reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.487 - Healthy Kids Program Timeliness Standards

Current through Register Vol. 48, No. 28, July 12, 2024
These timeliness standards for required Healthy Kids services
				  or activities apply regardless of the source from which medical or dental care
				  is provided.
a) Activity 1: Informing
				Eligible Families
1) Description:
The Department shall inform eligible families in writing
				  about the Healthy Kids Program, including: the importance of preventive health
				  care; the services which are available; how to request assistance in
				  identifying a willing and qualified provider or how to request assistance in
				  obtaining transportation to and from health care appointments; and that the
				  services are available at no cost to an eligible recipient, except as may be
				  limited by a spenddown requirement.
2) Timeliness Standards:
A) At the time of application for public
				assistance, the applicant will be informed orally by the intake worker and in
				writing.
B) An applicant determined
				to be eligible for benefits shall be informed by mail within sixty (60)
				calendar days of the date of the determination of eligibility for Medicaid
				services.
C) All eligible persons
				shall be informed annually by mail.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.488 - Periodicity Schedules, Immunizations and Diagnostic Laboratory Procedures

Current through Register Vol. 48, No. 28, July 12, 2024
a) Health Screening
				Periodicity Schedule. Eligible clients may receive one periodic health
				screening during each of the following time periods, except a second screening
				may be given as explained in Section
				140.485(d)(2):
1) birth to two weeks;
2) two weeks to one month;
3) one to two months;
4) two to four months;
5) four to six months;
6) six to nine months;
7) nine to 12 months;
8) 12 to 15 months;
9) 15 to 18 months;
10) 18 to 24 months;
11) two to three years;
12) three to four years;
13) four to five years;
14) five to six years;
15) six to eight years;
16) eight to 10 years;
17) 10 to 12 years;
18) 12 to 14 years;
19) 14 to 16 years;
20) 16 to 18 years; and
21) 18 to 21 years.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.491 - Medical Transportation Limitations and Authorization Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) For payment to
				be made, the transportation service must be to the nearest available
				appropriate provider, by the least expensive mode that is adequate to meet the
				individual's need. When public transportation is available and is a practical
				form of transportation, payment will not be made for a more expensive mode of
				transportation.
b) Approval from
				the Department, or its authorized agent, is required prior to providing
				transportation to and from the source of medical care, except:
1) For transportation provided by an
				ambulance in emergency situations.
2) For transportation provided by an
				ambulance for an individual who is transported from one hospital to a second
				hospital for services not available at the sending hospital.
3) For transportation provided by a
				helicopter when it is demonstrated to be medically necessary as indicated by
				the written order of the responsible physician in an emergency situation. An
				emergency may include, but is not limited to:
A) life threatening medical
				conditions;
B) severe burns
				requiring treatment in a burn center;
C) multiple trauma;
D) cardiogenic shock; and
E) high-risk neonates.
4) When post-authorization, informal review
				of request for appeal, and appeal are allowed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.493 - Payment for Helicopter Transportation

Current through Register Vol. 48, No. 28, July 12, 2024
Notwithstanding the provisions set forth in this Section,
				  beginning July 1, 2002, the reimbursement rates paid for helicopter
				  transportation services shall be the lesser of the provider's usual and
				  customary charge to the general public or 94 percent of the fiscal year 2002
				  rate otherwise determined by the Department under this Section. Notwithstanding
				  Section
				  140.405,
				  beginning with dates of service July 1, 2013 and thereafter, the Department's
				  established maximum rate for helicopter transportation services shall be
				  equivalent to 100% of the rate in effect on June 30, 2012, as reflected on the
				  Department's Fee Schedule. Payment for helicopter transportation services shall
				  be made in accordance with the methodologies outlined in this Section. In no
				  case shall rates exceed the Medicare allowable, where applicable, or the rates
				  charged to the general public. The Department shall pay for medically necessary
				  helicopter transportation services provided in accordance with Section
				  140.491(b)(3)
				  at an all inclusive rate that includes base rate, mileage, supplies and all
				  other services.
a) Helicopter
				transportation providers will be reimbursed a maximum rate per trip or the
				usual and customary charges, whichever is less.
b) If a hospital provides the transport team
				but does not own the helicopter, the Department will equally divide the
				established reimbursement rate or the usual and customary charges of the
				provider, whichever is less, between the hospital and the helicopter
				provider.
c) Hospitals that own
				their own helicopter and report its costs on their cost reports will not be
				paid for helicopter transportation services.
d) The Department shall not cover the
				services of helicopter transportation providers that have entered into payment
				agreements with receiving facilities.
e) Helicopter transportation claims that are
				denied because the patient does not meet the medically necessary criteria (see
				Section
				140.491(b)(3)
				), but does meet emergency ground transportation criteria, will be reimbursed
				by the Department at the appropriate ground rate.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.494 - Record Requirements for Medical Transportation Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) The record must,
				at a minimum, contain a dispatcher's log and individual trip tickets that
				document:
1) Identification of the client
				(name, address and client number);
2) Name and address or facility name of
				person or entity requesting service;
3) A copy of the Transportation
				Invoice;
4) Identification of the
				type of vehicle used (for example, ambulance, medicar, service car) and the
				vehicle's license plate number; and
5) The name of the driver and attendant, if
				applicable.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.495 - Psychological Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Payment
				for the provision of psychological services shall be made to:
1) A psychologist in private
				practice.
2) State-aided Community
				Mental Health Clinics.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.496 - Payment for Psychological Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Payment is made to a psychologist in
				private practice in an amount which is the lesser of:
1) The psychologist's usual and customary
				charges, or
2) The prevailing rate
				determined by the Department based on the time involved and the tests
				administered.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.497 - Hearing Aids

