2006 IHCA Annual Public Policy Report
Designed to showcase the entire spectrum of work completed by the Illinois Health Care Association during the 2006 calendar year, this report includes a comprehensive overview of all aspects of the work done by the Public Policy Department of the Association.
The legislative, regulatory and reimbursement issues which IHCA works on impact the entire continuum of the long-term care industry, and are wide ranging and many. An attempt to capture the entire scope of the work done by this very important department within the association would take many pages to cover, however this report contains the highlights of their accomplishments this year.
To view specific sections of this report, please use the links provided below.
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The second year of regular legislative session of the 94th General Assembly came to a close on Thursday, May 7 th , a full month beyond the originally scheduled adjournment date of April 7.
The extra month provided the opportunity for Members of the General Assembly to pass legislation that had not made it through the process up until that point. Also during this time period the Governor's office and the Democratic Legislative leaders met numerous times to come to an agreement on the budget.
MDS Funding Secured
The budget was finalized during the first week of May and brought before the respective Appropriations and Executive Committees of both chambers before being released to the Assembly for a vote. The budget passed on a strictly partisan roll call with all Democratic members and the single independent member voting in favor.
As a result of our work with the Downstate Democratic Caucus in the House and the support of Speaker Michael Madigan, President Emil Jones, and the Governor, we were able to secure $30 million in the budget, beginning in January of 2007 for the MDS implementation. In addition, the Governor added $75 million of additional money to reduce the payment cycle in the next budget year.
Legislation Impacting the Industry Increased
A side effect of the originally scheduled adjournment date was a decision by the Speaker of the House, Michael Madigan (D- Chicago), to limit the number of bills to three that House Members would be allowed to carry and pass. Intended as a means to help keep session short and limit controversial issues, this actually had the unintended consequence of the Senate actually introducing nearly as much substantive legislative as the House of Representatives. In general the Senate would produce only half as much language.
Following suit with past sessions, the 94 th General Assembly introduced, in total, nearly 11,000 pieces of legislation. This level of activity is typical of what usually happens in an election year.
IHCA identified over 160 bills and resolutions which would either directly or indirectly affect our members and their residents. Another 30 plus shell bills were introduced which had the potential to directly impact relevant sections of Illinois law.
Coalition Efforts Effective
For the second legislative session, IHCA worked in cooperation with the other two statewide long term care associations, Illinois Council on Long Term Care and Life Services Network, on our major legislative initiatives.
At a time of great divisiveness between the top policy makers of the State, our unified front was able to claim victory on all major introduced legislative initiatives of concern to the industry. From the defeat of the latest Community First language, to the extension of the Certificate of Need process as required under the Illinois Health Facilities Planning Board, to the implementation of the MDS reimbursement system, the joint efforts of the three associations met with great success.
Due to this tremendous success, IHCA looks forward with great anticipation to the continuation of these Coalition activities.
Member Involvement Key to Legislative Success
Staff members were assisted in their legislative efforts by Vice Presidents Michael Bibo of the DD Constituency Committee, Blair Minton of the Assisted Living Constituency Committee, Holgeir Oksnevad of the Legislative and Regulatory Committee, and Lester Robertson of the Nursing Facility Constituency as well as their respective committee members.
This open dialog between staff and key members helps us determine the impact legislation will have on the operations at the facility level. Again, a step that must be completed before lobbying can begin.
Lobbying Efforts
Lobbying involves a great deal more than talking to members of the General Assembly about legislation. IHCA Public Policy staff works in partnership with members on a variety of fronts to help make change for the good of the industry and the legislation that impacts us.
Among the activities involved in the lobbying process:
Monitoring all House and Senate sessions, as well as always maintaining a presence in every meeting of the various committees that hear legislation of interest to the industry. Providing testimony, both oral and written when priority industry legislation is to be heard before committee and personal face to face visits with all members of the committee which is scheduled to hear priority industry legislation.
IHCA Public Policy staff actively agrees to drafting legislative language in the attempt to compromise on the regulations that would impact us as an industry.
And perhaps most importantly, keeping members informed about legislation as it moves through the legislative process.
As staggering as it may seem, in addition to each regular work-week, the IHCA Public Policy staff alone logged over 850 hours of overtime on legislative issues between mid January and adjournment on May 7. That does not take into account all of the contributions by other IHCA staff members.
Legislative Initiatives Actively Supported
SB2487 Senator Ira Silverstein (D- Chicago)
Representative Lou Lang (D- Skokie)
The biggest priority legislative effort of the Long Term Care industry was the implementation of the MDS-based reimbursement system.
