Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 147 - REIMBURSEMENT FOR NURSING COSTS FOR GERIATRIC FACILITIES › Section 147.335 - Enhanced Care Rates

Current through Register Vol. 48, No. 28, July 12, 2024
An additional enhanced rate is applied for certain categories
				of residents that are in need of more resources.
a) Ventilator Services - The following
			 criteria shall be met to be eligible for enhanced rates.
1) Ventilators are defined as any type of
			 electrical or pneumatically powered closed mechanical system for residents who
			 are, or who may become, unable to support their own respiration. It does not
			 include Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway
			 Pressure (BiPAP) devices. When ventilators are used to deliver CPAP or BiPAP
			 they shall not be counted as ventilator services for enhanced rates.
2) Ventilators set to PEEP or CPAP to aid in
			 weaning a resident from the ventilator are included. The weaning process shall
			 be documented in the clinical record. Ventilators used to deliver CPAP or BiPAP
			 services for the resident with Sleep Apnea are not included.
3) Nursing facility shall notify the
			 Department using a Department designated form that includes a physician order
			 sheet that identifies the need and delivery of ventilator services. A facility
			 shall also use the designated form to notify the Department when a resident is
			 no longer receiving ventilator services. In addition, a Section S item response
			 of the MDS may be used.
4) The
			 following criteria shall be met in order for a facility to qualify for
			 ventilator care reimbursement.
A) A facility
			 shall establish admission criteria to ensure the medical stability of patients
			 prior to transfer from an acute care setting.
B) Facilities shall be equipped with
			 technology that enables it to meet the respiratory therapy, mobility and
			 comfort needs of its patients.
C)
			 Clinical assessment of oxygenation and ventilation-arterial blood gases or
			 other methods of monitoring carbon dioxide and oxygenation shall be available
			 on-site for the management of residents. Documentation shall support clinical
			 monitoring of oxygenation stability was completed at least twice a
			 day.
D) Emergency and life support
			 equipment, including mechanical ventilators, shall be connected to electrical
			 outlets with back-up generator power in the event of a power failure.
E) Ventilators shall be equipped with
			 internal batteries to provide a short term back-up system in case of a total
			 loss of power.
F) An audible,
			 redundant ventilator alarm system shall be required to alert staff of a
			 ventilator malfunction, failure or resident disconnect. A back-up ventilator
			 shall be available at all times.
G)
			 Facilities licensed under the Nursing Home Care Act [210 ILCS 45 ] shall have a
			 minimum of one RN on duty for 8 consecutive hours, 7 days per week, as required
			 by 77 Ill. Adm. Code
			 300.1240.
			 For facilities licensed under the Hospital Licensing Act, an RN shall be on
			 duty at all times, as required by 77 Ill. Adm. Code
			 250.910.
			 Additional RN staff may be determined necessary by the Department, based on the
			 Department's review of the ventilator services.
H) Licensed nursing staff shall be on duty in
			 sufficient numbers to meet the needs of residents as required by 77 Ill. Adm.
			 Code
			 300.1230.
			 For facilities licensed under the Nursing Home Care Act, the Department
			 requires that an RN shall be on call, if not on duty, at all times.
I) No less than one licensed respiratory care
			 practitioner licensed in Illinois shall be available at the facility or on call
			 24-hours a day to provide care, monitor life support systems, administer
			 medical gases and aerosol medications, and perform diagnostic testing as
			 determined by the needs and number of the residents being served by a facility.
			 The practitioner shall evaluate and document the respiratory status of a
			 ventilator resident on no less than a weekly basis.
J) A pulmonologist, or physician experienced
			 in the management of ventilator care, shall direct the care plan for ventilator
			 residents on no less than a twice per week basis.
K) At least one of the full-time licensed
			 nursing staff members shall have successfully completed a course in the care of
			 ventilator dependent individuals and the use of the ventilators, conducted and
			 documented by a licensed respiratory care practitioner or a qualified
			 registered nurse who has at least one-year experience in the care of ventilator
			 dependent individuals.