Current through Register Vol. 48, No. 28, July 12, 2024
a) Hearing aids are
				reimbursed in accordance with Section
				140.481(d).
b) In order to be eligible for reimbursement
				from the Department for monaural and binaural hearing aids, the following
				criteria must be met:
1) When testing is
				performed in an acoustically treated sound suite:
A) The hearing loss must be 20 decibels or
				greater at any two of the following frequencies: 500, 1000, 2000, 4000, 8000
				Hertz; or
B) The hearing loss must
				be 25 decibels or greater at any one of 500, 1000, 2000 Hertz.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.498 - Fingerprint-Based Criminal Background Checks

Current through Register Vol. 48, No. 28, July 12, 2024
a) Vendors who pose a risk of fraud, waste,
				abuse or harm, as defined in Section
				140.13, and
				applicants of the Medical Assistance Program shall submit to a
				fingerprint-based criminal background check on current and future information
				available in the State system for criminal background checks, and current
				information available through the Federal Bureau of Investigation's fingerprint
				system, by submitting all necessary fees and information in the form and manner
				prescribed by the Illinois State Police. New vendor applicants must submit to
				fingerprint-based criminal background checks within 30 days after the
				submission of the application. When the Department initiates a re-enrollment of
				all classes of vendors pursuant to Section
				140.11(e),
				the Department may require the vendors to re-submit to fingerprint-based
				criminal background checks as provided in this Section. Fingerprint-based
				criminal background checks requested pursuant to Section
				140.11(e)
				must be submitted within 60 days after the submission of the updated enrollment
				information. Vendors shall be responsible for the payment of the costs of
				fingerprint-based criminal background checks.
b) The following individuals shall be subject
				to the fingerprint-based background check:
1)
				In the case of a vendor that is a corporation, all officers and individuals
				owning, directly or indirectly, five percent or more of the shares of stock or
				other evidence of ownership in a corporate vendor.
2) In the case of a vendor that is a
				partnership, every partner.
3) In
				the case of a vendor that is a sole proprietorship, the sole
				proprietor.
4) Each officer and
				each individual with management responsibility of the vendor.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.499 - Behavioral Health Clinic

Current through Register Vol. 48, No. 28, July 12, 2024
The Behavioral Health Clinic (BHC) shall:
a) Provide community-based mental health
				services pursuant to Section
				140.453;
b) Enroll with the Department as a medical
				provider pursuant to Section
				140.11
				and comply with Subparts A and B;
c) Not be enrolled for participation in the
				Medical Assistance Program as a clinic pursuant to Section
				140.460(a)
				or as a Community Mental Health Center pursuant to 59 Ill. Adm. Code
				132;
d) Provide cost reporting
				information to the Department in a manner and format specified by the
				Department with a minimum of 90 days written notice; and
e) Comply with requirements established in
				Table O.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.500 - Long Term Care Services

