103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2026   Introduced 2/9/2023, by Sen. Laura M. Murphy   SYNOPSIS AS INTRODUCED:   5 ILCS 100/5-45.35 new 5 ILCS 100/5-45.36 new 20 ILCS 1705/74 305 ILCS 5/5-5.4   from Ch. 23, par. 5-5.4     Amends the Mental Health and Developmental Disabilities Administrative Act. Provides that for community-based providers serving persons with intellectual or developmental disabilities, the rates taking effect for services delivered on or after January 1, 2024 shall be increased sufficiently to: (i) provide a minimum $4.00 per hour wage increase over the wages in 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 in by the Department of Human Services. 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 January 1, 2024 shall be increased sufficiently to: (i) provide a minimum $4.00 per hour wage increase over the wages in 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 in rule by the Department of Healthcare and Family Services. Amends the Illinois Administrative Procedure Act. Grants the Departments of Human Services and Healthcare and Family Services emergency rulemaking authority. Effective immediately. LRB103 28363 SPS 54743 b     A BILL FOR
SB2026 LRB103 28363 SPS 54743 b
1		AN ACT concerning State government.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Administrative Procedure Act is
5		amended by adding Sections 5-45.35 and 5-45.36 as follows:
6		(5 ILCS 100/5-45.35 new)
7		Sec. 5-45.35. Emergency rulemaking; Mental Health and
8		Developmental Disabilities Administrative Act. To provide for
9		the expeditious and timely implementation of the changes made
10		to Section 74 of the Mental Health and Developmental
11		Disabilities Administrative Act by this amendatory Act of the
12		103rd General Assembly, emergency rules implementing the
13		changes made to Section 74 of the Mental Health and
14		Developmental Disabilities Administrative Act by this
15		amendatory Act of the 103rd General Assembly may be adopted in
16		accordance with Section 5-45 by the Department of Human
17		Services. The adoption of emergency rules authorized by
18		Section 5-45 and this Section is deemed to be necessary for the
19		public interest, safety, and welfare.
20		This Section is repealed one year after the effective date
21		of this amendatory Act of the 103rd General Assembly.
22		(5 ILCS 100/5-45.36 new)

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1		Sec. 5-45.36. Emergency rulemaking; Illinois Public Aid
2		Code. To provide for the expeditious and timely implementation
3		of the changes made to Section 5-5.4 of the Illinois Public Aid
4		Code by this amendatory Act of the 103rd General Assembly,
5		emergency rules implementing the changes made to Section 5-5.4
6		of the Illinois Public Aid Code by this amendatory Act of the
7		103rd General Assembly may be adopted in accordance with
8		Section 5-45 by the Department of Healthcare and Family
9		Services. The adoption of emergency rules authorized by
10		Section 5-45 and this Section is deemed to be necessary for the
11		public interest, safety, and welfare.
12		This Section is repealed one year after the effective date
13		of this amendatory Act of the 103rd General Assembly.
14		Section 10. The Mental Health and Developmental
15		Disabilities Administrative Act is amended by changing Section
16		74 as follows:
17		(20 ILCS 1705/74)
18		Sec. 74. Rates and reimbursements.
19		(a) Within 30 days after July 6, 2017 (the effective date
20		of Public Act 100-23), the Department shall increase rates and
21		reimbursements to fund a minimum of a $0.75 per hour wage
22		increase for front-line personnel, including, but not limited
23		to, direct support professionals, aides, front-line
24		supervisors, qualified intellectual disabilities

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1		professionals, nurses, and non-administrative support staff
2		working in community-based provider organizations serving
3		individuals with developmental disabilities. The Department
4		shall adopt rules, including emergency rules under subsection
5		(y) of Section 5-45 of the Illinois Administrative Procedure
6		Act, to implement the provisions of this Section.
7		(b) Rates and reimbursements. Within 30 days after June 4,
8		2018 (the effective date of Public Act 100-587) this
9		amendatory Act of the 100th General Assembly, the Department
10		shall increase rates and reimbursements to fund a minimum of a
11		$0.50 per hour wage increase for front-line personnel,
12		including, but not limited to, direct support professionals,
13		aides, front-line supervisors, qualified intellectual
14		disabilities professionals, nurses, and non-administrative
15		support staff working in community-based provider
16		organizations serving individuals with developmental
17		disabilities. The Department shall adopt rules, including
18		emergency rules under subsection (bb) of Section 5-45 of the
19		Illinois Administrative Procedure Act, to implement the
20		provisions of this Section.
21		(c) Rates and reimbursements. Within 30 days after June 5,
22		2019 (the effective date of Public Act 101-10) this amendatory
23		Act of the 101st General Assembly, subject to federal
24		approval, the Department shall increase rates and
25		reimbursements in effect on June 30, 2019 for community-based
26		providers for persons with Developmental Disabilities by 3.5%

