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HB 3156

Relating to utilities.

2025 Regular Session Introduced by Jami Cate and 6 co-sponsors

Illinois Medicaid nursing facility payments shift to a PDPM-based system with an Access Adjustment of $5.75 per day starting July 1, 2025, plus staffing add-ons tied to STRIVE targ

Chapter 97, (2025 Laws): Effective date January 1, 2026.
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Bill Summary · HB 3156

HB 3156 — Relating to utilities (actually: amendments to Medicaid nursing facility payments)

Note: Although the bill caption reads “Relating to utilities,” the enacted bill amends the Illinois Public Aid Code governing Medicaid payments to nursing facilities (305 ILCS 5/5-5.2). Companion measures: SB 1399 and HB 49.

Purpose / Intent

HB 3156 revises how Illinois reimburses nursing facilities under Medicaid. It (1) sets the Medicaid Access Adjustment payment level for certain dates of service, (2) continues and refines the shift to a Patient Driven Payment Model (PDPM)-based reimbursement system, and (3) establishes/updates methodology for staffing-related per-diem add-ons tied to federal staffing reports and the STRIVE staffing targets.

Key provisions and changes

  • Medicaid Access Adjustment: For dates of service beginning July 1, 2025, the Medicaid Access Adjustment to nursing facility Medicaid payments is set at $5.75 per day (per the bill synopsis).
  • PDPM reimbursement framework:
    • Replaces prior nursing reimbursement methodology with a PDPM-based system once PDPM is “fully operationalized.”
    • Establishes implementation mechanics tied to CMS approval and state rulemaking; for purposes of a prior public act, implementation dates and conditions (July 1, 2022, or delayed to Oct 1, 2022) are referenced.
    • Requires annual rebasing of costs and quarterly updates to case-mix indices.
    • Includes regional wage adjustors based on Health Service Areas (HSA) with a floor adjustor of 1.06.
    • Assigns PDPM nursing case-mix indices with a statutory floor (no less than 0.7858 of CMS unadjusted PDPM values as of March 1, 2022).
    • Determines the pool of funds and base facility rates per a formula in the statute (subsection d-1).
  • Staffing add-on methodology:
    • Uses federal Payroll-Based Journal (PBJ) staffing reports and the federal Provider Information File to calculate facility staffing percentages.
    • Establishes the PDPM STRIVE Staffing Ratio and phased transitional denominators for calculating staffing percentages across several quarters (Oct 1, 2024 through July 1, 2025).
    • Sets tiered per-diem staffing add-on amounts tied to percent of STRIVE staffing achieved; specified dollar amounts in the text include examples such as $9, $16.52, $25.77 and up to $30.98 per diem for higher staffing attainment (text truncated in the source; full schedule available in the enacted statute).
  • Error correction and data submission: directs use of PBJ data, and requires the Department to correct verified missing/inaccurate PBJ reports.

Who is affected

  • Primary: Medicaid-enrolled nursing facilities in Illinois (payment rates, case-mix assignment, and staffing add-ons).
  • Secondary: Illinois Department of Healthcare and Family Services (or referenced “Department”) for implementation, rulemaking, and data processing; federal CMS for approvals; Medicaid beneficiaries indirectly through provider payment structure.

Timeline and procedural status

  • Introduced: February 18–21, 2025
  • Legislative action: Passed both chambers in May 2025; Governor signed May 19, 2025.
  • Enacted: Chapter 97, 2025 Laws.
  • Effective date of the Act: January 1, 2026.
  • Note: The statute itself references specific implementation and retrospective service dates (e.g., July 1, 2025 for the Access Adjustment; various PDPM dates including July 1, 2022 and Oct 1, 2022; phased staffing dates Oct 1, 2024–July 1, 2025). Those internal dates should be reviewed in the final statute text for applicability and any retroactive payment instructions.

Fiscal impact

The bill increases per-diem adjustments and restructures payment mechanisms, which is likely to increase Medicaid expenditures for nursing facility services; the source document does not include a fiscal estimate.

(Disclosure: source text was partially truncated; readers should consult the enacted statute, 305 ILCS 5/5‑5.2 as amended by Chapter 97 (2025), for full statutory language and exact dollar schedules.)

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

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