(305 ILCS 5/5-5e)
(Text of Section before amendment by P.A. 98-1166)
Sec. 5-5e. Adjusted rates of reimbursement.
(a) Rates or payments for services in effect on June 30, 2012 shall be adjusted and services shall be affected as required by any other provision of this amendatory Act of the 97th General Assembly. In addition, the Department shall do the following:
(1) Delink the per diem rate paid for supportive
living facility services from the per diem rate paid for nursing facility services, effective for services provided on or after May 1, 2011.
(2) Cease payment for bed reserves in nursing
facilities and specialized mental health rehabilitation facilities.
(2.5) Cease payment for bed reserves for purposes of
inpatient hospitalizations to intermediate care facilities for persons with development disabilities, except in the instance of residents who are under 21 years of age.
(3) Cease payment of the $10 per day add-on payment
to nursing facilities for certain residents with developmental disabilities.
(b) After the application of subsection (a), notwithstanding any other provision of this Code to the contrary and to the extent permitted by federal law, on and after July 1, 2012, the rates of reimbursement for services and other payments provided under this Code shall further be reduced as follows:
(1) Rates or payments for physician services, dental
services, or community health center services reimbursed through an encounter rate, and services provided under the Medicaid Rehabilitation Option of the Illinois Title XIX State Plan shall not be further reduced.
(2) Rates or payments, or the portion thereof, paid
to a provider that is operated by a unit of local government or State University that provides the non-federal share of such services shall not be further reduced.
(3) Rates or payments for hospital services delivered
by a hospital defined as a Safety-Net Hospital under Section 5-5e.1 of this Code shall not be further reduced.
(4) Rates or payments for hospital services delivered
by a Critical Access Hospital, which is an Illinois hospital designated as a critical care hospital by the Department of Public Health in accordance with 42 CFR 485, Subpart F, shall not be further reduced.
(5) Rates or payments for Nursing Facility Services
shall only be further adjusted pursuant to Section 5-5.2 of this Code.
(6) Rates or payments for services delivered by long
term care facilities licensed under the ID/DD Community Care Act and developmental training services shall not be further reduced.
(7) Rates or payments for services provided under
capitation rates shall be adjusted taking into consideration the rates reduction and covered services required by this amendatory Act of the 97th General Assembly.
(8) For hospitals not previously described in this
subsection, the rates or payments for hospital services shall be further reduced by 3.5%, except for payments authorized under Section 5A-12.4 of this Code.
(9) For all other rates or payments for services
delivered by providers not specifically referenced in paragraphs (1) through (8), rates or payments shall be further reduced by 2.7%.
(c) Any assessment imposed by this Code shall continue and nothing in this Section shall be construed to cause it to cease.
(d) Notwithstanding any other provision of this Code to the contrary, subject to federal approval under Title XIX of the Social Security Act, for dates of service on and after July 1, 2014, rates or payments for services provided for the purpose of transitioning children from a hospital to home placement or other appropriate setting by a children's community-based health care center authorized under the Alternative Health Care Delivery Act shall be $683 per day.
(e) Notwithstanding any other provision of this Code to the contrary, subject to federal approval under Title XIX of the Social Security Act, for dates of service on and after July 1, 2014, rates or payments for home health visits shall be $72.
(f) Notwithstanding any other provision of this Code to the contrary, subject to federal approval under Title XIX of the Social Security Act, for dates of service on and after July 1, 2014, rates or payments for the certified nursing assistant component of the home health agency rate shall be $20.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
(Text of Section after amendment by P.A. 98-1166)
Sec. 5-5e. Adjusted rates of reimbursement.
(a) Rates or payments for services in effect on June 30, 2012 shall be adjusted and services shall be affected as required by any other provision of this amendatory Act of the 97th General Assembly. In addition, the Department shall do the following:
(1) Delink the per diem rate paid for supportive
living facility services from the per diem rate paid for nursing facility services, effective for services provided on or after May 1, 2011.
(2) Cease payment for bed reserves in nursing
facilities and specialized mental health rehabilitation facilities; for purposes of therapeutic home visits for individuals scoring as TBI on the MDS 3.0, beginning June 1, 2015, the Department shall approve payments for bed reserves in nursing facilities and specialized mental health rehabilitation facilities that have at least a 90% occupancy level and at least 80% of their residents are Medicaid eligible. Payment shall be at a daily rate of 75% of an individual's current Medicaid per diem and shall not exceed 10 days in a calendar month.
(2.5) Cease payment for bed reserves for purposes of
inpatient hospitalizations to intermediate care facilities for persons with development disabilities, except in the instance of residents who are under 21 years of age.
(3) Cease payment of the $10 per day add-on payment
to nursing facilities for certain residents with developmental disabilities.
(b) After the application of subsection (a), notwithstanding any other provision of this Code to the contrary and to the extent permitted by federal law, on and after July 1, 2012, the rates of reimbursement for services and other payments provided under this Code shall further be reduced as follows:
(1) Rates or payments for physician services, dental
services, or community health center services reimbursed through an encounter rate, and services provided under the Medicaid Rehabilitation Option of the Illinois Title XIX State Plan shall not be further reduced.
(2) Rates or payments, or the portion thereof, paid
to a provider that is operated by a unit of local government or State University that provides the non-federal share of such services shall not be further reduced.
(3) Rates or payments for hospital services delivered
by a hospital defined as a Safety-Net Hospital under Section 5-5e.1 of this Code shall not be further reduced.
(4) Rates or payments for hospital services delivered
by a Critical Access Hospital, which is an Illinois hospital designated as a critical care hospital by the Department of Public Health in accordance with 42 CFR 485, Subpart F, shall not be further reduced.
(5) Rates or payments for Nursing Facility Services
shall only be further adjusted pursuant to Section 5-5.2 of this Code.
(6) Rates or payments for services delivered by long
term care facilities licensed under the ID/DD Community Care Act and developmental training services shall not be further reduced.
(7) Rates or payments for services provided under
capitation rates shall be adjusted taking into consideration the rates reduction and covered services required by this amendatory Act of the 97th General Assembly.
(8) For hospitals not previously described in this
subsection, the rates or payments for hospital services shall be further reduced by 3.5%, except for payments authorized under Section 5A-12.4 of this Code.
(9) For all other rates or payments for services
delivered by providers not specifically referenced in paragraphs (1) through (8), rates or payments shall be further reduced by 2.7%.
(c) Any assessment imposed by this Code shall continue and nothing in this Section shall be construed to cause it to cease.
(d) Notwithstanding any other provision of this Code to the contrary, subject to federal approval under Title XIX of the Social Security Act, for dates of service on and after July 1, 2014, rates or payments for services provided for the purpose of transitioning children from a hospital to home placement or other appropriate setting by a children's community-based health care center authorized under the Alternative Health Care Delivery Act shall be $683 per day.
(e) Notwithstanding any other provision of this Code to the contrary, subject to federal approval under Title XIX of the Social Security Act, for dates of service on and after July 1, 2014, rates or payments for home health visits shall be $72.
(f) Notwithstanding any other provision of this Code to the contrary, subject to federal approval under Title XIX of the Social Security Act, for dates of service on and after July 1, 2014, rates or payments for the certified nursing assistant component of the home health agency rate shall be $20.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 98-1166, eff. 6-1-15.)
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Last modified: February 18, 2015