reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.440 - Home Transfusion Arrangements

Current through Register Vol. 48, No. 28, July 12, 2024
a) The State Hemophilia Program shall assist
				patients for whom the Hemophilia Treatment Center hematologists request
				assistance in securing and funding home transfusion materials, including the
				necessary anti-hemophilia factors in coordination with their insurance
				coverage. The obligation for training and supervision of patients shall remain
				with the center directors.
b) The
				Hemophilia Treatment Center hematologists shall provide to the selected
				manufacturer's representative or other recognized provider a prescription for
				the required amount, type, and assay of the specific factor.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.450 - Obligations of the Department

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department shall reimburse enrolled providers for eligible hemophilia services
				for patients in the State Hemophilia Program.
b) The Department's reimbursement shall be
				adjusted to reflect the Patient's Participation Fee, as applicable, and any
				amount that is eligible for payment or reimbursement by any hospital or medical
				insurance program, by any other government medical or financial assistance
				program, or by any charitable assistance program. (See
				410 ILCS
				420/1(7).)
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.500 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
The Alternative Health Care Delivery Act [210 ILCS
				  3/35 ] establishes an alternative health care delivery
				  model, the Children's Community-Based Health Care Center. This Subpart sets
				  forth the conditions that a Children's Community-Based Health Care Center must
				  meet in order to participate in the Medical Assistance Program and outlines the
				  services provided by a Children's Community-Based Health Care Center for which
				  the Department will provide reimbursement.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.510 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of this Subpart, the following terms shall be
				  defined as follows:
"Children's Community-Based Health Care Center" means an
				  entity defined as a Children's Community-Based Health Care Center under Section
				  35 of the Alternative Health Care Delivery Act [210 ILCS
				  3/35 ]. The term "Children's Community-Based Health
				  Care Center" does not include:
Any institution, place, building or agency required to be
				  licensed pursuant to the Hospital Licensing Act [210 ILCS 85 ];
Any person or institution required to be licensed pursuant to
				  the Nursing Home Care Act [210 ILCS 45 ].
"Children's Community-Based Health Care Center Services"
				  means services as referenced in Section
				  146.540
				  that are provided by a Children's Community-Based Health Care Center that is
				  licensed by the Department of Public Health.
"Department" means the Illinois Department of Public
				  Aid.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.520 - Participation Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
To participate in the Medical Assistance Program, a
				  Children's Community-Based Health Care Center must, in addition to any other
				  Department requirements, be:
a)
				licensed by the Illinois Department of Public Health pursuant to 77 Ill. Adm.
				Code 260; and
b) enrolled for
				participation in the Medical Assistance Program in accordance with 89 Ill. Adm.
				Code
				140.11.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.530 - Records and Data Reporting Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) In addition to any other Department record
				requirements, including those specified in 89 Ill. Adm. Code
				140.28,
				a Children's Community-Based Health Care Center must maintain complete,
				comprehensive and accurate medical records to ensure adequate patient care that
				includes, but is not limited to, the following:
1) Patient identification;
2) Significant medical history;
3) Any known allergies and abnormal drug
				reactions;
4) Documentation of
				properly executed informed patient consent;
5) Medications and treatments ordered and
				administered; and
6) Clinical and
				nursing notes.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.540 - Covered Children's Community-Based Health Care Center Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department
				will reimburse a Children's Community-Based Health Care Center for services in
				accordance with Section
				146.550
				for individuals eligible under Section
				146.560
				for the following services:
1) nursing care up
				to the authorized in-home nursing hours approved by the Department for a period
				of one to 14 days; and
2) nursing
				care for the purpose of transitioning children from a hospital to home
				placement or other appropriate setting and reuniting families for a maximum of
				up to 120 days.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.550 - Reimbursement for Services

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Effective for dates of service on and after July 1, 2014, services provided
				under Section
				146.540(a)(1)
				shall be reimbursed in accordance with 89 Ill. Adm. Code
				140.474(c).
b) Services provided under Section
				146.540(a)(2)
				shall be reimbursed on a per diem basis at the lower of the Children's
				Community-Based Health Care Center's usual and customary charge to the public
				or at the Department's statutory rate of $950. Payments at this rate are exempt
				from the 2.7 % rate reduction required under Section 5-5e of the Public Aid
				Code.
c) Services provided under
				Section
				146.540(b)(1)
				shall be reimbursed in accordance with 89 Ill. Adm. Code
				140.474(c).
d) Effective for dates of service on or after
				July 1, 2012, reimbursement rates paid under this Section shall be reduced by
				2.7% from the rates in effect on June 30, 2012.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.560 - Individuals Eligible for Services Provided in a Children's Community-Based Health Care Center

