reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 141 - SOCIAL SERVICE FOR NON-WAIVER HOME AND COMMUNITY BASED SERVICES › Subpart B - CHILDREN'S MENTAL HEALTH HOME AND COMMUNITY-BASED SERVICES › Section 141.250 - Participant Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
For appeals by individuals or their authorized
				  representatives regarding CMH-HCBS participation or services, the following
				  shall apply:
a) The individual, parent
				or legal guardian, or authorized representative may appeal the following
				issues:
1) Failure to take action on a request
				for eligibility determination or a request for services;
2) Denial of a request for CMH-HCBS
				eligibility or a request for services;
3) Any action by the Department to reduce,
				change, suspend or terminate any service; or
4) Termination of eligibility for
				CMH-HCBS.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 141 - SOCIAL SERVICE FOR NON-WAIVER HOME AND COMMUNITY BASED SERVICES › Subpart B - CHILDREN'S MENTAL HEALTH HOME AND COMMUNITY-BASED SERVICES › Section 141.260 - Provider Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
Appeals regarding participation as a provider of CMH-HCBS
				  services or the Department's decision regarding program approval, as outlined
				  in this Part, shall be conducted pursuant to the process outlined in 89 Ill.
				  Adm. Code 140.Table N(f).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 142 - JOINT RULES OF THE DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES AND THE CAPITAL DEVELOPMENT BOARD: HEALTHCARE TRANSFORMATION CAPITAL INVESTMENT GRANT PROGRAM

Current through Register Vol. 48, No. 28, July 12, 2024
The text of this Joint Rule appears at 71 Ill. Adm. Code
				44.
AUTHORITY: Implementing and authorized by Section 20 of the
				Capital Development Board Act [20 ILCS 3105 ] and Section 50 of the Grant
				Accountability and Transparency Act [30 ILCS 708
				].
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 143 - MANAGED CARE COMMUNITY NETWORKS › Section 143.100 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of this Part, the terms below shall be defined as
				follows:
"Contract" means a document containing certain terms and
				conditions that meet the requirements of this Part and is entered into by a
				Managed Care Community Network (MCCN) and the Department.
"County MCCN" means a county with a population of over three
				million that has a contract with the Department to provide primary, secondary,
				or tertiary managed health care services as an MCCN.
"Department" means the Illinois Department of Public Aid and
				any successor agencies.
"Eligible enrollee" means anyone who is eligible to receive
				medical services through programs administered by the Department and is
				eligible to receive services through an MCCN.
"Enrollee" means a person who receives medical services through
				an MCCN.
"Managed Care Community Network (MCCN)" means an entity, other
				than a health maintenance organization, that is owned, operated, or governed by
				providers of health care services within Illinois and that provides or arranges
				primary, secondary and tertiary managed health care services under contract
				with the Department exclusively to persons participating in programs
				administered by the Department. An MCCN may choose to contract with the
				Department to provide only pediatric health care services.
"Person" means any individual, corporation, proprietorship,
				firm, partnership, limited partnership, trust, association, governmental
				authority or other entity, whether acting in an individual, fiduciary or other
				capacity.
"Provider" means a person who is approved by the Department to
				furnish medical, educational or rehabilitative services to
				enrollees.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 143 - MANAGED CARE COMMUNITY NETWORKS › Section 143.200 - Organizational Structure