Initially the bill extended the implementation date another quarter, to October 1st, 2007 . After negotiations with the Department of Healthcare and Family Services the industry agreed to postpone the implementation another quarter to January 1 st of 2007.
SB14 Senator Emil Jones (D- Chicago)
Representative Jay Hoffman (D- Collinsville)
This legislation, an initiative of the Governor, increased the long term care line item by $167 million after matching funds which would reduce payment cycle about 40 additional days.
IHCA strongly favored this bill and actively lobbied the entire General Assembly to help ensure its passage. This bill passed both Chambers and was signed into law by the Governor.
SB2436 Senator Maggie Crotty (D- Oak Forest )
Representative Lisa Dugan (D- Bradley)
This bill would require Nursing Homes to report inactive beds to IHFPB. IHCA supported this as a SB2880 trailer and as part of the AARP coalition work. This bill also includes an extension of the CON process scheduled to sunset July 1, 2006 . The CON process is extended to April of 2007.
HB5311 Representative Lee Daniels (R- Elmhurst)
The MR/DD Community Care Act, drafted by IHCA and supported in partnership with IARF, would have removed all MR/DD facilities from the Nursing Home Care Act and created a new Act. The purpose of this legislation was to erase future confusion that arises from these facilities being included under the Nursing Home Care Act. This bill was not enacted by the General Assembly.
Legislative Initiatives Actively Negotiated
HB4785 Representative James Brosnahan (D- Evergreen Park)
Senator Edward Maloney (D- Chicago)
The Attorney General's office introduced this legislation as a follow up to the language passed last year on the Felons in Nursing Homes issue.
The bill sets forth procedures for conducting nursing home preadmission criminal history background checks; changes "Identified Offender Risk Analysis" to "Criminal History Analysis", and requires the Department of Public Health to complete an analysis as soon as practicable, but not later than 14 days (instead of within 10 days) after receiving notice from a nursing home; adds items to be included in a Criminal History Analysis; provides that if, based on the Criminal History Analysis Report, a nursing home determines that it cannot manage an identified offender resident, it must commence involuntary transfer or discharge proceedings (instead of contacting the Department of Public Health to locate an alternative facility); provides for immunity from civil and criminal liability for any person authorized to participate in the development of a Criminal History Analysis or Criminal History Analysis Report; and replaces provisions concerning notice to nursing home residents and employees in connection with identified offenders.
The bill also establishes state abuse prevention review teams, mandates background checks on all existing residents and adds a provision allowing IDPH to waive notice requirements to families if resident is considered safe.
The end compromise bill met many of IHCA 's demands, including removal of Under Age 22 facilities from the requirements of the bill and a more lenient waiver process. This passed General Assembly after numerous meetings with the interested parties and was made law by the Governor.
Legislative Initiatives Defeated
SB618 Senator Maggie Crotty (D- Oak Forest )
This bill is an example of how the legislature can throw curveballs, making constant vigilance very important. This bill started as a shell bill for the state Treasurer's Act at the beginning of 2005. It moved through the legislative process and then stalled until late this session when the new sponsor drafted a second attempt at Community First language onto the bill. This legislation did not pass the General Assembly.
SB2559 Senator Ira Silverstein (D- Chicago)
This bill marked the return of the effort to require defibrillators in every Nursing Home in the State. Through actively lobbying of the sponsor, we were able to get an agreement not to move this bill. A commitment was made to speak with proponents during the summer at attempt to reach a compromise agreement.
If passed this bill would have created an unfunded mandate for Nursing Homes to purchase expensive AED equipment.
HB4534 Representative Patrick Verschoore (D- Milan)
Initially represented as an attempt to make State law compatible with Federal guidelines regarding visiting hours in facilities, this bill represents one of the hardest worked by IHCA staff this session.
IHCA contacted the sponsor to educate him about Nursing Home regulations in general, specifically the area he was trying to change, and to let him know of our concerns with the bill.
The Representative put staff in contact with the woman who was the genesis of this bill.
The driving motivation behind the bill was actually to help with a lawsuit regarding this individuals removal from a facility. After her mother had been admitted to a facility, the woman and her sister basically moved into the facility themselves, staying around the clock and causing great disruptions to other residents. After repeatedly asking for the woman to modify her behavior and repeatedly being ignored the facility was left with no option but to have the authorities remove the woman from the property.
As federal law preempts State law, Illinois facilities are already required to follow the guidelines set by the Feds. Additionally this language, as drafted, disallowed facilities from taking action to remove immediate family visitors, EVEN AT THE REQUEST of the resident.
The sponsor of the bill initially sat down and revisited the language with IHCA after many contacts between staff and himself. When the bill came before committee, however, the sponsor reneged on placing the amendment on the bill and moved the bill from committee to the House floor.