Current through Register Vol. 48, No. 28, July 12, 2024
The Department shall pay for services provided by a
				  Children's Community-Based Health Care Center under this Subpart D to children
				  eligible under the Medical Assistance Program or the Illinois Home and
				  Community-Based Services Waiver for Medically Fragile, Technology Dependent
				  Children who are 20 years of age and younger and who have been determined by
				  the Department to have a medical need for in-home nursing care pursuant to 89
				  Ill. Adm. Code
				  120.530.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart D - CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS › Section 146.570 - Prior and Post Approval of Services

Current through Register Vol. 48, No. 28, July 12, 2024
Prior and post approval by the Department, or its designee,
				  is required for services described in Section
				  146.540.
				  Prior and post approval for services provided by Children's Community-Based
				  Health Care Centers shall be determined according to the requirements at 89
				  Ill. Adm. Code
				  140.40
				  through
				  140.43.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.600 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department will implement a pilot program to test the viability of a dementia
				care unit in SLFs. The pilot shall not exceed three years from the time the
				first facility is ready to operate a dementia care unit. Up to five SLFs may be
				admitted to the pilot in the first 12 months of the three-year period.
				Applicants for the pilot shall demonstrate experience with serving persons with
				a diagnosis of Alzheimer's disease or related dementia.
b) Unless otherwise indicated in this
				Subpart, the dementia care unit shall meet all requirements found in Subpart B
				of this Part.
c) SLFs with dementia
				care units shall promote independence, dignity, respect and well-being in the
				most cost effective manner for residents age 65 years and over who have a
				diagnosis of Alzheimer's disease or related dementia and meet the requirements
				described in Section
				146.630.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.610 - Structural Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) General
				Requirements
1) Each dementia care unit shall
				consist of no more than 20 apartments within each dementia care unit located
				within an existing SLF, attached to an existing SLF or in a free-standing SLF
				dementia care unit.
2) Apartments
				designated for a dementia care unit shall not be located above the second story
				and shall be contiguous.
3) Each
				dementia care unit shall have alarmed doors with delays requiring a resident to
				hold the push bar for several seconds before opening. This applies to all doors
				exiting the dementia care unit.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.620 - Participation Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
If applicable, the reservation of 25 percent of apartments
				  for Medicaid-eligible residents referenced in Section
				  146.215(d)
				  shall be calculated separately from the general SLF
				  population.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.630 - Resident Participation Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Residents in the dementia care unit shall
				have a diagnosis of Alzheimer's disease or related form of dementia that has
				been confirmed by a physician. A record of the diagnosis shall be kept in the
				resident's record.
b) Identified
				sex offenders shall not be admitted to the dementia care unit.
c) A roommate, such as a spouse, sibling,
				parent, other relative or significant other without dementia, may be admitted
				to a double occupancy apartment in the dementia care unit as long as the
				roommate meets the resident participation requirements found in Section
				146.220.
d) The SLF shall not receive the dementia
				unit rate for Medicaid-eligible roommates without dementia.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.640 - Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Medication
				Administration and Oversight
1) Residents of
				the dementia care unit shall not be allowed to self-administer
				medications.
2) At a minimum, SLF
				medication management services shall include set up, verbal reminders, and
				documentation by CNA or licensed nurse, as applicable, that medication was
				taken or refused.
3) All medication
				administration shall be delivered by a licensed nurse.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.650 - Reimbursement for Medicaid Residents