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
			 Managed Care Community Network (MCCN) shall be a separate entity organized as a
			 corporation, limited liability company, or partnership under the laws of this
			 State for the purpose of operating an MCCN and, except for a county MCCN, doing
			 no business other than that of an MCCN.
b) If organized as a stock corporation or
			 limited liability company, 100 percent of all voting shares must be owned by,
			 or 100 percent of all members in the limited liability company must be,
			 providers of health care services who are subject to licensure by the Illinois
			 Department of Professional Regulation, or who are subject to licensure or
			 certification by the Illinois Department of Public Health or the Illinois
			 Department of Human Services.
c) If
			 organized as an Illinois not-for-profit corporation, the governing body must be
			 constituted of at least 80 percent of providers of health care services who are
			 subject to licensure by the Illinois Department of Professional Regulation, or
			 who are subject to licensure or certification by the Illinois Department of
			 Public Health or the Illinois Department of Human Services, or be employees or
			 officers of such providers of health care services. For the purpose of this
			 subsection, a State-owned medical school shall be a qualified provider of
			 health care services.
d) If
			 organized as a partnership, all limited and general partners must be providers
			 of health care services who are subject to licensure by the Illinois Department
			 of Professional Regulation, or who are subject to licensure or certification by
			 the Illinois Department of Public Health or the Illinois Department of Human
			 Services.
e) A County MCCN:
1) May be formed without establishing a
			 separate entity;
2) Is entitled to
			 enter into a contract to provide services in any or all of a county with a
			 population of over three million; and
3) Is not required to accept enrollees who do
			 not reside within the county.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 143 - MANAGED CARE COMMUNITY NETWORKS › Section 143.300 - General Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
			 Department shall enter into contracts with MCCNs for the provision of medical
			 care to eligible enrollees in accordance with Section 5-11 of the Illinois
			 Public Aid Code [305
			 ILCS 5/5-11 ].
b) The Department may limit the number of
			 MCCNs with which it contracts and shall specify a maximum enrollment capacity
			 per MCCN.
c) Covered services to be
			 provided or arranged by an MCCN shall be established in each MCCN's
			 contract.
d) The Department shall
			 include, in every contract with an MCCN, language describing the sanctions that
			 the Department may impose upon the MCCN for failure to comply with this Part or
			 the terms and conditions of that contract.
1)
			 The contract shall provide for sanctions including, but not limited to, one or
			 more of the following:
A) Monetary sanctions
			 established and assessed by the Department against the MCCN;
B) Freezing enrollment for a period to be
			 determined by the Department;
C)
			 Liquidated damages;
D)
			 Disenrollment of enrollees;
E)
			 Withholding all payments or any portion of a payment due the MCCN;
			 and
F) Any other sanctions that are
			 deemed appropriate by the Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 143 - MANAGED CARE COMMUNITY NETWORKS › Section 143.400 - Financial Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Minimum
			 Net Worth
Each MCCN must have and maintain at all times a net worth that
				meets the minimum net worth requirements as follows:
1) Prior to entering into the contract, net
			 worth shall be at least $500,000.
2) For the first contract year and all
			 subsequent contract years, net worth shall be the greater of:
A) $500,000; or
B) two percent of the first $120,000,000 in
			 annual captitated payments plus one percent of the annual capitated payments in
			 excess of $120,000,000; or
C) An
			 amount equal to the sum of three months of uncovered health care expenditures
			 as reported on the most recent quarterly report filed pursuant to subsection
			 (d); or
D) The sum of eight percent
			 of the annual health care expenditures paid on a non-capitated basis to
			 non-affiliated providers and four percent of the annual health care
			 expenditures paid on a capitated basis to non-affiliated providers plus the
			 annual health care expenditures paid on a non-capitated basis to affiliated
			 providers. Annual health care expenditures that are paid on a capitated basis
			 to affiliated providers are not included in this calculation of the net worth
			 requirement (regardless of downstream arrangements from the affiliated
			 provider). "Affiliated provider" as used in this Section has the same meaning
			 as found at
			 42 CFR
			 422.354.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 143 - MANAGED CARE COMMUNITY NETWORKS › Section 143.500 - Certification

Current through Register Vol. 48, No. 28, July 12, 2024
An MCCN that meets the requirements of this Part is deemed to
				be certified by the Department as a risk bearing entity solely for the purpose
				of meeting the requirements of a Medicaid Managed Care Organization as defined
				in Section 1903(m) of the Social Security Act and the Department may enter into
				a contract with such certified MCCN.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.1 - Incorporation By Reference

Current through Register Vol. 48, No. 28, July 12, 2024
Any rules or regulations of an agency of the United States or
				of a nationally recognized organization or association that are incorporated by
				reference in this Part are incorporated as of the date specified, and do not
				include any later amendments or editions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.5 - 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 Part are those certified as Intermediate Care
			 Facilities for the Mentally Retarded (ICF/MR) and licensed as:
1) intermediate care facilities for
			 individuals with developmental disabilities (ICF/DD) (including specialized
			 living centers (SLC));
2) long term
			 care facilities for residents under 22 years of age (hereinafter referred to as
			 SNF/PED); and
3) intermediate care
			 facilities for individuals with developmental disabilities of 16 beds or less
			 (ICF/DD-16) (including small scale facilities with four or six beds).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.25 - ICF/MR Service Criteria