IHCA staff lobbied the entire House of Representatives very hard to defeat this bill on the floor. With strong backing on both sides of the aisle, this bill was strongly defeated when it came up for a floor vote.
94th General Assembly Fall Veto Session
The Veto Session of the 94 th General Assembly was held in the month of November. The first scheduled week of veto session was November 14 th through the 16 th . Legislators were given the following week off for the Thanksgiving holiday break and returned to finish veto session business the next week, from the 28 th through the 30 th .
The main agenda items, both of which have potentially huge impacts on the long term care industry, were the minimum wage increase legislation, and the electric rate freeze extension.
The minimum wage increase passed both chambers and the electric rate freeze will be acted upon when session resumes in early January.
For questions or concerns regarding legislative issues, please contact one of the following IHCA staff members:
Pat Comstock , Vice President of Public Policy pcomstock@ihca.com ,
Phyllis Parkinson , Manager – House Issues pparkinson@ihca.com ,
Matt Hartman , Manager – Senate Issues mhartman@ihca.com
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For the first time the Illinois Health Care Association and the Illinois Council on Long Term Care drafted and executed a joint political plan. Life Services Network, our third Coaliton partner was also involved in the educational session and legislative tours that were conducted during the campaign season.
Members of the Associations were asked to make a choice as to which candidate to support in a given race. The first stage of the process was an educational session with each candidate in an identified race. Staff members from each long term care association were present at these meetings where we presented the candidate with information regarding the legislative intentions of the industry. The second stage was a question and answer session where members sat with each candidate and interviewed them on issues of importance to the industry
These races encompassed a wide representation of different areas of the state; Elgin, Schaumburg, Park Ridge, Plainfield, Aurora, Joliet, Peoria, Pekin, Carlinville, Taylorville, Quincy, Carlyle, Centralia, Kankakee, Coal City, Morris, Champaign, Danville, Decatur, Marion, Harrisburg, Oak Park, Will County, the Northwestern Chicago Suburbs, and the Southeastern portion of the state among many others.
A total of 6 races were identified as Tier One contests and we achieved victory in four of the six in a year when Republicans suffered widespread defeat. In addition IHCA was involved in 13 Tier Two races. In these races, where support is characterized by lesser direct staff support and a smaller financial stake, IHCA fared far better, claiming victory in all but two contests.
IHCA's ability to impact local and state-wide races was greatly enhanced by the fundraising efforts coordinated by the IHCA-PAC Board, IHCA Board members and key IHCA members. As a result, IHCA-PAC raised an unprecedented $300,000 to help candidates who support long-term care issues.
For questions or concerns regarding IHCA-PAC issues, please contact one of the following IHCA staff members:
Pat Comstock , Vice President of Public Policy pcomstock@ihca.com
Phyllis Parkinson , Manager – House Issues pparkinson@ihca.com
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Regulatory activities of state agencies continue to command the time and attention of IHCA members and staff. IHCA is a major stakeholder in the development of policies, regulations and rules affecting the long-term care profession. We successfully compelled the Department of Public Health to re-convene quarterly provider association/Department meetings. These meetings provide another forum to address member concerns with existing and new regulations, surveys and other pertinent issues affecting long-term care facilities.
IHCA continues to follow and respond to proposed and adopted rules throughout the rulemaking process, which includes submitting comments on behalf of members, etc. A summary of proposed and adopted rules is published in Members Only on a weekly basis.
Below is a summary of some of the ongoing regulatory issues IHCA has worked on over the past year:
Identified Offender
We began in 2005 and continued in 2006 working intensely with the Department of Public Health (DPH) in an attempt to make the “identified offender” rules more reasonable and workable for long-term care facilities. The numerous changes to and drafts of these rules and how they would be implemented lead to confusion as to what was and wasn't expected and what the law did and didn't actually require.
The Association worked for the inclusion of provisions in HB 4785 (Public Act 094-0752) which amended the identified offender law to make some of the previous provisions in the law and hence, the regulation more workable. After a lot of work and compromise, some of the positive changes include: removing facilities' responsibility for conducting an identified offender risk analysis and instead requiring a criminal history analysis to be conducted by the Department of Public Health, removing Long-Term Care for Under Age 22 facilities from the requirements of the bill and establishing a waiver of the fingerprint check requirement when certain circumstances are met. The Association has made some positive strides toward making the provisions of this law more conducive to the population our members serve, and will continue to work on improvements to the law and the regulations that implement it.
Health Care Worker Background Checks
Public Act 94-0665 expanded the purpose and scope of the Health Care Worker Background Check Act and added a new Section to implement a federal grant from the Centers for Medicare and Medicaid Services (CMMS).