Current through Register Vol. 48, No. 28, July 12, 2024
The Department shall establish its portion of the
				  reimbursement for Medicaid residents residing in the dementia care unit by
				  calculating 72 percent of the weighted average (weighted by Medicaid patient
				  days), for the geographic group in which the Supportive Living Program (SLP) is
				  located (see Section
				  146.290 ), paid
				  for Medicaid-eligible nursing facility residents residing in Department of
				  Public Health certified Alzheimer's special care units pursuant to 77 Ill. Adm.
				  Code
				  300.163.
a) Notwithstanding the provisions set forth
				in 89 Ill. Adm. Code
				153.126,
				and subject to federal CMS approval, as of July 1, 2014, rates for the
				supportive living programs with residents residing in a dementia care unit
				shall no longer be 72 percent of the weighted average nursing facility rates
				for the geographic group rate, based upon the nursing facility geographic group
				in which it is located.
b)
				Notwithstanding the provisions set forth in 89 Ill. Adm. Code 153.126, and
				subject to federal CMS approval, for dates of service on or after July 1, 2014,
				rates effective June 30, 2014 shall be increased 8.85 percent.
c) Notwithstanding the provisions set forth
				in 89 Ill. Adm. Code 153.126, and subject to federal CMS approval of the
				imposition of the assessment in 89 Ill. Adm. Code
				140.86,
				for dates of service on or after July 1, 2014, rates effective July 1, 2014
				shall be increased an additional 9.09 percent.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.660 - Staffing

Current through Register Vol. 48, No. 28, July 12, 2024
a) The SLF manager
				shall be responsible for the entire facility, including the dementia care unit.
				However, this does not preclude the SLF from hiring a separate manager or
				director to oversee the dementia care unit.
b) The SLF shall have no less than one
				licensed nurse available at all times on-site or on-call to meet medication
				administration needs of the resident in the dementia care unit. The licensed
				nurse may share duties in the general SLF.
c) The SLF shall have no less than one
				certified nursing assistant (CNA) for every ten residents on all shifts.
				Roommates without dementia shall not be used when determining the 1:10 staff to
				resident ratio. CNAs on duty in the dementia care units shall be awake at all
				times. The CNA cannot work in the general SLF during the same shift.
d) The SLF dementia care unit may share
				activity, dietary, housekeeping and maintenance staff with the general SLF
				population.
e) All staff who work
				on the unit (e.g., nurses, CNAs, housekeepers, activities staff) shall have
				four hours of training specific to working with persons with Alzheimer's
				disease or related dementia within seven days after working on the unit. The
				training shall include, but not be limited to, the following:
1) Information about the causes, nature,
				progression and management of Alzheimer's disease and other dementia;
2) Techniques for successful
				communication;
3) Handling
				behavior;
4) Planning
				activities;
5) Techniques for
				creating an environment that minimizes behavior;
6) Identifying and minimizing safety
				risks;
7) Delivering personal care;
				and
8) How to partner with families
				and the community.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.670 - Assessment and Service Plan and Quarterly Evaluation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Residents who move from the general
				population of the SLF to the dementia care unit shall be reassessed prior to
				the move. This includes a new Comprehensive Resident Assessment and Service
				Plan. This provision does not apply to a free-standing SLF dementia care
				unit.
b) In addition to the
				Comprehensive Resident Assessment, a more in-depth mental and cognitive
				assessment, the Saint Louis University Mental Status (SLUMS) or the Montreal
				Cognitive Assessment (MOCA), shall be required. During the term of the pilot,
				the Department has the sole discretion to require a different or additional
				in-depth assessment as determined by the Department's evaluation during the
				pilot.
c) A Department-designated
				quarterly assessment specifically designed for use in the dementia care unit
				shall be used.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.680 - Monitoring

Current through Register Vol. 48, No. 28, July 12, 2024
Designated Department staff shall monitor compliance for
				  certification of the dementia care unit no less than
				  biannually.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.690 - Reporting Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Costs
				for the dementia care unit shall be included in the cost report required under
				Section
				146.265(c)(4);
				however, for purposes of this pilot, the SLF with a dementia care unit shall
				also submit a separate cost report reflecting only the costs associated with
				the dementia care unit.
b)
				Residents of the dementia care unit shall be identified separately when
				submitting the Resident Identification Report required in Section
				146.265.
c) The Department reserves
				the right to request periodic reporting to assist with evaluation of the
				pilot.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.700 - Resident Rights

Current through Register Vol. 48, No. 28, July 12, 2024
a) Department
				posters with the phone number of the Department's Complaint Hotline shall be
				posted on the dementia care unit in a location accessible to all residents.
				Department brochures providing resident rights and the phone number to the
				Complaint Hotline shall be made available to all residents and their families
				or designated representatives.
b)
				Long Term Care Ombudsman Program posters provided by the ombudsman shall be
				posted on the dementia care unit in a location accessible to all
				residents.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart E - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS › Section 146.710 - Discharge

