DHS-DSP WAGE&CILA RATE INCREAS

Illinois General Assembly - Full Text of SB3427

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3427

Introduced 2/4/2026, by Sen. David Koehler

SYNOPSIS AS INTRODUCED:

5 ILCS 100/5-45.71 new
20 ILCS 1705/74
20 ILCS 1705/80 new
305 ILCS 5/5-5.4

from Ch. 23, par. 5-5.4

Amends the Mental Health and Developmental Disabilities
Administrative Act. Requires the Department of Human Services to file an
amendment to the Home and Community-Based Services Waiver Program for
Adults with Developmental Disabilities that shall include an increase in
the rate methodology sufficient to provide for a wage rate of 150% of the
statewide, regional, or local minimum wage for services delivered on or
after January 1, 2027, for all direct support personnel and all other
frontline personnel who are not subject to the Bureau of Labor Statistics'
average wage increases and who work in residential and community day
services settings. Provides that for services delivered on or after
January 1, 2027, the rates shall include adjustments to employment-related
expenses as defined by rule by the Department. Requires the Department to
adopt rules, including emergency rules, to implement the rate increases.
Contains provisions on benchmark rates for therapy and counseling for
adults with intellectual and developmental disabilities; tiered rates for
community day services; community integration supports for community day
services; and benchmark rates for CILA transportation cost and for the
supported employment program for adults with intellectual and
developmental disabilities. Amends the Medical Assistance Article of the
Illinois Public Aid Code. Requires the Department of Healthcare and Family
Services to submit a Title XIX State Plan amendment to the federal Centers
for Medicare and Medicaid Services that shall include an increase in the
rate methodology sufficient to provide for a wage rate of 150% of the
statewide, regional, or local minimum wage for services delivered on or
after January 1, 2027, for all direct support personnel and all other
frontline personnel at ID/DD and MC/DD facilities. Provides that the State
Plan amendment shall provide wage increases for all residential
non-executive direct care staff. Effective immediately.
LRB104 19074 KTG 32519 b

A BILL FOR

SB3427
LRB104 19074 KTG 32519 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 1.
The Illinois Administrative Procedure Act is
5
amended by adding Section 5-45.71 as follows:

6

(5 ILCS 100/5-45.71 new)
7

Sec. 5-45.71.
Emergency rulemaking; wage increase for
8
direct support personnel.
To provide for the expeditious and
9
timely implementation of subsection (i) of Section 74 of the
10
Mental Health and Developmental Disabilities Administrative
11
Act, emergency rules implementing the changes may be adopted
12
in accordance with Section 5-45 by the Department of Human
13
Services. The adoption of emergency rules authorized by
14
Section 5-45 and this Section is deemed to be necessary for the
15
public interest, safety, and welfare.

16

This Section is repealed one year after the effective date
17
of this amendatory Act of the 104th General Assembly.

18

Section 5.
The Mental Health and Developmental
19
Disabilities Administrative Act is amended by changing Section
20
74 and by adding Section 80 as follows:

21

(20 ILCS 1705/74)

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LRB104 19074 KTG 32519 b
1

Sec. 74.
Rates and reimbursements.
2

(a) Within 30 days after July 6, 2017 (the effective date
3
of Public Act 100-23), the Department shall increase rates and
4
reimbursements to fund a minimum of a $0.75 per hour wage
5
increase for frontline personnel, including, but not limited
6
to, direct support professionals, aides, frontline
7
supervisors, qualified intellectual disabilities
8
professionals, nurses, and non-administrative support staff
9
working in community-based provider organizations serving
10
individuals with developmental disabilities. The Department
11
shall adopt rules, including emergency rules under subsection
12
(y) of Section 5-45 of the Illinois Administrative Procedure
13
Act, to implement the provisions of this Section.
14

(b) Rates and reimbursements. Within 30 days after June 4,
15
2018 (the effective date of Public Act 100-587), the
16
Department shall increase rates and reimbursements to fund a
17
minimum of a $0.50 per hour wage increase for frontline
18
personnel, including, but not limited to, direct support
19
professionals, aides, frontline supervisors, qualified
20
intellectual disabilities professionals, nurses, and
21
non-administrative support staff working in community-based
22
provider organizations serving individuals with developmental
23
disabilities. The Department shall adopt rules, including
24
emergency rules under subsection (bb) of Section 5-45 of the
25
Illinois Administrative Procedure Act, to implement the
26
provisions of this Section.