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1		The Department shall adopt rules, including emergency rules
2		under subsection (jj) of Section 5-45 of the Illinois
3		Administrative Procedure Act, to implement the provisions of
4		this Section, including wage increases for direct care staff.
5		(d) For community-based providers serving persons with
6		intellectual/developmental disabilities, subject to federal
7		approval of any relevant Waiver Amendment, the rates taking
8		effect for services delivered on or after January 1, 2022,
9		shall include an increase in the rate methodology sufficient
10		to provide a $1.50 per hour wage increase for direct support
11		professionals in residential settings and sufficient to
12		provide wages for all residential non-executive direct care
13		staff, excluding direct support professionals, at the federal
14		Department of Labor, Bureau of Labor Statistics' average wage
15		as defined in rule by the Department.
16		The establishment of and any changes to the rate
17		methodologies for community-based services provided to persons
18		with intellectual/developmental disabilities are subject to
19		federal approval of any relevant Waiver Amendment and shall be
20		defined in rule by the Department. The Department shall adopt
21		rules, including emergency rules as authorized by Section 5-45
22		of the Illinois Administrative Procedure Act, to implement the
23		provisions of this subsection (d).
24		(e) For community-based providers serving persons with
25		intellectual/developmental disabilities, subject to federal
26		approval of any relevant Waiver Amendment, the rates taking

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1		effect for services delivered on or after January 1, 2023,
2		shall include an increase in the rate methodology sufficient
3		to provide a $1.00 per hour wage increase for all direct
4		support professionals personnel and all other frontline
5		personnel who are not subject to the Bureau of Labor
6		Statistics' average wage increases, who work in residential
7		and community day services settings, with at least $0.50 of
8		those funds to be provided as a direct increase to base wages,
9		with the remaining $0.50 to be used flexibly for base wage
10		increases. In addition, the rates taking effect for services
11		delivered on or after January 1, 2023 shall include an
12		increase sufficient to provide wages for all residential
13		non-executive direct care staff, excluding direct support
14		professionals personnel, at the federal Department of Labor,
15		Bureau of Labor Statistics' average wage as defined in rule by
16		the Department.
17		The establishment of and any changes to the rate
18		methodologies for community-based services provided to persons
19		with intellectual/developmental disabilities are subject to
20		federal approval of any relevant Waiver Amendment and shall be
21		defined in rule by the Department. The Department shall adopt
22		rules, including emergency rules as authorized by Section 5-45
23		of the Illinois Administrative Procedure Act, to implement the
24		provisions of this subsection.
25		(f) For community-based providers serving persons with
26		intellectual or developmental disabilities, subject to federal

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1		approval of any relevant Waiver Amendment, the rates taking
2		effect for services delivered on or after January 1, 2024,
3		shall include an increase in the rate methodology sufficient
4		to provide a $4.00 per hour wage rate increase for all direct
5		support professionals and all other frontline personnel who
6		are not subject to the Bureau of Labor Statistics' average
7		wage increases, who work in residential and community day
8		services settings, with at least $2.00 of those funds to be
9		provided as a direct increase to base wages, with the
10		remaining $2.00 to be used flexibly for base wage increases.
11		In addition, the rates taking effect for services delivered on
12		or after January 1, 2024, shall include an increase sufficient
13		to provide wages for all residential non-executive direct care
14		staff, excluding direct support professionals, at the federal
15		Department of Labor, Bureau of Labor Statistics' average wage
16		as defined in rule by the Department. For services delivered
17		on or after January 1, 2024, the rates shall include
18		adjustments to employment-related expenses as defined in rule
19		by the Department.
20		The establishment of and any changes to the rate
21		methodologies for community-based services provided to persons
22		with intellectual or developmental disabilities are subject to
23		federal approval of any relevant Waiver Amendment and shall be
24		defined in rule by the Department. The Department shall adopt
25		rules, including emergency rules as authorized by Section 5-45
26		of the Illinois Administrative Procedure Act, to implement the

