MEDICAID ACCESS ADJUSTMENT

Illinois General Assembly - Full Text of SB3833

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3833

Introduced 2/6/2026, by Sen. Elgie R. Sims, Jr.

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.2

Amends the Medical Assistance Article of the Illinois Public Aid
Code. In provisions concerning the Medicaid Access Adjustment payments to
nursing facilities, provides that for dates of service beginning January
1, 2027, the Medicaid Access Adjustment shall be increased by $5.75 to
$10.50 per diem. Provides that beginning January 1, 2027, facilities
located outside of Rate Areas 6, 7, and 8 shall have the Medicaid percent
of occupied bed days to be at least 60% of all occupied bed days adjusted
quarterly to qualify for the Medicaid Access Adjustment. Provides that the
remaining facilities shall have their threshold remain at 70%.
LRB104 19965 KTG 33415 b

A BILL FOR

SB3833
LRB104 19965 KTG 33415 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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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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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 19965 KTG 33415 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

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LRB104 19965 KTG 33415 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

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LRB104 19965 KTG 33415 b
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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:

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LRB104 19965 KTG 33415 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.

SB3833
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LRB104 19965 KTG 33415 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

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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.
For

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dates of service beginning January 1, 2027, the Medicaid
2
Access Adjustment shall be increased by $5.75 to $10.50 per
3
diem. Beginning January 1, 2027, facilities located outside of
4
Rate Areas 6, 7, and 8 shall have the Medicaid percent of
5
occupied bed days to be at least 60% of all occupied bed days
6
adjusted quarterly to qualify for the Medicaid Access
7
Adjustment. The remaining facilities shall have their
8
threshold remain at 70%.

This subsection shall be inoperative
9
on and after January 1, 2028.

10

(e-4) Subject to federal approval, on and after January 1,
11
2024, the Department shall increase the rate add-on at
12
paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
13
for ventilator services from $208 per day to $481 per day.
14
Payment is subject to the criteria and requirements under 89
15
Ill. Adm. Code 147.335.
16

(f) (Blank).
17

(g) Notwithstanding any other provision of this Code, on
18
and after July 1, 2012, for facilities not designated by the
19
Department of Healthcare and Family Services as "Institutions
20
for Mental Disease", rates effective May 1, 2011 shall be
21
adjusted as follows:
22

(1) (Blank);
23

(2) (Blank);
24

(3) Facility rates for the capital and support
25

components shall be reduced by 1.7%.
26

(h) Notwithstanding any other provision of this Code, on

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LRB104 19965 KTG 33415 b
1
and after July 1, 2012, nursing facilities designated by the
2
Department of Healthcare and Family Services as "Institutions
3
for Mental Disease" and "Institutions for Mental Disease" that
4
are facilities licensed under the Specialized Mental Health
5
Rehabilitation Act of 2013 shall have the nursing,
6
socio-developmental, capital, and support components of their
7
reimbursement rate effective May 1, 2011 reduced in total by
8
2.7%.
9

(i) On and after July 1, 2014, the reimbursement rates for
10
the support component of the nursing facility rate for
11
facilities licensed under the Nursing Home Care Act as skilled
12
or intermediate care facilities shall be the rate in effect on
13
June 30, 2014 increased by 8.17%.
14

(i-1) Subject to federal approval, on and after January 1,
15
2024, the reimbursement rates for the support component of the
16
nursing facility rate for facilities licensed under the
17
Nursing Home Care Act as skilled or intermediate care
18
facilities shall be the rate in effect on June 30, 2023
19
increased by 12%.
20

(j) Notwithstanding any other provision of law, subject to
21
federal approval, effective July 1, 2019, sufficient funds
22
shall be allocated for changes to rates for facilities
23
licensed under the Nursing Home Care Act as skilled nursing
24
facilities or intermediate care facilities for dates of
25
services on and after July 1, 2019: (i) to establish, through
26
June 30, 2022 a per diem add-on to the direct care per diem