Current through Register Vol. 48, No. 28, July 12, 2024
Payments to provide medical long term care services to
				  Medicaid clients shall be made only to facilities licensed by the Illinois
				  Department of Public Health and approved and certified for participation by
				  that Department except such payments as are made pursuant to Section
				  140.504,
				  Section
				  140.506
				  or 89 Ill. Adm. Code
				  104.273.
				  These facilities include skilled nursing homes (SNF), intermediate care
				  facilities (ICF), intermediate care facilities for the mentally retarded
				  (ICF/MR), skilled nursing homes for pediatrics (SNF/PED), specialized living
				  centers (SLC), and State operated facilities. Provision of and payments for
				  long term care services are governed by Sections
				  140.500
				  through
				  140.907
				  and 89 Ill. Adm. Code 104.273.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.502 - Cessation of Payment at Federal Direction

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may cease payments for the care of a resident
				  in a long term care facility, who is eligible under the Medical Assistance
				  Program, effective 30 days following the final disqualification of that
				  facility by the federal government from participation in the Medicare or
				  Medicaid programs, unless the Department shall have determined pursuant to
				  Section
				  140.504
				  that payment should be continued for that resident.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.503 - Cessation of Payment for Improper Level of Care

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may cease payments for the care of a resident
				  in a long term care facility, who is eligible under the Medical Assistance
				  Program, effective 30 days following the Department's decision that the
				  facility does not provide a level of care commensurate with the level of care
				  needed by that resident, unless the Department shall have determined that
				  payments should be continued for that resident. The Department has sole
				  discretion to continue payment when there are circumstances affecting the
				  health, safety and welfare of the resident that justify continued payment. Such
				  circumstances include, but are not limited to, alternate facility placement
				  cannot be found or transfer of a resident, as certified by a physician, may
				  endanger the resident's life.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.504 - Cessation of Payment Because of Termination of Facility

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department shall cease payments for
				the care of a Medicaid client residing in an ICF/MR facility effective 30 days
				following the Department's decision after hearing that the facility be
				terminated from participation in the Department's Medical Assistance Program,
				unless the Department determines, pursuant to subsection (c) below, that
				payments should be continued.
b)
				The Department shall cease payments for care of a Medicaid client residing in a
				nursing home (not an ICF/MR facility) effective with the termination date
				established by the Department, unless the Department determines, pursuant to
				subsection (c) below, that payments should be continued. Pursuant to 89 Ill.
				Adm. Code
				104.208(c),
				the termination will be effective on such date regardless of whether any
				hearing requested has been completed.
c) The Department has sole discretion to
				continue payment after the termination date when there are circumstances
				affecting the health, safety, and welfare of the long term care facility's
				residents which justify continued payment. Such circumstances include, but are
				not limited to, alternate facility placement cannot be found or transfer of a
				resident, as certified by a physician, may endanger the resident's
				life.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.505 - Informal Hearing Process for Denial of Payment for New ICF/MR Admissions

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department
				may deny payment for new admissions to an Intermediate Care Facility for the
				Mentally Retarded (ICF/MR) that is found to be out of compliance with the
				applicable conditions of participation ( 42 CFR 483, Subpart I) as the result
				of a survey and follow-up survey conducted by the Department of Public Health
				(DPH). The sanction of denial of payment for new admissions shall be imposed if
				the facility has failed to correct cited deficiencies and comply with
				conditions of participation for ICFs/MR within 60 days after the exit date of
				the DPH initial survey. The Department shall only impose the sanction of denial
				of payment for new admissions if the facility has been issued a notice of
				termination/decertification pursuant to 89 Ill. Adm. Code
				104.208(d).
b) If, at the end of the 60 days referenced
				in subsection (a) of this Section, the facility has not achieved compliance,
				the Department shall issue a written notice to the facility setting forth:
1) A statement that the Department intends to
				impose the sanction of denial of payment for new admissions; and
2) A statement that the facility is entitled
				to an informal hearing prior to imposition of the sanction.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.506 - Provider Voluntary Withdrawal

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				A long term care facility may voluntarily withdraw from participation in the
				Medical Assistance Program by notifying the Department in writing at least 60
				days prior to the effective date of the withdrawal.
b) If a long term care facility informs the
				Department that it intends to withdraw from the Medical Assistance Program, the
				Department shall not pay for the care of new admissions to the facility on or
				after the effective date of voluntary withdrawal.
c) The Department shall continue to pay for
				the care of individuals who are residing in a facility which voluntarily
				withdraws from participation in the Medical Assistance Program provided that:
1) Payment is not terminated by operation of
				Sections
				140.502,
				140.503
				or
				140.504.
2) The facility continues to receive
				certification surveys and enters into provider agreements.
3) The individual has continuously resided in
				the facility since the day before the effective date of the facility's
				voluntary withdrawal with the Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.507 - Continuation of Provider Agreement