SB3427
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LRB104 19074 KTG 32519 b
1

(c) Rates and reimbursements. Within 30 days after June 5,
2
2019 (the effective date of Public Act 101-10), subject to
3
federal approval, the Department shall increase rates and
4
reimbursements in effect on June 30, 2019 for community-based
5
providers for persons with Developmental Disabilities by 3.5%
6
The Department shall adopt rules, including emergency rules
7
under subsection (jj) of Section 5-45 of the Illinois
8
Administrative Procedure Act, to implement the provisions of
9
this Section, including wage increases for direct care staff.
10

(d) For community-based providers serving persons with
11
intellectual/developmental disabilities, subject to federal
12
approval of any relevant Waiver Amendment, the rates taking
13
effect for services delivered on or after January 1, 2022,
14
shall include an increase in the rate methodology sufficient
15
to provide a $1.50 per hour wage increase for direct support
16
professionals in residential settings and sufficient to
17
provide wages for all residential non-executive direct care
18
staff, excluding direct support professionals, at the federal
19
Department of Labor, Bureau of Labor Statistics' average wage
20
as defined in rule by the Department.
21

The establishment of and any changes to the rate
22
methodologies for community-based services provided to persons
23
with intellectual/developmental disabilities are subject to
24
federal approval of any relevant Waiver Amendment and shall be
25
defined in rule by the Department. The Department shall adopt
26
rules, including emergency rules as authorized by Section 5-45

SB3427
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LRB104 19074 KTG 32519 b
1
of the Illinois Administrative Procedure Act, to implement the
2
provisions of this subsection (d).
3

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

The establishment of and any changes to the rate
22
methodologies for community-based services provided to persons
23
with intellectual/developmental disabilities are subject to
24
federal approval of any relevant Waiver Amendment and shall be
25
defined in rule by the Department. The Department shall adopt
26
rules, including emergency rules as authorized by Section 5-45

SB3427
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LRB104 19074 KTG 32519 b
1
of the Illinois Administrative Procedure Act, to implement the
2
provisions of this subsection.
3

(f) For community-based providers serving persons with
4
intellectual/developmental disabilities, subject to federal
5
approval of any relevant Waiver Amendment, the rates taking
6
effect for services delivered on or after January 1, 2024
7
shall include an increase in the rate methodology sufficient
8
to provide a $2.50 per hour wage increase for all direct
9
support professionals and all other frontline personnel who
10
are not subject to the Bureau of Labor Statistics' average
11
wage increases and who work in residential and community day
12
services settings. At least $1.25 of the per hour wage
13
increase shall be provided as a direct increase to base wages,
14
and the remaining $1.25 of the per hour wage increase shall be
15
used flexibly for base wage increases. In addition, the rates
16
taking effect for services delivered on or after January 1,
17
2024 shall include an increase sufficient to provide wages for
18
all residential non-executive direct care staff, excluding
19
direct support professionals, at the federal Department of
20
Labor, Bureau of Labor Statistics' average wage as defined in
21
rule by the Department.
22

The establishment of and any changes to the rate
23
methodologies for community-based services provided to persons
24
with intellectual/developmental disabilities are subject to
25
federal approval of any relevant Waiver Amendment and shall be
26
defined in rule by the Department. The Department shall adopt

SB3427
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LRB104 19074 KTG 32519 b
1
rules, including emergency rules as authorized by Section 5-45
2
of the Illinois Administrative Procedure Act, to implement the
3
provisions of this subsection.
4

(g) For community-based providers serving persons with
5
intellectual or developmental disabilities, subject to federal
6
approval of any relevant Waiver Amendment, the rates taking
7
effect for services delivered on or after January 1, 2025
8
shall include an increase in the rate methodology sufficient
9
to provide a $1 per hour wage rate increase for all direct
10
support personnel and all other frontline personnel who are
11
not subject to the Bureau of Labor Statistics' average wage
12
increases and who work in residential and community day
13
services settings, with at least $0.75 of those funds to be
14
provided as a direct increase to base wages and the remaining
15
$0.25 to be used flexibly for base wage increases. These
16
increases shall not be used by community-based providers for
17
operational or administrative expenses. In addition, the rates
18
taking effect for services delivered on or after January 1,
19
2025 shall include an increase sufficient to provide wages for
20
all residential non-executive direct care staff, excluding
21
direct support personnel, at the federal Department of Labor,
22
Bureau of Labor Statistics' average wage as defined by rule by
23
the Department. For services delivered on or after January 1,
24
2025, the rates shall include adjustments to
25
employment-related expenses as defined by rule by the
26
Department.

SB3427
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LRB104 19074 KTG 32519 b
1

The establishment of and any changes to the rate
2
methodologies for community-based services provided to persons
3
with intellectual or developmental disabilities are subject to
4
federal approval of any relevant Waiver Amendment and shall be
5
defined in rule by the Department. The Department shall adopt
6
rules, including emergency rules as authorized by Section 5-45
7
of the Illinois Administrative Procedure Act, to implement the
8
provisions of this subsection.
9

(h) For community-based providers serving persons with
10
intellectual or developmental disabilities, subject to federal
11
approval of any relevant Waiver Amendment, the rates taking
12
effect for services delivered on or after January 1, 2026
13
shall include an increase in the rate methodology sufficient
14
to provide a $0.80 per hour wage increase for all direct
15
support personnel and all other frontline personnel who are
16
not subject to the Bureau of Labor Statistics' average wage
17
increases and who work in residential and community day
18
services settings, with at least $0.60 of the per hour wage
19
increase to be provided as a direct increase to base wages, and
20
the remaining $0.20 of the per hour wage increase to be used
21
flexibly for base wage increases. These increases shall not be
22
used by community-based providers for operational or
23
administrative expenses. In addition, the rates taking effect
24
for services delivered on or after January 1, 2026 shall
25
include an increase sufficient to provide wages for all
26
residential non-executive direct care staff, excluding direct

