MEDICAID-STAR RECOMPUTATION

Illinois General Assembly - Full Text of HB5061

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5061

Introduced 2/10/2026, by Rep. Robyn Gabel

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.2

Amends the Medical Assistance Article of the Illinois Public Aid
Code. Requires the Department of Healthcare and Family Services, beginning
January 1, 2027, to recompute the STAR rating of nursing facilities who had
their antipsychotic medication quality measure score suppressed and their
STAR rating set to one due to audit action by the federal Centers for
Medicare and Medicaid Services. Requires quality payments to such nursing
facilities to be made based on the recomputed score. Provides that in order
to facilitate the recomputation, nursing facilities may provide the
Department with documentation regarding the status of the suppression of
the score and STAR rating as well as the quarterly report issued by the
federal Centers for Medicare and Medicaid Services that lists the
long-stay rating points for the quarter.
LRB104 18808 KTG 32251 b

A BILL FOR

HB5061
LRB104 18808 KTG 32251 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

HB5061
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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

HB5061
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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

HB5061
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LRB104 18808 KTG 32251 b
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

HB5061
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LRB104 18808 KTG 32251 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

Facilities with at least 70% of the staffing
13

indicated by the STRIVE study shall be paid a per diem
14

add-on of $9, increasing by equivalent steps for each
15

whole percentage point until the facilities reach a per
16

diem of $16.52. Facilities with at least 80% of the
17

staffing indicated by the STRIVE study shall be paid a per
18

diem add-on of $16.52, increasing by equivalent steps for
19

each whole percentage point until the facilities reach a
20

per diem add-on of $25.77. Facilities with at least 92% of
21

the staffing indicated by the STRIVE study shall be paid a
22

per diem add-on of $25.77, increasing by equivalent steps
23

for each whole percentage point until the facilities reach
24

a per diem add-on of $30.98. Facilities with at least 100%
25

of the staffing indicated by the STRIVE study shall be
26

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

HB5061
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LRB104 18808 KTG 32251 b
1

steps for each whole percentage point until the facilities
2

reach a per diem add-on of $36.44. Facilities with at
3

least 110% of the staffing indicated by the STRIVE study
4

shall be paid a per diem add-on of $36.44, increasing by
5

equivalent steps for each whole percentage point until the
6

facilities reach a per diem add-on of $38.68. Facilities
7

with at least 125% or higher of the staffing indicated by
8

the STRIVE study shall be paid a per diem add-on of $38.68.
9

No nursing facility's variable staffing per diem add-on
10

shall be reduced by more than 5% in 2 consecutive
11

quarters. For the quarters beginning July 1, 2022 and
12

October 1, 2022, no facility's variable per diem staffing
13

add-on shall be calculated at a rate lower than 85% of the
14

staffing indicated by the STRIVE study. No facility below
15

70% of the staffing indicated by the STRIVE study shall
16

receive a variable per diem staffing add-on after December
17

31, 2022.
18

(7) For dates of services beginning July 1, 2022, the
19

PDPM nursing component per diem for each nursing facility
20

shall be the product of the facility's (i) statewide PDPM
21

nursing base per diem rate, $92.25, adjusted for the
22

facility average PDPM case mix index calculated quarterly
23

and (ii) the regional wage adjuster, and then add the
24

Medicaid access adjustment as defined in (e-3) of this
25

Section. Transition rates for services provided between
26

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

HB5061
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LRB104 18808 KTG 32251 b
1

