Medicaid expansion bill one step closer in Illinois

Being a reimbursement and operational specialist, I feel it has become very important to keep everyone informed of the Illinois Medicare-Medicaid Alignment Initiative that has been happening in long-term care. Like many, we have experienced Medicaid payment changes throughout the years and one thing that we have learned is that we have to be aware of the changes and be prepared.

In May 2013, Illinois passed the Medicaid Expansion Bill that includes Resource Utilization Grouper (RUGS) payment methodology. Both chambers passed Senate Bill 26 and sent the bill to the Governor to sign. This is expected soon. As we anticipated, the new methodology is scheduled to begin January 1, 2014. There is a phase-in period of one year in which facilities who qualify for a higher rate will only receive 88% of the full value of the RUG rate and providers with a reduced rate will receive only 13% of the scheduled reduction. It is planned that the full RUG rates will be implemented on January 1, 2015. Work continues on the details of payment but this is a major step forward. Facilities should begin now to ensure appropriate programs and supporting clinical documentation is in place to manage this transition.

Bottom line, what does this mean?  This new information means that it is very important to prepare your clinical staff to understand the 48 RUG Grouper methodology. Senate Bill 26 contains news about the RUGS and other issues that affect long-term care providers.

Feel free to personally contact me at (708) 574-1686 or email me at  jmccarthy@provinet.com to learn how to prepare your clinical staff for these new changes or visit the Illinois General Assembly website to view a synopsis of the Bill status.