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HB4914 - 104th General Assembly

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4914

Introduced , by Rep. Natalie A. Manley

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.2

Amends the Medical Assistance Article of the Illinois Public Aid
Code. Sets per diem add-on rates, beginning January 1, 2027, for nursing
facilities based on a facility's STRIVE study staffing levels. Provides
that no nursing facility's variable staffing per diem add-on shall be
reduced by more than 5% in 2 consecutive quarters; and that no facility
below 73% of the staffing indicated by the STRIVE study shall receive a
variable per diem staffing add-on after December 31, 2026. Provides that
beginning January 1, 2027, the Department of Healthcare and Family
Services must split the support rate into its cost report based parts,
general services and general administration. Provides that the general
services portion shall be referred to as "Support - non-nurse staff" and
the general administration portion shall be referred to as "Support -
Administrative". Makes other changes. Effective immediately.
LRB104 20244 KTG 33695 b

A BILL FOR

HB4914
LRB104 20244 KTG 33695 b
1

AN ACT concerning public aid.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Public Aid Code is amended by
5
changing Section 5-5.2 as follows:

6

(305 ILCS 5/5-5.2)
7

Sec. 5-5.2.
Payment.
8

(a) All nursing facilities that are grouped pursuant to
9
Section 5-5.1 of this Act shall receive the same rate of
10
payment for similar services.
11

(b) It shall be a matter of State policy that the Illinois
12
Department shall utilize a uniform billing cycle throughout
13
the State for the long-term care providers.
14

(c) (Blank).
15

(c-1) Notwithstanding any other provisions of this Code,
16
the methodologies for reimbursement of nursing services as
17
provided under this Article shall no longer be applicable for
18
bills payable for nursing services rendered on or after a new
19
reimbursement system based on the Patient Driven Payment Model
20
(PDPM) has been fully operationalized, which shall take effect
21
for services provided on or after the implementation of the
22
PDPM reimbursement system begins. For the purposes of Public
23
Act 102-1035, the implementation date of the PDPM

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LRB104 20244 KTG 33695 b
1
reimbursement system and all related provisions shall be July
2
1, 2022 if the following conditions are met: (i) the Centers
3
for Medicare and Medicaid Services has approved corresponding
4
changes in the reimbursement system and bed assessment; and
5
(ii) the Department has filed rules to implement these changes
6
no later than June 1, 2022. Failure of the Department to file
7
rules to implement the changes provided in Public Act 102-1035
8
no later than June 1, 2022 shall result in the implementation
9
date being delayed to October 1, 2022.
10

(d) The new nursing services reimbursement methodology
11
utilizing the Patient Driven Payment Model, which shall be
12
referred to as the PDPM reimbursement system, taking effect
13
July 1, 2022, upon federal approval by the Centers for
14
Medicare and Medicaid Services, shall be based on the
15
following:
16

(1) The methodology shall be resident-centered,
17

facility-specific, cost-based, and based on guidance from
18

the Centers for Medicare and Medicaid Services.
19

(2) Costs shall be annually rebased and case mix index
20

quarterly updated. The nursing services methodology will
21

be assigned to the Medicaid enrolled residents on record
22

as of 30 days prior to the beginning of the rate period in
23

the Department's Medicaid Management Information System
24

(MMIS) as present on the last day of the second quarter
25

preceding the rate period based upon the Assessment
26

Reference Date of the Minimum Data Set (MDS).

