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Article 5 - Facility Payment

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(210 ILCS 49/Art. 5 heading)

(210 ILCS 49/5-101) Sec. 5-101. Managed care entity, coordinated care entity, and accountable care entity payments. For facilities licensed by the Department of Public Health under this Act, the payment for services provided shall be determined by negotiation with managed care entities, coordinated care entities, or accountable care entities. However, for 3 years after the effective date of this Act, in no event shall the reimbursement rate paid to facilities licensed under this Act be less than the rate in effect on June 30, 2013 less $7.07 times the number of occupied bed days, as that term is defined in Article V-B of the Illinois Public Aid Code, for each facility previously licensed under the Nursing Home Care Act on June 30, 2013; or the rate in effect on June 30, 2013 for each facility licensed under the Specialized Mental Health Rehabilitation Act on June 30, 2013. Any adjustment in the support component or the capital component for facilities licensed by the Department of Public Health under the Nursing Home Care Act shall apply equally to facilities licensed by the Department of Public Health under this Act for the duration of the provisional licensure period as defined in Section 4-105 of this Act. The Department of Healthcare and Family Services shall publish a reimbursement rate for triage, crisis stabilization, and transitional living services by December 1, 2014. (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)

(210 ILCS 49/5-102) Sec. 5-102. Transition payments. In addition to payments already required by law, the Department of Healthcare and Family Services shall make payments to facilities licensed under this Act in the amount of $29.43 per licensed bed, per day, for the period beginning June 1, 2014 and ending June 30, 2014. (Source: P.A. 98-651, eff. 6-16-14.)

(210 ILCS 49/5-103) Sec. 5-103. Medicaid rates. Notwithstanding any provision of law to the contrary, the Medicaid rates for Specialized Mental Health Rehabilitation Facilities effective on July 1, 2017 must be equal to the rates in effect for Specialized Mental Health Rehabilitation Facilities on June 30, 2017, increased by 2.8%. (Source: P.A. 100-23, eff. 7-6-17.)

(210 ILCS 49/5-104) Sec. 5-104. Medicaid rates. Notwithstanding any provision of law to the contrary, the Medicaid rates for Specialized Mental Health Rehabilitation Facilities effective on July 1, 2018 must be equal to the rates in effect for Specialized Mental Health Rehabilitation Facilities on June 30, 2018, increased by 4%. The Department shall adopt rules, including emergency rules under subsection (bb) of Section 5-45 of the Illinois Administrative Procedure Act, to implement the provisions of this Section. (Source: P.A. 100-587, eff. 6-4-18; 101-81, eff. 7-12-19.)

(210 ILCS 49/5-105) Sec. 5-105. Therapeutic visit rates. For a facility licensed under this Act on or before June 1, 2018 or provisionally licensed under this Act on or before June 1, 2018, a payment shall be made for therapeutic visits that have been indicated by an interdisciplinary team as therapeutically beneficial. Payment under this Section shall be at a rate of 75% of the facility's rate on the effective date of this amendatory Act of the 100th General Assembly and may not exceed 20 days in a fiscal year and shall not exceed 10 days consecutively. (Source: P.A. 100-587, eff. 6-4-18.)

(210 ILCS 49/5-106) Sec. 5-106. Therapeutic visit rates. For a facility licensed under this Act by June 1, 2018 or provisionally licensed under this Act by June 1, 2018, a payment shall be made for therapeutic visits that have been indicated by an interdisciplinary team as therapeutically beneficial. Payment under this Section shall be at a rate of 75% of the facility's rate on July 27, 2018 (the effective date of Public Act 100-646) and may not exceed 20 days in a fiscal year and shall not exceed 10 days consecutively. (Source: P.A. 100-646, eff. 7-27-18; 101-81, eff. 7-12-19.)

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Article 5 - Facility Payment