This Act requires facilities to initiate, or have initiated on its behalf, a criminal history record check for all employees hired on or after January 1, 2006 with duties that involve or may involve contact with residents or access to the living quarters or the financial, medical, or personal records of residents. The Act also creates a CMMS federal grant pilot program which establishes the framework for a program to evaluate fingerprint background checks on prospective employees with direct access to patients of long-term care facilities or providers. The Association submitted to the Department of Public Health (DPH), comments on behalf of its members outlining our position on the regulations that implement P.A. 94-0665. IHCA has also represented members' on this issue during numerous meetings with the DPH.
MDS Reimbursement System
Many years of development by the three major long-term care associations and the Department of Healthcare and Family Services (HFS) resulted in the creation of HFS rule 147 which was adopted in 2003. This rule established a case mix reimbursement system that reflected current resident acuity as scored on the Minimum Data Set (MDS). Questions on the adequacy of the system lead to a combined association audit of the system. IHCA took the lead on this project which took several days and was conducted by a combined team of nurses from IHCA and the other two long-term care associations. The results of the audit raised questions about the adequacy of reimbursement in certain areas, missing medical services and sufficient restorative care.
IHCA and the other long-term care associations participated in numerous negotiation meetings with HFS to try to address these issues. The negotiations resulted in:
- a revised rule for the MDS-based Medicaid nursing rate reimbursement system published on January 27, 2006.
- the addition of 13 new payable categories allowing increases in reimbursement for previously overlooked medical services and increased reimbursement for residents with mental illness. The system did receive modest changes in restorative care but limits to the number of restorative services were added.
- the incorporation of many Exceptional Care level Services into the basic system and the ending of the Exceptional Care Program.
IHCA also took the lead in successfully working to add an additional $30 million to a budget implementation bill that increased the Medicaid nursing rate effective January 1, 2007 and has an annual $60 million impact on the Medicaid nursing rate.
For questions or concerns regarding legislative issues, please contact one of the following IHCA staff members:
Pat Comstock , Vice President of Public Policy pcomstock@ihca.com ,
Karen O'Beirne, Director of DD Services kobeirne@ihca.com
Brenda Langheim , Director of Geriatric and Assisted Living Services blangheim@ihca.com
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Years of development by the three major long-term care associations – Illinois Health Care Association, Life Services Network of Illinois and the Illinois Council on Long Term Care and The Illinois Department of Healthcare and Family Services (HFS) had resulted in a rule 147 published in 2003 that established a case mix reimbursement system that reflected the current resident acuity as scored on the MDS. This tool allowed for a wide range of gainers and losers. Questions on the adequacy of the system lead to a combined association audit of the system that raised questions of adequate reimbursement for mentally ill residents, residents with dementia, therapy services, missing medical services and sufficient restorative care.
More negotiations resulted from the audit and resulted in a revised rule for the MDS-based Medicaid nursing rate reimbursement system published on January 27, 2006. The rule provided changes in the system that added 13 new payable categories allowing increases in reimbursement for previously overlooked medical services and increased reimbursement for residents with mental illness. The system did receive modest changes in restorative care but limits to the number of restorative services were added.
The previous rule established in FY2003 had less reimbursement potential than the new system. FY04 data based on the old system shows an average reimbursable time in the rate system staff model as 197 minutes and the statewide average nursing rate of $62.00 based on full FY01 wage values. The new system based upon June 30, 2006 data shows
an average reimbursable time in the rate system staff model of 256 minutes and the statewide average nursing rate of $70.70 based on full FY01 wage values.
Legislative action in the spring session provided an added $30 million to a Budget Implementation bill that will increase the Medicaid nursing rate effective January 1, 2007 and has an annual $60 million impact on the Medicaid nursing rate.
The three major long-term care associations wrote a joint response to the initial filing of the rule which lead to further face to face negotiations between the three associations and HFS. The negotiations lead to a second filing of the rule which was published in the September 22, 2006, Illinois Register. There were several small technical changes but the most significant changes in the second notice were changes in the Exceptional Care program and the method of blending the MDS-based Medicaid nursing rate with the current frozen Medicaid nursing rate. The existing Exceptional Care programs now have a guarantee base that will protect providers until the MDS based system is fully funded. The second notice also includes a method that uses new additional appropriations as the major element in determining the blending percent. This provision gives facilities the time to adjust to the new and very complex system with rate protection if homes do not initially adjust well.
For questions or concerns regarding reimbursement issues, please contact one of the following IHCA staff members:
Pat Comstock , Vice President of Public Policy pcomstock@ihca.com ,
Jim Hunter , Reimbursement Manager jhunter@ihca.com
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