Current through Register Vol. 48, No. 28, July 12, 2024
No resident shall remain in the dementia care unit if he or
				  she is a danger to self or others and the SLF is unable to eliminate the danger
				  through the use of treatment modalities or interventions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart F - BIRTH CENTERS › Section 146.800 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
This Part sets forth the conditions that a birth center must
				  meet in order to participate in medical programs administered by the
				  Department. For the purposes of this Part, "birth center" means an alternative
				  healthcare delivery model that is exclusively dedicated to serving the
				  childbirth-related needs of women and their newborns and has no more than 10
				  beds. A birth center is a designated site in which births are planned to occur
				  following a normal, uncomplicated, and low-risk pregnancy that is away from the
				  mother's usual place of residence.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart F - BIRTH CENTERS › Section 146.810 - Participation Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
Effective May 1, 2013, to participate in medical programs
				  administered by the Department, a birth center must:
a) Meet all requirements for licensure
				established by the Illinois Department of Public Health at 77 Ill. Adm. Code
				265.1250.
b) Meet all requirements for enrollment and
				participation in medical programs administered by the Department as defined in
				Subpart B of 89 Ill. Adm. Code 140.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart F - BIRTH CENTERS › Section 146.820 - Record Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
In addition to Department record requirements in 89 Ill. Adm.
				  Code 140, a birth center must maintain complete, comprehensive and accurate
				  clinical records to ensure adequate patient care. These records include, but
				  may not be limited to, the record requirements identified in the Illinois
				  Department of Public Health's administrative rules at 77 Ill. Adm. Code
				  265.2200. The
				  Department shall describe, by notice to providers, any other records that are
				  to be maintained.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart F - BIRTH CENTERS › Section 146.830 - Covered Birth Center Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department shall pay a birth center for the provision of essential delivery
				services, not otherwise excluded or limited, that are provided by a birth
				center in compliance with birth center licensure standards (see 77 Ill. Adm.
				Code 265).
b) The Department shall
				pay a birth center for observation services, the need for which must be
				documented in the medical record. The practitioner's orders must support the
				need for observation services and the corresponding nurses' notes must document
				that skilled observation services were furnished.
c) The Department shall pay a transfer fee to
				a birth center when a birth center transfers a woman to a hospital due to
				complications arising prior to the delivery.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart F - BIRTH CENTERS › Section 146.840 - Reimbursement of Birth Center Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Facility services provided by a birth
				center located in Cook County will be reimbursed at the lower of billed charges
				or 75 percent of the average facility payment rate made to a hospital located
				in Cook County for an uncomplicated vaginal birth.
b) Facility services provided by a birth
				center located outside of Cook County will be reimbursed at the lower of billed
				charges or 75 percent of the statewide average facility payment rate made to a
				hospital located outside of Cook County for an uncomplicated vaginal
				birth.
c) Observation services will
				be reimbursed at the lower of billed charges or at 75 percent of the rate
				established by the Department for the number of hours of observation billed
				pursuant to 89 Ill. Adm. Code
				148.140(b)(1)(D)
				 as reflected at
				http://www2.illinois.gov/hfs/PublicInvolvement/hospitalratereform/Pages/
				Rules.aspx through dates of service on June 30, 2014. Effective for dates of
				service on or after July 1, 2014, observation services will be reimbursed at
				the lower of billed charges or $53.56 for 1 hour or more.
d) Transfer fees for a birth center located
				in Cook County will be reimbursed at the lower of billed charges or 15 percent
				of the average facility payment rate made to a hospital located in Cook County
				for an uncomplicated vaginal birth.
e) Transfer fees for a birth center located
				outside of Cook County will be reimbursed at the lower of billed charges or 15
				percent of the statewide average facility payment rate made to a hospital
				located outside of Cook County for an uncomplicated vaginal birth.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart G - SPECIALIZED MENTAL HEALTH REHABILITATION FACILITIES › Section 146.900 - General Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Specialized Mental Health Rehabilitation Act of 2013 [210 ILCS 49 ] provides
				for licensure of long-term care facilities that are federally designated as
				institutions for mental disease on the effective date of the Act and specialize
				in providing services to individuals with serious mental illness. On and after
				July 22, 2013, these facilities shall be governed by the Act and this Part
				instead of the Nursing Home Care Act.
b) All consent decrees that applied to
				facilities federally designated as institutions for mental disease prior to the
				enactment of the Specialized Mental Health Rehabilitation Act shall continue to
				apply to facilities licensed under the Specialized Mental Health Rehabilitation
				Act of 2013.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart G - SPECIALIZED MENTAL HEALTH REHABILITATION FACILITIES › Section 146.910 - Reimbursement