L) All staff
			 caring for ventilator dependent residents shall have documented in-service
			 training in ventilator care prior to providing such care. In-service training
			 shall be conducted at least annually by a licensed respiratory care
			 practitioner or qualified registered nurse who has at least one-year experience
			 in the care of ventilator dependent individuals. Training shall include, but is
			 not limited to, status and needs of the resident, infection control techniques,
			 communicating with the ventilator resident, and assisting the resident with
			 activities. In-service training documentation shall include name and title of
			 the in-service director, duration of the presentation, content of presentation,
			 and signature and position description of all participants.
M) Documentation shall support the resident
			 has a health condition that requires medical supervision 24-hours a day of
			 licensed nursing care and specialized services or equipment.
N) The medical records shall contain
			 physician's orders for respiratory care that includes, but is not limited to,
			 diagnosis, ventilator settings, tracheostomy care and suctioning, when
			 applicable.
O) Documentation shall
			 support the resident receive tracheostomy care at least daily.
5) To be eligible to receive
			 ventilator add-on, facilities shall also be required to implement the
			 established written protocols on the following areas:
A) Pressure Ulcers. A facility shall have
			 established policies and procedures on assessing, monitoring and prevention of
			 pressure ulcers, including development of a method of monitoring the occurrence
			 of pressure ulcers. Staff shall receive in-service training on those areas.
i) Documentation shall support the resident
			 has been assessed quarterly for their risk for developing pressure
			 ulcers.
ii) Documentation shall
			 support that interventions for pressure ulcer prevention were implemented and
			 include, but are not limited to, a turning and repositioning schedule, use of
			 pressuring reducing devices, hydration and nutritional interventions and daily
			 skin checks.
B) Pain. A
			 facility shall have established policies and procedures on assessing the
			 occurrence of pain, including development of a method of monitoring the
			 occurrence of pain. Staff shall receive in-service training on this area.
i) Documentation shall support the resident
			 has been assessed quarterly for the presence of pain and the risk factors for
			 developing pain.
ii) Documentation
			 shall support an effective pain management regime is in place for the
			 resident.
C) Immobility.
			 A facility shall have established policies and procedures to assess the
			 possible effects of immobility. These shall include, but not be limited to,
			 range of motion techniques, contracture risk. Staff shall receive in-service
			 training on this area.
i) Documentation shall
			 support the resident's risk for contractures were assessed quarterly and
			 interventions are in place to reduce the risk.
ii) Effects of immobility will be monitored
			 and interventions implemented as needed.
D) Risk of infection. A facility shall have
			 established policies and procedures on assessing risk for developing infection
			 and prevention techniques. These shall include, but are not limited to proper
			 hand washing techniques, aseptic technique in delivery care to a resident, and
			 proper care of equipment and supplies. Staff shall receive in-service training
			 on this area.
i) Documentation shall support
			 the resident was given oral care every shift to reduce the risk of
			 infection.
ii) Documentation shall
			 support the facility has a method to monitor and track infections.
E) Social Isolation. A facility
			 shall have a method of assessing a resident's risk for social isolation.
			 Interventions shall be in place to involve a resident in activities when
			 possible.
F) Ventilator Weaning. A
			 facility shall have a method of routinely assessing a resident's weaning
			 potential and interventions implemented as needed. Documentation shall support
			 the weaning process and the use of mechanical ventilation for a portion of each
			 day for stabilization.
G) Policies
			 shall include monitoring expectations of the ventilator resident, routine
			 maintenance of equipment and specific staff training related to ventilator
			 settings and care.
H) In order to
			 maintain quality standards and reduce cross contamination, the facility shall
			 have a policy for cleaning and maintaining equipment.
6) Department staff shall conduct on-site
			 visits on a random or targeted basis to ensure both facility and resident
			 compliance with requirements. All records shall be accessible to determine that
			 the needs of a resident are being met and to determine the appropriateness of
			 ventilator services. In addition to the requirements of this subsection (a),
			 Department review shall include, at a minimum, the following:
A) The tracking of Ventilator Associated
			 Pneumonia;
B) Documentation to
			 track hospitalizations, reason for hospitalizations, and interventions aimed at
			 reducing hospitalizations for ventilator residents;
C) Ventilator weaning.
7) An enhanced payment shall be added to the
			 rate determined by the methodology currently in place:
A) Payment shall be made for each individual
			 resident receiving ventilator services;
B) The rate add-on for ventilator service is
			 $208 per day.