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1

(3) Regional wage adjustors based on the Health
2

Service Areas (HSA) groupings and adjusters in effect on
3

April 30, 2012 shall be included, except no adjuster shall
4

be lower than 1.06.
5

(4) PDPM nursing case mix indices in effect on March
6

1, 2022 shall be assigned to each resident class at no less
7

than 0.7858 of the Centers for Medicare and Medicaid
8

Services PDPM unadjusted case mix values, in effect on
9

March 1, 2022.
10

(5) The pool of funds available for distribution by
11

case mix and the base facility rate shall be determined
12

using the formula contained in subsection (d-1).
13

(6) The Department shall establish a variable per diem
14

staffing add-on in accordance with the most recent
15

available federal staffing report, currently the Payroll
16

Based Journal, for the same period of time, and if
17

applicable adjusted for acuity using the same quarter's
18

MDS. The Department shall rely on Payroll Based Journals
19

provided to the Department of Public Health to make a
20

determination of non-submission. If the Department is
21

notified by a facility of missing or inaccurate Payroll
22

Based Journal data or an incorrect calculation of
23

staffing, the Department must make a correction as soon as
24

the error is verified for the applicable quarter.
25

Beginning October 1, 2024, the staffing percentage
26

used in the calculation of the per diem staffing add-on

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1

shall be its PDPM STRIVE Staffing Ratio which equals: its
2

Reported Total Nurse Staffing Hours Per Resident Per Day
3

as published in the most recent federal staffing report
4

(the Provider Information File), divided by the facility's
5

PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
6

Staffing Target is equal to .82 times the facility's
7

Illinois Adjusted Facility Case-Mix Hours Per Resident Per
8

Day. A facility's Illinois Adjusted Facility Case Mix
9

Hours Per Resident Per Day is equal to its Case-Mix Total
10

Nurse Staffing Hours Per Resident Per Day (as published in
11

the most recent federal Provider Information file) times
12

3.662 (which reflects the national resident days-weighted
13

mean Reported Total Nurse Staffing Hours Per Resident Per
14

Day as calculated using the January 2024 federal Provider
15

Information Files), divided by the national resident
16

days-weighted mean Reported Total Nurse Staffing Hours Per
17

Resident Per Day calculated using the most recent State US
18

Averages file.
19

Beginning January 1, 2025, the staffing percentage
20

used in the calculation of the per diem staffing add-on
21

shall be its PDPM STRIVE Staffing Ratio which equals: its
22

Reported Total Nurse Staffing Hours Per Resident Per Day
23

as published in the most recent federal staffing report
24

(the Provider Information File), divided by the facility's
25

PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
26

Staffing Target is equal to .7122 times the facility's

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1

Illinois Adjusted Facility Case-Mix Hours Per Resident Per
2

Day. A facility's Illinois Adjusted Facility Case Mix
3

Hours Per Resident Per Day is equal to its Case-Mix Total
4

Nurse Staffing Hours Per Resident Per Day (as published in
5

the most recent federal staffing report Provider
6

Information file) times 3.79 (which is the Reported Total
7

Nurse Staffing Hours Per Resident Per Day for the Nation
8

as reported the January 2024 State US Averages file),
9

divided by the Reported Total Nurse Staffing Hours Per
10

Resident Per Day for the Nation as reported in the most
11

recent State US Averages file.
12

(6.5) Beginning July 1, 2024, the paid per diem
13

staffing add-on shall be the paid per diem staffing add-on
14

in effect April 1, 2024. For dates beginning October 1,
15

2024 and through September 30, 2025, the denominator for
16

the staffing percentage shall be the lesser of the
17

facility's PDPM STRIVE Staffing Target and:
18

(A) For the quarter beginning October 1, 2024, the
19

sum of 20% of the facility's PDPM STRIVE Staffing
20

Target and 80% of the facility's Case-Mix Total Nurse
21

Staffing Hours Per Resident Per Day (as published in
22

the January 2024 federal staffing report).
23

(B) For the quarter beginning January 1, 2025, the
24

sum of 40% of the facility's PDPM STRIVE Staffing
25

Target and 60% of the facility's Case-Mix Total Nurse
26

Staffing Hours Per Resident Per Day (as published in

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LRB104 20244 KTG 33695 b
1

the January 2024 federal staffing report).
2

(C) For the quarter beginning March 1, 2025, the
3

sum of 60% of the facility's PDPM STRIVE Staffing
4

Target and 40% of the facility's Case-Mix Total Nurse
5

Staffing Hours Per Resident Per Day (as published in
6

the January 2024 federal staffing report).
7

(D) For the quarter beginning July 1, 2025, the
8

sum of 80% of the facility's PDPM STRIVE Staffing
9

Target and 20% of the facility's Case-Mix Total Nurse
10

Staffing Hours Per Resident Per Day (as published in
11

the January 2024 federal staffing report).
12

From July 1, 2022 through December 31, 2026,
13

facilities

Facilities
with at least 70% of the staffing
14

indicated by the STRIVE study shall be paid a per diem
15

add-on of $9, increasing by equivalent steps for each
16

whole percentage point until the facilities reach a per
17

diem of $16.52. Facilities with at least 80% of the
18

staffing indicated by the STRIVE study shall be paid a per
19

diem add-on of $16.52, increasing by equivalent steps for
20

each whole percentage point until the facilities reach a
21

per diem add-on of $25.77. Facilities with at least 92% of
22

the staffing indicated by the STRIVE study shall be paid a
23

per diem add-on of $25.77, increasing by equivalent steps
24

for each whole percentage point until the facilities reach
25

a per diem add-on of $30.98. Facilities with at least 100%
26

of the staffing indicated by the STRIVE study shall be

HB4914
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LRB104 20244 KTG 33695 b
1