Current through Register Vol. 48, No. 28, July 12, 2024
a) Facilities
				licensed under Specialized Mental Health Rehabilitation Act of 2013 shall be
				reimbursed at:
1) The rate in effect on June
				30, 2014, less $7.07 for each facility
				previously licensed under the Nursing Home Care Act on June 30, 2013;
2) The rate in effect on June 30, 2013 for
				each facility licensed under the Specialized Mental Health Rehabilitation Act
				on June 30, 2013;
3) Effective for
				services provided on or after July 1, 2017, the rate in effect on June 30, 2017
				increased by 2.8 %;
4) Effective for services provided on or
				after July 1, 2018, the rate in effect on June 30, 2018 increased by 4%;
				or,
5) Effective for services
				provided on or after July 1, 2022, the rate in effect on June 30, 2022,
				increased by 5%.
6) Effective for
				services provided on or after October 1, 2022, providers outside of the Chicago
				metro area will have their rates increased to reflect the Chicago area regional
				wage factor.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1000 - Applicability of This Part

Current through Register Vol. 48, No. 28, July 12, 2024
a) These
				rules and regulations replace and supersede rules and regulations related to
				the reimbursement of medically complex for the developmentally disabled (MC/DD)
				facilities, adopted by the Illinois Department of Human Services at 89 Ill.
				Adm. Code 144, except that any proceeding arising from any occurrence happening
				prior to the applicable provision of these rules and regulations shall be
				governed by the above described rules.
b) This subpart addresses exceptional care
				requirements and reimbursement rates for MC/DD facilities. The previous
				requirements for exceptional care rates for these facilities at Section
				153.126(i) are
				moved to this Subpart in accordance with Public Act 100-0646. Rates for these
				facilities contain three parts: active treatment costs as defined in this
				Subpart, capital cost (Section
				140.563), and support costs
				(Section 140.561). These rate components
				are subject to the provisions of Section
				153.100(a).
				However, if facility residents qualify for an exceptional care rate as defined
				in this Subpart, the exceptional care rate will be paid to the facility in lieu
				of the other rate components. Any rate adjustments for MC/DD facilities will
				continue to be listed at 89 Ill. Adm. Code
				153.125.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1001 - MC/DD Service Criteria

Current through Register Vol. 48, No. 28, July 12, 2024
Need for MC/DD Services
a) The need for MC/DD services shall be
				established through a comprehensive assessment (see 89 Ill. Adm. Code
				140.642), the Level II
				assessment, that demonstrates that the individual has a condition requiring
				skilled level nursing care, needs active treatment and has either:
1) an intellectual disability; or
2) a related condition that meets all of the
				following conditions:
A) It is attributed to
				cerebral palsy, epilepsy, autism, or any other condition, other than mental
				illness or infirmities of aging, found to be closely related to intellectual
				disability because this condition results in impairment of general intellectual
				functioning or adaptive behavior similar to that of intellectually disabled
				persons, and requires treatment or services similar to those required for these
				persons;
B) It is manifested before
				the person reaches age 22;
C) It is
				likely to continue indefinitely; and
D) It results in substantial functional
				limitations in three or more of the following areas of major life activity:
				self care, understanding and use of language, learning, mobility, self
				direction, and capacity for independent living.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1005 - Determination of Program (Active Treatment) Costs