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1
rate not to exceed $70,000,000 annually in the aggregate
2
taking into account federal matching funds for the purpose of
3
addressing the facility's unique staffing needs, adjusted
4
quarterly and distributed by a weighted formula based on
5
Medicaid bed days on the last day of the second quarter
6
preceding the quarter for which the rate is being adjusted.
7
Beginning July 1, 2022, the annual $70,000,000 described in
8
the preceding sentence shall be dedicated to the variable per
9
diem add-on for staffing under paragraph (6) of subsection
10
(d); and (ii) in an amount not to exceed $170,000,000 annually
11
in the aggregate taking into account federal matching funds to
12
permit the support component of the nursing facility rate to
13
be updated as follows:
14

(1) 80%, or $136,000,000, of the funds shall be used
15

to update each facility's rate in effect on June 30, 2019
16

using the most recent cost reports on file, which have had
17

a limited review conducted by the Department of Healthcare
18

and Family Services and will not hold up enacting the rate
19

increase, with the Department of Healthcare and Family
20

Services.
21

(2) After completing the calculation in paragraph (1),
22

any facility whose rate is less than the rate in effect on
23

June 30, 2019 shall have its rate restored to the rate in
24

effect on June 30, 2019 from the 20% of the funds set
25

aside.
26

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

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1

used to increase each facility's rate by an equal
2

percentage.
3

(k) During the first quarter of State Fiscal Year 2020,
4
the Department of Healthcare of Family Services must convene a
5
technical advisory group consisting of members of all trade
6
associations representing Illinois skilled nursing providers
7
to discuss changes necessary with federal implementation of
8
Medicare's Patient-Driven Payment Model. Implementation of
9
Medicare's Patient-Driven Payment Model shall, by September 1,
10
2020, end the collection of the MDS data that is necessary to
11
maintain the current RUG-IV Medicaid payment methodology. The
12
technical advisory group must consider a revised reimbursement
13
methodology that takes into account transparency,
14
accountability, actual staffing as reported under the
15
federally required Payroll Based Journal system, changes to
16
the minimum wage, adequacy in coverage of the cost of care, and
17
a quality component that rewards quality improvements.
18

(l) The Department shall establish per diem add-on
19
payments to improve the quality of care delivered by
20
facilities, including:
21