Current through Register Vol. 48, No. 28, July 12, 2024
a) Need for
			 ICF/MR Services
1) The need for ICF/MR
			 services shall be established through a comprehensive assessment (see 89 Ill.
			 Adm. Code
			 140.642
			 ), the Level II assessment, that demonstrates that the individual needs active
			 treatment and has either:
A) mental
			 retardation; or
B) a related
			 condition that meets all of the following conditions:
i) 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 mental retardation because
			 this condition results in impairment of general intellectual functioning or
			 adaptive behavior similar to that of mentally retarded persons, and requires
			 treatment or services similar to those required for these persons.
ii) It is manifested before the person
			 reaches age 22.
iii) It is likely
			 to continue indefinitely.
iv) 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, capacity for independent living.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.30 - Developmental Disability Provider Rate Adjustments

Current through Register Vol. 48, No. 28, July 12, 2024
a) Adjustments in FY 18 and FY 19
Pursuant to PA 100-23 and PA 100-587, providers of services to
				individuals with developmental disabilities shall ensure that all wages earned
				by front-line direct care personnel are at least $1.25 per hour
				higher than those wages that existed on July 31, 2017.
b) Adjustments in FY 20
Pursuant to PA 101-10, rates established for providers of
				services to individuals with developmental disabilities effective July 1, 2019
				shall be increased 3.5 percent above rates in effect on June 30, 2019, subject
				to federal approval. Providers shall determine whether to allocate the entirety
				or a portion of the 3.5 percent to the wages of direct care staff.
c) Adjustments in FY 21
1) Pursuant to Public Act 101-0636 and
			 subject to federal approval of the increases, providers of community-based
			 services and supports to individuals with developmental disabilities shall
			 increase wages for non-executive staff as follows:
A) Effective July 1, 2020, by $1.00 per hour,
			 with at least eighty (80) cents per hour of those funds to be provided for a
			 direct increase to non-executive staff wages, with priority given to direct
			 care staff; and
B) Effective
			 January 1, 2021, by $0.50 per hour, with at least forty (40) cents per hour of
			 those funds to be provided for a direct increase to non-executive staff wages,
			 with priority given to direct care staff.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.50 - 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 Mental Health and Developmental
			 Disabilities' (DMHDD) management.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.102 - High Medical/High Personal Care Needs of Individuals with Developmental Disabilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) For
			 services provided on or after July 1, 2010, daily rates for qualifying ICFs/MR
			 shall have their own reimbursement rates adjusted pursuant to this
			 Section.
b) Qualifying Criteria
In order to receive rate adjustments under this Section,
				facilities must meet the following criteria:
1) Be a licensed ICF/MR, as defined in 77
			 Ill. Adm. Code 350, with more than 16 licensed beds and is not:
A) An SNF/PED, as defined in 77 Ill. Adm.
			 Code 390; or
B) A campus facility,
			 as defined under 89 Ill. Adm. Code
			 140.583.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.150 - 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 need(s), as determined by the IDT's assessment,
				enables him/her to participate in his/her IPP and be supported toward greater
				independence. Additional reimbursement is paid for an individual who needs and
				receives services for health and/or sensory disabilities (Section
				144.275(c)(2)
				), when those services meet the criteria under subsections (b),(c) and/or (d)
				of this Section.
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 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.160 - Base Nursing in Facilities Licensed as ICF/DD-16s including Small Scale (4 and 6 bed) ICF/DD-16s

Current through Register Vol. 48, No. 28, July 12, 2024
a) Base
			 nursing in ICF/DD-16s staffing and reimbursement recognizes the need for adults
			 with developmental disabilities to have regular health care supports.
b) Base nursing provides for licensed
			 practical nurse services and/or registered professional nurse services and
			 supervision.
c) The addition of
			 base nursing provides for nursing assessments, development and updating of
			 nursing care plans, health risk identification and planning, Tardive Dyskinesia
			 (TD) screening, coordination and implementation of medical services, monitoring
			 of medication effectiveness and side effects, and annual flu
			 immunization.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.165 - Medication Administration in Facilities Licensed as ICF/DD-16s including Small Scale Residential Facilities (4 and 6 bed) ICF/DD-16s

