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SB 3594

MEDICAID-STAR RECOMPUTATION

104th Regular Session Introduced by Elgie Sims

Starting Jan 1, 2027, HFS must recompute STAR ratings for facilities with antipsychotic suppression actions and base quality payments on the revised STAR scores.

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Bill Summary · SB 3594

Summary of SB3594 (104th Illinois General Assembly)

Title: MEDICAID-STAR RECOMPUTATION

Purpose
- This bill amends the Illinois Public Aid Code to address nursing facilities that had their antipsychotic medication quality measure suppressed and their overall STAR rating set to one due to CMS audit actions. Starting January 1, 2027, it requires the Department of Healthcare and Family Services (HFS) to recompute the facility’s STAR rating using the actual long-stay points for the antipsychotic measure and to base quality payments on the recomputed score. The goal is to ensure funding and quality payments reflect the facility’s true performance as determined by CMS.

Key Provisions
- STAR rating recomputation (mandatory for affected facilities)
- Effective date: January 1, 2027.
- For facilities with suppressed long-stay antipsychotic measure points and a STAR rating of 1 due to CMS audit action, HFS must recompute the STAR rating using CMS’s actual long-stay rating points for the quarter.
- Quality payments for these facilities will be paid based on the recomputed STAR score.
- To facilitate recomputation, facilities may submit documentation about the suppression status and the CMS quarterly long-stay rating report.

  • Quality payments and STAR-based distributions

    • The bill retains and governs the general framework for quality payments to nursing facilities, with the recomputed STAR score affecting eligibility and amounts for those facilities.

  • PDPM-based reimbursement system and related provisions (existing framework carried forward)

    • The bill contains extensive references to Illinois’ PDPM-based nursing reimbursement system, including:
    • Transition rules (effective July 1, 2022) and staged transition through subsequent quarters.
    • Rules for base year statewide RUG-IV per diem, regional wage adjustors, and case-mix indices.
    • A variable per diem staffing add-on tied to staffing metrics (PDPM STRIVE Staffing Ratio) with phased changes through 2024–2025 and tiered per diem amounts based on staffing levels.
    • Medicaid Access Adjustment ($4 in 2022, $4.75 in 2023; phased out by 2028).
    • Ventilator service add-on updates subject to federal approval.
    • These provisions largely reflect the state’s long-standing PDPM framework and related add-ons and are included to provide context for rate setting and adjustments.

  • CNA wage and tenure-related payments (policy alignment)

    • Provisions for per diem add-ons linked to CNA tenure and promotions, with Medicaid’s share determined by the ratio of Medicaid bed days to total bed days.
    • Rules to increase CNA compensation through tenure and promotion increments, with specified dollar amounts and conditions.
    • The department may establish rules to implement these CNA-related payments.

  • Data integrity and implementation coordination

    • The bill directs the Department to collaborate with nursing facility associations to design data integrity policies for information from federal reporting sites used in setting rates.
    • Encourages transparency and consultation in adjusting quality metrics and payment methodologies.

Affected Parties
- Nursing facilities enrolled in Illinois’ Medicaid program.
- CMS-designated facilities with antipsychotic suppression actions and STAR ratings set to 1 due to CMS audits (eligible for recomputation and adjusted payments).
- Department of Healthcare and Family Services (state agency implementing the recomputation and quality payment framework).
- Stakeholders in long-term care, including CNA workforce, providers, and advocates, given CNA wage/tenure provisions and quality metrics.

Timing and Process
- Recompute STAR ratings starting January 1, 2027 for eligible facilities.
- Facilities may provide documentation to aid recomputation (suppression status and CMS quarterly reports).
- Quality payments to be based on recomputed STAR scores for those facilities.

Notes
- The bill references an extensive PDPM-related framework already in place, integrating it with the proposed STAR recomputation to ensure alignment of rate setting, staffing add-ons, and quality payments.
- The bill’s full PDPM provisions are complex and would require careful implementation and CMS/state rule alignment.

Sponsor
- Primary sponsor: Sen. Elgie R. Sims, Jr. (Co-sponsor listed)

This summary focuses on the substantive change: mandatory recomputation of STAR ratings for certain CMS-audited facilities and the corresponding quality payments, within the broader PDPM-era rate framework.

Compiled from official sources — confirm details with the bill’s official record.

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