SPRINGFIELD – The Illinois Department of Healthcare and Family Services has issued a series of recommendations for nursing home payment reform, which are geared towards creating a system of long-term care in Illinois that is safer, more equitable, and more dignified for all nursing home residents.

The COVID-19 pandemic has shown that there is significant danger posed by overcrowded and understaffed nursing homes. Black and Brown customers, who were disproportionately affected by COVID-19, are more likely to be in overcrowded “ward”-style rooms with three or four beds per room, and they are more likely to reside in understaffed facilities.

The Department recommends increasing funding to the industry to address these disparities, and recommends that any new revenue to the industry – whether from general funds or generated from an enhanced nursing home assessment -- must be linked to safety and quality improvements for residents.

“The COVID-19 pandemic has had a devastating impact on long-term care facilities and, more importantly, the people who reside there. Our analysis shows that Black and Brown Medicaid customers were disproportionately affected. This is unacceptable,” said Illinois Department of Healthcare and Family Services Director Theresa Eagleson. “This report sets forth our proposal for holding nursing homes accountable for providing high-quality care for all residents and creating a more equitable future of long-term care in Illinois. We look forward to continuing to engage with legislators, the nursing home industry, labor representatives, and other stakeholders, as we work to make this vision a reality.”

HFS began convening regular meetings with representatives from the nursing home industry and staff from the four legislative caucuses more than 18 months ago, to discuss changes to the nursing home payment rate methodology.

These discussions have centered on the transition to the Patient Driven Payment Model (PDPM) used by Medicare, as well as to tying nursing home payments to staffing and other measures that increase quality care and safety for residents. The Department recommends funding these enhancements through a combination of streamlining and increasing the nursing home assessment and using one-time funding to address pandemic-related safety improvements.

HFS serves roughly 45,000 Medicaid customers who are nursing home residents across the state. Medicaid is the largest payor of nursing facility days both in Illinois and in the country. Medicaid pays for roughly 60% of nursing facility days in Illinois.

As required by law, HFS has issued the report detailing these recommendations to the General Assembly. The full report and recommendations can be found on the HFS nursing home payment update page.

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