Bill Text: IL HB3125 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023 (rather than 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%. Effective July 1, 2023.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2023-05-19 - Rule 19(a) / Re-referred to Rules Committee [HB3125 Detail]

Download: Illinois-2023-HB3125-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3125 Introduced , by Rep. Elizabeth "Lisa" Hernandez 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. Provides that, on and after July 1, 2023 (rather than 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%. Effective July 1, 2023.
LRB103 29884 KTG 56295 b
A BILL FOR
HB3125 LRB103 29884 KTG 56295 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) (Blank).
(c-1) 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 Patient Driven Payment Model
(PDPM) has been fully operationalized, which shall take effect
for services provided on or after the implementation of the
PDPM reimbursement system begins. For the purposes of this
amendatory Act of the 102nd General Assembly, the

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implementation date of the PDPM reimbursement system and all
related provisions shall be July 1, 2022 if the following
conditions are met: (i) the Centers for Medicare and Medicaid
Services has approved corresponding changes in the
reimbursement system and bed assessment; and (ii) the
Department has filed rules to implement these changes no later
than June 1, 2022. Failure of the Department to file rules to
implement the changes provided in this amendatory Act of the
102nd General Assembly no later than June 1, 2022 shall result
in the implementation date being delayed to October 1, 2022.
(d) The new nursing services reimbursement methodology
utilizing the Patient Driven Payment Model, which shall be
referred to as the PDPM reimbursement system, taking effect
July 1, 2022, upon federal approval by the Centers for
Medicare and Medicaid Services, shall be based on the
following:
(1) The methodology shall be resident-centered,
facility-specific, cost-based, and based on guidance from
the Centers for Medicare and Medicaid Services.
(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

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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, except no adjuster shall
be lower than 1.06.
(4) PDPM nursing case mix indices in effect on March
1, 2022 shall be assigned to each resident class at no less
than 0.7858 of the Centers for Medicare and Medicaid
Services PDPM unadjusted case mix values, in effect on
March 1, 2022.
(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).
(6) The Department shall establish a variable per diem
staffing add-on in accordance with the most recent
available federal staffing report, currently the Payroll
Based Journal, for the same period of time, and if
applicable adjusted for acuity using the same quarter's
MDS. The Department shall rely on Payroll Based Journals
provided to the Department of Public Health to make a
determination of non-submission. If the Department is
notified by a facility of missing or inaccurate Payroll
Based Journal data or an incorrect calculation of
staffing, the Department must make a correction as soon as
the error is verified for the applicable quarter.
Facilities with at least 70% of the staffing indicated

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by the STRIVE study shall be paid a per diem add-on of $9,
increasing by equivalent steps for each whole percentage
point until the facilities reach a per diem of $14.88.
Facilities with at least 80% of the staffing indicated by
the STRIVE study shall be paid a per diem add-on of $14.88,
increasing by equivalent steps for each whole percentage
point until the facilities reach a per diem add-on of
$23.80. Facilities with at least 92% of the staffing
indicated by the STRIVE study shall be paid a per diem
add-on of $23.80, increasing by equivalent steps for each
whole percentage point until the facilities reach a per
diem add-on of $29.75. Facilities with at least 100% of
the staffing indicated by the STRIVE study shall be paid a
per diem add-on of $29.75, increasing by equivalent steps
for each whole percentage point until the facilities reach
a per diem add-on of $35.70. Facilities with at least 110%
of the staffing indicated by the STRIVE study shall be
paid a per diem add-on of $35.70, increasing by equivalent
steps for each whole percentage point until the facilities
reach a per diem add-on of $38.68. Facilities with at
least 125% or higher of the staffing indicated by the
STRIVE study shall be paid a per diem add-on of $38.68.
Beginning April 1, 2023, no nursing facility's variable
staffing per diem add-on shall be reduced by more than 5%
in 2 consecutive quarters. For the quarters beginning July
1, 2022 and October 1, 2022, no facility's variable per

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diem staffing add-on shall be calculated at a rate lower
than 85% of the staffing indicated by the STRIVE study. No
facility below 70% of the staffing indicated by the STRIVE
study shall receive a variable per diem staffing add-on
after December 31, 2022.
(7) For dates of services beginning July 1, 2022, the
PDPM nursing component per diem for each nursing facility
shall be the product of the facility's (i) statewide PDPM
nursing base per diem rate, $92.25, adjusted for the
facility average PDPM case mix index calculated quarterly
and (ii) the regional wage adjuster, and then add the
Medicaid access adjustment as defined in (e-3) of this
Section. Transition rates for services provided between
July 1, 2022 and October 1, 2023 shall be the greater of
the PDPM nursing component per diem or:
(A) for the quarter beginning July 1, 2022, the
RUG-IV nursing component per diem;
(B) for the quarter beginning October 1, 2022, the
sum of the RUG-IV nursing component per diem
multiplied by 0.80 and the PDPM nursing component per
diem multiplied by 0.20;
(C) for the quarter beginning January 1, 2023, the
sum of the RUG-IV nursing component per diem
multiplied by 0.60 and the PDPM nursing component per
diem multiplied by 0.40;
(D) for the quarter beginning April 1, 2023, the