Current through Register Vol. 48, No. 28, July 12, 2024
If the Department continues to pay for a recipient in a group
				  care facility with which the Department no longer has a currently effective
				  provider agreement, the terms of the provider agreement previously in force
				  shall be deemed to continue in force for the purposes of governing the
				  relationship between the provider and the Department in respect to the
				  recipient or recipients remaining in the facility for as long as the recipient
				  remains in that facility as a recipient.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.510 - Determination of Need for Group Care

Current through Register Vol. 48, No. 28, July 12, 2024
The Department, or its designee, shall verify the initial
				  need for group care in accordance with Section
				  140.642.
				  The Department shall verify the continued need for group care in accordance
				  with Sections
				  140.512(b)(3) and
				  (4),
				  140.850
				  through
				  140.880,
				  and
				  140.900
				  through
				  140.902.
				  The prior approval of the Department or its designee is required before
				  payments will be authorized for a recipient admitted to a group care facility.
				  Approval shall be based on a determination that a need for group care exists
				  and that the provider meets the participation requirements of Sections
				  140.11
				  and
				  140.12.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.511 - Long Term Care Services Covered By Department Payment

Current through Register Vol. 48, No. 28, July 12, 2024
Skilled nursing facilities and intermediate care facilities
				  (SNF and ICF) and intermediate care facilities for the mentally retarded
				  (ICF/MR) providing long term care to Medicaid eligible residents shall provide
				  the following services at no additional charge:
a) All staff, routine equipment and supplies
				including oxygen (if less than one tank has been furnished to the resident for
				the month in question);
b) Room and
				board, supervision and oversight, and all laundry services;
c) Food substitutes and nutritional
				supplements;
d) Medications which
				are regularly available without prescription at a commercial pharmacy and which
				may be stocked by the facility under Department of Public Health
				regulations;
e) Over-the-counter
				drugs or items ordered by a physician (including but not limited to, drugs and
				items listed in the Department's Long Term Care Provider Handbook, Appendix
				C-26, and excluding drugs and items reimbursed under the Department's Drug
				Program); and
f) All other services
				necessary for compliance with the requirements of the Department of Public
				Health as set forth in Skilled Nursing and Intermediate Care Facilities Code
				(77 Ill. Adm. Code 300) and the Intermediate Care for the Developmentally
				Disabled Facilities Code (77 Ill. Adm. Code 350).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.512 - Utilization Control

Current through Register Vol. 48, No. 28, July 12, 2024
Each intermediate care facility for the mentally retarded
				  (ICF/MR) shall have a written Utilization Review (UR) Plan on file that
				  provides necessary information about each client that is necessary for the
				  Department or its designee to perform UR; see
				  42
				  CFR 456.401 -
				  456.438(1989).
				  The Individual Program Plans that are written for each client residing in the
				  facility can satisfy this requirement.
a) The Department or its designee shall
				conduct medical and utilization reviews (UR) in conjunction with the Inspection
				of Care (IOC) Program, to insure the quality of care provided to residents of
				ICF/MR facilities.
b) Inspections
				of Care of ICFs/MR shall be conducted in accordance with the provisions of 42
				CFR 456, Subparts F and I (1989) to evaluate:
1) The care being provided to
				clients;
2) The adequacy of
				services available in a particular facility;
3) The necessity and desirability of
				continued placement in a particular facility;
4) The feasibility of alternative solutions
				to continued placement in a particular facility;
5) The facility's Utilization Review Plan;
				and
6) The written plan of care for
				each client.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.513 - Notification of Admissions and Changes in Resident Status

Current through Register Vol. 48, No. 28, July 12, 2024
a) Long term care providers shall submit all
				changes in resident status, including, but not limited to, death, discharge,
				requests for enhanced care rates, changes in patient credit, and third party
				liability (TPL), to the Department through the Medical Electronic Data
				Interchange (MEDI) system or through an Electronic Data Interchange (EDI)
				Service Vendor (see Section
				140.55)
				, formerly known as Recipient Eligibility Verification (REV) system, after the
				change occurs, within the following timeframes:
1) Death of a resident - 15 calendar
				days.
2) Discharge of a resident -
				15 calendar days.
3) Changes in
				patient credit - 45 calendar days.
4) Third party liability - 45 calendar
				days.
5) Request for enhanced care
				rate - 45 calendar days from the effective date of the enhanced rate.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.515 - Management of Recipient Funds-Personal Allowance Funds