paid a per diem add-on of $30.98, increasing by equivalent
2

steps for each whole percentage point until the facilities
3

reach a per diem add-on of $36.44. Facilities with at
4

least 110% of the staffing indicated by the STRIVE study
5

shall be paid a per diem add-on of $36.44, increasing by
6

equivalent steps for each whole percentage point until the
7

facilities reach a per diem add-on of $38.68. Facilities
8

with at least 125% or higher of the staffing indicated by
9

the STRIVE study shall be paid a per diem add-on of $38.68.
10

No nursing facility's variable staffing per diem add-on
11

shall be reduced by more than 5% in 2 consecutive
12

quarters. For the quarters beginning July 1, 2022 and
13

October 1, 2022, no facility's variable per diem staffing
14

add-on shall be calculated at a rate lower than 85% of the
15

staffing indicated by the STRIVE study. No facility below
16

70% of the staffing indicated by the STRIVE study shall
17

receive a variable per diem staffing add-on after December
18

31, 2022.
19

Beginning on January 1, 2027, facilities with at least
20

73% of the staffing indicated by the STRIVE study shall be
21

paid a per diem add-on of $11.26 increasing by equivalent
22

steps for each whole percentage point until the facilities
23

reach a per diem of $16.52. Facilities with at least 80% of
24

the staffing indicated by the STRIVE study shall be paid a
25

per diem add-on of $16.52, increasing by equivalent steps
26

for each whole percentage point until the facilities reach

HB4914
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LRB104 20244 KTG 33695 b
1

a per diem add-on of $25.77. Facilities with at least 92%
2

of the staffing indicated by the STRIVE study shall be
3

paid a per diem add-on of $25.77, increasing by equivalent
4

steps for each whole percentage point until the facilities
5

reach a per diem add-on of $30.98. Facilities with at
6

least 100% of the staffing indicated by the STRIVE study
7

shall be paid a per diem add-on of $30.98, increasing by
8

equivalent steps for each whole percentage point until the
9

facilities reach a per diem add-on of $36.44. Facilities
10

with at least 110% of the staffing indicated by the STRIVE
11

study shall be paid a per diem add-on of $36.44,
12

increasing by equivalent steps for each whole percentage
13

point until the facilities reach a per diem add-on of
14

$43.18. Facilities with at least 125% of the staffing
15

indicated by the STRIVE study shall be paid a per diem
16

add-on of $43.18, increasing by equivalent steps for each
17

whole percentage point until the facilities reach a per
18

diem add-on of $50.68. Facilities with at least 150% or
19

higher of the staffing indicated by the STRIVE study shall
20

be paid a per diem add-on of $50.68. No nursing facility's
21

variable staffing per diem add-on shall be reduced by more
22

than 5% in 2 consecutive quarters. No facility below 73%
23

of the staffing indicated by the STRIVE study shall
24

receive a variable per diem staffing add-on after December
25

31, 2026.

26

(7) For dates of services beginning July 1, 2022, the

HB4914
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LRB104 20244 KTG 33695 b
1

PDPM nursing component per diem for each nursing facility
2

shall be the product of the facility's (i) statewide PDPM
3

nursing base per diem rate, $92.25, adjusted for the
4

facility average PDPM case mix index calculated quarterly
5

and (ii) the regional wage adjuster, and then add the
6

Medicaid access adjustment as defined in (e-3) of this
7

Section. Transition rates for services provided between
8

July 1, 2022 and October 1, 2023 shall be the greater of
9

the PDPM nursing component per diem or:
10

(A) for the quarter beginning July 1, 2022, the
11

RUG-IV nursing component per diem;
12

(B) for the quarter beginning October 1, 2022, the
13

sum of the RUG-IV nursing component per diem
14

multiplied by 0.80 and the PDPM nursing component per
15

diem multiplied by 0.20;
16

(C) for the quarter beginning January 1, 2023, the
17

sum of the RUG-IV nursing component per diem
18

multiplied by 0.60 and the PDPM nursing component per
19

diem multiplied by 0.40;
20

(D) for the quarter beginning April 1, 2023, the
21

sum of the RUG-IV nursing component per diem
22

multiplied by 0.40 and the PDPM nursing component per
23

diem multiplied by 0.60;
24

(E) for the quarter beginning July 1, 2023, the
25

sum of the RUG-IV nursing component per diem
26

multiplied by 0.20 and the PDPM nursing component per

HB4914
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LRB104 20244 KTG 33695 b
1