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department reimburses residential
				facilities for program costs associated with the delivery of active treatment
				to individuals with developmental disabilities, according to information
				obtained during each facility's most recent Inspection of Care (IOC) Review.
				Facilities affected by this Subpart are those certified as Intermediate Care
				Facilities for the Developmentally Disabled (ICF/DD) and licensed as long term
				care facilities for residents with complex or extensive medical needs
				(hereinafter referred to as MC/DD).
b) IOC Review assessments of 100% of the
				Medicaid residents are conducted in these facilities by the Department of
				Public Health every 12 months. These will be conducted in accordance with
				federal regulations at 42
				CFR 456, Subpart I. Program rate
				determination is based upon IOC Review criteria and Specialized Care needs as
				described in Sections
				146.1020 and
				146.1025 in conjunction with the
				reimbursement methodology found at Section
				146.1035.
c) Reimbursable services under this Section
				do not include services to maintain generally independent individuals who are
				able to function with little supervision or in the absence of a continuous
				active treatment program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1010 - Inspection of Care and Rate Setting Appeal Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) Inspection of Care Appeal Process
1) Resident Assessment - A facility may
				request an appeal of the resident assessment conducted by the Inspection of
				Care (IOC) team. Examples of conditions which may be appealed include level of
				functioning (IQ, results of functional assessments and existence of related
				conditions), medical add-ons, behavioral add-ons, major life area limitations,
				special transportation needs, special care nursing and information on the
				developmental training agency attended. Differences between the facility and
				the IOC team regarding the conditions of the residents will be addressed using
				a three-step approach:
A) exit conference
				discussion between the facility and the IOC team;
B) informal review involving the Department
				of Public Health (DPH) regional supervisor and/or central office staff upon
				request by the facility; and
C)
				formal review to be heard by the Department of Healthcare and Family Services,
				Bureau of Long Term Care (BLTC) management.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1015 - Exceptional Care Needs of Clients with Developmental Disabilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) Exceptional Care
				Program
1) The Department of Healthcare and
				Family Services (Department) will make exceptional care payments to Medically
				Complex for the Developmentally Disabled Facilities (MC/DD) which meet
				licensure and certification requirements as may be prescribed by the Department
				of Public Health (DPH) (see the Department of Public Health's rules at 77 Ill.
				Adm. Code 390). A participating facility must maintain its licensure and
				certification and be in compliance with the applicable conditions of
				participation and licensing and certification standards to be eligible for
				exceptional care reimbursement. If DPH notifies the facility, in writing, of a
				need for a plan of correction for non-compliance with one or more conditions of
				participation, or that an imposed plan of correction for a Type A or B
				licensure finding is required, or if DPH notifies the facility because it has
				been declared an "immediate and serious threat" to the welfare of any
				residents, that facility will not be allowed to receive exceptional care
				reimbursement for any additional individuals from the date of DPH's written
				notification until the date DPH officially determines any and all of the
				conditions leading to the notification have been satisfactorily resolved. No
				payment for exceptional care shall be made retroactively for any residents
				admitted to the facility while the facility was in violation of DPH's rules at
				77 Ill. Adm. Code 390. Exceptional care payment for such individuals shall
				commence when all such violations have been corrected, if such individuals are
				approved for exceptional care.
2)
				Exceptional medical care is defined as the level of care with extraordinary
				costs related to services which may include nurse, ancillary specialist
				services, and medical equipment and/or supplies that have been determined to be
				a medical necessity.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1025 - Specialized Care - Health and Sensory Disabilities

Current through Register Vol. 48, No. 28, July 12, 2024
These specialized services refer to three categories (Levels)
				  of care which some individuals must receive, fully or in part, in order to
				  attain physical health and development. The delivery of specialized care in
				  accordance with an individual's needs, as determined by the IDT's assessment,
				  enables the individual to participate in the individual program plan (IPP) and
				  be supported toward greater independence. Additional reimbursement is paid for
				  an individual who needs and receives services for health and sensory
				  disabilities (Section
				  146.1035(c)(2)),
				  when those services meet the criteria under subsections (b), (c) or (d).
a) Definitions
1) Ambulatory - The individual is capable of
				walking without assistance or the aid of adaptive equipment or
				devices.
2) Mobile nonambulatory -
				The individual is capable of locomotion with mobility assistance such as
				adaptive equipment or devices.
3)
				Nonmobile - The individual is not capable of locomotion even with mobility
				assistance.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1030 - Functional Needs