the PDPM nursing component per diem or:
2

(A) for the quarter beginning July 1, 2022, the
3

RUG-IV nursing component per diem;
4

(B) for the quarter beginning October 1, 2022, the
5

sum of the RUG-IV nursing component per diem
6

multiplied by 0.80 and the PDPM nursing component per
7

diem multiplied by 0.20;
8

(C) for the quarter beginning January 1, 2023, the
9

sum of the RUG-IV nursing component per diem
10

multiplied by 0.60 and the PDPM nursing component per
11

diem multiplied by 0.40;
12

(D) for the quarter beginning April 1, 2023, the
13

sum of the RUG-IV nursing component per diem
14

multiplied by 0.40 and the PDPM nursing component per
15

diem multiplied by 0.60;
16

(E) for the quarter beginning July 1, 2023, the
17

sum of the RUG-IV nursing component per diem
18

multiplied by 0.20 and the PDPM nursing component per
19

diem multiplied by 0.80; or
20

(F) for the quarter beginning October 1, 2023 and
21

each subsequent quarter, the transition rate shall end
22

and a nursing facility shall be paid 100% of the PDPM
23

nursing component per diem.
24

(d-1) Calculation of base year Statewide RUG-IV nursing
25
base per diem rate.
26

(1) Base rate spending pool shall be:

HB5061
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LRB104 18808 KTG 32251 b
1

(A) The base year resident days which are
2

calculated by multiplying the number of Medicaid
3

residents in each nursing home as indicated in the MDS
4

data defined in paragraph (4) by 365.
5

(B) Each facility's nursing component per diem in
6

effect on July 1, 2012 shall be multiplied by
7

subsection (A).
8

(C) Thirteen million is added to the product of
9

subparagraph (A) and subparagraph (B) to adjust for
10

the exclusion of nursing homes defined in paragraph
11

(5).
12

(2) For each nursing home with Medicaid residents as
13

indicated by the MDS data defined in paragraph (4),
14

weighted days adjusted for case mix and regional wage
15

adjustment shall be calculated. For each home this
16

calculation is the product of:
17

(A) Base year resident days as calculated in
18

subparagraph (A) of paragraph (1).
19

(B) The nursing home's regional wage adjustor
20

based on the Health Service Areas (HSA) groupings and
21

adjustors in effect on April 30, 2012.
22

(C) Facility weighted case mix which is the number
23

of Medicaid residents as indicated by the MDS data
24

defined in paragraph (4) multiplied by the associated
25

case weight for the RUG-IV 48 grouper model using
26

standard RUG-IV procedures for index maximization.

HB5061
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LRB104 18808 KTG 32251 b
1

(D) The sum of the products calculated for each
2

nursing home in subparagraphs (A) through (C) above
3

shall be the base year case mix, rate adjusted
4

weighted days.
5

(3) The Statewide RUG-IV nursing base per diem rate:
6

(A) on January 1, 2014 shall be the quotient of the
7

paragraph (1) divided by the sum calculated under
8

subparagraph (D) of paragraph (2);
9

(B) on and after July 1, 2014 and until July 1,
10

2022, shall be the amount calculated under
11

subparagraph (A) of this paragraph (3) plus $1.76; and
12

(C) beginning July 1, 2022 and thereafter, $7
13

shall be added to the amount calculated under
14

subparagraph (B) of this paragraph (3) of this
15

Section.
16

(4) Minimum Data Set (MDS) comprehensive assessments
17

for Medicaid residents on the last day of the quarter used
18

to establish the base rate.
19

(5) Nursing facilities designated as of July 1, 2012
20

by the Department as "Institutions for Mental Disease"
21

shall be excluded from all calculations under this
22

subsection. The data from these facilities shall not be
23

used in the computations described in paragraphs (1)
24

through (4) above to establish the base rate.
25

(e) Beginning July 1, 2014, the Department shall allocate
26
funding in the amount up to $10,000,000 for per diem add-ons to

HB5061
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LRB104 18808 KTG 32251 b
1
the RUGS methodology for dates of service on and after July 1,
2
2014:
3

(1) $0.63 for each resident who scores in I4200
4

Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
5

(2) $2.67 for each resident who scores either a "1" or
6

"2" in any items S1200A through S1200I and also scores in
7

RUG groups PA1, PA2, BA1, or BA2.
8

(e-1) (Blank).
9

(e-2) For dates of services beginning January 1, 2014 and
10
ending September 30, 2023, the RUG-IV nursing component per
11
diem for a nursing home shall be the product of the statewide
12
RUG-IV nursing base per diem rate, the facility average case
13
mix index, and the regional wage adjustor. For dates of
14
service beginning July 1, 2022 and ending September 30, 2023,
15
the Medicaid access adjustment described in subsection (e-3)
16
shall be added to the product.
17

