HB 4032 — MEDICAID-NURSING HOME RATES

*LRB09409950DRJ42629b* HB4032 94THEngrossed GENERALLRB094 ASSEMBLY09950 StateDRJ of42629 Illinoisb andAN 2006ACT HB4032in Introducedrelation 02/28/05,to bypublic Rep.aid.

Lee A.

Daniels SYNOPSIS AS INTRODUCED:

ILCS 5/5-5.4 from Ch.

23, par.

5-5.4 Amends the Illinois Public Aid Code.

Provides that effective January 1, 2006, Medicaid rates for nursing homes and other community providers serving the developmentally disabled or mentally ill licensed by the Department of Public Health 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.

Requires that these costs be passed through to facilities licensed by the Department under the Nursing Home Care Act as skilled nursing facilities or intermediate care facilities or other Department-licensed community providers serving the developmentally disabled or mentally ill without caps or limitations, except for adjustments required under normal auditing procedures.

Effective January 1, 2006.

LRB094 09950 DRJ 42629 b FISCAL NOTE ACT MAY APPLY A BILL FOR HB4032 LRB094 09950 DRJ 42629 b AN ACT in relation to public aid.

For facilities licensed by the Department of Public Health HB4032 Engrossed - 2 - LRB094 09950 DRJ 42629 b 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%.

The Department of Public Aid shall develop the HB4032 Engrossed - 3 - LRB094 09950 DRJ 42629 b 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.

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 HB4032 Engrossed - 4 - LRB094 09950 DRJ 42629 b shall include a statewide increase of 7.85%, as defined by the Department.

These rates shall take effect only upon approval and implementation of the payment methodologies required under HB4032 Engrossed - 5 - LRB094 09950 DRJ 42629 b Section 5A-12.

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 facilitiesfacilities, or other Department-licensed community providers serving the developmentally disabled or mentally ill, effective January 1, 2006,2005, 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.

Notwithstanding any other provision of this Section, 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, effective January 1, 2006, 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 HB4032 Engrossed - 6 - LRB094 09950 DRJ 42629 b facility without caps or limitations, except for adjustments required under normal auditing procedures.

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 HB4032 - 6 - LRB094 09950 DRJ 42629 b midpoint of the rate year.

The Department of Public Aid shall develop precise HB4032 Engrossed - 7 - LRB094 09950 DRJ 42629 b standards for payments to reimburse nursing 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.

93-841, HB4032 - 7 - LRB094 09950 DRJ 42629 b eff.

7-30-04.)7-30-04; Section 99.

93-1087, eff.

2-28-05.) Section 10.

The Community Services Act is amended by changing Section 4 as follows:

(405 ILCS 30/4) (from Ch.

91 1/2, par.

904) Sec.

4.

Financing for Community Services.

The Department of Human Services is authorized to provide financial assistance to eligible private service providers, corporations, local government entities or voluntary associations for the provision of services to persons with mental illness, persons with a developmental disability and alcohol and drug dependent persons living in the community for the purpose of achieving the goals of this Act.

The Department shall utilize the following funding mechanisms for community services:

(1) Purchase of Care Contracts:

services purchased on a predetermined fee per unit of service basis from private providers or governmental entities.

Fee per service rates are set by an established formula which covers some portion of personnel, supplies, and other allowable costs, and which makes some allowance for geographic variations in costs as well as for additional program components.

(2) Grants:

sums of money which the Department grants to private providers or governmental entities pursuant to HB4032 Engrossed - 8 - LRB094 09950 DRJ 42629 b the grant recipient’s agreement to provide certain services, as defined by departmental grant guidelines, to an approximate number of service recipients.

Grant levels are set through consideration of personnel, supply and other allowable costs, as well as other funds available to the program.

(3) Other Funding Arrangements:

funding mechanisms may be established on a pilot basis in order to examine the feasibility of alternative financing arrangements for the provision of community services.

The Department shall strive to establish and maintain an equitable system of payment which encourages providers to improve their clients’ capabilities for independence and reduces their reliance on community or State-operated services.