SB3427
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LRB104 19074 KTG 32519 b
1
support personnel, at the federal Department of Labor, Bureau
2
of Labor Statistics' average wage as defined in rule by the
3
Department.
4

The establishment of and any changes to the rate
5
methodologies for community-based services provided to persons
6
with intellectual or developmental disabilities are subject to
7
federal approval of any relevant Waiver Amendment and shall be
8
defined in rule by the Department. The Department shall adopt
9
rules, including emergency rules as authorized by Section 5-45
10
of the Illinois Administrative Procedure Act, to implement the
11
provisions of this subsection.
12

(i) For community-based providers serving persons with
13
intellectual or developmental disabilities, by no later than
14
January 1, 2027, the Department shall file an amendment to the
15
Home and Community-Based Services Waiver Program for Adults
16
with Developmental Disabilities authorized under Section
17
1915(c) of the Social Security Act that shall include an
18
increase in the rate methodology sufficient to provide for a
19
wage rate of 150% of the statewide, regional, or local minimum
20
wage for services delivered on or after January 1, 2027, for
21
all direct support personnel and all other frontline personnel
22
who are not subject to the Bureau of Labor Statistics' average
23
wage increases and who work in residential and community day
24
services settings. The amendment shall also include an
25
increase in the rate methodology sufficient to provide wage
26
increases for all residential non-executive direct care staff,

SB3427
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LRB104 19074 KTG 32519 b
1
excluding direct support personnel, at the federal Department
2
of Labor, Bureau of Labor Statistics' average wage as defined
3
by rule by the Department of Human Services for services
4
delivered on or after January 1, 2027. For services delivered
5
on or after January 1, 2027, the rates shall include
6
adjustments to employment-related expenses as defined by rule
7
by the Department of Human Services. The Department of Human
8
Services shall adopt rules, including emergency rules as
9
authorized by Section 5-45 of the Illinois Administrative
10
Procedure Act, to implement the provisions of this subsection.
11

(j) Benchmark rates for therapy and counseling for adults
12
with intellectual and developmental disabilities. The
13
Department shall file an amendment to the Home and
14
Community-Based Services Waiver Program for Adults with
15
Developmental Disabilities authorized under Section 1915(c) of
16
the Social Security Act sufficient to establish rate increases
17
for therapy and counseling services at the levels prescribed
18
in the Department's Guidehouse Rate Study for State Fiscal
19
Year 2027. This Section is subject to federal approval. The
20
Department shall adopt rules to implement this Section.

21

(k) Tiered rates for community day services. The
22
Department shall file an amendment to the Home and
23
Community-Based Services Waiver Program for Adults with
24
Developmental Disabilities authorized under Section 1915(c) of
25
the Social Security Act sufficient to establish rate increases
26
to implement tiered rates for community day services. The

SB3427
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LRB104 19074 KTG 32519 b
1
Department shall establish enhanced rates tiered for acuity
2
for each day program to provide additional supports to
3
individuals with significant medical or behavioral needs. The
4
tiered rates shall be implemented in the manner prescribed in
5
the Department's Guidehouse Rate Study. This Section is
6
subject to federal approval. The Department shall adopt rules
7
to implement this Section.

8

(l) Community integration supports for community day
9
services. The Department shall file an amendment to the Home
10
and Community-Based Services Waiver Program for Adults with
11
Developmental Disabilities authorized under Section 1915(c) of
12
the Social Security Act sufficient to establish rate increases
13
to implement Community Integration Supports for Community Day
14
Services in the manner prescribed in the Department's
15
Guidehouse Rate Study. This Section is subject to federal
16
approval. The Department shall adopt rules to implement this
17
Section.

18

(m) Benchmark rates for CILA transportation cost center
19
vehicle purchase allowances for adults with intellectual and
20
developmental disabilities. The Department shall file an
21
amendment to the Home and Community-Based Services Waiver
22
Program for Adults with Developmental Disabilities authorized
23
under Section 1915(c) of the Social Security Act sufficient to
24
establish rate increases for the vehicle purchase allowance
25
contained within the community-integrated living arrangement
26
transportation cost center rate. The increases shall be

SB3427
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LRB104 19074 KTG 32519 b
1
implemented in the manner prescribed within the Department's
2
Guidehouse Rate Study. This Section is subject to federal
3
approval. The Department shall adopt rules to implement this
4
Section.

5

(n) Benchmark rates for the supported employment program
6
for adults with intellectual and developmental disabilities.
7
The Department shall file an amendment to the Home and
8
Community-Based Services Waiver Program for Adults with
9
Developmental Disabilities authorized under Section 1915(c) of
10
the Social Security Act sufficient to establish rate increases
11
for the Supported Employment Program for individuals (36U),
12
small group (33G), and large group (36G), at the levels
13
prescribed in the Department's Guidehouse Rate Study for State
14
Fiscal Year 2027. This Section is subject to federal approval.
15
The Department shall adopt rules to implement this Section.

16
(Source: P.A. 103-8, eff. 6-7-23; 103-154, eff. 6-30-23;
17
103-588, eff. 6-5-24; 104-2, eff. 6-16-25.)