Current through Register Vol. 48, No. 28, July 12, 2024
a) Medications may
			 be administered by unlicenced staff who have been trained and are supervised by
			 registered professional nurses, in accordance with P.A. 91-0630 and 59 Ill.
			 Adm. Code 116.
b) Reimbursement for
			 the supervision of this medication administration will be provided as described
			 in Sections
			 144.275
			 and
			 144.300.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.175 - 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 ICF/MR 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
				144.275(c)(2)
				). This reimbursement is provided only when an individual meets the criteria
				for mobility assistance and/or high personal care under Specialized Care-Health
				and Sensory Disabilities (Section
				144.150(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.
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 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.230 - Reconciliation of Resident Funds

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Upon the death of a resident who has monies which are managed by the facility,
			 the facility is to:
1) convey the resident's
			 funds and a final accounting of those funds to the individual administering the
			 deceased's estate within five business days following the resident's death;
			 and
2) notify the local Public Aid
			 office of the amount of all monies which belonged to the deceased.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.275 - Reimbursement for Program (Active Treatment) Costs in Residential Facilities for Clients with Developmental Disabilities

Current through Register Vol. 48, No. 28, July 12, 2024
Residential facilities, including distinct parts of facilities,
				for clients with developmental disabilities (ICF/MR certification with
				licensure for ICF/DD, ICF/DD-16, SLC, and ICF/MR-SNF/PED license), excluding
				State-operated facilities for individuals with developmental disabilities, will
				be reimbursed for an active treatment program for each client. Facility program
				reimbursement levels will be derived by the Department from the following four
				determinants which in combination will result in a total facility program per
				diem amount. These four determinants will be determined according to
				information provided in the most recent Inspection of Care (IOC) conducted by
				Department of Public Health survey staff. This IOC information must be
				validated by the survey staff prior to utilization for payment purposes. The
				new reimbursement level will be effective on the first day of the quarter
				following a facility's IOC. Where dollar, wage, or salary amounts are used,
				these shall be inflated to the fiscal year for which reimbursement will be
				made.
a) Minimum Staffing
1) Direct Services - Facilities must be in
			 compliance with the Health Care Financing Administration's (HCFA) (
			 42 CFR
			 483.430(1996) ) minimum
			 average daily staffing standards relative to client population according to
			 each individual's overall level of functioning:
Overall Level of Functioning
FTE* Staff:Client Ratio
Mild
1:5
Moderate
1:2.5
Severe or Profound
1:2
*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), will 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 must be administered by a
			 psychologist who is registered in Illinois under the Clinical Psychologist
			 Licensing Act (Illinois Department of Professional Regulation); and
ii) an assessment of adaptive behaviors using
			 a nationally 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 will be utilized by at least one
			 Qualified Mental Retardation Professional (QMRP) to evaluate each client's
			 functional skills and adaptive behaviors.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.325 - Capital Rate Calculation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Capital
			 rates for ICF/MR facilities with four or six beds will be calculated by the
			 Department according to this Section, which provides calculation methods for
			 rates for various capital categories. Rate charts will be prepared each year
			 based upon these provisions. The rate for an individual facility will be
			 selected based upon the following criteria:
1) New construction or remodeled building. If
			 the facility is a remodeled building the base cost will be used to assign it to
			 a category.
2) Base Year
3) Location
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Table A - Overview of Staff Intensity Scale of Maladaptive Behaviors

Current through Register Vol. 48, No. 28, July 12, 2024
a) Staff Intensity
			 Scale
1) The Staff Intensity Scale (SIS) is
			 designed to describe behavior problems which are displayed by children and
			 adults who have developmental disabilities. The rating categories were not
			 "borrowed" from instruments used to describe problems among other disability
			 groups. Rather, the behavior modification practitioners who designed the SIS
			 focused on the behavior problems of people with developmental disabilities who
			 live in institutions or community settings.
2) The Staff Intensity Scale measures
			 twenty-four major areas of problem behavior. These areas are denoted within the
			 scale as capitalized and underlined section headings. The 24 behavior areas
			 include the following:
A) Coercive Sexual
			 Behavior
B) Offensive Bodily
			 Exposure
C) Suicide Attempts and
			 Threats
D) Pica
E) Verbal Abuse
F) Mania
G) Inappropriate Affect
H) Manipulative Behavior
I) Physical Assault
J) Property Theft
K) Substance Abuse
L) Extreme Irritability
M) Hyperactivity
N) Temper Tantrums
O) Wanders, Roams, Runs Away
P) Depression or Excessive
			 Withdrawal
Q)
			 Hallucination
R)
			 Delusions
S) Fire
			 Settings
T) Self-Injurious
			 Actions
U) Handles/Plays with
			 Bodily Waste
V) Property
			 Destruction
W) Resists
			 Supervision
X) Stereotypical
			 Behavior
3) Proper use
			 results in descriptions of three behavioral dimensions. First, the absence or
			 presence of a behavior problem in each of the twenty-four major areas can be
			 indicated. Second, the rater can describe the severity of the behavior, problem
			 within a major area. For example, within the major area PHYSICAL AGGRESSION,
			 light slaps directed at another can be differentiated from a range of
			 aggressive behavior including life-threatening attacks. Third, the rating scale
			 also yields a description of the frequency of a problem along a frequency
			 continuum which is appropriate to the behavior. For example, since
			 self-stimulatory behavior usually occurs at a much higher rate than coercive
			 sexual behavior, the frequency continua for the two behavioral areas differ
			 accordingly.
4) Beyond providing a
			 basis for comparative information for clinical client evaluation at two or more
			 points in time, the rating scale also allows comparison is an important aspect
			 of the SIS. If the relative severity of individuals' behavior problems can be
			 measured accurately, then allocation of staffing resources can occur in accord
			 with problem severity.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Table D - Guidelines for Determining Levels of Functioning