(e-3) A Medicaid Access Adjustment of $4 adjusted for the
18
facility average PDPM case mix index calculated quarterly
19
shall be added to the statewide PDPM nursing per diem for all
20
facilities with annual Medicaid bed days of at least 70% of all
21
occupied bed days adjusted quarterly. For each new calendar
22
year and for the 6-month period beginning July 1, 2022, the
23
percentage of a facility's occupied bed days comprised of
24
Medicaid bed days shall be determined by the Department
25
quarterly. For dates of service beginning January 1, 2023, the
26
Medicaid Access Adjustment shall be increased to $4.75. This

HB5061
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LRB104 18808 KTG 32251 b
1
subsection shall be inoperative on and after January 1, 2028.
2

(e-4) Subject to federal approval, on and after January 1,
3
2024, the Department shall increase the rate add-on at
4
paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
5
for ventilator services from $208 per day to $481 per day.
6
Payment is subject to the criteria and requirements under 89
7
Ill. Adm. Code 147.335.
8

(f) (Blank).
9

(g) Notwithstanding any other provision of this Code, on
10
and after July 1, 2012, for facilities not designated by the
11
Department of Healthcare and Family Services as "Institutions
12
for Mental Disease", rates effective May 1, 2011 shall be
13
adjusted as follows:
14

(1) (Blank);
15

(2) (Blank);
16

(3) Facility rates for the capital and support
17

components shall be reduced by 1.7%.
18

(h) Notwithstanding any other provision of this Code, on
19
and after July 1, 2012, nursing facilities designated by the
20
Department of Healthcare and Family Services as "Institutions
21
for Mental Disease" and "Institutions for Mental Disease" that
22
are facilities licensed under the Specialized Mental Health
23
Rehabilitation Act of 2013 shall have the nursing,
24
socio-developmental, capital, and support components of their
25
reimbursement rate effective May 1, 2011 reduced in total by
26
2.7%.

HB5061
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LRB104 18808 KTG 32251 b
1

(i) On and after July 1, 2014, the reimbursement rates for
2
the support component of the nursing facility rate for
3
facilities licensed under the Nursing Home Care Act as skilled
4
or intermediate care facilities shall be the rate in effect on
5
June 30, 2014 increased by 8.17%.
6

(i-1) Subject to federal approval, on and after January 1,
7
2024, the reimbursement rates for the support component of the
8
nursing facility rate for facilities licensed under the
9
Nursing Home Care Act as skilled or intermediate care
10
facilities shall be the rate in effect on June 30, 2023
11
increased by 12%.
12

(j) Notwithstanding any other provision of law, subject to
13
federal approval, effective July 1, 2019, sufficient funds
14
shall be allocated for changes to rates for facilities
15
licensed under the Nursing Home Care Act as skilled nursing
16
facilities or intermediate care facilities for dates of
17
services on and after July 1, 2019: (i) to establish, through
18
June 30, 2022 a per diem add-on to the direct care per diem
19
rate not to exceed $70,000,000 annually in the aggregate
20
taking into account federal matching funds for the purpose of
21
addressing the facility's unique staffing needs, adjusted
22
quarterly and distributed by a weighted formula based on
23
Medicaid bed days on the last day of the second quarter
24
preceding the quarter for which the rate is being adjusted.
25
Beginning July 1, 2022, the annual $70,000,000 described in
26
the preceding sentence shall be dedicated to the variable per

HB5061
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LRB104 18808 KTG 32251 b
1
diem add-on for staffing under paragraph (6) of subsection
2
(d); and (ii) in an amount not to exceed $170,000,000 annually
3
in the aggregate taking into account federal matching funds to
4
permit the support component of the nursing facility rate to
5
be updated as follows:
6

