reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart A - AMBULATORY SURGICAL TREATMENT CENTERS › Section 146.110 - Participation Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
To participate in the Medical Assistance Program, an
				  ambulatory surgical treatment center (ASTC) must, in addition to any other
				  Department requirements:
a) Be
				licensed by the Illinois Department of Public Health pursuant to 77 Ill. Adm.
				Code 205.
b) In the case of an
				out-of-state ASTC, be licensed by the state in which it is located or, where a
				state does not license ASTCs, be accredited by a national accrediting
				body.
c) Meet the requirements in
				42 CFR 416.
d) Maintain a
				contractual relationship, including a transfer and referral plan with a
				hospital. Such a plan shall include procedures for effecting transfer of the
				patient from the ASTC to a hospital.
1) The
				contracting hospital must be within 15 minutes of the ASTC.
2) Have an effective procedure for the
				immediate transfer to a hospital of patients requiring emergency medical care
				beyond the capabilities of the ASTC.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart A - AMBULATORY SURGICAL TREATMENT CENTERS › Section 146.115 - Records and Data Reporting Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) In addition to any other Department record
				requirements, the ambulatory surgical treatment center (ASTC) must maintain
				complete, comprehensive and accurate medical records to ensure adequate patient
				care that includes, but is not limited to, the following:
1) Patient identification.
2) Significant medical history and results of
				physical examination.
3)
				Preoperative diagnostic studies (entered before surgery), if
				performed.
4) Findings and
				techniques of the operation, including a pathologist's report on all tissues
				removed during surgery, except those exempted by the governing body of the ASTC
				or State law.
5) Any known
				allergies and abnormal drug reactions.
6) Entries related to anesthesia
				administration.
7) Documentation of
				properly executed informed patient consent.
8) Discharge diagnosis.
9) Medications ordered and
				administered.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart A - AMBULATORY SURGICAL TREATMENT CENTERS › Section 146.125 - Covered Ambulatory Surgical Treatment Center Services

Current through Register Vol. 48, No. 28, July 12, 2024
Effective for dates of service on or after July 1,
				  2014:
a) The Department of Healthcare
				and Family Services will reimburse ambulatory surgical treatment centers
				(ASTCs) for facility services in accordance with covered enhanced ambulatory
				patient group (EAPG) services as defined in 89 Ill. Adm. Code
				148.140(b)(1).
				The Department may exclude from coverage in an ASTC any procedure identified as
				only appropriate for coverage in a hospital setting.
b) Facility services furnished by an ASTC
				include, but are not limited to:
1) Nursing,
				technician and related services.
2)
				Use of the ASTC facilities.
3)
				Supplies (such as drugs, biological products (e.g., blood)), surgical
				dressings, splints, casts and appliances, and equipment directly related to the
				provision of surgical procedures.
4) Diagnostic or therapeutic services or
				items directly related to the provision of a surgical procedure.
5) Administrative, record keeping, and
				housekeeping items and services.
6)
				Materials for anesthesia.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart A - AMBULATORY SURGICAL TREATMENT CENTERS › Section 146.130 - Reimbursement for Services