Current through Register Vol. 48, No. 28, July 12, 2024
COGNITIVE ABILITY IQ SCORE
FUNCTIONAL ADAPTIVE BEHAVIORS
PROBLEMS
IDPA 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 144 - DEVELOPMENTAL DISABILITIES SERVICES › Table E - Standardized Adaptive Functional Assessment

Current through Register Vol. 48, No. 28, July 12, 2024
Mental Age Level Equivalents With Level of Functioning
Adult MA 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 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.20 - General Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
Sections 1905(a)(16) and 1905(a)(27)(B) of the Social
				  Security Act provide that federal financial participation (FFP) is not
				  available for any medical assistance under Title XIX for services provided to
				  any individual who is older than 21 years of age and under 65 years of age and
				  who is a patient in an IMD. The purpose of this Subpart B is to set forth the
				  process by which the Department shall identify nursing facilities that are IMDs
				  or that are at risk of becoming IMDs, the preventive measures to be taken to
				  avoid classification of a nursing facility as an IMD, and the actions to be
				  taken if a facility is identified as an IMD.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of this Part, the following terms shall be
				  defined as follows:
"IMD" means a nursing facility that is considered to be an
				  Institution for Mental Diseases (IMD) under Section 1905(i) of the Social
				  Security Act (
				  42 USC
				  1396 d(i)). Federal regulations provide that:
				  An IMD is primarily engaged in providing diagnosis, treatment, or care of
				  persons with mental diseases, including medical attention, nursing care, and
				  related services. An IMD has an overall character of a facility established and
				  maintained primarily for the care and treatment of individuals with mental
				  diseases. An institution for the mentally retarded (ICF/MR) is not an IMD (see
				  42 CFR
				  435.1009 ).
"Class I IMD" means a nursing facility determined to be an
				  IMD during the initial review conducted pursuant to Section
				  145.40.
"Class II IMD" means a nursing facility determined to be an
				  IMD in a subsequent review conducted pursuant to Section
				  145.50.
"IMD Guidelines" means the Guidelines in Section 4390 of the
				  CMMS State Medicaid Manual relating to Institutions for Mental Diseases
				  (Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore
				  MD 21244-1850 (1994, no later amendments or editions included)). Criteria used
				  in determining whether the overall character of a facility is that of an IMD
				  include whether the current need for institutionalization for more than 50
				  percent of all the patients in the facility results from mental diseases and
				  whether the facility specializes in providing psychiatric/psychological care
				  and treatment.
"Mental Disease" means mental disease or mental illness as
				  defined in the IMD Guidelines. Mental disease includes those diseases listed as
				  mental disorders in the International Classification of Diseases, 9th Revision,
				  Clinical Modification (ICD-9-CM) until implementation of the International
				  Classification of Diseases, 10th Revision, Clinical
				  Modification (ICD-10-CM) and its classifications for mental disorders, with the
				  exception of mental retardation, senility and organic brain syndrome.
"Current need for nursing facility care results from mental
				  disease" means that a review of the resident's diagnoses, the character and
				  nature of his or her problems, functional status, and his or her care needs
				  indicates that the resident's need for nursing facility care results from his
				  or her mental disease and not a physical or medical reason.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.40 - Initial IMD Review, Determination and Classification of Facilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) An initial
				review of data on nursing facility residents in enrolled nursing facilities
				shall be conducted by the Department. The initial data review shall be based on
				Minimum Data Set data electronically submitted to the Department on nursing
				facility residents who are residents of the facility as of March 1, 2001. Based
				on the review, a determination shall be made of the number of residents whose
				current need for nursing facility care results from mental disease. The
				facility's total resident census shall be determined by the Department at the
				time of the data review.
b) The
				percentage of residents whose current need for nursing facility care results
				from mental disease will be determined by dividing the number of the residents
				whose current need for nursing facility care results from mental disease,
				identified in the data review in subsection (a) of this Section, by the total
				resident census.
c) If the initial
				data review of a facility indicates that further information is needed in order
				to determine whether the current need for nursing facility care for more than
				50 percent of all residents in the facility results from mental diseases, the
				Department may contact the facility or make an on-site visit to obtain
				additional information. The Department will verify the resident count and make
				a determination of the facility's IMD status based on the IMD
				Guidelines.
d) If a facility is
				determined to be an IMD during the initial review and determination, the
				Department shall notify the facility that it has been identified as a Class I
				IMD nursing facility.
e) A facility
				that is classified as a Class I IMD nursing facility in accordance with the
				review and determination process in this Section shall receive the Class I IMD
				per diem reimbursement rate as stipulated in Section
				145.80(a).
f) A change in ownership or operator shall
				not change or otherwise affect the designation of a facility as an IMD under
				this Section.
g) A Class I IMD
				facility that no longer meets the definition of an IMD shall relinquish its
				Class I IMD classification and may not again be classified as a Class I
				IMD.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.50 - Subsequent IMD Reviews, Determinations and Classifications