(1) Incentive payments determined by facility
22

performance on specified quality measures in an initial
23

amount of $70,000,000. Nothing in this subsection shall be
24

construed to limit the quality of care payments in the
25

aggregate statewide to $70,000,000, and, if quality of
26

care has improved across nursing facilities, the

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1

Department shall adjust those add-on payments accordingly.
2

The quality payment methodology described in this
3

subsection must be used for at least State Fiscal Year
4

2023. Beginning with the quarter starting July 1, 2023,
5

the Department may add, remove, or change quality metrics
6

and make associated changes to the quality payment
7

methodology as outlined in subparagraph (E). Facilities
8

designated by the Centers for Medicare and Medicaid
9

Services as a special focus facility or a hospital-based
10

nursing home do not qualify for quality payments.
11

(A) Each quality pool must be distributed by
12

assigning a quality weighted score for each nursing
13

home which is calculated by multiplying the nursing
14

home's quality base period Medicaid days by the
15

nursing home's star rating weight in that period.
16

(B) Star rating weights are assigned based on the
17

nursing home's star rating for the LTS quality star
18

rating. As used in this subparagraph, "LTS quality
19

star rating" means the long-term stay quality rating
20

for each nursing facility, as assigned by the Centers
21

for Medicare and Medicaid Services under the Five-Star
22

Quality Rating System. The rating is a number ranging
23

from 0 (lowest) to 5 (highest).
24

(i) Zero-star or one-star rating has a weight
25

of 0.
26

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

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1

(iii) Three-star rating has a weight of 1.5.
2

(iv) Four-star rating has a weight of 2.5.
3

(v) Five-star rating has a weight of 3.5.
4

(C) Each nursing home's quality weight score is
5

divided by the sum of all quality weight scores for
6

qualifying nursing homes to determine the proportion
7

of the quality pool to be paid to the nursing home.
8

(D) The quality pool is no less than $70,000,000
9

annually or $17,500,000 per quarter. The Department
10

shall publish on its website the estimated payments
11

and the associated weights for each facility 45 days
12

prior to when the initial payments for the quarter are
13

to be paid. The Department shall assign each facility
14

the most recent and applicable quarter's STAR value
15

unless the facility notifies the Department within 15
16

days of an issue and the facility provides reasonable
17

evidence demonstrating its timely compliance with
18

federal data submission requirements for the quarter
19

of record. If such evidence cannot be provided to the
20

Department, the STAR rating assigned to the facility
21

shall be reduced by one from the prior quarter.
22

(E) The Department shall review quality metrics
23

used for payment of the quality pool and make
24

recommendations for any associated changes to the
25

methodology for distributing quality pool payments in
26

consultation with associations representing long-term

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1

care providers, consumer advocates, organizations
2

representing workers of long-term care facilities, and
3

payors. The Department may establish, by rule, changes
4

to the methodology for distributing quality pool
5

payments.
6

(F) The Department shall disburse quality pool
7

payments from the Long-Term Care Provider Fund on a
8

monthly basis in amounts proportional to the total
9

quality pool payment determined for the quarter.
10

(G) The Department shall publish any changes in
11

the methodology for distributing quality pool payments
12

prior to the beginning of the measurement period or
13

quality base period for any metric added to the
14

distribution's methodology.
15

(2) Payments based on CNA tenure, promotion, and CNA
16

training for the purpose of increasing CNA compensation.
17

It is the intent of this subsection that payments made in
18

accordance with this paragraph be directly incorporated
19

into increased compensation for CNAs. As used in this
20

paragraph, "CNA" means a certified nursing assistant as
21

that term is described in Section 3-206 of the Nursing
22

Home Care Act, Section 3-206 of the ID/DD Community Care
23

Act, and Section 3-206 of the MC/DD Act. The Department
24

shall establish, by rule, payments to nursing facilities
25

equal to Medicaid's share of the tenure wage increments
26

specified in this paragraph for all reported CNA employee

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1

hours compensated according to a posted schedule
2

consisting of increments at least as large as those
3

specified in this paragraph. The increments are as
4

follows: an additional $1.50 per hour for CNAs with at
5

least one and less than 2 years' experience plus another
6

$1 per hour for each additional year of experience up to a
7

maximum of $6.50 for CNAs with at least 6 years of
8

experience. For purposes of this paragraph, Medicaid's
9

share shall be the ratio determined by paid Medicaid bed
10

days divided by total bed days for the applicable time
11

period used in the calculation. In addition, and additive
12

to any tenure increments paid as specified in this
13

paragraph, the Department shall establish, by rule,
14

payments supporting Medicaid's share of the
15

promotion-based wage increments for CNA employee hours
16

compensated for that promotion with at least a $1.50
17

hourly increase. Medicaid's share shall be established as
18

it is for the tenure increments described in this
19

paragraph. Qualifying promotions shall be defined by the
20

Department in rules for an expected 10-15% subset of CNAs
21

assigned intermediate, specialized, or added roles such as
22

CNA trainers, CNA scheduling "captains", and CNA
23

specialists for resident conditions like dementia or
24

memory care or behavioral health.
25

(m) The Department shall work with nursing facility
26
industry representatives to design policies and procedures to

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1
permit facilities to address the integrity of data from
2
federal reporting sites used by the Department in setting
3
facility rates.
4
(Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
5
102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
6
Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
7
Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
8
7-1-24; 103-1075, eff. 3-21-25.)

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