diem multiplied by 0.80; or
2

(F) for the quarter beginning October 1, 2023 and
3

each subsequent quarter, the transition rate shall end
4

and a nursing facility shall be paid 100% of the PDPM
5

nursing component per diem.
6

(d-1) Calculation of base year Statewide RUG-IV nursing
7
base per diem rate.
8

(1) Base rate spending pool shall be:
9

(A) The base year resident days which are
10

calculated by multiplying the number of Medicaid
11

residents in each nursing home as indicated in the MDS
12

data defined in paragraph (4) by 365.
13

(B) Each facility's nursing component per diem in
14

effect on July 1, 2012 shall be multiplied by
15

subsection (A).
16

(C) Thirteen million is added to the product of
17

subparagraph (A) and subparagraph (B) to adjust for
18

the exclusion of nursing homes defined in paragraph
19

(5).
20

(2) For each nursing home with Medicaid residents as
21

indicated by the MDS data defined in paragraph (4),
22

weighted days adjusted for case mix and regional wage
23

adjustment shall be calculated. For each home this
24

calculation is the product of:
25

(A) Base year resident days as calculated in
26

subparagraph (A) of paragraph (1).

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LRB104 20244 KTG 33695 b
1

(B) The nursing home's regional wage adjustor
2

based on the Health Service Areas (HSA) groupings and
3

adjustors in effect on April 30, 2012.
4

(C) Facility weighted case mix which is the number
5

of Medicaid residents as indicated by the MDS data
6

defined in paragraph (4) multiplied by the associated
7

case weight for the RUG-IV 48 grouper model using
8

standard RUG-IV procedures for index maximization.
9

(D) The sum of the products calculated for each
10

nursing home in subparagraphs (A) through (C) above
11

shall be the base year case mix, rate adjusted
12

weighted days.
13

(3) The Statewide RUG-IV nursing base per diem rate:
14

(A) on January 1, 2014 shall be the quotient of the
15

paragraph (1) divided by the sum calculated under
16

subparagraph (D) of paragraph (2);
17

(B) on and after July 1, 2014 and until July 1,
18

2022, shall be the amount calculated under
19

subparagraph (A) of this paragraph (3) plus $1.76; and
20

(C) beginning July 1, 2022 and thereafter, $7
21

shall be added to the amount calculated under
22

subparagraph (B) of this paragraph (3) of this
23

Section.
24

(4) Minimum Data Set (MDS) comprehensive assessments
25

for Medicaid residents on the last day of the quarter used
26

to establish the base rate.

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LRB104 20244 KTG 33695 b
1

(5) Nursing facilities designated as of July 1, 2012
2

by the Department as "Institutions for Mental Disease"
3

shall be excluded from all calculations under this
4

subsection. The data from these facilities shall not be
5

used in the computations described in paragraphs (1)
6

through (4) above to establish the base rate.
7

(e) Beginning July 1, 2014, the Department shall allocate
8
funding in the amount up to $10,000,000 for per diem add-ons to
9
the RUGS methodology for dates of service on and after July 1,
10
2014:
11

(1) $0.63 for each resident who scores in I4200
12

Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
13

Beginning January 1, 2027, the rate must be multiplied by
14

5 for nursing facilities which have disclosed its status
15

as an Alzheimer's special care unit under the requirements
16

of Alzheimer's Disease and Related Dementias Special Care
17

Disclosure Act. The Department must update the status for
18

nursing facilities for rates effective each January 1st.