Current through Register Vol. 48, No. 28, July 12, 2024
a) The recipient, the correspondent or the
				facility may manage the recipient's personal allowance funds.
b) The monthly personal allowance of each
				recipient is that individual's personal property. The personal allowance may be
				used or accumulate as the recipient or correspondent wishes.
c) Personal allowance funds may be
				accumulated by the recipient as part of allowable assets up to the asset
				disregard. All monies accumulated in excess of the allowable asset limit shall
				be applied toward the cost of care.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.516 - Recipient Management of Funds

Current through Register Vol. 48, No. 28, July 12, 2024
If the recipient manages the funds, that individual shall
				  promptly report changes in circumstances to the local office and notify the
				  local office of any lump sum payment received.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.517 - Correspondent Management of Funds

Current through Register Vol. 48, No. 28, July 12, 2024
If the correspondent manages the funds, that individual
				  shall:
a) Report changes in the
				recipient's circumstances to the local office;
b) Expend the funds for the recipient's
				benefit;
c) Keep an accurate record
				of all expenditures;
d) Safeguard
				the confidentiality of the recipient's funds; and
e) Notify the local office of any lump sum
				payment received.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.518 - Facility Management of Funds

Current through Register Vol. 48, No. 28, July 12, 2024
A facility shall manage a resident's personal funds only upon
				  written authorization from, in order of priority, the resident, the resident's
				  guardian, the resident's representative, or the resident's immediate family
				  member. Such authorization shall be attested to by a witness who has no
				  pecuniary interest in the facility or its operations and who is not connected
				  in any way to facility personnel or the administrator in any manner. If the
				  facility manages such personal funds, it shall:
a) Establish a separate, written record of
				each resident's account;
b) Provide
				a written record of the account at least quarterly to each resident or
				authorized representative included in the account;
c) Retain all records of personal allowance
				funds for three (3) years for residents currently residing in the facility and
				for residents who have died or been discharged from the facility;
d) Report changes in circumstances to the
				local office;
e) Notify local
				office of any lump sum payment received;
f) Keep resident funds in an account or
				accounts which are separate from any facility operating funds or the funds of
				any person other than another resident. The facility shall establish and
				maintain a system that assures a full and complete and separate accounting of
				each resident's account balance. For resident funds that are commingled with
				the funds of other residents, all interest earned on the resident's funds shall
				be pro-rated and properly credited to each resident's account balance. The
				system shall contain documents identifying all transactions made by the
				facility on behalf of the resident. All deposits and withdrawals are to be
				shown by date and amount and identifiable receipts for all purchases must be
				retained; and
g) Notify each
				resident who receives Medicaid benefits when the amount in the resident's
				account reaches $200.00 less than the SSI resource limit for one person. The
				facility must notify the resident that the amount in the account, in addition
				to the value of the resident's other nonexempt resources, exceeds the one
				person SSI resource limit of $2,000.00.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.519 - Use or Accumulation of Funds

Current through Register Vol. 48, No. 28, July 12, 2024
The facility or correspondent shall not expend or allow use
				  of recipient funds for any person other than the recipient. The facility and
				  Department shall explain to the recipient or correspondent that funds are not
				  to be spent for the purchase of or as a contribution toward the purchase of
				  items/equipment that the facility is required to provide for the
				  recipient.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.520 - Management of Recipient Funds - Local Office Responsibility

Current through Register Vol. 48, No. 28, July 12, 2024
The local office shall:
a) Review each recipient's personal allowance
				account during the determination/redetermination process;
b) Provide advice and consultation to the
				recipient regarding handling of personal allowance funds; and
c) Provide counseling to the recipient
				regarding requests to purchase certain items/equipment normally provided by the
				facility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.521 - Room and Board Accounts

Current through Register Vol. 48, No. 28, July 12, 2024
a) A room
				and board account is a record of transactions about the patient's cost of care,
				all monies received which may be applied to the cost of care and the current
				balance of the account.
b) If a
				facility has a room and board account for the recipient it shall:
1) Maintain a ledger of all information
				pertaining to the recipient's expenditures and receipts of all monies of the
				account.
2) Maintain a written
				record of each recipient's account in which all transactions are
				identifiable.
3) Notify the local
				office of the receipt of any lump sum payment.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.522 - Reconciliation of Recipient Funds