18

(20 ILCS 1705/80 new)
19

Sec. 80.
Zero hour staffing model for CILAs.
Beginning
20
January 1, 2027, the Department shall implement the Zero Hour
21
Staffing Model for Community-Integrated Living Arrangements
22
for community-based providers serving persons with
23
intellectual and developmental disabilities at rates
24
consistent with what is outlined in the Department's
25
Guidehouse Rate Study. Implementation of the Zero Hour

SB3427
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LRB104 19074 KTG 32519 b
1
Staffing Model shall not mandate staff be present in
2
community-integrated living arrangements when individuals are
3
not present nor shall it eliminate the Enhanced Residential
4
Billing code (37U). The Department shall adopt administrative
5
rules to implement this Section.

6

Section 10.
The Illinois Public Aid Code is amended by
7
changing Section 5-5.4 as follows:

8

(305 ILCS 5/5-5.4)

(from Ch. 23, par. 5-5.4)
9

Sec. 5-5.4.
Standards of payment; Department of Healthcare
10
and Family Services.
The Department of Healthcare and Family
11
Services shall develop standards of payment of nursing
12
facility and ICF/DD services in facilities providing such
13
services under this Article which:
14

(1) Provide for the determination of a facility's payment
15
for nursing facility or ICF/DD services on a prospective
16
basis. The amount of the payment rate for all nursing
17
facilities certified by the Department of Public Health under
18
the ID/DD Community Care Act or the Nursing Home Care Act as
19
Intermediate Care for the Developmentally Disabled facilities,
20
Long Term Care for Under Age 22 facilities, Skilled Nursing
21
facilities, or Intermediate Care facilities under the medical
22
assistance program shall be prospectively established annually
23
on the basis of historical, financial, and statistical data
24
reflecting actual costs from prior years, which shall be

SB3427
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LRB104 19074 KTG 32519 b
1
applied to the current rate year and updated for inflation,
2
except that the capital cost element for newly constructed
3
facilities shall be based upon projected budgets. The annually
4
established payment rate shall take effect on July 1 in 1984
5
and subsequent years. No rate increase and no update for
6
inflation shall be provided on or after July 1, 1994, unless
7
specifically provided for in this Section. The changes made by
8
Public Act 93-841 extending the duration of the prohibition
9
against a rate increase or update for inflation are effective
10
retroactive to July 1, 2004.
11

For facilities licensed by the Department of Public Health
12
under the Nursing Home Care Act as Intermediate Care for the
13
Developmentally Disabled facilities or Long Term Care for
14
Under Age 22 facilities, the rates taking effect on July 1,
15
1998 shall include an increase of 3%. For facilities licensed
16
by the Department of Public Health under the Nursing Home Care
17
Act as Skilled Nursing facilities or Intermediate Care
18
facilities, the rates taking effect on July 1, 1998 shall
19
include an increase of 3% plus $1.10 per resident-day, as
20
defined by the Department. For facilities licensed by the
21
Department of Public Health under the Nursing Home Care Act as
22
Intermediate Care Facilities for the Developmentally Disabled
23
or Long Term Care for Under Age 22 facilities, the rates taking
24
effect on January 1, 2006 shall include an increase of 3%. For
25
facilities licensed by the Department of Public Health under
26
the Nursing Home Care Act as Intermediate Care Facilities for

SB3427
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LRB104 19074 KTG 32519 b
1
the Developmentally Disabled or Long Term Care for Under Age
2
22 facilities, the rates taking effect on January 1, 2009
3
shall include an increase sufficient to provide a $0.50 per
4
hour wage increase for non-executive staff. For facilities
5
licensed by the Department of Public Health under the ID/DD
6
Community Care Act as ID/DD Facilities the rates taking effect
7
within 30 days after July 6, 2017 (the effective date of Public
8
Act 100-23) shall include an increase sufficient to provide a
9
$0.75 per hour wage increase for non-executive staff. The
10
Department shall adopt rules, including emergency rules under
11
subsection (y) of Section 5-45 of the Illinois Administrative
12
Procedure Act, to implement the provisions of this paragraph.
13
For facilities licensed by the Department of Public Health
14
under the ID/DD Community Care Act as ID/DD Facilities and
15
under the MC/DD Act as MC/DD Facilities, the rates taking
16
effect within 30 days after June 5, 2019 (the effective date of
17
Public Act 101-10) shall include an increase sufficient to
18
provide a $0.50 per hour wage increase for non-executive
19
frontline personnel, including, but not limited to, direct
20
support persons, aides, frontline supervisors, qualified
21
intellectual disabilities professionals, nurses, and
22
non-administrative support staff. The Department shall adopt
23
rules, including emergency rules under subsection (bb) of
24
Section 5-45 of the Illinois Administrative Procedure Act, to
25
implement the provisions of this paragraph.
26

For facilities licensed by the Department of Public Health

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LRB104 19074 KTG 32519 b
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

SB3427
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LRB104 19074 KTG 32519 b
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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LRB104 19074 KTG 32519 b
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

SB3427
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LRB104 19074 KTG 32519 b
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