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1		provisions of this subsection.
2		(Source: P.A. 101-10, eff. 6-5-19; 102-16, eff. 6-17-21;
3		102-699, eff. 4-19-22; 102-830, eff. 1-1-23; revised
4		12-13-22.)
5		Section 15. The Illinois Public Aid Code is amended by
6		changing Section 5-5.4 as follows:
7		(305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
8		Sec. 5-5.4. Standards of Payment - Department of
9		Healthcare and Family Services. The Department of Healthcare
10		and Family Services shall develop standards of payment of
11		nursing facility and ICF/DD services in facilities providing
12		such services under this Article which:
13		(1) Provide for the determination of a facility's payment
14		for nursing facility or ICF/DD services on a prospective
15		basis. The amount of the payment rate for all nursing
16		facilities certified by the Department of Public Health under
17		the ID/DD Community Care Act or the Nursing Home Care Act as
18		Intermediate Care for the Developmentally Disabled facilities,
19		Long Term Care for Under Age 22 facilities, Skilled Nursing
20		facilities, or Intermediate Care facilities under the medical
21		assistance program shall be prospectively established annually
22		on the basis of historical, financial, and statistical data
23		reflecting actual costs from prior years, which shall be
24		applied to the current rate year and updated for inflation,

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1		except that the capital cost element for newly constructed
2		facilities shall be based upon projected budgets. The annually
3		established payment rate shall take effect on July 1 in 1984
4		and subsequent years. No rate increase and no update for
5		inflation shall be provided on or after July 1, 1994, unless
6		specifically provided for in this Section. The changes made by
7		Public Act 93-841 extending the duration of the prohibition
8		against a rate increase or update for inflation are effective
9		retroactive to July 1, 2004.
10		For facilities licensed by the Department of Public Health
11		under the Nursing Home Care Act as Intermediate Care for the
12		Developmentally Disabled facilities or Long Term Care for
13		Under Age 22 facilities, the rates taking effect on July 1,
14		1998 shall include an increase of 3%. For facilities licensed
15		by the Department of Public Health under the Nursing Home Care
16		Act as Skilled Nursing facilities or Intermediate Care
17		facilities, the rates taking effect on July 1, 1998 shall
18		include an increase of 3% plus $1.10 per resident-day, as
19		defined by the Department. For facilities licensed by the
20		Department of Public Health under the Nursing Home Care Act as
21		Intermediate Care Facilities for the Developmentally Disabled
22		or Long Term Care for Under Age 22 facilities, the rates taking
23		effect on January 1, 2006 shall include an increase of 3%. For
24		facilities licensed by the Department of Public Health under
25		the Nursing Home Care Act as Intermediate Care Facilities for
26		the Developmentally Disabled or Long Term Care for Under Age

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1		22 facilities, the rates taking effect on January 1, 2009
2		shall include an increase sufficient to provide a $0.50 per
3		hour wage increase for non-executive staff. For facilities
4		licensed by the Department of Public Health under the ID/DD
5		Community Care Act as ID/DD Facilities the rates taking effect
6		within 30 days after July 6, 2017 (the effective date of Public
7		Act 100-23) shall include an increase sufficient to provide a
8		$0.75 per hour wage increase for non-executive staff. The
9		Department shall adopt rules, including emergency rules under
10		subsection (y) of Section 5-45 of the Illinois Administrative
11		Procedure Act, to implement the provisions of this paragraph.
12		For facilities licensed by the Department of Public Health
13		under the ID/DD Community Care Act as ID/DD Facilities and
14		under the MC/DD Act as MC/DD Facilities, the rates taking
15		effect within 30 days after the effective date of this
16		amendatory Act of the 100th General Assembly shall include an
17		increase sufficient to provide a $0.50 per hour wage increase
18		for non-executive front-line personnel, including, but not
19		limited to, direct support persons, aides, front-line
20		supervisors, qualified intellectual disabilities
21		professionals, nurses, and non-administrative support staff.
22		The Department shall adopt rules, including emergency rules
23		under subsection (bb) of Section 5-45 of the Illinois
24		Administrative Procedure Act, to implement the provisions of
25		this paragraph.
26		For facilities licensed by the Department of Public Health