19

(2) $2.67 for each resident who scores either a "1" or
20

"2" in any items S1200A through S1200I and also scores in
21

RUG groups PA1, PA2, BA1, or BA2.
22

(e-1) (Blank).
23

(e-2) For dates of services beginning January 1, 2014 and
24
ending September 30, 2023, the RUG-IV nursing component per
25
diem for a nursing home shall be the product of the statewide
26
RUG-IV nursing base per diem rate, the facility average case

HB4914
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LRB104 20244 KTG 33695 b
1
mix index, and the regional wage adjustor. For dates of
2
service beginning July 1, 2022 and ending September 30, 2023,
3
the Medicaid access adjustment described in subsection (e-3)
4
shall be added to the product.
5

(e-3) A Medicaid Access Adjustment of $4 adjusted for the
6
facility average PDPM case mix index calculated quarterly
7
shall be added to the statewide PDPM nursing per diem for all
8
facilities with annual Medicaid bed days of at least 70% of all
9
occupied bed days adjusted quarterly. For each new calendar
10
year and for the 6-month period beginning July 1, 2022, the
11
percentage of a facility's occupied bed days comprised of
12
Medicaid bed days shall be determined by the Department
13
quarterly. For dates of service beginning January 1, 2023, the
14
Medicaid Access Adjustment shall be increased to $4.75. This
15
subsection shall be inoperative on and after January 1, 2028.
16

(e-4) Subject to federal approval, on and after January 1,
17
2024, the Department shall increase the rate add-on at
18
paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
19
for ventilator services from $208 per day to $481 per day.
20
Payment is subject to the criteria and requirements under 89
21
Ill. Adm. Code 147.335.
22

(f) (Blank).
23

(g) Notwithstanding any other provision of this Code, on
24
and after July 1, 2012, for facilities not designated by the
25
Department of Healthcare and Family Services as "Institutions
26
for Mental Disease", rates effective May 1, 2011 shall be

HB4914
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LRB104 20244 KTG 33695 b
1
adjusted as follows:
2

(1) (Blank);
3

(2) (Blank);
4

(3) Facility rates for the capital and support
5

components shall be reduced by 1.7%.
6

(h) Notwithstanding any other provision of this Code, on
7
and after July 1, 2012, nursing facilities designated by the
8
Department of Healthcare and Family Services as "Institutions
9
for Mental Disease" and "Institutions for Mental Disease" that
10
are facilities licensed under the Specialized Mental Health
11
Rehabilitation Act of 2013 shall have the nursing,
12
socio-developmental, capital, and support components of their
13
reimbursement rate effective May 1, 2011 reduced in total by
14
2.7%.
15

(i) On and after July 1, 2014, the reimbursement rates for
16
the support component of the nursing facility rate for
17
facilities licensed under the Nursing Home Care Act as skilled
18
or intermediate care facilities shall be the rate in effect on
19
June 30, 2014 increased by 8.17%.
20

(i-1) Subject to federal approval, on and after January 1,
21
2024, the reimbursement rates for the support component of the
22
nursing facility rate for facilities licensed under the
23
Nursing Home Care Act as skilled or intermediate care
24
facilities shall be the rate in effect on June 30, 2023
25
increased by 12%.
26

(j) Notwithstanding any other provision of law, subject to

HB4914
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LRB104 20244 KTG 33695 b
1
federal approval, effective July 1, 2019, sufficient funds
2
shall be allocated for changes to rates for facilities
3
licensed under the Nursing Home Care Act as skilled nursing
4
facilities or intermediate care facilities for dates of
5
services on and after July 1, 2019: (i) to establish, through
6
June 30, 2022 a per diem add-on to the direct care per diem
7
rate not to exceed $70,000,000 annually in the aggregate
8
taking into account federal matching funds for the purpose of
9
addressing the facility's unique staffing needs, adjusted
10
quarterly and distributed by a weighted formula based on
11
Medicaid bed days on the last day of the second quarter
12
preceding the quarter for which the rate is being adjusted.
13
Beginning July 1, 2022, the annual $70,000,000 described in
14
the preceding sentence shall be dedicated to the variable per
15
diem add-on for staffing under paragraph (6) of subsection
16
(d); and (ii) in an amount not to exceed $170,000,000 annually
17
in the aggregate taking into account federal matching funds to
18
permit the support component of the nursing facility rate to
19
be updated as follows:
20

(1) 80%, or $136,000,000, of the funds shall be used
21

to update each facility's rate in effect on June 30, 2019
22

using the most recent cost reports on file, which have had
23

a limited review conducted by the Department of Healthcare
24

and Family Services and will not hold up enacting the rate
25

increase, with the Department of Healthcare and Family
26

Services.