(1) 80%, or $136,000,000, of the funds shall be used
7

to update each facility's rate in effect on June 30, 2019
8

using the most recent cost reports on file, which have had
9

a limited review conducted by the Department of Healthcare
10

and Family Services and will not hold up enacting the rate
11

increase, with the Department of Healthcare and Family
12

Services.
13

(2) After completing the calculation in paragraph (1),
14

any facility whose rate is less than the rate in effect on
15

June 30, 2019 shall have its rate restored to the rate in
16

effect on June 30, 2019 from the 20% of the funds set
17

aside.
18

(3) The remainder of the 20%, or $34,000,000, shall be
19

used to increase each facility's rate by an equal
20

percentage.
21

(k) During the first quarter of State Fiscal Year 2020,
22
the Department of Healthcare of Family Services must convene a
23
technical advisory group consisting of members of all trade
24
associations representing Illinois skilled nursing providers
25
to discuss changes necessary with federal implementation of
26
Medicare's Patient-Driven Payment Model. Implementation of

HB5061
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LRB104 18808 KTG 32251 b
1
Medicare's Patient-Driven Payment Model shall, by September 1,
2
2020, end the collection of the MDS data that is necessary to
3
maintain the current RUG-IV Medicaid payment methodology. The
4
technical advisory group must consider a revised reimbursement
5
methodology that takes into account transparency,
6
accountability, actual staffing as reported under the
7
federally required Payroll Based Journal system, changes to
8
the minimum wage, adequacy in coverage of the cost of care, and
9
a quality component that rewards quality improvements.
10

(l) The Department shall establish per diem add-on
11
payments to improve the quality of care delivered by
12
facilities, including:
13

(1) Incentive payments determined by facility
14

performance on specified quality measures in an initial
15

amount of $70,000,000. Nothing in this subsection shall be
16

construed to limit the quality of care payments in the
17

aggregate statewide to $70,000,000, and, if quality of
18

care has improved across nursing facilities, the
19

Department shall adjust those add-on payments accordingly.
20

The quality payment methodology described in this
21

subsection must be used for at least State Fiscal Year
22

2023. Beginning with the quarter starting July 1, 2023,
23

the Department may add, remove, or change quality metrics
24

and make associated changes to the quality payment
25

methodology as outlined in subparagraph (E). Facilities
26

designated by the Centers for Medicare and Medicaid

HB5061
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LRB104 18808 KTG 32251 b
1