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1		under the Nursing Home Care Act as Intermediate Care for the
2		Developmentally Disabled facilities or Long Term Care for
3		Under Age 22 facilities, the rates taking effect on July 1,
4		1999 shall include an increase of 1.6% plus $3.00 per
5		resident-day, as defined by the Department. For facilities
6		licensed by the Department of Public Health under the Nursing
7		Home Care Act as Skilled Nursing facilities or Intermediate
8		Care facilities, the rates taking effect on July 1, 1999 shall
9		include an increase of 1.6% and, for services provided on or
10		after October 1, 1999, shall be increased by $4.00 per
11		resident-day, as defined by the Department.
12		For facilities licensed by the Department of Public Health
13		under the Nursing Home Care Act as Intermediate Care for the
14		Developmentally Disabled facilities or Long Term Care for
15		Under Age 22 facilities, the rates taking effect on July 1,
16		2000 shall include an increase of 2.5% per resident-day, as
17		defined by the Department. For facilities licensed by the
18		Department of Public Health under the Nursing Home Care Act as
19		Skilled Nursing facilities or Intermediate Care facilities,
20		the rates taking effect on July 1, 2000 shall include an
21		increase of 2.5% per resident-day, as defined by the
22		Department.
23		For facilities licensed by the Department of Public Health
24		under the Nursing Home Care Act as skilled nursing facilities
25		or intermediate care facilities, a new payment methodology
26		must be implemented for the nursing component of the rate

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1		effective July 1, 2003. The Department of Public Aid (now
2		Healthcare and Family Services) shall develop the new payment
3		methodology using the Minimum Data Set (MDS) as the instrument
4		to collect information concerning nursing home resident
5		condition necessary to compute the rate. The Department shall
6		develop the new payment methodology to meet the unique needs
7		of Illinois nursing home residents while remaining subject to
8		the appropriations provided by the General Assembly. A
9		transition period from the payment methodology in effect on
10		June 30, 2003 to the payment methodology in effect on July 1,
11		2003 shall be provided for a period not exceeding 3 years and
12		184 days after implementation of the new payment methodology
13		as follows:
14		(A) For a facility that would receive a lower nursing
15		component rate per patient day under the new system than
16		the facility received effective on the date immediately
17		preceding the date that the Department implements the new
18		payment methodology, the nursing component rate per
19		patient day for the facility shall be held at the level in
20		effect on the date immediately preceding the date that the
21		Department implements the new payment methodology until a
22		higher nursing component rate of reimbursement is achieved
23		by that facility.
24		(B) For a facility that would receive a higher nursing
25		component rate per patient day under the payment
26		methodology in effect on July 1, 2003 than the facility

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1		received effective on the date immediately preceding the
2		date that the Department implements the new payment
3		methodology, the nursing component rate per patient day
4		for the facility shall be adjusted.
5		(C) Notwithstanding paragraphs (A) and (B), the
6		nursing component rate per patient day for the facility
7		shall be adjusted subject to appropriations provided by
8		the General Assembly.
9		For facilities licensed by the Department of Public Health
10		under the Nursing Home Care Act as Intermediate Care for the
11		Developmentally Disabled facilities or Long Term Care for
12		Under Age 22 facilities, the rates taking effect on March 1,
13		2001 shall include a statewide increase of 7.85%, as defined
14		by the Department.
15		Notwithstanding any other provision of this Section, for
16		facilities licensed by the Department of Public Health under
17		the Nursing Home Care Act as skilled nursing facilities or
18		intermediate care facilities, except facilities participating
19		in the Department's demonstration program pursuant to the
20		provisions of Title 77, Part 300, Subpart T of the Illinois
21		Administrative Code, the numerator of the ratio used by the
22		Department of Healthcare and Family Services to compute the
23		rate payable under this Section using the Minimum Data Set
24		(MDS) methodology shall incorporate the following annual
25		amounts as the additional funds appropriated to the Department
26		specifically to pay for rates based on the MDS nursing