February 16, 2011 (the effective date of Public Act
12

96-1530), $416,500,000 or an amount as may be necessary to
13

complete the transition to the MDS methodology for the
14

nursing component of the rate. Increased payments under
15

this item (iv) are not due and payable, however, until (i)
16

the methodologies described in this paragraph are approved
17

by the federal government in an appropriate State Plan
18

amendment and (ii) the assessment imposed by Section 5B-2
19

of this Code is determined to be a permissible tax under
20

Title XIX of the Social Security Act.
21

Notwithstanding any other provision of this Section, for
22
facilities licensed by the Department of Public Health under
23
the Nursing Home Care Act as skilled nursing facilities or
24
intermediate care facilities, the support component of the
25
rates taking effect on January 1, 2008 shall be computed using
26
the most recent cost reports on file with the Department of

SB3427
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LRB104 19074 KTG 32519 b
1
Healthcare and Family Services no later than April 1, 2005,
2
updated for inflation to January 1, 2006.
3

For facilities licensed by the Department of Public Health
4
under the Nursing Home Care Act as Intermediate Care for the
5
Developmentally Disabled facilities or Long Term Care for
6
Under Age 22 facilities, the rates taking effect on April 1,
7
2002 shall include a statewide increase of 2.0%, as defined by
8
the Department. This increase terminates on July 1, 2002;
9
beginning July 1, 2002 these rates are reduced to the level of
10
the rates in effect on March 31, 2002, as defined by the
11
Department.
12

For facilities licensed by the Department of Public Health
13
under the Nursing Home Care Act as skilled nursing facilities
14
or intermediate care facilities, the rates taking effect on
15
July 1, 2001 shall be computed using the most recent cost
16
reports on file with the Department of Public Aid no later than
17
April 1, 2000, updated for inflation to January 1, 2001. For
18
rates effective July 1, 2001 only, rates shall be the greater
19
of the rate computed for July 1, 2001 or the rate effective on
20
June 30, 2001.
21

Notwithstanding any other provision of this Section, for
22
facilities licensed by the Department of Public Health under
23
the Nursing Home Care Act as skilled nursing facilities or
24
intermediate care facilities, the Illinois Department shall
25
determine by rule the rates taking effect on July 1, 2002,
26
which shall be 5.9% less than the rates in effect on June 30,

SB3427
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LRB104 19074 KTG 32519 b
1
2002.
2

Notwithstanding any other provision of this Section, for
3
facilities licensed by the Department of Public Health under
4
the Nursing Home Care Act as skilled nursing facilities or
5
intermediate care facilities, if the payment methodologies
6
required under Section 5A-12 and the waiver granted under 42
7
CFR 433.68 are approved by the United States Centers for
8
Medicare and Medicaid Services, the rates taking effect on
9
July 1, 2004 shall be 3.0% greater than the rates in effect on
10
June 30, 2004. These rates shall take effect only upon
11
approval and implementation of the payment methodologies
12
required under Section 5A-12.
13

Notwithstanding any other provisions of this Section, for
14
facilities licensed by the Department of Public Health under
15
the Nursing Home Care Act as skilled nursing facilities or
16
intermediate care facilities, the rates taking effect on
17
January 1, 2005 shall be 3% more than the rates in effect on
18
December 31, 2004.
19

Notwithstanding any other provision of this Section, for
20
facilities licensed by the Department of Public Health under
21
the Nursing Home Care Act as skilled nursing facilities or
22
intermediate care facilities, effective January 1, 2009, the
23
per diem support component of the rates effective on January
24
1, 2008, computed using the most recent cost reports on file
25
with the Department of Healthcare and Family Services no later
26
than April 1, 2005, updated for inflation to January 1, 2006,

SB3427
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LRB104 19074 KTG 32519 b
1
shall be increased to the amount that would have been derived
2
using standard Department of Healthcare and Family Services
3
methods, procedures, and inflators.
4

Notwithstanding any other provisions of this Section, for
5
facilities licensed by the Department of Public Health under
6
the Nursing Home Care Act as intermediate care facilities that
7
are federally defined as Institutions for Mental Disease, or
8
facilities licensed by the Department of Public Health under
9
the Specialized Mental Health Rehabilitation Act of 2013, a
10
socio-development component rate equal to 6.6% of the
11
facility's nursing component rate as of January 1, 2006 shall
12
be established and paid effective July 1, 2006. The
13
socio-development component of the rate shall be increased by
14
a factor of 2.53 on the first day of the month that begins at
15
least 45 days after January 11, 2008 (the effective date of
16
Public Act 95-707). As of August 1, 2008, the
17
socio-development component rate shall be equal to 6.6% of the
18
facility's nursing component rate as of January 1, 2006,
19
multiplied by a factor of 3.53. For services provided on or
20
after April 1, 2011, or the first day of the month that begins
21
at least 45 days after February 16, 2011 (the effective date of
22
Public Act 96-1530), whichever is later, the Illinois
23
Department may by rule adjust these socio-development
24
component rates, and may use different adjustment
25
methodologies for those facilities participating, and those
26
not participating, in the Illinois Department's demonstration

