Bill
HB 1785
Illinois nursing facility Medicaid per-diem staffing add-on will be calculated using a new PDPM STRIVE Staffing Ratio, linking targets to facility case-mix and national benchmarks
Note on materials provided
- The material supplied includes multiple, conflicting entries labeled “HB 1785” (an Illinois bill about Medicaid nursing facility reimbursement, an Arkansas county depository board amendment, and an unrelated Education Reform title). This summary focuses on the substantive Illinois Public Aid Code language included in the bill text (PDPM STRIVE staffing ratio), which is the most detailed legislative content available. If you intended a different state/version, tell me which one and I will produce a focused summary.
Purpose and intent
- Modify how the Medicaid per-diem staffing add-on for Illinois nursing facilities is calculated by adopting a new “PDPM STRIVE Staffing Ratio” methodology and by setting facility-specific PDPM STRIVE staffing targets tied to facility case-mix and national staffing benchmarks. The intent is to standardize and (phased) transition to a PDPM-based, resident-centered staffing add-on calculation.
Key provisions and formulas
- Effective date: provisions take effect July 1, 2025 (with transitional language covering earlier quarters).
- New staffing percentage: beginning July 1, 2025, the staffing percentage used to compute the Medicaid per-diem staffing add-on will be each facility’s PDPM STRIVE Staffing Ratio, defined as:
- PDPM STRIVE Staffing Ratio = Reported Total Nurse Staffing Hours Per Resident Per Day (from the most recent federal Provider Information File) ÷ PDPM STRIVE Staffing Target.
- PDPM STRIVE Staffing Target:
- Beginning July 1, 2025, Target = 0.76 × Illinois Adjusted Facility Case‑Mix Hours Per Resident Per Day.
- Illinois Adjusted Facility Case‑Mix Hours Per Resident Per Day:
- Defined as the facility’s Nursing Case‑Mix (from the most recent federal Provider Information File) divided by 1.4627 and multiplied by 3.79 (3.79 is cited as the national Reported Total Nurse Staffing HPRD from the January 2024 State US Averages file).
- Earlier/transition language:
- The bill also contains earlier phased or interim provisions (applicable Oct 1, 2024 through Sept 30, 2025) that blend prior measures with PDPM STRIVE targets (for example, initial quarters may use a weighted blend such as 20% PDPM STRIVE Target + 80% facility Case‑Mix Total Nurse Staffing HPRD from January 2024 data). The text also preserves a paid per‑diem staffing add‑on in effect April 1, 2024 for certain dates beginning July 1, 2024.
- Data sources and administration:
- Relies on federal staffing reports (Provider Information File), Payroll Based Journal data provided to the Department of Public Health, and the Minimum Data Set (MDS). The Department must correct verified data errors and base some assignments on quarterly MDS reference dates.
Who is affected
- Primary: Licensed nursing facilities in Illinois that receive Medicaid reimbursements — their per‑diem staffing add‑on payments will be calculated under the new PDPM STRIVE formula.
- Secondary: Illinois Department of Healthcare and Family Services (administration of reimbursement rules), Medicaid beneficiaries (potential indirect effects on facility staffing and quality), and facilities’ financials and budgeting (potential increases or decreases in staffing add‑on dollars depending on each facility’s reported staffing relative to its new target).
Potential impacts and considerations
- Facilities with reported staffing above their PDPM STRIVE target would see higher staffing percentages used in the add‑on calculation; those below target would see lower percentages.
- The use of national benchmark factors (3.79) and a fixed multiplier (0.76 and divisor 1.4627) standardizes targets but may shift payments regionally or by facility case‑mix.
- The bill does not include explicit statewide fiscal estimates in the text provided; actual budgetary impact would depend on aggregate facility compliance with targets and claim volumes.
- Implementation depends on accurate and timely federal reporting (Provider Information File, PBJ, MDS) and Department rulemaking/administration.
Procedural status (as provided)
- Listed status: “Second Reading referred to Rules” (per initial header). The legislative actions supplied include multiple entries and appear to mix materials from different jurisdictions—please confirm intended state and bill version for precise status tracking.
If you want, I can:
- Produce a simplified one-page explainer for facility administrators,
- Run examples showing how the new formula changes a facility’s staffing ratio and add‑on, or
- Verify the bill’s current status and fiscal notes in the Illinois General Assembly records.
Compiled from official sources — confirm details with the bill’s official record.
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