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1		component methodology in excess of the funding in effect on
2		December 31, 2006:
3		(i) For rates taking effect January 1, 2007,
4		$60,000,000.
5		(ii) For rates taking effect January 1, 2008,
6		$110,000,000.
7		(iii) For rates taking effect January 1, 2009,
8		$194,000,000.
9		(iv) For rates taking effect April 1, 2011, or the
10		first day of the month that begins at least 45 days after
11		the effective date of this amendatory Act of the 96th
12		General Assembly, $416,500,000 or an amount as may be
13		necessary to complete the transition to the MDS
14		methodology for the nursing component of the rate.
15		Increased payments under this item (iv) are not due and
16		payable, however, until (i) the methodologies described in
17		this paragraph are approved by the federal government in
18		an appropriate State Plan amendment and (ii) the
19		assessment imposed by Section 5B-2 of this Code is
20		determined to be a permissible tax under Title XIX of the
21		Social Security Act.
22		Notwithstanding any other provision of this Section, for
23		facilities licensed by the Department of Public Health under
24		the Nursing Home Care Act as skilled nursing facilities or
25		intermediate care facilities, the support component of the
26		rates taking effect on January 1, 2008 shall be computed using

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1		the most recent cost reports on file with the Department of
2		Healthcare and Family Services no later than April 1, 2005,
3		updated for inflation to January 1, 2006.
4		For facilities licensed by the Department of Public Health
5		under the Nursing Home Care Act as Intermediate Care for the
6		Developmentally Disabled facilities or Long Term Care for
7		Under Age 22 facilities, the rates taking effect on April 1,
8		2002 shall include a statewide increase of 2.0%, as defined by
9		the Department. This increase terminates on July 1, 2002;
10		beginning July 1, 2002 these rates are reduced to the level of
11		the rates in effect on March 31, 2002, as defined by the
12		Department.
13		For facilities licensed by the Department of Public Health
14		under the Nursing Home Care Act as skilled nursing facilities
15		or intermediate care facilities, the rates taking effect on
16		July 1, 2001 shall be computed using the most recent cost
17		reports on file with the Department of Public Aid no later than
18		April 1, 2000, updated for inflation to January 1, 2001. For
19		rates effective July 1, 2001 only, rates shall be the greater
20		of the rate computed for July 1, 2001 or the rate effective on
21		June 30, 2001.
22		Notwithstanding any other provision of this Section, for
23		facilities licensed by the Department of Public Health under
24		the Nursing Home Care Act as skilled nursing facilities or
25		intermediate care facilities, the Illinois Department shall
26		determine by rule the rates taking effect on July 1, 2002,

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1		which shall be 5.9% less than the rates in effect on June 30,
2		2002.
3		Notwithstanding any other provision of this Section, for
4		facilities licensed by the Department of Public Health under
5		the Nursing Home Care Act as skilled nursing facilities or
6		intermediate care facilities, if the payment methodologies
7		required under Section 5A-12 and the waiver granted under 42
8		CFR 433.68 are approved by the United States Centers for
9		Medicare and Medicaid Services, the rates taking effect on
10		July 1, 2004 shall be 3.0% greater than the rates in effect on
11		June 30, 2004. These rates shall take effect only upon
12		approval and implementation of the payment methodologies
13		required under Section 5A-12.
14		Notwithstanding any other provisions of this Section, for
15		facilities licensed by the Department of Public Health under
16		the Nursing Home Care Act as skilled nursing facilities or
17		intermediate care facilities, the rates taking effect on
18		January 1, 2005 shall be 3% more than the rates in effect on
19		December 31, 2004.
20		Notwithstanding any other provision of this Section, for
21		facilities licensed by the Department of Public Health under
22		the Nursing Home Care Act as skilled nursing facilities or
23		intermediate care facilities, effective January 1, 2009, the
24		per diem support component of the rates effective on January
25		1, 2008, computed using the most recent cost reports on file
26		with the Department of Healthcare and Family Services no later

