2023 Illinois Compiled Statutes › Chapter 210 - HEALTH FACILITIES AND REGULATION › 210 ILCS 49/ - Specialized Mental Health Rehabilitation Act of 2013. › Article 5 - Facility Payment

(210 ILCS 49/Art. 5 heading)
ARTICLE 5.
FACILITY PAYMENT
(Source: P.A. 98-104, eff. 7-22-13.)
(210 ILCS 49/5-101)
Sec. 5-101. Managed care entity, coordinated care entity, and accountable care entity payments. For facilities licensed by the Department of Public Health under this Act, the payment for services provided shall be determined by negotiation with managed care entities, coordinated care entities, or accountable care entities. However, in no event shall the reimbursement rate paid to facilities licensed under this Act be less than the rate in effect on July 1, 2021. Any adjustment in the support component or the capital component, including the real estate tax per diem rate, for facilities licensed by the Department of Public Health under the Nursing Home Care Act shall apply equally to facilities licensed by the Department of Public Health under this Act.
The Department of Healthcare and Family Services shall publish a reimbursement rate for triage, crisis stabilization, and transitional living services by December 1, 2014.
(Source: P.A. 102-16, eff. 6-17-21.)
(210 ILCS 49/5-102)
Sec. 5-102. Transition payments.
(a) In addition to payments already required by law, the Department of Healthcare and Family Services shall make payments to facilities licensed under this Act in the amount of $29.43 per licensed bed, per day, for the period beginning June 1, 2014 and ending June 30, 2014.
(b)   For the purpose of incentivizing reduced room occupancy and notwithstanding any provision of law to the contrary, the Medicaid rates for specialized mental health rehabilitation facilities effective on July 1, 2022 must be equal to the rates in effect for specialized mental health rehabilitation facilities on June 30, 2022, increased by 5.0%. This rate shall be in effect from July
1, 2022 through June 30, 2024. After June 30, 2024, this rate shall remain in effect only for any occupied bed that is in a room with no more than 2 beds. The rate increase shall be effective for payment for services under both the fee-for-service and managed care medical assistance programs established under Article V of the Illinois Public Aid Code.
(Source: P.A. 102-699, eff. 4-19-22.)
(210 ILCS 49/5-103)
Sec. 5-103. Medicaid rates. Notwithstanding any provision of law to the contrary, the Medicaid rates for Specialized Mental Health Rehabilitation Facilities effective on July 1, 2017 must be equal to the rates in effect for Specialized Mental Health Rehabilitation Facilities on June 30, 2017, increased by 2.8%.
(Source: P.A. 100-23, eff. 7-6-17.)
(210 ILCS 49/5-104)
Sec. 5-104. Medicaid rates. Notwithstanding any provision of law to the contrary, the Medicaid rates for Specialized Mental Health Rehabilitation Facilities effective on July 1, 2018 must be equal to the rates in effect for Specialized Mental Health Rehabilitation Facilities on June 30, 2018, increased by 4%. The Department shall adopt rules, including emergency rules under subsection (bb) of Section 5-45 of the Illinois Administrative Procedure Act, to implement the provisions of this Section.
(Source: P.A. 100-587, eff. 6-4-18; 101-81, eff. 7-12-19.)
(210 ILCS 49/5-105)
Sec. 5-105. Therapeutic visit rates. For a facility licensed under this Act on or before June 1, 2018 or provisionally licensed under this Act on or before June 1, 2018, a payment shall be made for therapeutic visits that have been indicated by an interdisciplinary team as therapeutically beneficial. Payment under this Section shall be at a rate of 75% of the facility's rate on the effective date of this amendatory Act of the 100th General Assembly and may not exceed 20 days in a fiscal year and shall not exceed 10 days consecutively.
(Source: P.A. 100-587, eff. 6-4-18.)
(210 ILCS 49/5-106)
Sec. 5-106. Therapeutic visit rates. For a facility licensed under this Act by June 1, 2018 or provisionally licensed under this Act by June 1, 2018, a payment shall be made for therapeutic visits that have been indicated by an interdisciplinary team as therapeutically beneficial. Payment under this Section shall be at a rate of 75% of the facility's current paid rate and may not exceed 20 days in a fiscal year and shall not exceed 10 days consecutively.
(Source: P.A. 100-646, eff. 7-27-18; 101-81, eff. 7-12-19; 101-636, eff. 6-10-20.)
(210 ILCS 49/5-107)
Sec. 5-107. Quality of life enhancement. Beginning on July 1, 2019, for improving the quality of life and the quality of care, an additional payment shall be awarded to a facility for their single occupancy rooms. This payment shall be in addition to the rate for recovery and rehabilitation. The additional rate for single room occupancy shall be no less than $10 per day, per single room occupancy.  The Department of Healthcare and Family Services shall adjust payment to Medicaid managed care entities to cover these costs. Beginning July 1, 2022, for improving the quality of life and the quality of care, a payment of no less than $5 per day, per single room occupancy shall be added to the existing $10 additional per day, per single room occupancy rate for a total of at least $15 per day, per single room occupancy. For improving the quality of life and the quality of care, on January 1, 2024, a payment of no less than $10.50 per day, per single room occupancy shall be added to the existing $15 additional per day, per single room occupancy rate for a total of at least $25.50 per day, per single room occupancy. Beginning July 1, 2022, for improving the quality of life and the quality of care, an additional payment shall be awarded to a facility for its dual-occupancy rooms. This payment shall be in addition to the rate for recovery and rehabilitation. The additional rate for dual-occupancy rooms shall be no less than $10 per day, per Medicaid-occupied bed, in each dual-occupancy room. Beginning January 1, 2024, for improving the quality of life and the quality of care, a payment of no less than $4.50 per day, per dual-occupancy room shall be added to the existing $10 additional per day, per dual-occupancy room rate for a total of at least $14.50, per Medicaid-occupied bed, in each dual-occupancy room. The Department of Healthcare and Family Services shall adjust payment to Medicaid managed care entities to cover these costs. As used in  this Section, "dual-occupancy room" means a room that contains 2 resident beds.