Current through Register Vol. 48, No. 28, July 12, 2024
Effective for dates of service on or after July 1,
				  2014:
a) With respect to all non-EAPG
				procedures, reimbursement levels shall be at the lower of the ASTC's usual and
				customary charge to the public or the Department's Statewide maximum
				reimbursement screen.
b) With
				respect to EAPG procedures described in 89 Ill. Adm. Code
				148.140(b)(1),
				reimbursement for those services shall be in accordance with 89 Ill. Adm. Code
				148.140(d)(7).
c) Laboratory, x-ray, prescription, physician
				or dental services, provided in connection with a covered surgical procedure,
				must be billed by the providers rendering those services. If the ASTC provides
				the laboratory or x-ray service, then:
1)
				Separate billing is NOT allowed if provided on the day of surgery; or
2) Separate billing IS allowed if provided on
				other than the day of surgery.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.200 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Public Aid Code [305 ILCS
				5/5-5.01a ] calls for the Department to establish and
				provide oversight for a program of supportive living facilities (SLFs) that
				seeks to promote independence, dignity, respect and well-being for residents in
				the most cost effective manner. When submitting an application for
				participation in the Supportive Living Program, each SLF shall designate which
				population it will serve, either:
1) persons
				with a disability who are 22 to 64 years of age; or
2) persons who are 65 years of age and over
				who meet the requirements described in Section
				146.220.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.210 - Structural Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Building
				Construction
1) An SLF's architectural plans
				shall conform to the current State building codes for the respective building
				type, local Fire and Life Safety Standards for health care occupancy or the
				2000 National Fire Protection Association Life Safety Code (NFPA) 101, Chapter
				32, Residential Board and Care Occupancies, National Fire Protection
				Association, 1 Batterymarch Park, Quincy MA 02269 (March 11, 2003, no later
				amendments or editions included) or local building codes if more
				stringent.
2) An SLF shall meet
				accessibility standards of the Americans With Disabilities Act of 1990 (
				42 USC 12101
				et seq.). If the facility is subject to the requirements of the Illinois
				Accessibility Code (71 Ill. Adm. Code 400), it shall be deemed residential or
				multi-story housing for determining the requirements under that Code.
3) An SLF shall not have any apartments below
				grade level.
4) A freestanding
				facility consisting of two or more stories with 75 or fewer units shall have a
				minimum of one elevator available for resident use. A freestanding facility
				consisting of two or more stories with 76 or more units shall have a minimum of
				two elevators available for resident use.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.215 - SLP Participation Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Facilities or distinct parts of facilities
				that are certified in the SLP and are in good standing with provisions
				contained in this Subpart B and, when applicable, Subpart E are exempt from the
				provisions of the Nursing Home Care Act [210 ILCS 45], the Illinois Health
				Facilities Planning Act [20 ILCS 3960] and the Assisted Living and Shared
				Housing Act [210 ILCS 9]. Nursing facilities rehabilitating a portion of the
				facility to conform with this Subpart B shall be allowed to retain their
				Certificate of Need for the nursing facility beds that were converted until the
				conclusion of the project or until the facility wishes to withdraw from the
				project and convert the SLP setting beds back to NF beds.
b) An SLP setting does not include:
1) A home, institution, or other place
				operated by the federal government or agency thereof, or by the State of
				Illinois;
2) A "long term care
				facility" licensed by the Nursing Home Care Act or Hospital Licensing Act.
				However, a nursing facility licensed under the aforementioned Acts can convert
				a distinct part to an SLP setting;
3) Any "facility for child care" as defined
				in the Child Care Act of 1969 [225 ILCS 10];
4) Any "Community Living Facility" as defined
				in the Community Living Facilities Licensing Act [210 ILCS 35];
5) Any "community residential alternative" as
				defined in the Community Residential Alternatives Licensing Act [405 ILCS
				30];
6) Any nursing home or
				sanitarium operated solely by and for persons who rely exclusively upon
				treatment by spiritual means through prayer, in accordance with the creed of
				any well recognized church or religious denomination;
7) Any facility licensed by the Department of
				Human Services as a community-integrated living arrangement as defined in the
				Community Integrated Living Arrangements Licensure and Certification Act [210
				ILCS 135];
8) Any "Supportive
				Residence" licensed under the Supportive Residences Licensing Act [210 ILCS
				65];
9) Any freestanding hospice
				facility [210 ILCS 60];
10) Any
				"life care facility" as defined in the Life Care Facilities Act [210 ILCS 40];
				or
11) Any "assisted living and
				shared housing establishment" licensed under the Assisted Living and Shared
				Housing Act [210 ILCS 9].
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.225 - Reimbursement for Medicaid Residents