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1		than April 1, 2005, updated for inflation to January 1, 2006,
2		shall be increased to the amount that would have been derived
3		using standard Department of Healthcare and Family Services
4		methods, procedures, and inflators.
5		Notwithstanding any other provisions of this Section, for
6		facilities licensed by the Department of Public Health under
7		the Nursing Home Care Act as intermediate care facilities that
8		are federally defined as Institutions for Mental Disease, or
9		facilities licensed by the Department of Public Health under
10		the Specialized Mental Health Rehabilitation Act of 2013, a
11		socio-development component rate equal to 6.6% of the
12		facility's nursing component rate as of January 1, 2006 shall
13		be established and paid effective July 1, 2006. The
14		socio-development component of the rate shall be increased by
15		a factor of 2.53 on the first day of the month that begins at
16		least 45 days after January 11, 2008 (the effective date of
17		Public Act 95-707). As of August 1, 2008, the
18		socio-development component rate shall be equal to 6.6% of the
19		facility's nursing component rate as of January 1, 2006,
20		multiplied by a factor of 3.53. For services provided on or
21		after April 1, 2011, or the first day of the month that begins
22		at least 45 days after the effective date of this amendatory
23		Act of the 96th General Assembly, whichever is later, the
24		Illinois Department may by rule adjust these socio-development
25		component rates, and may use different adjustment
26		methodologies for those facilities participating, and those

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1		not participating, in the Illinois Department's demonstration
2		program pursuant to the provisions of Title 77, Part 300,
3		Subpart T of the Illinois Administrative Code, but in no case
4		may such rates be diminished below those in effect on August 1,
5		2008.
6		For facilities licensed by the Department of Public Health
7		under the Nursing Home Care Act as Intermediate Care for the
8		Developmentally Disabled facilities or as long-term care
9		facilities for residents under 22 years of age, the rates
10		taking effect on July 1, 2003 shall include a statewide
11		increase of 4%, as defined by the Department.
12		For facilities licensed by the Department of Public Health
13		under the Nursing Home Care Act as Intermediate Care for the
14		Developmentally Disabled facilities or Long Term Care for
15		Under Age 22 facilities, the rates taking effect on the first
16		day of the month that begins at least 45 days after the
17		effective date of this amendatory Act of the 95th General
18		Assembly shall include a statewide increase of 2.5%, as
19		defined by the Department.
20		Notwithstanding any other provision of this Section, for
21		facilities licensed by the Department of Public Health under
22		the Nursing Home Care Act as skilled nursing facilities or
23		intermediate care facilities, effective January 1, 2005,
24		facility rates shall be increased by the difference between
25		(i) a facility's per diem property, liability, and malpractice
26		insurance costs as reported in the cost report filed with the

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1		Department of Public Aid and used to establish rates effective
2		July 1, 2001 and (ii) those same costs as reported in the
3		facility's 2002 cost report. These costs shall be passed
4		through to the facility without caps or limitations, except
5		for adjustments required under normal auditing procedures.
6		Rates established effective each July 1 shall govern
7		payment for services rendered throughout that fiscal year,
8		except that rates established on July 1, 1996 shall be
9		increased by 6.8% for services provided on or after January 1,
10		1997. Such rates will be based upon the rates calculated for
11		the year beginning July 1, 1990, and for subsequent years
12		thereafter until June 30, 2001 shall be based on the facility
13		cost reports for the facility fiscal year ending at any point
14		in time during the previous calendar year, updated to the
15		midpoint of the rate year. The cost report shall be on file
16		with the Department no later than April 1 of the current rate
17		year. Should the cost report not be on file by April 1, the
18		Department shall base the rate on the latest cost report filed
19		by each skilled care facility and intermediate care facility,
20		updated to the midpoint of the current rate year. In
21		determining rates for services rendered on and after July 1,
22		1985, fixed time shall not be computed at less than zero. The
23		Department shall not make any alterations of regulations which
24		would reduce any component of the Medicaid rate to a level
25		below what that component would have been utilizing in the
26		rate effective on July 1, 1984.

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1		(2) Shall take into account the actual costs incurred by
2		facilities in providing services for recipients of skilled
3		nursing and intermediate care services under the medical
4		assistance program.
5		(3) Shall take into account the medical and psycho-social
6		characteristics and needs of the patients.
7		(4) Shall take into account the actual costs incurred by
8		facilities in meeting licensing and certification standards
9		imposed and prescribed by the State of Illinois, any of its
10		political subdivisions or municipalities and by the U.S.
11		Department of Health and Human Services pursuant to Title XIX
12		of the Social Security Act.
13		The Department of Healthcare and Family Services shall
14		develop precise standards for payments to reimburse nursing
15		facilities for any utilization of appropriate rehabilitative
16		personnel for the provision of rehabilitative services which
17		is authorized by federal regulations, including reimbursement
18		for services provided by qualified therapists or qualified
19		assistants, and which is in accordance with accepted
20		professional practices. Reimbursement also may be made for
21		utilization of other supportive personnel under appropriate
22		supervision.
23		The Department shall develop enhanced payments to offset
24		the additional costs incurred by a facility serving
25		exceptional need residents and shall allocate at least
26		$4,000,000 of the funds collected from the assessment

