Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.648 - Determination of the Amount of Reimbursement for Developmental Training (DT) Programs

Current through Register Vol. 48, No. 28, July 12, 2024
a) A DT
				program which is certified by the Department of Mental Health and Developmental
				Disabilities (DMHDD), shall be reimbursed for active treatment services
				delivered on or after January 1, 1990, to eligible participants.
b) The total rate shall be comprised of a
				Program Component and an Agency Component. Reimbursement levels for the Program
				Component shall be derived from four determinants which, in combination, shall
				result in the total Program per diem amount. The four determinants will be
				reviewed and validated according to information provided in the most recent
				Inspection of Care (IOC) conducted by Department surveillance staff in a long
				term care (LTC) facility (nursing facility or ICF/MR). Where dollar, wage or
				salary amounts are used, respective amounts shall be inflated to the fiscal
				year for which reimbursement shall be made.
c) Program Component. The four determinants
				which result in the total Program Component per diem are:
1) Direct Services - DT agencies shall be in
				compliance with the Health Care Financing Administration's (HCFA) minimum
				average daily staffing standards ( 42 CFR 442.430(1990) ) relative to client
				population according to each individual's overall leval of functioning. In
				order to meet and exceed the staffing standards set by HCFA and to assure
				adequate reimbursement for the delivery of active treatment service, the
				Department shall base reimbursement for direct service staff at the following
				per shift ratios:
Overall Level of Functioning
FTE*Staff: Client Ratio
Mild
1:10
Moderate
1:8
Severe-Profound
1:5
*FTE = Full Time Equivalent
A)
				Determination of levels of functioning of clients with mental retardation and
				related conditions, in accordance with the definition of the American
				Association of Mental Retardation (mental retardation refers to significantly
				subaverage general intellectual functioning existing concurrently with deficits
				in adaptive behavior and manifested during the developmental period), shall
				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
				shall be administered by a psychologist who is registered in Illinois under the
				Illinois Psychological Act (Illinois Department of Professional Regulation);
				and
ii) an assessment of adaptive
				behaviors using a national 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 shall be
				utilized by at least one Qualified Mental Retardation Professional (QMRP) (89
				Ill. Adm. Code
				144.275(b)(1)
				 and
				42 CFR
				483.430(1989) to evaluate
				each client's functional skills and adaptive behaviors. The Scales of
				Independent Behavior and the Inventory for Client and Agency Planning are
				published by, and available from, DLM Teaching Resources, 1 DLM Park, Allen,
				Texas 75002 (1-800-527-4747). The 1986 edition is incorporated and no later
				amendments or editions are included.
iii) The final determination of each client's
				overall level of functioning employs both the assessment of intellectual
				functioning and the assessment of adaptive behaviors, and will be made
				according to the criteria set forth in 89 Ill. Adm. Code 144.Table D and
				144.Table E.