Services as a special focus facility or a hospital-based
2

nursing home do not qualify for quality payments.
3

(A) Each quality pool must be distributed by
4

assigning a quality weighted score for each nursing
5

home which is calculated by multiplying the nursing
6

home's quality base period Medicaid days by the
7

nursing home's star rating weight in that period.
8

(B) Star rating weights are assigned based on the
9

nursing home's star rating for the LTS quality star
10

rating. As used in this subparagraph, "LTS quality
11

star rating" means the long-term stay quality rating
12

for each nursing facility, as assigned by the Centers
13

for Medicare and Medicaid Services under the Five-Star
14

Quality Rating System. The rating is a number ranging
15

from 0 (lowest) to 5 (highest).
16

(i) Zero-star or one-star rating has a weight
17

of 0.
18

(ii) Two-star rating has a weight of 0.75.
19

(iii) Three-star rating has a weight of 1.5.
20

(iv) Four-star rating has a weight of 2.5.
21

(v) Five-star rating has a weight of 3.5.
22

(C) Each nursing home's quality weight score is
23

divided by the sum of all quality weight scores for
24

qualifying nursing homes to determine the proportion
25

of the quality pool to be paid to the nursing home.
26

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

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1

annually or $17,500,000 per quarter. The Department
2

shall publish on its website the estimated payments
3

and the associated weights for each facility 45 days
4

prior to when the initial payments for the quarter are
5

to be paid. The Department shall assign each facility
6

the most recent and applicable quarter's STAR value
7

unless the facility notifies the Department within 15
8

days of an issue and the facility provides reasonable
9

evidence demonstrating its timely compliance with
10

federal data submission requirements for the quarter
11

of record. If such evidence cannot be provided to the
12

Department, the STAR rating assigned to the facility
13

shall be reduced by one from the prior quarter.
14

(E) The Department shall review quality metrics
15

used for payment of the quality pool and make
16

recommendations for any associated changes to the
17

methodology for distributing quality pool payments in
18

consultation with associations representing long-term
19

care providers, consumer advocates, organizations
20

representing workers of long-term care facilities, and
21

payors. The Department may establish, by rule, changes
22

to the methodology for distributing quality pool
23

payments.
24

(F) The Department shall disburse quality pool
25

payments from the Long-Term Care Provider Fund on a
26

monthly basis in amounts proportional to the total

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1

quality pool payment determined for the quarter.
2

(G) The Department shall publish any changes in
3

the methodology for distributing quality pool payments
4

prior to the beginning of the measurement period or
5

quality base period for any metric added to the
6

distribution's methodology.
7

(H) Beginning January 1, 2027, for facilities that
8

have had their long-stay percentage of residents who
9

received an antipsychotic medication quality measure
10

score suppressed and their STAR rating set to one due
11

to audit action by the federal Centers for Medicare
12

and Medicaid Services, the Department shall recompute
13

the facility's STAR rating using the actual long-stay
14

rating points for the quarter per the methodology used
15

by the federal Centers for Medicare and Medicaid
16

Services. Quality payments shall be made based on the
17

recomputed score.

18

In order to facilitate the evaluation and
19

completion of the recomputation required in this
20

subparagraph, facilities may provide the Department
21

with documentation regarding the status of the
22

suppression of the score and STAR rating as well as the
23

quarterly report issued by the federal Centers for
24

Medicare and Medicaid Services that lists the
25

long-stay rating points for the quarter.

26

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

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1

training for the purpose of increasing CNA compensation.
2

It is the intent of this subsection that payments made in
3

accordance with this paragraph be directly incorporated
4

into increased compensation for CNAs. As used in this
5

paragraph, "CNA" means a certified nursing assistant as
6

that term is described in Section 3-206 of the Nursing
7

Home Care Act, Section 3-206 of the ID/DD Community Care
8

Act, and Section 3-206 of the MC/DD Act. The Department
9

shall establish, by rule, payments to nursing facilities
10

equal to Medicaid's share of the tenure wage increments
11

specified in this paragraph for all reported CNA employee
12

hours compensated according to a posted schedule
13

consisting of increments at least as large as those
14

specified in this paragraph. The increments are as
15

follows: an additional $1.50 per hour for CNAs with at
16

least one and less than 2 years' experience plus another
17

$1 per hour for each additional year of experience up to a
18

maximum of $6.50 for CNAs with at least 6 years of
19

experience. For purposes of this paragraph, Medicaid's
20

share shall be the ratio determined by paid Medicaid bed
21

days divided by total bed days for the applicable time
22

period used in the calculation. In addition, and additive
23

to any tenure increments paid as specified in this
24

paragraph, the Department shall establish, by rule,
25

payments supporting Medicaid's share of the
26

promotion-based wage increments for CNA employee hours

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1

compensated for that promotion with at least a $1.50
2

hourly increase. Medicaid's share shall be established as
3

it is for the tenure increments described in this
4

paragraph. Qualifying promotions shall be defined by the
5

Department in rules for an expected 10-15% subset of CNAs
6

assigned intermediate, specialized, or added roles such as
7

CNA trainers, CNA scheduling "captains", and CNA
8

specialists for resident conditions like dementia or
9

memory care or behavioral health.
10

(m) The Department shall work with nursing facility
11
industry representatives to design policies and procedures to
12
permit facilities to address the integrity of data from
13
federal reporting sites used by the Department in setting
14
facility rates.
15
(Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
16
102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
17
Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
18
Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
19
7-1-24; 103-1075, eff. 3-21-25.)

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