Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 153 - LONG TERM CARE REIMBURSEMENT CHANGES › Subpart A - GENERAL PROVISIONS › Section 153.100 - Reimbursement for Long Term Care Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Notwithstanding the provisions set forth
				in 89 Ill. Adm. Code 140, 144, 146 Subpart H and 147 for reimbursement of long
				term care services, effective January 18, 1994, reimbursement rates for long
				term care facilities (SNF/ICF and ICF/MR) and day training providers will
				remain at the levels in effect on January 18, 1994, except as otherwise
				provided in this Section.
b)
				Capital and support rates in effect on January 18, 1994, will be adjusted based
				on final audits of cost report data in accordance with 89 Ill. Adm. Code
				140.582(b) and
				140.590.
c) Capital rates will be increased for major
				capital improvements in accordance with 89 Ill. Adm. Code
				140.560(c) and
				(e).
d) New facilities which are assigned median
				rates in accordance with 89 Ill. Adm. Code
				140.560(b) will
				have rates recalculated based upon receipt of their first cost report and 89
				Ill. Adm. Code 147.150.
e) Requests for IOCs upon which rate
				determinations are based upon a Medicaid resident being transferred from a
				State operated facility for persons with developmental disabilities to a
				community setting will be considered on a case-by-case basis.
f) Fiscal year 1996 support rates may change
				based on the first cost report filed by new ownership reflecting six months or
				more of the new ownership's operation for any facility which changed ownership
				between July 1, 1992, and January 18, 1994. Only changes in ownership in
				arms-length transactions between unrelated parties will be recognized for this
				rate change. The new support rate for those facilities will be calculated in
				accordance with 89 Ill. Adm. Code
				140.560 and
				140.561. Support rates for
				facilities which qualify under this exception will not be decreased by the
				provisions in this Section. The capital rates of facilities which changed
				ownership between July 1, 1992, and January 18, 1994, will not be subject to
				changes in the capital rate based on the provisions of 89 Ill. Adm. Code
				140.571(b)(4),
				but can still be affected by the provisions of subsection (d).
g) For those for-profit facilities whose
				fiscal year 1994 capital rate does not include a real estate tax component
				because it is based upon a non-profit facility's cost report, effective July 1,
				1995, the real estate tax component will be added to the capital rate based
				upon the fiscal year 1994 median real estate tax rate for the geographic area
				in which the home is located.
h)
				For any capital rate increases for real estate tax additions made after
				December 31, 2011, a non-profit facility that changes ownership and the new
				owner is a for-profit facility, the facility must request in writing the real
				estate tax component be added to the capital rate. The request shall include
				the "Notice of Assessment" or the first real estate tax bill from the
				applicable county. The information from the county must indicate the initial
				date of tax assessment on the long term care facility site and building. In
				order to provide for efficient, accurate and timely rate adjustments, the
				facility shall submit its request within two years after the change in
				ownership date. The real estate tax component shall be added to the new owner's
				rate effective with the date of initial tax assessment determined by the county
				that was included in the facility's request. The effective date cannot go back
				beyond the change of ownership date as recognized by IDPH. The real estate tax
				component will be added at the geographic area median tax rate in effect for
				the month in which the real estate tax becomes effective. If the request is not
				received by the Department within two years after the IDPH change in ownership
				date, the real estate tax component shall be added effective the first day
				after the month subsequent to receipt of the facility's completed
				request.
i) For those non-profit
				facilities whose fiscal year 1994 capital rate includes a real estate tax
				component based upon a for-profit facility's cost report, effective July 1,
				1995, the real estate tax component of the capital rate will be removed (unless
				the non-profit facility rents the home from an unrelated for-profit
				entity).
j) If a for-profit
				facility changes ownership on or after July 1, 1995, and the new owner is a
				non-profit facility, the real estate tax component will be removed from the
				capital rate effective with the date of change in ownership as recognized by
				the Illinois Department of Public Health. The real estate tax component will
				not be removed for a non-profit facility that rents the facility from an
				unrelated for-profit entity.
k) The
				flat per diem paid to ICFs/MR to cover the cost of non-emergency dental
				services pursuant to 89 Ill. Adm. Code
				144.275 and
				144.300 will be increased from
				$.30 to $.40.
l) Day training
				provider rates shall be increased by three percent for services provided on or
				after July 1, 1996.
m) Effective
				for services provided on or after July 1, 1996, facilities which are located in
				an area which has changed geographic designation due to unique labor force
				factors shall have rates recalculated based upon the ceilings and norms of the
				newly designated geographic area.
n) Long term care facilities that have been
				assigned a median tax rate on the basis of geographic area in accordance with
				89 Ill. Adm. Code 140.560(b) and
				subsections (g) and (h) shall subsequently have those rates recalculated based
				upon the first full tax bill received by that facility. The revised rate will
				be the greater of the recalculated rate or the rate in effect from the
				aforementioned Section and subsections. Rates revised in accordance with this
				subsection shall result in payments retroactive to the applicable effective
				date of the updated rate. The updated rate will be effective the first day of
				the month subsequent to receipt by the Department of the facility's completed
				request. The facility shall request in writing that its tax rate be updated
				with the first full tax bill. This tax bill must be included with the request
				made to the Department. In order to calculate the potential tax rate, the real
				estate tax from the first full tax bill for the long term care property will be
				divided by the greater of the annualized capital days (see 89 Ill. Adm. Code
				140.570(b)(3))
				from the cost report used to calculate the remainder of the capital rate in
				accordance with 89 Ill. Adm. Code
				140.570 through
				140.574, or 93 percent of
				annualized bed days based upon the number of licensed beds available at the end
				of the period covered by the tax bill. No inflation factor will be used for
				this calculation.
o) Interim IOCs
				may be conducted in an ICF/MR, at the facility's written request, if there has
				been a change in the resident population of at least 25 percent since the last
				IOC used to set the rate. A facility is limited to one request in any 12 month
				period. The rate effective date will be the first day of the month following
				the month of the facility's written request. The written request must contain
				documentation supporting the change in the resident population.
p) Interim IOCs may be conducted for
				developmental training services when the population of an ICF/MR changes by at
				least 25 percent since the last IOC used to set the rate. The ICF/MR is limited
				to one request in any 12 month period. The rate effective date will be the
				first day of the month following the month of the facility's written request.
				Documentation must be submitted supporting the change in the resident
				population.
q) Rates shall be
				adjusted for an ICF/MR entering into a downsizing agreement with the Department
				of Human Services, under the provisions of 89 Ill. Adm. Code 140.560, with the
				rate effective on the date a benchmark for such downsizing is
				achieved.
r) For an ICF/MR with 16
				or fewer licensed beds, rate changes shall be made in the program active
				treatment rate component to reflect an increase of 13 hours of base nursing and
				nurse supervision for administration of medication by unlicensed direct service
				staff, effective for services provided on or after January 1, 2000.
s) The nursing component of a nursing
				facility's per diem shall be adjusted in accordance with 89 Ill. Adm. Code
				147.150.
t) Effective for any
				capital rates calculated with an effective date of July 1, 2006 or later, the
				capital rates shall be adjusted based upon audits of cost report data in
				accordance with the updates and clarifications contained in 89 Ill. Adm. Code
				140.534 and 140.560.