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provider organizations serving individuals with developmental
disabilities. The Department shall adopt rules, including
emergency rules under subsection (bb) of Section 5-45 of the
Illinois Administrative Procedure Act, to implement the
provisions of this Section.
(c) Within 30 days after the effective date of this
amendatory Act of the 101st General Assembly, subject to
federal approval, the Department shall increase rates and
reimbursements in effect on June 30, 2019 for community-based
providers for persons with Developmental Disabilities by 3.5%.
The Department shall adopt rules, including emergency rules
under subsection (ii) of Section 5-45 of the Illinois
Administrative Procedure Act, to implement the provisions of
this Section, including wage increases for direct care staff.
(d) For community-based providers serving persons with
intellectual or developmental disabilities, subject to federal
approval, the rates taking effect for services delivered on or
after July 1, 2022, shall be increased sufficiently to provide
a minimum $3.50 per hour wage increase over the wages in effect
on June 30, 2022 for front-line personnel, including, but not
limited to, direct support persons, aides, front-line
supervisors, and non-administrative support staff working in
community-based provider organizations serving individuals
with developmental disabilities, and sufficient to provide
wages for all other residential non-executive direct care
staff, excluding direct support personnel, at the U.S.

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Department of Labor, Bureau of Labor Statistics' average wage
as defined, by rule, by the Department. The Department shall
adopt rules, including emergency rules in accordance with the
Illinois Administrative Procedure Act, to implement the
provisions of this subsection.
(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18;
101-10, eff. 6-5-19.)
Section 99. Effective date. This Act takes effect upon
becoming law.