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Upon death or discharge of the recipient, the facility shall:
1) File a report of the amount of monies held
				in the recipient's account with the local office.
2) Promptly refund any money belonging to the
				recipient or the recipient's authorized representative.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.523 - Bed Reserves

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Effective for dates of service on or after July 1, 2012, no payments for bed
				reserve days will be made to a facility licensed under the Nursing Home Care
				Act [ 210 ILCS 45 ] or the Specialized Mental Rehabilitation Act [ 210 ILCS 48
				]. However, beginning June 1, 2015, for purposes of therapeutic home visits for
				individuals scoring as TBI on the MDS 3.0, payment shall be approved for bed
				reserve days in facilities that have at least a 90% occupancy level if at least
				80% of their residents are Medicaid eligible. Payment shall be at 75% of the
				facility's current Medicaid per diem rate and shall not exceed 10 days in a
				calendar month.
b) Effective July
				22, 2013, ICF/MR Facilities (including ICF/DD and SNF/Ped licenses)
1) All bed reserves must:
A) be authorized by the interdisciplinary
				team (IDT); and
B) be limited to
				residents who desire to return to the same facility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.524 - Cessation of Payment Due to Loss of License

Current through Register Vol. 48, No. 28, July 12, 2024
Payment to a long term care facility for services to Public
				  Aid recipients will cease effective 30 days following notice from the Illinois
				  Department of Public Health that the facility is no longer
				  licensed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.525 - Quality Incentive Program (QUIP) Payment Levels

Current through Register Vol. 48, No. 28, July 12, 2024
a) For the period beginning July 1, 1991, and
				ending January 31, 1992, Quality Incentive Program (QUIP) payments are:
1) For nursing facilities, the amount they
				were eligible for under QUIP as of July 1, 1991. Additionally, all nursing
				facilities, regardless of QUIP status, receive $.96 per resident, per day for
				this period.
2) For ICF/MR
				facilities, $2.57 per resident, per day.
3) For developmental training (DT) agencies,
				$9.33 per month for each DT client.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.530 - Basis of Payment for Long Term-Care Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) The amount approved for payment for long
				term care services is based on the type and amount of services required by and
				actually being furnished to a resident and is determined in accordance with the
				Department's rate schedule.
b)
				Costs not related to patient care, as well as costs in excess of those required
				for the efficient and economical delivery of care, will not be
				reimbursed.
c) Rates and payments
1) Rates for long term care services shall be
				the sum of the reimbursable costs of capital, support, and nursing, as defined
				in this Part and 89 Ill. Adm. Code 147.
2) Additionally, for county-owned or operated
				nursing facilities, rates shall include allowable costs incurred in excess of
				the reimbursable costs defined in this Part and 89 Ill. Adm. Code 147. Costs in
				excess of reimbursable costs shall be certified from the signed annual cost
				report submitted by the county to the Department.
3) Payment for long term care services is on
				a per diem basis. In determining the number of days for which payment can be
				made, the day of admission to the facility is counted. The day of discharge
				from the facility is not counted, unless it is the day of death and death
				occurs in the facility or a reserved bed has been authorized for that
				day.
4) Payments by the Department
				for long term care services shall not exceed reimbursable costs as defined in
				this Part and 89 Ill. Adm. Code 147 less what is contributed by third party
				liability.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.531 - General Service Costs

Current through Register Vol. 48, No. 28, July 12, 2024
General service costs are allowable as follows:
a) Dietary - Allowable dietary costs include
				salaries and wages earned by those preparing food, serving food, and
				dishwashing; fees paid to dietary consultants; supplies used in preparing and
				serving food; and other items such as soaps and detergents, menus, aprons and
				uniforms for dietary personnel.
b)
				Donated Goods - The fair market value of nondepreciable, care related, donated
				goods is an allowable cost.
c) Food
				- The cost of food and food supplement items are allowable. If meals are sold
				to employees or visitors, the cost of these meals is not allowable. The cost of
				employee meals is allowable only if they are provided at no cost to the
				employee and if their provision is required by contract or is explicitly stated
				in the facility's written wage Personnel policies. If employee meals are
				provided at no cost, they must be reported on the cost report as employee
				benefits.
d) Heat and Other
				Utilities - Cost of fuel or electricity to heat and cool the facility is
				allowable.
e) Housekeeping -
				Allowable costs include salaries and wages of housekeepers, maids, porters,
				janitors, etc., and supplies such as brooms, brushes, cleaning compounds,
				disinfectants, germicides, insecticides, mops, polish, soap, paper towels, and
				drinking cups.
f) Laundry -
				Allowable costs include salaries and wages of laundry personnel, and supplies
				such as linens and soaps, detergents and bleaches to operate laundry service.
				If laundry services are purchased, the expense is allowable. If laundry
				services are sold, the cost of such services is not allowable.
g) Maintenance - Allowable costs include
				salaries and wages of maintenance personnel; supplies, parts, and materials
				required to maintain building and equipment; inspection fees for elevators and
				builders; expense of outside contractors to repair or maintain building or
				equipment.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.532 - Health Care Costs