SB3427
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LRB104 19074 KTG 32519 b
1
program pursuant to the provisions of Title 77, Part 300,
2
Subpart T of the Illinois Administrative Code, but in no case
3
may such rates be diminished below those in effect on August 1,
4
2008.
5

For facilities licensed by the Department of Public Health
6
under the Nursing Home Care Act as Intermediate Care for the
7
Developmentally Disabled facilities or as long-term care
8
facilities for residents under 22 years of age, the rates
9
taking effect on July 1, 2003 shall include a statewide
10
increase of 4%, as defined by the Department.
11

For facilities licensed by the Department of Public Health
12
under the Nursing Home Care Act as Intermediate Care for the
13
Developmentally Disabled facilities or Long Term Care for
14
Under Age 22 facilities, the rates taking effect on the first
15
day of the month that begins at least 45 days after January 11,
16
2008 (the effective date of Public Act 95-707) shall include a
17
statewide increase of 2.5%, as defined by the Department.
18

Notwithstanding any other provision of this Section, for
19
facilities licensed by the Department of Public Health under
20
the Nursing Home Care Act as skilled nursing facilities or
21
intermediate care facilities, effective January 1, 2005,
22
facility rates shall be increased by the difference between
23
(i) a facility's per diem property, liability, and malpractice
24
insurance costs as reported in the cost report filed with the
25
Department of Public Aid and used to establish rates effective
26
July 1, 2001 and (ii) those same costs as reported in the

SB3427
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1
facility's 2002 cost report. These costs shall be passed
2
through to the facility without caps or limitations, except
3
for adjustments required under normal auditing procedures.
4

Rates established effective each July 1 shall govern
5
payment for services rendered throughout that fiscal year,
6
except that rates established on July 1, 1996 shall be
7
increased by 6.8% for services provided on or after January 1,
8
1997. Such rates will be based upon the rates calculated for
9
the year beginning July 1, 1990, and for subsequent years
10
thereafter until June 30, 2001 shall be based on the facility
11
cost reports for the facility fiscal year ending at any point
12
in time during the previous calendar year, updated to the
13
midpoint of the rate year. The cost report shall be on file
14
with the Department no later than April 1 of the current rate
15
year. Should the cost report not be on file by April 1, the
16
Department shall base the rate on the latest cost report filed
17
by each skilled care facility and intermediate care facility,
18
updated to the midpoint of the current rate year. In
19
determining rates for services rendered on and after July 1,
20
1985, fixed time shall not be computed at less than zero. The
21
Department shall not make any alterations of regulations which
22
would reduce any component of the Medicaid rate to a level
23
below what that component would have been utilizing in the
24
rate effective on July 1, 1984.
25

(2) Shall take into account the actual costs incurred by
26
facilities in providing services for recipients of skilled

SB3427
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LRB104 19074 KTG 32519 b
1
nursing and intermediate care services under the medical
2
assistance program.
3

(3) Shall take into account the medical and psycho-social
4
characteristics and needs of the patients.
5

(4) Shall take into account the actual costs incurred by
6
facilities in meeting licensing and certification standards
7
imposed and prescribed by the State of Illinois, any of its
8
political subdivisions or municipalities and by the U.S.
9
Department of Health and Human Services pursuant to Title XIX
10
of the Social Security Act.
11

The Department of Healthcare and Family Services shall
12
develop precise standards for payments to reimburse nursing
13
facilities for any utilization of appropriate rehabilitative
14
personnel for the provision of rehabilitative services which
15
is authorized by federal regulations, including reimbursement
16
for services provided by qualified therapists or qualified
17
assistants, and which is in accordance with accepted
18
professional practices. Reimbursement also may be made for
19
utilization of other supportive personnel under appropriate
20
supervision.
21

The Department shall develop enhanced payments to offset
22
the additional costs incurred by a facility serving
23
exceptional need residents and shall allocate at least
24
$4,000,000 of the funds collected from the assessment
25
established by Section 5B-2 of this Code for such payments.
26
For the purpose of this Section, "exceptional needs" means,

SB3427
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1
but need not be limited to, ventilator care and traumatic
2
brain injury care. The enhanced payments for exceptional need
3
residents under this paragraph are not due and payable,
4
however, until (i) the methodologies described in this
5
paragraph are approved by the federal government in an
6
appropriate State Plan amendment and (ii) the assessment
7
imposed by Section 5B-2 of this Code is determined to be a
8
permissible tax under Title XIX of the Social Security Act.
9

Beginning January 1, 2014 the methodologies for
10
reimbursement of nursing facility services as provided under
11
this Section 5-5.4 shall no longer be applicable for services
12
provided on or after January 1, 2014.
13

No payment increase under this Section for the MDS
14
methodology, exceptional care residents, or the
15
socio-development component rate established by Public Act
16
96-1530 of the 96th General Assembly and funded by the
17
assessment imposed under Section 5B-2 of this Code shall be
18
due and payable until after the Department notifies the
19
long-term care providers, in writing, that the payment
20
methodologies to long-term care providers required under this
21
Section have been approved by the Centers for Medicare and
22
Medicaid Services of the U.S. Department of Health and Human
23
Services and the waivers under 42 CFR 433.68 for the
24
assessment imposed by this Section, if necessary, have been
25
granted by the Centers for Medicare and Medicaid Services of
26
the U.S. Department of Health and Human Services. Upon