HB4914
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LRB104 20244 KTG 33695 b
1

(2) After completing the calculation in paragraph (1),
2

any facility whose rate is less than the rate in effect on
3

June 30, 2019 shall have its rate restored to the rate in
4

effect on June 30, 2019 from the 20% of the funds set
5

aside.
6

(3) The remainder of the 20%, or $34,000,000, shall be
7

used to increase each facility's rate by an equal
8

percentage.
9

(k) During the first quarter of State Fiscal Year 2020,
10
the Department of Healthcare of Family Services must convene a
11
technical advisory group consisting of members of all trade
12
associations representing Illinois skilled nursing providers
13
to discuss changes necessary with federal implementation of
14
Medicare's Patient-Driven Payment Model. Implementation of
15
Medicare's Patient-Driven Payment Model shall, by September 1,
16
2020, end the collection of the MDS data that is necessary to
17
maintain the current RUG-IV Medicaid payment methodology. The
18
technical advisory group must consider a revised reimbursement
19
methodology that takes into account transparency,
20
accountability, actual staffing as reported under the
21
federally required Payroll Based Journal system, changes to
22
the minimum wage, adequacy in coverage of the cost of care, and
23
a quality component that rewards quality improvements.
24

(l) The Department shall establish per diem add-on
25
payments to improve the quality of care delivered by
26
facilities, including:

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(1) Incentive payments determined by facility
2