Current through Register Vol. 48, No. 28, July 12, 2024
a) Subsequent reviews of data on nursing
				facility residents in enrolled nursing facilities shall be conducted
				periodically using the Minimum Data Set data electronically submitted to the
				Department.
b) The percentage of
				residents whose current need for nursing facility care results from mental
				disease will be determined by dividing the number of the residents whose
				current need for nursing facility care results from mental disease, identified
				in the data review in subsection (a) of this Section, by the total resident
				census. The facility's total resident census shall be determined by the
				Department at the time of the data review.
c) If a subsequent data review indicates that
				further information is needed in order to determine whether the current need
				for nursing facility care for more than 50 percent of all residents in the
				facility results from mental diseases, the Department may contact the facility
				or make an on-site visit to obtain additional information. The Department will
				verify the resident count and make a determination of the facility's status
				based on the IMD Guidelines.
d)
				Within 45 days after the on-site visit, the Department shall determine whether
				the facility is an IMD and notify the facility of its IMD status.
e) A facility determined to be an IMD as the
				result of a subsequent data review and determination shall be classified as a
				Class II IMD nursing facility effective the first day of the quarter after the
				determination. A change in ownership or operator shall not change or otherwise
				affect the designation of a facility as an IMD under this Section.
f) No facility may be classified as a Class I
				IMD nursing facility as a result of a subsequent review under this
				Section.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.60 - Effect of Becoming a Class II IMD and Redetermination Reviews

Current through Register Vol. 48, No. 28, July 12, 2024
a) A facility that
				is classified as a Class II IMD nursing facility in accordance with the review
				and determination process in Section
				145.50 shall
				receive the Class II IMD per diem reimbursement rate as stipulated in Section
				145.80(b).
b) The Class II IMD rate shall be effective
				on the first day of the quarter after the Department makes its determination
				that a facility is a Class II IMD.
c) If requested by a Class II IMD nursing
				facility, the Department shall make a redetermination of a facility's status as
				an IMD by conducting a resident data review and on-site visit of the
				facility.
d) If the Department
				determines that the facility is not an IMD as the result of a redetermination
				review, the facility shall be reclassified to non-IMD status effective the
				first day of the month following the redetermination review.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.70 - Watch List of Nursing Facilities at Risk of Becoming IMDs

Current through Register Vol. 48, No. 28, July 12, 2024
a) If the initial, subsequent or any other
				Department data reviews indicate that the current need for nursing facility
				care for 40 percent or more of the residents residing in the facility results
				from mental disease, the Department shall notify the facility that it is at
				risk of becoming an IMD, advise the facility of the consequences of becoming an
				IMD, and place the facility on an "at risk" list. The Department may conduct an
				on-site review of an "at risk" facility at any time.
b) The Department shall notify the State
				mental health authority when a facility is at risk of becoming an
				IMD.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.80 - Reimbursement Rate for IMD Nursing Facility Classifications