SB3427
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LRB104 19074 KTG 32519 b
1
notification to the Department of approval of the payment
2
methodologies required under this Section and the waivers
3
granted under 42 CFR 433.68, all increased payments otherwise
4
due under this Section prior to the date of notification shall
5
be due and payable within 90 days of the date federal approval
6
is received.
7

On and after July 1, 2012, the Department shall reduce any
8
rate of reimbursement for services or other payments or alter
9
any methodologies authorized by this Code to reduce any rate
10
of reimbursement for services or other payments in accordance
11
with Section 5-5e.
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, subject to federal
15
approval, the rates taking effect for services delivered on or
16
after August 1, 2019 shall be increased by 3.5% over the rates
17
in effect on June 30, 2019. The Department shall adopt rules,
18
including emergency rules under subsection (ii) of Section
19
5-45 of the Illinois Administrative Procedure Act, to
20
implement the provisions of this Section, including wage
21
increases for direct care staff.
22

For facilities licensed by the Department of Public Health
23
under the ID/DD Community Care Act as ID/DD Facilities and
24
under the MC/DD Act as MC/DD Facilities, subject to federal
25
approval, the rates taking effect on the latter of the
26
approval date of the State Plan Amendment for these facilities

SB3427
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LRB104 19074 KTG 32519 b
1
or the Waiver Amendment for the home and community-based
2
services settings shall include an increase sufficient to
3
provide a $0.26 per hour wage increase to the base wage for
4
non-executive staff. The Department shall adopt rules,
5
including emergency rules as authorized by Section 5-45 of the
6
Illinois Administrative Procedure Act, to implement the
7
provisions of this Section, including wage increases for
8
direct care staff.
9

For facilities licensed by the Department of Public Health
10
under the ID/DD Community Care Act as ID/DD Facilities and
11
under the MC/DD Act as MC/DD Facilities, subject to federal
12
approval of the State Plan Amendment and the Waiver Amendment
13
for the home and community-based services settings, the rates
14
taking effect for the services delivered on or after July 1,
15
2020 shall include an increase sufficient to provide a $1.00
16
per hour wage increase for non-executive staff. For services
17
delivered on or after January 1, 2021, subject to federal
18
approval of the State Plan Amendment and the Waiver Amendment
19
for the home and community-based services settings, shall
20
include an increase sufficient to provide a $0.50 per hour
21
increase for non-executive staff. 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 Section, including wage increases for
25
direct care staff.
26

For facilities licensed by the Department of Public Health

SB3427
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LRB104 19074 KTG 32519 b
1
under the ID/DD Community Care Act as ID/DD Facilities and
2
under the MC/DD Act as MC/DD Facilities, subject to federal
3
approval of the State Plan Amendment, the rates taking effect
4
for the residential services delivered on or after July 1,
5
2021, shall include an increase sufficient to provide a $0.50
6
per hour increase for aides in the rate methodology. For
7
facilities licensed by the Department of Public Health under
8
the ID/DD Community Care Act as ID/DD Facilities and under the
9
MC/DD Act as MC/DD Facilities, subject to federal approval of
10
the State Plan Amendment, the rates taking effect for the
11
residential services delivered on or after January 1, 2022
12
shall include an increase sufficient to provide a $1.00 per
13
hour increase for aides in the rate methodology. In addition,
14
for residential services delivered on or after January 1, 2022
15
such rates shall include an increase sufficient to provide
16
wages for all residential non-executive direct care staff,
17
excluding aides, at the federal Department of Labor, Bureau of
18
Labor Statistics' average wage as defined in rule by the
19
Department. The Department shall adopt rules, including
20
emergency rules as authorized by Section 5-45 of the Illinois
21
Administrative Procedure Act, to implement the provisions of
22
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

SB3427
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LRB104 19074 KTG 32519 b
1
for services delivered on or after January 1, 2023, shall
2
include a $1.00 per hour wage increase for all direct support
3
personnel and all other frontline personnel who are not
4
subject to the Bureau of Labor Statistics' average wage
5
increases, who work in residential and community day services
6
settings, with at least $0.50 of those funds to be provided as
7
a direct increase to all aide base wages, with the remaining
8
$0.50 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, 2023 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, 2023, 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

For facilities licensed by the Department of Public Health
22
under the ID/DD Community Care Act as ID/DD facilities and
23
under the MC/DD Act as MC/DD facilities, subject to federal
24
approval of the State Plan Amendment, the rates taking effect
25
for services delivered on or after January 1, 2024 shall
26
include a $2.50 per hour wage increase for all direct support

