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Illinois nursing home rate reform plan signed into law

Published: May. 31, 2022 at 6:42 PM CDT
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SPRINGFIELD, Ill. (WGEM) - Illinois nursing homes will undergo long-awaited rate reform this year. Gov. J.B. Pritzker signed a bill into law Tuesday tying funding for nursing homes to staffing levels and the quality of care provided for seniors.

Nearly 45,000 people in Illinois living in nursing homes rely on Medicaid. Those patients make up roughly 70% of the nursing home residents in Illinois. The Illinois Department of Healthcare and Family Services has been negotiating a patient-driven payment model for several years.

Lawmakers and advocates say this law ensures Illinois will no longer allow facilities to put profits over those people. The state will now invest more than $700 million in Medicaid funding for the nursing home industry, simplifying and expanding the current nursing home assessment tax and providing additional general revenue funds.

“When the pandemic hit, all the system’s most egregious cracks and faults were exposed. Enough is enough,” Pritzker said. “We are standing together to stop the bad actors from billing extra while they provide poor quality care for their residents.”

Pritzker said this law will help seniors will get the care they deserve. The patient-driven payment model is designed to more accurately reflect the clinical care needs of residents and hold nursing home owners accountable. It specifically requires transparency of financial disclosures from the people running congregate care facilities.

The law also includes a new pay scale for certified nursing assistants to help increase wages based on years of experience. Pritzker and bill sponsors say this is crucial for Black and brown nursing home residents who are more likely to live in understaffed facilities.

Additional funding will be set aside to address increased costs at these facilities due to labor shortages and wage increases. The legislation calls for an adjustment of $4 per resident day for nursing homes that serve an above-average percentage of Medicaid customers. Workers could see their wages rise by as much as $8 per hour depending on their role and years working in nursing homes.

“I have had the opportunity to hear from nursing home workers who shared what it’s like to be stretched thin and how transformative this legislation can be,” said Lt. Gov. Juliana Stratton. “With this bill, we are building a better future for residents and workers alike with their voices at the forefront.”

HFS will pay all Illinois nursing homes as if they were well-staffed for the first six months. That plan is separate from a 15-month transition period where the old and new payment models will be combined to help facilities adjust. HFS Director Theresa Eagleson said she is overjoyed that nursing home payment reform is becoming a reality in Illinois. Eagleson noted it was clear change was needed to ensure nursing home residents were getting proper care.

“This will drive better staffing levels, improved care, and a better quality of life for so many people and is the result of leadership starting with the governor and hard work by the HFS team, in collaboration with nursing home trade associations and individual nursing home owners, advocates, and frontline workers,” Eagleson said. “There is now a direct relationship between staffing and quality and funding.”

The plan was supported by AARP Illinois, the Affordable Assisted Living Coalition, Illinois Health Care Association, SEIU Healthcare Illinois, and LeadingAge Illinois among other advocacy groups.

“For far too long, our seniors and their families have been at the mercy of nursing home facilities that placed profit over quality of care,” said Rep. Anna Moeller (D-Elgin). “Those practices must end. House Bill 246 will help make that happen.”

The law is set to take effect on July 1 pending federal approval. However, that could be delayed to October 1 if the Centers for Medicare and Medicaid Services don’t approve corresponding changes to the reimbursement system and bed assessment for nursing homes.

“This legislation will absolutely positively affect the care and quality of life for tens of thousands of nursing home residents across the state by putting in place accountability measures and tying new funding to quality metrics,” said Sen. Ann Gillespie (D-Arlington Heights). “I am proud of the work that went into this legislation and the message that it sends - in Illinois nursing homes, we will not tolerate profits being valued over people.”

The plan passed out of both chambers with unanimous support in April.

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