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sum of the RUG-IV nursing component per diem
multiplied by 0.40 and the PDPM nursing component per
diem multiplied by 0.60;
(E) for the quarter beginning July 1, 2023, the
sum of the RUG-IV nursing component per diem
multiplied by 0.20 and the PDPM nursing component per
diem multiplied by 0.80; or
(F) for the quarter beginning October 1, 2023 and
each subsequent quarter, the transition rate shall end
and a nursing facility shall be paid 100% of the PDPM
nursing component per diem.
(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
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

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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 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);
(B) on and after July 1, 2014 and until July 1,
2022, shall be the amount calculated under
subparagraph (A) of this paragraph (3) plus $1.76; and
(C) beginning July 1, 2022 and thereafter, $7

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shall be added to the amount calculated under
subparagraph (B) of this paragraph (3) of this
Section.
(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.
(e-1) (Blank).
(e-2) For dates of services beginning January 1, 2014 and
ending September 30, 2023, 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

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mix index, and the regional wage adjustor. For dates of
service beginning July 1, 2022 and ending September 30, 2023,
the Medicaid access adjustment described in subsection (e-3)
shall be added to the product.
(e-3) A Medicaid Access Adjustment of $4 adjusted for the
facility average PDPM case mix index calculated quarterly
shall be added to the statewide PDPM nursing per diem for all
facilities with annual Medicaid bed days of at least 70% of all
occupied bed days adjusted quarterly. For each new calendar
year and for the 6-month period beginning July 1, 2022, the
percentage of a facility's occupied bed days comprised of
Medicaid bed days shall be determined by the Department
quarterly. For dates of service beginning January 1, 2023, the
Medicaid Access Adjustment shall be increased to $4.75. This
subsection shall be inoperative on and after January 1, 2028.
(f) (Blank).
(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) (Blank);
(2) (Blank);
(3) Facility rates for the capital and support
components shall be reduced by 1.7%.
(h) Notwithstanding any other provision of this Code, on

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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
reimbursement rate effective May 1, 2011 reduced in total by
2.7%.
(i) On and after July 1, 2023 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) Notwithstanding any other provision of law, subject to
federal approval, effective July 1, 2019, sufficient funds
shall be allocated for changes to rates for facilities
licensed under the Nursing Home Care Act as skilled nursing
facilities or intermediate care facilities for dates of
services on and after July 1, 2019: (i) to establish, through
June 30, 2022 a per diem add-on to the direct care per diem
rate not to exceed $70,000,000 annually in the aggregate
taking into account federal matching funds for the purpose of
addressing the facility's unique staffing needs, adjusted
quarterly and distributed by a weighted formula based on
Medicaid bed days on the last day of the second quarter
preceding the quarter for which the rate is being adjusted.

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Beginning July 1, 2022, the annual $70,000,000 described in
the preceding sentence shall be dedicated to the variable per
diem add-on for staffing under paragraph (6) of subsection
(d); and (ii) in an amount not to exceed $170,000,000 annually
in the aggregate taking into account federal matching funds to
permit the support component of the nursing facility rate to
be updated as follows:
(1) 80%, or $136,000,000, of the funds shall be used
to update each facility's rate in effect on June 30, 2019
using the most recent cost reports on file, which have had
a limited review conducted by the Department of Healthcare
and Family Services and will not hold up enacting the rate
increase, with the Department of Healthcare and Family
Services.
(2) After completing the calculation in paragraph (1),
any facility whose rate is less than the rate in effect on
June 30, 2019 shall have its rate restored to the rate in
effect on June 30, 2019 from the 20% of the funds set
aside.
(3) The remainder of the 20%, or $34,000,000, shall be
used to increase each facility's rate by an equal
percentage.
(k) During the first quarter of State Fiscal Year 2020,
the Department of Healthcare of Family Services must convene a
technical advisory group consisting of members of all trade
associations representing Illinois skilled nursing providers

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to discuss changes necessary with federal implementation of
Medicare's Patient-Driven Payment Model. Implementation of
Medicare's Patient-Driven Payment Model shall, by September 1,
2020, end the collection of the MDS data that is necessary to
maintain the current RUG-IV Medicaid payment methodology. The
technical advisory group must consider a revised reimbursement
methodology that takes into account transparency,
accountability, actual staffing as reported under the
federally required Payroll Based Journal system, changes to
the minimum wage, adequacy in coverage of the cost of care, and
a quality component that rewards quality improvements.
(l) The Department shall establish per diem add-on
payments to improve the quality of care delivered by
facilities, including:
(1) Incentive payments determined by facility
performance on specified quality measures in an initial
amount of $70,000,000. Nothing in this subsection shall be
construed to limit the quality of care payments in the
aggregate statewide to $70,000,000, and, if quality of
care has improved across nursing facilities, the
Department shall adjust those add-on payments accordingly.
The quality payment methodology described in this
subsection must be used for at least State Fiscal Year
2023. Beginning with the quarter starting July 1, 2023,
the Department may add, remove, or change quality metrics
and make associated changes to the quality payment