Current through Register Vol. 48, No. 28, July 12, 2024
Health care costs are allowable as follows:
a) Activities - Allowable costs are salaries
				and wages paid to employees working in the activity program, supplies used in
				the program, and expenses incurred for religious services.
b) Daycare and Outpatient Services - The cost
				of daycare and outpatient services is not allowable.
c) Medical Director - The salary or fee paid
				to a physician serving as medical director is allowable. If the medical
				director provides routine care to patients, that portion of his salary due to
				providing direct care is not an allowable cost and must be allocated to
				ancillary services based on number of hours spent in each function.
d) Non-Paid Workers - Allowable costs are
				salaries at the value that would be paid if employees were hired, only if
				volunteers are used to meet minimum standards and cost is
				determinable.
e) Nursing and
				Medical Records - Allowable costs are salaries and wages paid to nurses, aides,
				orderlies, and medical records personnel; consultant fees; and nursing supplies
				such as adhesive tape, dressings, gauze, rubber goods, thermometers, oxygen,
				diapers, and group care restricted drugs (non-prescription medicines).
				Facilities shall not reclassify cost of nurses reported for staff requirements
				to other sections of cost report forms. Revenue derived from providing medical
				records information to interested parties must be used to offset
				cost.
f) Social Services -
				Allowable costs are salaries and wages paid to employees working in the social
				service program, as well as supplies incidental to the program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.534 - Ownership Costs

Current through Register Vol. 48, No. 28, July 12, 2024
Ownership costs are allowable as follows:
a) Depreciation
Depreciation on care related assets is an allowable cost
				  subject to the following conditions:
1) Depreciation must be computed on a
				straight-line basis, starting from the date of completion or
				installation.
2) Depreciation must
				be based on historical cost of the asset (purchased assets) or fair market
				value at the time of donation or inheritance of the asset (donated or inherited
				assets).
3) Depreciation must be
				spread over the useful life of the asset using the American Hospital
				Association guidelines followed by Medicare at a minimum.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.535 - Costs for Interest, Taxes and Rent

Current through Register Vol. 48, No. 28, July 12, 2024
a) Allowable costs for interest expenses
1) Interest - Reasonable and necessary
				interest on both current and capital indebtedness is an allowable cost provided
				that the indebtedness is related to patient care. No interest cost shall be
				recognized to the extent it exceeds payment used on 125 percent of the
				prevailing mortgage rate at the time of the loan. Interest paid on loans from
				the providers' donor-restricted funds or qualified pension fund is allowable.
				Interest income from unrestricted funds must be used to offset allowable
				interest expense. Interest incurred during construction must be capitalized and
				amortized over the life of the asset. Interest penalties are not allowable
				costs. Interest on loans to purchase capital stock are not allowable
				costs.
2) Effective for the rate
				year beginning July 1, 1984, for sales occuring January 1, 1978, and after,
				where the increased capital cost is deemed unreasonable, and adjustment to
				interest expense is made, the principal on which interest is computed must be
				reduced by the excess of the purchase price over the calculated reasonable
				capital expense.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.536 - Organization and Pre-Operating Costs

Current through Register Vol. 48, No. 28, July 12, 2024
a) Material pre-operating and organization
				costs must be capitalized and amortized ratably over a 60 month period starting
				with the month the first patient is admitted. Allowable organization costs
				include legal fees incurred in establishing the corporation or other
				organization, necessary accounting fees, expenses of temporary directors, and
				organizational meetings of directors and stockholders. Fees paid to States for
				incorporation costs relating to the issuance and sale of shares of capital
				stock or other securities are not allowable.
b) Pre-operating costs are incurred from the
				time preparation begins on a building, wing, or floor to the time the first
				patient is admitted. If material, these costs must be amortized to cover a 60
				month period. Pre-operating costs include administrative and nursing salaries,
				heat, gas, and electricity, taxes, insurance, mortgage and other interest from
				the completion of construction until the first patient is admitted, employee
				training costs, housekeeping, and any other allowable costs incident to the
				standard period.
c) Expenditures
				attributable to the negotiation or settlement of the sale or purchase of any
				capital asset (including legal fees, accounting and administrative costs,
				travel costs, and the costs of feasibility studies) shall not be considered to
				be allowable costs for cost reporting and reimbursement purposes.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.537 - Payments to Related Organizations