Current through Register Vol. 48, No. 28, July 12, 2024
Functional needs are the basic needs of all persons. All
				  functional needs of each individual residing in an MC/DD must be addressed. The
				  individual's IPP must provide a current assessment of his/her developmental
				  level in each area of functional need. On the basis of the assessment outcome,
				  the IDT determines if each area of an individual's functional needs can be
				  addressed independently by the person, or is to be addressed as a service need
				  or through a training program. The IPP specifies the individual's level of
				  dependence/independence, types of assistance needed, and developmental skill
				  interventions (programs) designed to increase functional independence. The IPP
				  shall address skill maintenance if the individual demonstrates any skill
				  regression or loss of functional status. The individual's preferences shall
				  also be acknowledged (i.e., tub or shower bathing). Additional reimbursement is
				  paid for an individual who needs and receives partial or total assistance in
				  meeting functional needs (Section
				  146.1035(c)(2)).
				  This reimbursement is provided only when an individual meets the criteria for
				  mobility assistance or high personal care under Specialized Care-Health and
				  Sensory Disabilities (Section
				  146.1025(b) and
				  (c)). The functional needs of all individuals
				  are:
a) Bathing. Bathing means bathing
				all, or some part of the body, including the hair, whether the bath occurs in a
				tub, shower, or bed;
b) Clothing.
				Clothing means total dressing and undressing, including stockings or socks and
				shoes;
c) Eating. Eating means to
				consume or assimilate food or nutriments to fulfill nutritional needs. Eating
				includes both oral and tube feedings;
d) Grooming/Personal Hygiene.
				Grooming/personal hygiene means bodily maintenance including combing hair,
				cleaning and clipping nails, shaving if applicable, tooth brushing and oral
				hygiene including denture care, daily deodorant use, hygiene associated with
				menstruation, makeup application when desirable and appropriate, daily hands
				and face washing;
e)
				Toileting/Continence. Toileting means the appropriate use of a toilet,
				including related undressing/dressing activities, and necessary follow-up
				hygiene;
f) Mobility. Mobility
				means the power of locomotion and includes transfers/movements which are
				accomplished by independent ambulation and via the employment of assistive
				devices such as walkers, wheelchairs, braces, and prostheses; and
g) Psychosocial Mental Status. Psychosocial
				mental status means the achievement of a sense of well-being and emotional
				balance in one's relationship with self, other persons, and one's daily
				environment.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Table A - Guidelines for Determining Levels of Functioning

Current through Register Vol. 48, No. 28, July 12, 2024
COGNITIVE ABILITY IQ SCORE
FUNCTIONAL ADAPTIVE BEHAVIORS
CONDITIONS
LEVEL OF FUNCTIONING
I.
Mild
Moderate
Severe/
Moderate or
Severe
Profound
Behavior
Based on Cognitive
Ability with
Specialized Service I, II, III, if applicable.
If a person's assessed adaptive behaviors are lower
							 than the assessed cognitive ability because of behavior, then the overall
							 functioning should be based upon the person's cognitive ability.
II.
Mild
Moderate
Severe/Profound
Moderate
Severe
Severe/Profound
Epilepsy
Autism
Cerebral Palsy
Based upon adaptive level. May also be eligible for
							 specialized service.
If a person's assessed adaptive behavior is lower
							 than the assessed cognitive ability because of a related condition (epilepsy,
							 autism, cerebral palsy or a seizure disorder which is/are currently active and
							 affect daily living), level of functioning should be based upon the person's
							 adaptive functional behavior.
III.
Mild
Moderate
Severe/Profound
Moderate or
Severe
Severe or Profound
None
Based upon the cognitive ability.
If a person's assessed adaptive behavior is lower
							 than the assessed cognitive ability, but not due to a related condition, then
							 the overall level of functioning is based upon the cognitive ability.
IV.
Mild
Moderate
Severe/Profound
Mild
Mild
Moderate
None
Based upon adaptive functional behavior.
If a person's assessed adaptive behavior is higher
							 than the assessed cognitive ability, then the overall level of functioning is
							 based upon the adaptive behavior.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Table B - Standardized Adaptive Functional Assessment

Current through Register Vol. 48, No. 28, July 12, 2024
Mental Age Level Equivalents With Level of Functioning
Adult Mental Age Functional Age
Mild
8 years, 6 months to 10 years, 1 month
Moderate
6 years, 1 month to 8 years, 5 months
Severe
3 years, 9 months to 6 years, 0 months
Profound
Below 3 years, 9 months
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 147 - REIMBURSEMENT FOR NURSING COSTS FOR GERIATRIC FACILITIES › Section 147.105 - Midnight Census Report