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1		established by Section 5B-2 of this Code for such payments.
2		For the purpose of this Section, "exceptional needs" means,
3		but need not be limited to, ventilator care and traumatic
4		brain injury care. The enhanced payments for exceptional need
5		residents under this paragraph are not due and payable,
6		however, until (i) the methodologies described in this
7		paragraph are approved by the federal government in an
8		appropriate State Plan amendment and (ii) the assessment
9		imposed by Section 5B-2 of this Code is determined to be a
10		permissible tax under Title XIX of the Social Security Act.
11		Beginning January 1, 2014 the methodologies for
12		reimbursement of nursing facility services as provided under
13		this Section 5-5.4 shall no longer be applicable for services
14		provided on or after January 1, 2014.
15		No payment increase under this Section for the MDS
16		methodology, exceptional care residents, or the
17		socio-development component rate established by Public Act
18		96-1530 of the 96th General Assembly and funded by the
19		assessment imposed under Section 5B-2 of this Code shall be
20		due and payable until after the Department notifies the
21		long-term care providers, in writing, that the payment
22		methodologies to long-term care providers required under this
23		Section have been approved by the Centers for Medicare and
24		Medicaid Services of the U.S. Department of Health and Human
25		Services and the waivers under 42 CFR 433.68 for the
26		assessment imposed by this Section, if necessary, have been

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1		granted by the Centers for Medicare and Medicaid Services of
2		the U.S. Department of Health and Human Services. Upon
3		notification to the Department of approval of the payment
4		methodologies required under this Section and the waivers
5		granted under 42 CFR 433.68, all increased payments otherwise
6		due under this Section prior to the date of notification shall
7		be due and payable within 90 days of the date federal approval
8		is received.
9		On and after July 1, 2012, the Department shall reduce any
10		rate of reimbursement for services or other payments or alter
11		any methodologies authorized by this Code to reduce any rate
12		of reimbursement for services or other payments in accordance
13		with Section 5-5e.
14		For facilities licensed by the Department of Public Health
15		under the ID/DD Community Care Act as ID/DD Facilities and
16		under the MC/DD Act as MC/DD Facilities, subject to federal
17		approval, the rates taking effect for services delivered on or
18		after August 1, 2019 shall be increased by 3.5% over the rates
19		in effect on June 30, 2019. The Department shall adopt rules,
20		including emergency rules under subsection (ii) of Section
21		5-45 of the Illinois Administrative Procedure Act, to
22		implement the provisions of this Section, including wage
23		increases for direct care staff.
24		For facilities licensed by the Department of Public Health
25		under the ID/DD Community Care Act as ID/DD Facilities and
26		under the MC/DD Act as MC/DD Facilities, subject to federal

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1		approval, the rates taking effect on the latter of the
2		approval date of the State Plan Amendment for these facilities
3		or the Waiver Amendment for the home and community-based
4		services settings shall include an increase sufficient to
5		provide a $0.26 per hour wage increase to the base wage for
6		non-executive staff. The Department shall adopt rules,
7		including emergency rules as authorized by Section 5-45 of the
8		Illinois Administrative Procedure Act, to implement the
9		provisions of this Section, including wage increases for
10		direct care staff.
11		For facilities licensed by the Department of Public Health
12		under the ID/DD Community Care Act as ID/DD Facilities and
13		under the MC/DD Act as MC/DD Facilities, subject to federal
14		approval of the State Plan Amendment and the Waiver Amendment
15		for the home and community-based services settings, the rates
16		taking effect for the services delivered on or after July 1,
17		2020 shall include an increase sufficient to provide a $1.00
18		per hour wage increase for non-executive staff. For services
19		delivered on or after January 1, 2021, subject to federal
20		approval of the State Plan Amendment and the Waiver Amendment
21		for the home and community-based services settings, shall
22		include an increase sufficient to provide a $0.50 per hour
23		increase for non-executive staff. The Department shall adopt
24		rules, including emergency rules as authorized by Section 5-45
25		of the Illinois Administrative Procedure Act, to implement the
26		provisions of this Section, including wage increases for