(Source: P.A. 102-699, eff. 4-19-22; 103-102, eff. 1-1-24.)
(210 ILCS 49/5-108)
Sec. 5-108. Infection prevention and facility safety improvement payments. Payments will be awarded to facilities on a per bed basis with the funded appropriation for Fiscal Year 2022 divided by the number of licensed beds in each facility.  Facilities will receive an equal amount for every licensed bed from the amount appropriated.  Facilities shall use these funds for improvements to their facilities that promote infection prevention or improve the safety within the facility.  Funding may be used for, but are not limited to, the following:  restroom renovations to promote infection prevention, kitchen and food delivery alterations that promote infection prevention, and HVAC or air filtration upgrades that promote infection prevention.  Facilities must attest to the Department of Healthcare and Family Services that the funding was utilized for the purpose of infection prevention and control or improved facility safety.  If the facility does not attest to the usage of the payments or cannot document the usage of payments the Department shall recoup the expenditure of funds by withholding payment of rate.
(Source: P.A. 102-16, eff. 6-17-21.)
(210 ILCS 49/5-109)
Sec. 5-109. Communication quality improvement payments. Payments will be awarded to facilities on a per bed basis with the funded appropriation for Fiscal Year 2022 divided by the number of licensed beds in each facility.  Facilities will receive an equal amount for every licensed bed from the amount appropriated.  Facilities shall use these funds for improvements to their facilities that increase access to digital communications or facilitate safe and private personal communications.  Funding may be used for, but are not limited to, the following:  the purchase of personal communication devices for facility use, the enhancement of broadband access and bandwidth, and the establishment or improvement of general meeting areas for the benefit of residents and employees.  Facilities must attest to the Department of Healthcare and Family Services that the funding was utilized for the purpose of communication, technological improvements, or facility training aid.  If the facility does not attest to the usage of the payments or cannot document the usage of payments the Department shall recoup the expenditure of funds by withholding payment of rate.
(Source: P.A. 102-16, eff. 6-17-21.)
(210 ILCS 49/5-110)
Sec. 5-110. Staff longevity payments. Payments will be awarded to facilities on a per bed basis with the funded appropriation for Fiscal Year 2022 divided by the number of licensed beds in each facility.  Facilities will receive an equal amount for every licensed bed from the amount appropriated.  Facilities shall use these funds to grant an extra week of payment to any direct care staff who has worked continuously in the same facility since March 1, 2020 through the time in which payments are awarded to facilities for this purpose by the Department of Healthcare and Family Services.  Facilities must attest to the Department of Healthcare and Family Services that the funding was utilized for the purpose of providing the staff longevity payments as detailed in this Section.  If the facility does not attest to the usage of the payments or cannot document the usage of payments the Department shall recoup the expenditure of funds by withholding payment of rate.
(Source: P.A. 102-16, eff. 6-17-21.)
(210 ILCS 49/5-111)
Sec. 5-111. Recruitment and Retention of Direct Care Staff.  Facilities shall receive funding to assist with the recruitment and retention of direct care staff.  Funding will be distributed based on the total number of licensed beds within a facility with the appropriated amount being divided by the total number of licensed beds in the State.
(Source: P.A. 102-16, eff. 6-17-21.)
(210 ILCS 49/5-112)
Sec. 5-112. Bed reduction payments. The Department of Healthcare and Family Services shall make payments to facilities licensed under this Act for the purpose of reducing bed capacity and room occupancy.  Facilities desiring to participate in these payments shall submit a proposal to the Department for review.  In the proposal the facility shall detail the number of beds that are seeking to eliminate and the price they are requesting to eliminate those beds.  The facility shall also detail in their proposal if the affected beds would reduce room occupancy from 3 or 4 beds to double occupancy or if the bed elimination would create single occupancy.  Priority will be given to proposals that eliminate the use of three-person or four-person occupancy rooms.  Proposals shall be collected by the Department within a specific time period and the Department will negotiate all payments before making final awards to ensure that the funding appropriated is sufficient to fund the awards.  Payments shall not be less than $25,000 per bed and proposals to eliminate beds that lead to single occupancy rooms shall receive an additional $10,000 per bed over and above any other negotiated bed elimination payment.  Before a facility can receive payment under this Section, the facility must receive approval from the Department of Public Health for the permanent removal of the beds for which they are receiving payment.  Payment for the elimination of the beds shall be made within 15 days of the facility notifying the Department of Public Health about the bed license elimination.  Under no circumstances shall a facility be allowed to increase the capacity of a facility once payment has been received for the elimination of beds.
(Source: P.A. 102-16, eff. 6-17-21; 102-687, eff. 12-17-21.)