performance on specified quality measures in an initial
3

amount of $70,000,000. Nothing in this subsection shall be
4

construed to limit the quality of care payments in the
5

aggregate statewide to $70,000,000, and, if quality of
6

care has improved across nursing facilities, the
7

Department shall adjust those add-on payments accordingly.
8

The quality payment methodology described in this
9

subsection must be used for at least State Fiscal Year
10

2023. Beginning with the quarter starting July 1, 2023,
11

the Department may add, remove, or change quality metrics
12

and make associated changes to the quality payment
13

methodology as outlined in subparagraph (E). Facilities
14

designated by the Centers for Medicare and Medicaid
15

Services as a special focus facility or a hospital-based
16

nursing home do not qualify for quality payments.
17

(A) Each quality pool must be distributed by
18

assigning a quality weighted score for each nursing
19

home which is calculated by multiplying the nursing
20

home's quality base period Medicaid days by the
21

nursing home's star rating weight in that period.
22

(B) Star rating weights are assigned based on the
23

nursing home's star rating for the LTS quality star
24

rating. As used in this subparagraph, "LTS quality
25

star rating" means the long-term stay quality rating
26

for each nursing facility, as assigned by the Centers

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1

for Medicare and Medicaid Services under the Five-Star
2

Quality Rating System. The rating is a number ranging
3

from 0 (lowest) to 5 (highest).
4

(i) Zero-star or one-star rating has a weight
5

of 0.
6

(ii) Two-star rating has a weight of 0.75.
7

(iii) Three-star rating has a weight of 1.5.
8

(iv) Four-star rating has a weight of 2.5.
9

(v) Five-star rating has a weight of 3.5.
10

(C) Each nursing home's quality weight score is
11

divided by the sum of all quality weight scores for
12

qualifying nursing homes to determine the proportion
13

of the quality pool to be paid to the nursing home.
14

(D) The quality pool is no less than $70,000,000
15

annually or $17,500,000 per quarter. The Department
16

shall publish on its website the estimated payments
17

and the associated weights for each facility 45 days
18

prior to when the initial payments for the quarter are
19

to be paid. The Department shall assign each facility
20

the most recent and applicable quarter's STAR value
21

unless the facility notifies the Department within 15
22

days of an issue and the facility provides reasonable
23

evidence demonstrating its timely compliance with
24

federal data submission requirements for the quarter
25

of record. If such evidence cannot be provided to the
26

Department, the STAR rating assigned to the facility

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1

shall be reduced by one from the prior quarter.
2

(E) The Department shall review quality metrics
3

used for payment of the quality pool and make
4

recommendations for any associated changes to the
5

methodology for distributing quality pool payments in
6

consultation with associations representing long-term
7

care providers, consumer advocates, organizations
8

representing workers of long-term care facilities, and
9

payors. The Department may establish, by rule, changes
10

to the methodology for distributing quality pool
11

payments.
12

(F) The Department shall disburse quality pool
13

payments from the Long-Term Care Provider Fund on a
14

monthly basis in amounts proportional to the total
15

quality pool payment determined for the quarter.
16

(G) The Department shall publish any changes in
17

the methodology for distributing quality pool payments
18

prior to the beginning of the measurement period or
19

quality base period for any metric added to the
20

distribution's methodology.
21

(2) Payments based on CNA tenure, promotion, and CNA
22

training for the purpose of increasing CNA compensation.
23

It is the intent of this subsection that payments made in
24

accordance with this paragraph be directly incorporated
25

into increased compensation for CNAs. As used in this
26

paragraph, "CNA" means a certified nursing assistant as

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1

that term is described in Section 3-206 of the Nursing
2

Home Care Act, Section 3-206 of the ID/DD Community Care
3

Act, and Section 3-206 of the MC/DD Act. The Department
4

shall establish, by rule, payments to nursing facilities
5

equal to Medicaid's share of the tenure wage increments
6

specified in this paragraph for all reported CNA employee
7

hours compensated according to a posted schedule
8

consisting of increments at least as large as those
9

specified in this paragraph. The increments are as
10

follows: an additional $1.50 per hour for CNAs with at
11

least one and less than 2 years' experience plus another
12

$1 per hour for each additional year of experience up to a
13

maximum of $6.50 for CNAs with at least 6 years of
14

experience. For purposes of this paragraph, Medicaid's
15

share shall be the ratio determined by paid Medicaid bed
16

days divided by total bed days for the applicable time
17

period used in the calculation. In addition, and additive
18

to any tenure increments paid as specified in this
19

paragraph, the Department shall establish, by rule,
20

payments supporting Medicaid's share of the
21

promotion-based wage increments for CNA employee hours
22

compensated for that promotion with at least a $1.50
23

hourly increase. Medicaid's share shall be established as
24

it is for the tenure increments described in this
25

paragraph. Qualifying promotions shall be defined by the
26

Department in rules for an expected 10-15% subset of CNAs

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assigned intermediate, specialized, or added roles such as
2

CNA trainers, CNA scheduling "captains", and CNA
3

specialists for resident conditions like dementia or
4

memory care or behavioral health.
5

(m) The Department shall work with nursing facility
6
industry representatives to design policies and procedures to
7
permit facilities to address the integrity of data from
8
federal reporting sites used by the Department in setting
9
facility rates.
10

(n) Beginning January 1, 2027, the Department must split
11
the support rate into its cost report based parts, general
12
services and general administration. The general services
13
portion shall be referred to as "Support - non-nurse staff"
14
and the general administration portion shall be referred to as
15
"Support - Administrative".
16

(1) The rate must be split based on the proportion of
17

allowable general service costs and allowable general
18

administrative costs from the 2024 Medicaid cost report.
19

If the split calculation results in an amount of less than
20

a penny, the Department must adjust the split to be whole
21

pennies favoring the Support - non-nurse staff rate.
22

(2) After January 1, 2027, rate updates or rebasings
23

for the support - non-nurse rate and support -
24

administrative rate shall be done according to the
25

Department's current policies except:
26

(A) After inflation, the general services costs

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1

and general administrative cost must not be added
2

together.
3

(B) The inflated general service costs must be
4

converted to the support - non-nurse per diem using
5

total patient days and the general administrative
6

costs must be converted to a per diem using the current
7

policy floor of 93% of licensed bed days.
8

(C) The conversion of the cost per diem follows
9

current policy except the rate ceiling for the support -
10

administrative rate must be 60% and the support-
11

non-nurse staff rate remains 75%.
12

(3) All future funding increases for support services
13

must first be applied to the Support - non-nurse rate with
14

residual amounts over a fully funded support-non-nurse
15

rate then applied to the support-administrative rate
16

except the support - administrative rate must not be
17

decreased as a result of applying this requirement of
18

increased funding. This requirement does not prevent an
19

increase to apply the support - non-nurse rate and exclude
20

the support - administrative rate but the support -
21

administrative rate may not be increased without
22

increasing the support - non-nurse rate unless the support -
23

non-nurse staff rate is fully funded.

24
(Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
25
102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
26
Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,

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1
Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
2
7-1-24; 103-1075, eff. 3-21-25.)

3

Section 99.
Effective date.
This Act takes effect upon
4
becoming law.

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