SB2026 - 23 - LRB103 28363 SPS 54743 b
1		direct care staff.
2		For facilities licensed by the Department of Public Health
3		under the ID/DD Community Care Act as ID/DD Facilities and
4		under the MC/DD Act as MC/DD Facilities, subject to federal
5		approval of the State Plan Amendment, the rates taking effect
6		for the residential services delivered on or after July 1,
7		2021, shall include an increase sufficient to provide a $0.50
8		per hour increase for aides in the rate methodology. For
9		facilities licensed by the Department of Public Health under
10		the ID/DD Community Care Act as ID/DD Facilities and under the
11		MC/DD Act as MC/DD Facilities, subject to federal approval of
12		the State Plan Amendment, the rates taking effect for the
13		residential services delivered on or after January 1, 2022
14		shall include an increase sufficient to provide a $1.00 per
15		hour increase for aides in the rate methodology. In addition,
16		for residential services delivered on or after January 1, 2022
17		such rates shall include an increase sufficient to provide
18		wages for all residential non-executive direct care staff,
19		excluding aides, at the federal Department of Labor, Bureau of
20		Labor Statistics' average wage as defined in rule by the
21		Department. The Department shall adopt rules, including
22		emergency rules as authorized by Section 5-45 of the Illinois
23		Administrative Procedure Act, to implement the provisions of
24		this Section.
25		For facilities licensed by the Department of Public Health
26		under the ID/DD Community Care Act as ID/DD facilities and

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1		under the MC/DD Act as MC/DD facilities, subject to federal
2		approval of the State Plan Amendment, the rates taking effect
3		for services delivered on or after January 1, 2023, shall
4		include a $1.00 per hour wage increase for all direct support
5		personnel and all other frontline personnel who are not
6		subject to the Bureau of Labor Statistics' average wage
7		increases, who work in residential and community day services
8		settings, with at least $0.50 of those funds to be provided as
9		a direct increase to all aide base wages, with the remaining
10		$0.50 to be used flexibly for base wage increases to the rate
11		methodology for aides. In addition, for residential services
12		delivered on or after January 1, 2023 the rates shall include
13		an increase sufficient to provide wages for all residential
14		non-executive direct care staff, excluding aides, at the
15		federal Department of Labor, Bureau of Labor Statistics'
16		average wage as determined by the Department. Also, for
17		services delivered on or after January 1, 2023, the rates will
18		include adjustments to employment-related expenses as defined
19		in rule by the Department. The Department shall adopt rules,
20		including emergency rules as authorized by Section 5-45 of the
21		Illinois Administrative Procedure Act, to implement the
22		provisions of this Section.
23		For facilities licensed by the Department of Public Health
24		under the ID/DD Community Care Act as ID/DD facilities and
25		under the MC/DD Act as MC/DD facilities, subject to federal
26		approval of the State Plan Amendment, the rates taking effect

SB2026 - 25 - LRB103 28363 SPS 54743 b
1		for services delivered on or after January 1, 2024, shall
2		include a $4.00 per hour wage rate increase for all direct
3		support personnel and all other frontline personnel who are
4		not subject to the Bureau of Labor Statistics' average wage
5		increases, who work in residential and community day services
6		settings, with at least $2.00 of those funds to be provided as
7		a direct increase to all aide base wages, with the remaining
8		$2.00 to be used flexibly for base wage increases to the rate
9		methodology for aides. In addition, for residential services
10		delivered on or after January 1, 2024, the rates shall include
11		an increase sufficient to provide wages for all residential
12		non-executive direct care staff, excluding aides, at the
13		federal Department of Labor, Bureau of Labor Statistics'
14		average wage as determined by the Department. Also, for
15		services delivered on or after January 1, 2024, the rates will
16		include adjustments to employment-related expenses as defined
17		in rule by the Department. The Department shall adopt rules,
18		including emergency rules as authorized by Section 5-45 of the
19		Illinois Administrative Procedure Act, to implement the
20		provisions of this Section.
21		(Source: P.A. 101-10, eff. 6-5-19; 101-636, eff. 6-10-20;
22		102-16, eff. 6-17-21; 102-699, eff. 4-19-22.)
23		Section 99. Effective date. This Act takes effect upon
24		becoming law.