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
			 census recorded must reflect the complete activities which took place in the 24
			 hour period from midnight. Midnight is defined as the last minute of the last
			 hour of the day.
b) The facility is
			 required to compile a midnight census report daily. The information to be
			 contained in the report includes:
1) Total
			 licensed capacity.
2) Current
			 number of residents in-house.
3)
			 Names and disposition of residents not present in facility, i.e. therapeutic
			 home visit, home visit, hospital (payable bedhold), hospital (non-payable
			 bedhold), other.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 147 - REIMBURSEMENT FOR NURSING COSTS FOR GERIATRIC FACILITIES › Section 147.300 - Payment to Nursing Facilities Serving Persons with Mental Illness

Current through Register Vol. 48, No. 28, July 12, 2024
a) Reimbursement
			 rates for nursing facilities (ICF and SNF) for program costs associated with
			 the delivery of psychiatric rehabilitation services to residents with mental
			 illness will remain at the level in effect on January 1, 2001, except as may
			 otherwise be provided by
			 305 ILCS 5/5-5.4
			 and 89 Ill. Adm. Code 153.
b)
			 Payment for services provided by nursing facilities for residents who have a
			 primary diagnosis of mental illness will be dependent upon the facility meeting
			 all criteria specified in 77 Ill. Adm. Code
			 300.4000
			 through
			 300.4090.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 147 - REIMBURSEMENT FOR NURSING COSTS FOR GERIATRIC FACILITIES › Section 147.301 - Sanctions for Noncompliance

Current through Register Vol. 48, No. 28, July 12, 2024
Based on a finding of noncompliance by the Department of Public
				Health on the part of a nursing facility with any requirement for providing
				services to persons with mental illness pursuant to 77 Ill. Adm. Code
				300.4000
				through
				300.4090,
				the Department may take action to terminate or suspend the facility pursuant to
				89 Ill. Adm. Code
				140.16
				and
				140.19
				or recommend to the Department of Public Health imposition of any of the
				remedies or penalties available under the Nursing Home Care Act [220 ILCS
				45/3-101 ].
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 147 - REIMBURSEMENT FOR NURSING COSTS FOR GERIATRIC FACILITIES › Section 147.310 - Implementation of a Case Mix System

Current through Register Vol. 48, No. 28, July 12, 2024
P.A. 98-0104 requires the Department to implement, effective
				January 1, 2014, an evidence-based payment methodology for the reimbursement of
				nursing services. The methodology shall take into consideration the needs of
				individual residents, as assessed and reported by the most current version of
				the nursing facility Minimum Data Set (MDS), adopted and in use by the federal
				government.
a) This Section establishes
			 the method and criteria used to determine the resident reimbursement
			 classification based upon the assessments of residents in nursing facilities.
			 All formulas, data sources, data sources, and collection periods specific to
			 the base rate, addons, pass through allocations, incentives and adjustments
			 specified in this section shall be published in sufficient detail to make an
			 appropriate estimation of appropriate payment in the Department's rate handbook
			 no later than July 20, 2022, and posted on the Department's website. Within 24
			 hours of publishing, the Department shall issue a provider notice to direct
			 them to the website. Each nursing facility shall be notified in advance of the
			 beginning of each quarter of its nursing component rate and all add-ons and
			 adjustments stated as a per diem except retention, promotion, and quality
			 incentive add-ons, which shall be stated as a quarterly lump sum payment. The
			 notice shall clearly state the amount attributed to each addon or adjustment
			 and in the case of the variable staffing add-on any adjustment resulting from
			 the application of 147.310(c)(3)(I).
			 The notice shall also clearly state the percent of Medicaid bed days used to
			 determine eligibility for the Medicaid Access Adjustment.
1) Effective January 1, 2014, resident
			 reimbursement classification shall be established utilizing the 48-group,
			 Resource Utilization Groups IV (RUG-IV) classification scheme and weights as
			 published by the United States Department of Health and Human Services, Centers
			 for Medicare and Medicaid Services (CMS).
2) Effective July 1, 2022, resident
			 reimbursement classification shall be established utilizing the Patient Driven
			 Payment Model (PDPM) nursing component classification methodology and
			 associated weights, as published by the United States Department of Health and
			 Human Services, Centers for Medicare and Medicaid Services (CMS), as of March
			 1, 2022, multiplied by
			 0.7858 and rounded to the
			 nearest four decimal places.
3) An
			 Illinois specific default group of AA1 is established in subsection (c)(5) of
			 this Section and with an assigned weight equal to the weight assigned to group
			 PA1.