Current through Register Vol. 48, No. 28, July 12, 2024
Supportive Living Programs (SLPs) shall accept the
				  reimbursement provided in this Section as payment in full for all services
				  provided to Medicaid residents.
a) The
				Department has established the rate methodology for SLP providers as follows:
1) Prior to July 1, 2014, the Department
				shall establish its portion of the reimbursement for Medicaid residents by
				calculating 60 percent of the weighted average (weighted by Medicaid patient
				days) nursing facility rates for the geographic grouping as defined in Section
				146.290. Each
				SLP shall be paid 60 percent of the weighted average nursing facility
				geographic group rate, based upon the nursing facility geographic group in
				which it is located. The rates paid to SLPs shall be updated semi-annually on
				April 1 and on October 1 to assure that the rates coincide with 60 percent of
				weighted average nursing facility geographic group rates. Notwithstanding the
				provisions of this subsection, the supportive living program rates shall remain
				at the level in effect on April 30, 2011.
2) Notwithstanding the provisions set forth
				in 89 Ill. Adm. Code
				153.126,
				and subject to federal CMS approval, as of July 1, 2014, supportive living
				program rates shall no longer be 60 percent of the weighted average nursing
				facility rates for the geographic group rate, based upon the nursing facility
				geographic group in which it is located.
3) Notwithstanding the provisions set forth
				in 89 Ill. Adm. Code 153.126, and subject to federal CMS approval, for dates of
				service on or after July 1, 2014, rates effective on June 30, 2014 shall be
				increased 8.85 percent.
4)
				Notwithstanding the provisions set forth in 89 Ill. Adm. Code 153.126, and
				subject to federal CMS approval of the imposition of the assessment in 89 Ill.
				Adm. Code
				140.86,
				for dates of service on or after July 1, 2014, rates effective July 1, 2014
				shall be increased an additional 9.09 percent.
5) Notwithstanding the provisions set forth
				in 89 Ill. Adm. Code 153.126, for dates of service on or after July 1, 2017,
				rates effective on June 30, 2017 shall be increased by 2.8 percent.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.230 - Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) An SLF must
				combine housing, personal and health related services in response to the
				individual needs of residents who need help in activities of daily living.
				Supportive services shall be available 24 hours per day to meet scheduled and
				unscheduled needs in a way that promotes resident self-direction and
				participation in decisions that emphasize independence, individuality, privacy,
				dignity and autonomy in a residential setting.
b) Nursing Services
1) The SLF shall conduct a comprehensive
				resident assessment and service plan for each SLF resident as required under
				Section
				146.245.
2) When a resident is unable to administer
				his or her own medications, a licensed nurse shall administer the
				medications.
3) Nursing services
				shall include medication set-up (such as preparing weekly pill caddies with
				that week's medication) and follow-up care, and shall be conducted by a
				licensed nurse.
4) Other nursing
				services include episodic and intermittent health promotion or disease
				prevention counseling and teaching self-care in meeting routine and special
				health care needs that can be done by other staff under the supervision of a
				registered nurse.
5) All nursing
				services shall be provided in accordance with the Nurse Practice Act [225 ILCS
				65 ].
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.235 - Staffing

Current through Register Vol. 48, No. 28, July 12, 2024
a) The SLP setting
				shall have a manager or a qualified designee present at the SLP during normal
				business hours plus whenever necessary to ensure attention to the management
				and administration of the resident contracts. Staff shall have access to the
				manager or the manager's designee at all times. The manager shall designate a
				qualified individual capable of acting in an emergency during his or her
				absence from the SLP setting.
b)
				The manager shall have at least five years' experience in providing health care
				services to adults with physical disabilities or the elderly population either
				in an assisted living program, inpatient hospital, long term care setting,
				adult day care or in a Department approved health related field. The manager
				shall also have at least two years of management experience.
c) The SLP setting shall have licensed and
				certified staff sufficient in number to meet the needs of the population being
				served.
d) Licensed nurses or
				certified nursing assistants on duty in the SLP setting shall not be utilized
				in an adjoining or other part of the building not certified in the SLP setting.
				This includes, but is not limited to, a nursing facility, assisted living
				facility, and independent living facility.
e) Staff Training. All staff training
				materials shall be available for review by the Department. If required by the
				Department, the SLP setting shall make changes in the training materials.
1) The SLP setting shall provide staff and
				subcontractors who provide direct care with:
A) training that takes place no later than 30
				days after beginning employment and semi-annual training in areas related to
				their employment;
B) training that
				covers resident rights; infection control; crisis intervention; prevention and
				notification of abuse, neglect and financial exploitation; behavioral
				intervention; tuberculosis identification, prevention, control and reporting;
				encouraging independence; potential resident inquiry and admission application
				policy; and non-discrimination policy (these subjects shall be trained as part
				of staff orientation and at least annually thereafter);
C) documented training performed by qualified
				individuals in their area or areas of responsibility;
D) training geared toward the manner in which
				services are to be performed;
E)
				training that includes techniques for working with persons with physical
				disabilities and the elderly populations; and
F) in the case of an SLP setting serving
				persons with physical disabilities, disability specific sensitivity training
				conducted by an outside entity familiar with working with persons with
				disabilities. The training shall occur for all staff initially prior to
				certification, at staff orientation for new staff, and at least annually
				thereafter.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.240 - Resident Contract