Current through Register Vol. 48, No. 28, July 12, 2024
a) Reimbursement Rate for Class I IMD Nursing
				Facilities
A facility classified under Section
				  145.40
				  shall have its per diem reimbursement rate for all residents set at the
				  reimbursement rate that would otherwise be determined under the Department's
				  administrative rules located at 89 Ill. Adm. Code 140, 147 and 153 for long
				  term care services provided by nursing facilities that are not IMDs.
b) Reimbursement Rate for Class II
				IMD Nursing Facilities
1) A facility
				classified as a Class II IMD pursuant to Section
				145.50 shall
				have its per diem reimbursement rate for residents who are 22 through 64 years
				of age set at one-half of the reimbursement rate that would otherwise be
				determined under Department rules for long term care services provided by
				nursing facilities that are not IMDs.
2) The per diem reimbursement rate for
				residents 21 years of age or younger and residents 65 years of age or older
				shall be set at the reimbursement rate that would otherwise be determined under
				Department rules for long term care services provided by nursing facilities
				that are not IMDs.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 145 - MENTAL HEALTH SERVICES IN NURSING FACILITIES › Subpart B - INSTITUTION FOR MENTAL DISEASES PROVISIONS FOR NURSING FACILITIES › Section 145.90 - Reviews

Current through Register Vol. 48, No. 28, July 12, 2024
a) Upon
				notification that it has been determined to be a Class II IMD, either as the
				result of a subsequent review pursuant to Section
				145.50 or a
				redetermination review pursuant to Section
				145.60(c),
				a facility may request a review of the Department's determination. Such a
				request must be submitted in writing and received by the Department within 30
				days after the date of the Department's notice to the facility that it has been
				determined to be an IMD. Such a request shall include a clear explanation and
				supporting documentation of the facility's basis for considering the
				Department's determination that it is an IMD to be in error. Department review
				shall be limited to the Department's:
1)
				calculation of the percentage of persons whose mental disease is the reason for
				being in the facility; and
2)
				determination of those residents who are counted in arriving at the number of
				persons whose mental disease is the reason for being in the facility and the
				number of residents who have a physical or medical reason for being in the
				facility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart A - AMBULATORY SURGICAL TREATMENT CENTERS › Section 146.100 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
This Part sets forth the conditions that an ambulatory
				  surgical treatment center must meet in order to participate in the Medical
				  Assistance Program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart A - AMBULATORY SURGICAL TREATMENT CENTERS › Section 146.105 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of this Part, the following terms shall be
				  defined as follows:
a) "Ambulatory
				Surgical Treatment Center" or "ASTC". Any distinct entity that operates
				primarily for the purpose of providing surgical services to patients not
				requiring hospitalization. Such facilities shall not provide beds or other
				accommodations for the overnight stay of patients; however, facilities devoted
				exclusively to the treatment of children may provide accommodations and beds
				for their patients for up to 23 hours following admission. Individual patients
				shall be discharged in an ambulatory condition without danger to the continued
				well-being of the patients or shall be transferred to a hospital or other
				similar environment. This provision shall include any place which meets the
				definition of an ambulatory surgical treatment center under the regulations of
				the Centers for Medicare and Medicaid Services ( 42 CFR 416 ). The term
				"ambulatory surgical treatment center" does not include:
1) Any institution, place, building or agency
				required to be licensed pursuant to the Hospital Licensing Act [210 ILCS 85
				].
2) Any person or institution
				required to be licensed pursuant to the Nursing Home Care Act [210 ILCS 45 ],
				the ID/DD Community Care Act [210 ILCS 47 ], or the Specialized Mental Health
				Rehabilitation Act of 2013 [210 ILCS 49 ].
3) Hospitals or ambulatory surgical treatment
				centers maintained by the State or any department or agency thereof, where such
				department or agency has authority under law to establish and enforce standards
				for the hospitals or ambulatory surgical treatment centers under its management
				and control.
4) Hospitals or
				ambulatory surgical treatment centers maintained by the federal government or
				agencies thereof.
5) Any place,
				agency, clinic or practice, public or private, whether organized for profit or
				not, devoted exclusively to the performance of dental or oral surgical
				procedures.