SB3427
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LRB104 19074 KTG 32519 b
1
personnel and all other frontline personnel who are not
2
subject to the Bureau of Labor Statistics' average wage
3
increases and who work in residential and community day
4
services settings. At least $1.25 of the per hour wage
5
increase shall be provided as a direct increase to all aide
6
base wages, and the remaining $1.25 of the per hour wage
7
increase shall be used flexibly for base wage increases to the
8
rate methodology for aides. In addition, for residential
9
services delivered on or after January 1, 2024, the rates
10
shall include an increase sufficient to provide wages for all
11
residential non-executive direct care staff, excluding aides,
12
at the federal Department of Labor, Bureau of Labor
13
Statistics' average wage as determined by the Department.
14
Also, for services delivered on or after January 1, 2024, the
15
rates will include adjustments to employment-related expenses
16
as defined in rule by the Department. The Department shall
17
adopt rules, including emergency rules as authorized by
18
Section 5-45 of the Illinois Administrative Procedure Act, to
19
implement the provisions of this Section.
20

For facilities licensed by the Department of Public Health
21
under the ID/DD Community Care Act as ID/DD facilities and
22
under the MC/DD Act as MC/DD facilities, subject to federal
23
approval of a State Plan Amendment, the rates taking effect
24
for services delivered on or after January 1, 2025 shall
25
include a $1.00 per hour wage increase for all direct support
26
personnel and all other frontline personnel who are not

SB3427
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LRB104 19074 KTG 32519 b
1
subject to the Bureau of Labor Statistics' average wage
2
increases and who work in residential and community day
3
services settings, with at least $0.75 of those funds to be
4
provided as a direct increase to all aide base wages and the
5
remaining $0.25 to be used flexibly for base wage increases to
6
the rate methodology for aides. These increases shall not be
7
used by facilities for operational and administrative
8
expenses. In addition, for residential services delivered on
9
or after January 1, 2025, the rates shall include an increase
10
sufficient to provide wages for all residential non-executive
11
direct care staff, excluding aides, at the federal Department
12
of Labor, Bureau of Labor Statistics' average wage as
13
determined by the Department. Also, for services delivered on
14
or after January 1, 2025, the rates will include adjustments
15
to employment-related expenses as defined in rule by the
16
Department. The Department shall adopt rules, including
17
emergency rules as authorized by Section 5-45 of the Illinois
18
Administrative Procedure Act, to implement the provisions of
19
this Section.
20

For facilities licensed by the Department of Public Health
21
under the ID/DD Community Care Act as ID/DD facilities and
22
under the MC/DD Act as MC/DD facilities, subject to federal
23
approval of a State Plan Amendment, the rates taking effect
24
for services delivered on or after January 1, 2026 shall
25
include a $0.80 per hour wage increase for all direct support
26
personnel and all other frontline personnel who are not

SB3427
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LRB104 19074 KTG 32519 b
1
subject to the Bureau of Labor Statistics' average wage
2
increases and who work in residential and community day
3
services settings, with at least $0.60 of those funds to be
4
provided as a direct increase to all aide base wages and the
5
remaining $0.20 to be used flexibly for base wage increases to
6
the rate methodology for aides. These increases shall not be
7
used by facilities for operational and administrative
8
expenses. In addition, for residential services delivered on
9
or after January 1, 2026, the rates shall include an increase
10
sufficient to provide wages for all residential non-executive
11
direct care staff, excluding aides, at the federal Department
12
of Labor, Bureau of Labor Statistics' average wage as
13
determined by the Department. Also, for services delivered on
14
or after January 1, 2026, the rates will include adjustments
15
to employment-related expenses as defined in rule by the
16
Department. The Department shall adopt rules, including
17
emergency rules as authorized by Section 5-45 of the Illinois
18
Administrative Procedure Act, to implement the provisions of
19
this Section.
20

Notwithstanding any other provision of this Section to the
21
contrary, any regional wage adjuster for facilities located
22
outside of the counties of Cook, DuPage, Kane, Lake, McHenry,
23
and Will shall be no lower than 1.00, and any regional wage
24
adjuster for facilities located within the counties of Cook,
25
DuPage, Kane, Lake, McHenry, and Will shall be no lower than
26
1.15.

SB3427
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LRB104 19074 KTG 32519 b
1

For facilities licensed by the Department of Public Health
2
under the ID/DD Community Care Act as ID/DD facilities and
3
under the MC/DD Act as MC/DD facilities, no later than January
4
1, 2027, the Department of Healthcare and Family Services must
5
submit a Title XIX State Plan amendment to the federal Centers
6
for Medicare and Medicaid Services that shall include an
7
increase in the rate methodology sufficient to provide for a
8
wage rate of 150% of the statewide, regional, or local minimum
9
wage for services delivered on or after January 1, 2027, for
10
all direct support personnel and all other frontline personnel
11
who are not subject to the Bureau of Labor Statistics' average
12
wage increases and who work in residential and community day
13
services settings. The State Plan amendment shall also include
14
an increase in the rate methodology sufficient to provide wage
15
increases for all residential non-executive direct care staff,
16
excluding direct support personnel, at the federal Department
17
of Labor, Bureau of Labor Statistics' average wage as defined
18
by rule by the Department for services delivered on or after
19
January 1, 2027. For services delivered on or after January 1,
20
2027, the rates shall include adjustments to
21
employment-related expenses as defined by rule by the
22
Department.

23
(Source: P.A. 103-8, eff. 6-7-23; 103-588, eff. 7-1-24; 104-2,
24
eff. 6-16-25.)

25

Section 99.
Effective date.
This Act takes effect upon
26
becoming law.

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