Current through Register Vol. 48, No. 28, July 12, 2024
a) The SLF
				shall have a signed contract with each resident, which specifies the terms of
				his or her agreement.
b) The
				resident contract shall include, but not be limited to, the following:
1) Information regarding SLF services the
				resident will receive that are covered under the Medical Assistance
				Program;
2) Arrangements for
				payment;
3) A grievance procedure
				that meets the requirements of Section
				146.260;
4) The SLF's agreement to comply with
				applicable federal, State and local laws and regulations;
5) The conditions under which the resident
				contract may be terminated by either party;
6) Rules for conduct and behavior of the
				staff, management and the resident;
7) A list of the resident rights as stated in
				Section
				146.250;
8) The SLF's policy regarding temporary
				absences from the facility, including absences due to a resident's admission to
				a nursing facility;
9) The SLF's
				policy regarding Supplemental Nutritional Assistance Program benefits being
				turned over by the resident to the SLF; and
10) The SLF's requirement, if any, for
				security deposits charged by the SLF. When applicable, the contract shall state
				that all deposits will be maintained in an interest-bearing account separate
				from the SLF's operating accounts or the funds of any person other than another
				resident. The SLF shall, within 30 days after the end of each 12 month rental
				period, pay the resident any interest, by cash or credit applied to rent due,
				except when the resident is in default under the terms of the lease. If
				required, the SLF shall follow the provisions of the Security Deposit Return
				Act [765 ILCS 710 ] regarding the return of the security deposit when a
				resident vacates the premises.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.245 - Assessment and Service Plan and Quarterly Evaluation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Interview: The SLP provider shall conduct
				a standardized interview geared toward the resident's service needs at or
				before the time of occupancy but not before the DON, or successor tool, and
				other required PAS assessments are completed and determinations provided to the
				SLP provider.
b) Initial
				Assessment: The SLP provider shall complete an initial assessment and service
				plan within 24 hours after admission that identifies needs and potential
				immediate problems. Each assessment shall be completed by, or co-signed by, a
				licensed practical nurse or a registered professional nurse.
c) Comprehensive Resident Assessment: The SLP
				provider shall complete a Comprehensive Resident Assessment Instrument (RAI)
				within 14 days after admission, annually and upon a significant change in the
				resident's mental or physical status. Each RAI shall be completed by, or
				co-signed by, a registered professional nurse.
d) Service Plan: Within seven days after
				completion of the RAI, a written service plan shall be developed by, or
				co-signed by, a registered professional nurse, with input from the resident and
				his or her designated representative. This includes coordination and inclusion
				of services being delivered to a resident by an outside entity. The service
				plan shall include a description of expected outcomes, approaches, frequency
				and duration of services provided and whether the services will be provided by
				licensed or unlicensed staff. The service plan must be individualized to
				address the health and behavior needs of each resident. The service plan shall
				document any services recommended by the SLP provider that are refused by the
				resident. The service plan shall be reviewed and updated in conjunction with
				the quarterly evaluation or as dictated by changes in resident needs or
				preferences.
e) Quarterly
				Evaluation: A quarterly evaluation of the health and behavior status of each
				resident using a Department designated form shall be completed by, or co-signed
				by, a registered professional nurse.
f) Service Plan for Identified Sex Offenders:
				Within seven days after completion of the RAI, a written service plan shall be
				developed by, or co-signed by, a registered professional nurse that addresses
				the following:
1) the amount of supervision
				required by the individual to ensure the safety of all residents, staff and
				visitors; and
2) determination of
				approaches developed in the service plan are appropriate and effective in
				dealing with any behaviors specific to the identified offender.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.255 - Discharge

