Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1035 - Reimbursement for Program (Active Treatment) Costs in Residential Facilities for Clients with Developmental Disabilities

Current through Register Vol. 48, No. 28, July 12, 2024
Residential facilities, including distinct parts of
				  facilities, for clients with developmental disabilities (ICF/DD certification
				  with licensure for MC/DD license), excluding State-operated facilities for
				  individuals with developmental disabilities, will be reimbursed for an active
				  treatment program for each client. Facility program reimbursement levels will
				  be derived by the Department from the following four determinants which in
				  combination will result in a total facility program per diem amount. These four
				  determinants will be determined according to information provided in the most
				  recent Inspection of Care (IOC) conducted by Department of Public Health survey
				  staff. This IOC information must be validated by the survey staff prior to
				  utilization for payment purposes. The new reimbursement level will be effective
				  on the first day of the quarter following a facility's IOC. Where dollar, wage,
				  or salary amounts are used, these shall be inflated to the fiscal year for
				  which reimbursement will be made. The Department reimburses for program costs
				  based on geographic area (see the Department's rule at 89 Ill. Adm. Code 140.
				  Table B) in which the facility is based.
a) Minimum Staffing
1) Direct Services - Facilities must be in
				compliance with the Health Care Financing Administration's (HCFA)
				(42 CFR
				483.430 (1996)) minimum average daily
				staffing standards relative to client population according to each individual's
				overall level of functioning:
Overall Level of Functioning
FTE* Staff: Client Ratio
Mild
1:5
Moderate
1:2.5
Severe or Profound
1:2
*FTE = Full Time Equivalent
A) Determination of levels of functioning of
				clients with intellectual disability and related conditions, in accordance with
				the definition of the American Association on Intellectual and Developmental
				Disabilities (Intellectual disability is a disability characterized by
				significant limitations in both intellectual functioning and in adaptive
				behavior, which covers many everyday social and practical skills. This
				disability originates before the age of 18), will include both:
i) an assessment of intellectual functioning
				as measured by a standardized, full scale, individual intelligence test such as
				the Stanford Binet and WAIS-R. Such an assessment must be administered by a
				psychologist who is registered in Illinois under the Clinical Psychologist
				Licensing Act (Illinois Department of Professional Regulation); and
ii) an assessment of adaptive behaviors using
				a nationally standardized, Department approved assessment instrument, such as
				the Scales of Independent Behavior (SIB) or the Inventory For Client and Agency
				Planning (ICAP). Such an assessment instrument will be utilized by at least one
				Qualified Intellectual Disabilities Professional (QIDP) to evaluate each
				client's functional skills and adaptive behaviors.