Current through Register Vol. 48, No. 28, July 12, 2024
a) Related organizations include those with
				overlapping ownership and organizations with any ownership interest held by
				relatives of the owners of the reporting facility. Relatives include spouses,
				children, parents, brothers, sisters, grandparents, grandchildren,
				parents-in-law, sister or brother-in-law, son or daughter-in-law, aunt, uncle,
				and cousins. Where the overlapping ownership or interest held by relatives is 5
				percent or more, a related organization exists for cost reporting purposes. An
				organization which has any control over operating policy of the reporting
				facility shall also be considered a related organization.
b) The following criteria govern costs
				regarding payments to related organizations:
1) Where facility makes rental payments to a
				related organization the rental payments are not allowable. The capital costs
				of the related organization must be used.
2) Interest paid by a facility to a related
				organization is allowable to the extent it does not exceed the prime rate of
				interest. The funds borrowed must be directly related to patient care. Interest
				is not allowed on loans from related parties in order to compensate or pay
				dividends to related parties, or to replace working capital used to pay for
				non-allowable expenses. Funds provided by owners to replace operating losses
				are contributions to capital and not allowable.
3) The cost of supplies or services purchased
				from a related organization are allowable if the following conditions are met:
A) Supplying organization is a bona fide
				separate organization;
B) At least
				95 percent of the business activity of the type carried on with the facility is
				conducted with unrelated organizations;
C) The charge to the facility is in line with
				charges to unrelated customers; and
D) The charge to the facility does not exceed
				fair market value.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.538 - Special Costs

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Transportation - The costs of transportation that is medically necessary and is
				of the type reimbursed by Public Aid in addition to the routine rate is not
				allowable. Other types of patient related transportation costs should be
				classified as either administrative costs or activity costs and are
				allowable.
b) Ancillary Services -
				are not an allowable expenditure. Ancillary services are those services which
				are not explicitly required by licensing requirements. Accordingly, the
				definition of ancillary service differs by licensure type, particularly between
				SNF and ICF, as compared to ICF/MR facilities.
c) For SNF or ICF, the following are
				ancillary services: occupational therapy by a licensed therapist, recreational
				therapy by a licensed therapist, dental care, work-related programs,
				rehabilitation by licensed personnel, pharmacy (other than "group care
				restricted"), psychological services (evaluation and diagnosis/behavior
				modification), and academic education by licensed personnel.
d) These services, when offered by the above
				practitioners are ancillary services whether they are offered in the facility
				or outside the facility. Note, this does not include consultants or services
				offered by unlicensed personnel within the facility even if they relate to the
				above program areas.
e) In an
				ICF/MR or SNF Pediatric facility the following services are ancillary:
				physician care, dental care - except for dental screening, work-related
				programs (other than Level I Developmental Training and Level II Developmental
				Training as defined in Section
				140.647,
				Description of Day Programming Service Levels), pharmacy (other than "group
				care restricted"), academic education, and any service for which the individual
				practitioner bills the Department directly or any service for which the
				Provider directly bills another Department or another governmental unit,
				including local school districts.
f) It is the responsibility of the individual
				provider to obtain prior approval before rendering ancillary services.
				Ancillary providers must be enrolled with the Department.
g) Oxygen in excess of one tank per patient
				per month is reimbursed directly rather than as part of the per diem. In order
				to submit claims the facility must be enrolled as a provider of
				oxygen.
h) Barber and Beauty Shops
				- Costs associated with barber and beauty shops are not allowable.
i) Coffee and Gift Shops - Costs associated
				with coffee and gift shops are not allowable.
j) Assessment fees required by Public Act
				87-861 or Public Act 88-88 to be paid to the Department of Public Aid are not
				an allowable cost for reimbursement purposes. This fee must be reported on the
				cost report Schedule V, Section E, Special Cost Centers, Line 42.