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SB 1490

MEDICAID-STRIVE CALCULATIONS

104th Regular Session Introduced by Mary Edly-Allen and 3 co-sponsors

Illinois will switch Medicaid nursing facility staffing add-ons to a PDPM STRIVE staffing ratio-based formula using federal staffing data.

Added as Co-Sponsor Sen. Doris Turner
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Bill Summary · SB 1490

SB 1490 — “Medicaid — STRIVE Calculations” (summary)

Status: Introduced (SB 1490) — added Co‑Sponsor Sen. Doris Turner
Introduced: Feb 20, 2025 (bill text filed Jan 31, 2025 in Illinois)
Primary sponsor (filed): Sen. Mary Edly‑Allen

Purpose / Intent

Amend Illinois’ Medical Assistance Article (Public Aid Code, section 5‑5.2) to change how the “per diem staffing add‑on” for nursing facilities is calculated under the Medicaid nursing services reimbursement system. The bill implements a PDPM STRIVE staffing ratio methodology intended to tie the staffing add‑on to federally reported nurse staffing hours adjusted for facility case mix.

Key provisions

  • Replaces the existing staffing percentage used to calculate the per diem staffing add‑on with each facility’s PDPM STRIVE Staffing Ratio.
  • Defines PDPM STRIVE Staffing Ratio as:
    • Reported Total Nurse Staffing Hours Per Resident Per Day (from the most recent federal staffing report — Provider Information File) divided by the facility’s PDPM STRIVE Staffing Target.
  • Defines each facility’s PDPM STRIVE Staffing Target as:
    • 0.76 × the facility’s Illinois Adjusted Facility Case‑Mix Hours Per Resident Per Day.
  • Defines Illinois Adjusted Facility Case‑Mix Hours Per Resident Per Day as:
    • the facility’s Nursing Case‑Mix (from the federal Provider Information file) divided by 1.4627, then multiplied by 3.79 (a national staffing benchmark derived from the January 2024 State US Averages file).
  • Incorporates use of federal Payroll‑Based Journal / Provider Information staffing data as the source for reported staffing hours and case‑mix metrics.
  • Includes transitional and implementation language elsewhere in the reimbursement section (references to prior quarters and temporary denominators), and ties the overall PDPM‑based reimbursement methodology to prior PDPM implementation and federal approvals.
  • Effective date language in the introduced text indicates changes will apply starting with the PDPM implementation schedule; core statutory change is noted as taking effect July 1, 2025.

Who is affected

  • Nursing facilities participating in Illinois Medicaid (providers) — their per‑facility per‑diem staffing add‑ons will be recalculated under the new formula.
  • The Illinois Medicaid program (payer) — payment distribution for staffing add‑ons may shift across facilities.
  • Medicaid beneficiaries in nursing facilities could be indirectly affected by changes in facility revenue and staffing incentives.

Likely impact / considerations

  • Payment shifts: Facilities with reported staffing above their PDPM STRIVE target will generally have larger staffing ratios (and thus potentially larger add‑ons); lower‑staffed facilities could see reduced add‑ons.
  • Redistribution risk: The formula’s reliance on federal reported staffing and the .76 multiplier for the target may reallocate Medicaid funds among providers depending on case mix and reported hours.
  • Data dependence: Implementation depends on accuracy and timeliness of federal Provider Information File / Payroll‑Based Journal data and specified case‑mix adjustments.
  • Administrative: AHCA/Department rulemaking, operational changes to payment systems, and provider notice/training will be necessary to implement the new calculation.
  • Fiscal effect: The bill text does not itself set aggregate funding changes; it changes the formula by which available staffing add‑on dollars are allocated.

What to watch next

  • Committee hearings, fiscal notes, and agency analyses for projected payment impacts and rulemaking timelines.
  • Final effective date and any transitional provisions adopted during amendment or enactment.
  • Data and methodology clarifications (e.g., choice of federal file/version and any quarterly smoothing).

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

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