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methodology as outlined in subparagraph (E). Facilities
designated by the Centers for Medicare and Medicaid
Services as a special focus facility or a hospital-based
nursing home do not qualify for quality payments.
(A) Each quality pool must be distributed by
assigning a quality weighted score for each nursing
home which is calculated by multiplying the nursing
home's quality base period Medicaid days by the
nursing home's star rating weight in that period.
(B) Star rating weights are assigned based on the
nursing home's star rating for the LTS quality star
rating. As used in this subparagraph, "LTS quality
star rating" means the long-term stay quality rating
for each nursing facility, as assigned by the Centers
for Medicare and Medicaid Services under the Five-Star
Quality Rating System. The rating is a number ranging
from 0 (lowest) to 5 (highest).
(i) Zero-star or one-star rating has a weight
of 0.
(ii) Two-star rating has a weight of 0.75.
(iii) Three-star rating has a weight of 1.5.
(iv) Four-star rating has a weight of 2.5.
(v) Five-star rating has a weight of 3.5.
(C) Each nursing home's quality weight score is
divided by the sum of all quality weight scores for
qualifying nursing homes to determine the proportion

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of the quality pool to be paid to the nursing home.
(D) The quality pool is no less than $70,000,000
annually or $17,500,000 per quarter. The Department
shall publish on its website the estimated payments
and the associated weights for each facility 45 days
prior to when the initial payments for the quarter are
to be paid. The Department shall assign each facility
the most recent and applicable quarter's STAR value
unless the facility notifies the Department within 15
days of an issue and the facility provides reasonable
evidence demonstrating its timely compliance with
federal data submission requirements for the quarter
of record. If such evidence cannot be provided to the
Department, the STAR rating assigned to the facility
shall be reduced by one from the prior quarter.
(E) The Department shall review quality metrics
used for payment of the quality pool and make
recommendations for any associated changes to the
methodology for distributing quality pool payments in
consultation with associations representing long-term
care providers, consumer advocates, organizations
representing workers of long-term care facilities, and
payors. The Department may establish, by rule, changes
to the methodology for distributing quality pool
payments.
(F) The Department shall disburse quality pool

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payments from the Long-Term Care Provider Fund on a
monthly basis in amounts proportional to the total
quality pool payment determined for the quarter.
(G) The Department shall publish any changes in
the methodology for distributing quality pool payments
prior to the beginning of the measurement period or
quality base period for any metric added to the
distribution's methodology.
(2) Payments based on CNA tenure, promotion, and CNA
training for the purpose of increasing CNA compensation.
It is the intent of this subsection that payments made in
accordance with this paragraph be directly incorporated
into increased compensation for CNAs. As used in this
paragraph, "CNA" means a certified nursing assistant as
that term is described in Section 3-206 of the Nursing
Home Care Act, Section 3-206 of the ID/DD Community Care
Act, and Section 3-206 of the MC/DD Act. The Department
shall establish, by rule, payments to nursing facilities
equal to Medicaid's share of the tenure wage increments
specified in this paragraph for all reported CNA employee
hours compensated according to a posted schedule
consisting of increments at least as large as those
specified in this paragraph. The increments are as
follows: an additional $1.50 per hour for CNAs with at
least one and less than 2 years' experience plus another
$1 per hour for each additional year of experience up to a

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maximum of $6.50 for CNAs with at least 6 years of
experience. For purposes of this paragraph, Medicaid's
share shall be the ratio determined by paid Medicaid bed
days divided by total bed days for the applicable time
period used in the calculation. In addition, and additive
to any tenure increments paid as specified in this
paragraph, the Department shall establish, by rule,
payments supporting Medicaid's share of the
promotion-based wage increments for CNA employee hours
compensated for that promotion with at least a $1.50
hourly increase. Medicaid's share shall be established as
it is for the tenure increments described in this
paragraph. Qualifying promotions shall be defined by the
Department in rules for an expected 10-15% subset of CNAs
assigned intermediate, specialized, or added roles such as
CNA trainers, CNA scheduling "captains", and CNA
specialists for resident conditions like dementia or
memory care or behavioral health.
(m) The Department shall work with nursing facility
industry representatives to design policies and procedures to
permit facilities to address the integrity of data from
federal reporting sites used by the Department in setting
facility rates.
(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff.
5-31-22; 102-1118, eff. 1-18-23.)

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Section 99. Effective date. This Act takes effect July 1,
2023.