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IL SB2245

IL SB2245
MEDICAID-NURSING PAYMENTS


summary

Introduced
02/07/2025
In Committee
02/07/2025
Crossed Over
Passed
Dead

Introduced Session

104th General Assembly

Bill Summary

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for the calendar year beginning January 1, 2026, and each calendar year thereafter, a nursing facility must spend at least 90% of its adjusted total revenue on resident care and other resident-related costs, as defined. Requires each nursing facility to provide as part of its financial reporting information necessary for the Department of Healthcare and Family Services to administer and enforce the provisions of the amendatory Act. Provides that such information shall be subject to audit provisions and comply with any applicable uniform standards under the Code. Provides that all non-allowable costs, related party adjustments, or compensation to owners reported shall be excluded from the calculation of the amount spent on resident care and other resident-related costs. Requires 25% of costs associated with contract nursing staff to be deducted from the amount spent on resident care and other resident-related costs. Provides that for the calendar year beginning January 1, 2027, and each calendar year thereafter, the Department shall use the required financial reporting submissions to determine whether each nursing facility has met the minimum resident care percent requirement. Provides that if a facility has not met the minimum resident care percent requirement, the amount defined by the facility's total adjusted revenue shall be treated as a vendor overpayment. Requires the Department to recover the full amount of any vendor overpayment by reducing future payments, requiring direct payment to the Department, or any other method permitted under the Code. Requires the Department to adopt rules.

AI Summary

This bill establishes new financial requirements for nursing facilities in Illinois, mandating that starting January 1, 2026, nursing facilities must spend at least 90% of their adjusted total revenue on resident care and related costs. The bill defines "resident care and other resident-related costs" comprehensively, including direct care by nurses and nursing assistants, support services like food, laundry, housekeeping, and social services, and ancillary medical services. Administrative costs, capital expenses, debt service, taxes, depreciation, and rent are explicitly excluded from this calculation. Nursing facilities will be required to provide detailed financial reporting to the Department of Healthcare and Family Services, and the information will be subject to audit. The bill also stipulates that certain costs will be subtracted from the resident care calculation, such as 25% of contract nursing staff costs and any related party transactions exceeding fair market value. If a nursing facility fails to meet the 90% spending requirement in a given calendar year, beginning in 2027, the Department will treat the shortfall as a vendor overpayment and can recover funds through reduced future payments or direct reimbursement. The goal of this legislation appears to be ensuring that nursing facilities allocate a significant majority of their revenue directly to resident care and services.

Sponsors (10)

Last Action

Added as Co-Sponsor Sen. Doris Turner (on 05/19/2025)

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