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a resident
				does not meet the terms for occupancy as stated in the resident contract, the
				SLF shall not commence involuntary discharge until the SLF has discussed the
				reasons for involuntary discharge with the resident and his or her designated
				representative. Documentation of the discussion shall be placed in the
				resident's record.
b) The SLF shall
				provide a resident with a 30-day written notice of proposed involuntary
				discharge unless such a delay might jeopardize the health, safety, and
				well-being of the resident or others. A copy of the notice required by this
				subsection (b) shall be placed in the resident's record and a copy shall be
				transmitted to the resident and the resident's designated representative. The
				notice shall be on a form prescribed by the Department and shall contain all of
				the following:
1) The stated reason for the
				proposed discharge;
2) The
				effective date of the proposed discharge;
3) A statement in not less than 14-point type
				that reads: "You have a right to appeal the SLF's decision to discharge you.
				You may file a request for a hearing with the Department within ten days after
				receiving this notice. If you request a hearing, you will not be discharged
				during that time unless you are unsafe to yourself or others and the SLF has
				given you a notice for an emergency discharge. If the SLF has not given you a
				notice for an emergency discharge, and if the decision following the hearing is
				not in your favor, you will not be discharged prior to the tenth day after
				receipt of the Department's hearing decision unless you are unsafe to yourself
				or others. If the SLF provided you with a notice of emergency discharge, and
				the decision following the hearing is in your favor, you will be entitled to
				readmission to the SLF upon the first available apartment. A form to appeal the
				SLF's decision and to request a hearing is attached. If you have any questions,
				call the Department at the telephone number listed below.";
4) A hearing request form, together with a
				postage paid, preaddressed envelope to the Department; and
5) The name, address, and telephone number of
				the person charged with the responsibility of supervising the
				discharge.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.260 - Grievance Procedure

Current through Register Vol. 48, No. 28, July 12, 2024
a) An SLF
				shall establish a grievance procedure for reviewing grievances registered by,
				or on behalf of, residents. Each resident shall be informed that a grievance
				procedure exists.
b) Records shall
				be maintained and made available to the Department on all written grievances
				and the SLF's response to and disposition of each grievance.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.265 - Records and Reporting Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) An SLP provider shall develop and maintain
				confidential written records regarding each resident, which shall include, but
				are not limited to:
1) The Comprehensive
				Resident Assessment;
2) The
				resident contract;
3) The service
				plan;
4) The quarterly
				evaluation;
5) Progress notes that
				shall be used to document decline or improvement in resident status;
6) The resident satisfaction
				survey;
7) Written documentation of
				the inquiry to the sex offender databases, including the result of the inquiry;
				and
8) Documentation of a
				tuberculosis test administered in accordance with Section
				146.220(d).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.270 - Quality Assurance Plan

Current through Register Vol. 48, No. 28, July 12, 2024
Each SLF shall be responsible for establishing an effective,
				  internal quality assurance plan that encompasses oversight and monitoring, peer
				  review, utilization review, resident satisfaction and ongoing quality
				  improvement and implementation of any corrective action plans that address
				  improved quality services. The quality assurance plan shall include:
a) Documentation of results of, and SLF
				responses to, the annual resident satisfaction survey that shall include, but
				not be limited to, whether the:
1) Residents
				have the opportunity to provide input into development and implementation of
				existing SLF policies and procedures;
2) Existing SLF policies and procedures are
				clear to residents;
3) Residents
				have access to existing SLF policies and procedures;
4) Residents have a degree of control over
				personal lifestyle preferences;
5)
				Residents have access to common areas;
6) Residents are satisfied with surroundings
				as "home-like"; and
7) Residents
				have the opportunity to exercise personal lifestyle preferences and direct
				services according to personal preferences (for example, meal choices and
				refusal of services).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.275 - Monitoring

Current through Register Vol. 48, No. 28, July 12, 2024
a) Monitoring and
				oversight of the SLF shall be conducted by the Department or its
				designee.
b) Designated Department
				staff shall coordinate the program, provide technical assistance and monitor
				compliance no less often than annually.
c) The Department shall investigate all
				complaints within seven days after receipt from a resident, a resident's
				designated representative or others expressing concern related to the health
				and safety of the residents. The Department may conduct a full certification
				review or make referrals to other appropriate entities for additional action if
				the results of a complaint investigation indicate the need to do so.
d) An SLF shall not restrict or hamper access
				by Department designated staff to the building, residents or designated records
				required to conduct routine or periodic reviews or investigations. A resident
				may limit access to his or her private dwelling space to Department designated
				staff, except for reviews regarding suspected violations or situations that may
				pose a threat to the resident's or others' health, safety or well-being. A
				resident may also elect to limit access to himself or herself and his or her
				records, except as required as a condition of payment for housing and services
				by a third party.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.280 - Non-Compliance Action

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department may terminate or suspend or not renew a provider agreement subject
				to the provisions of 89 Ill. Adm. Code
				140.16.
b) In the event that the SLF is found to be
				out of compliance with certification requirements during any on-site review or
				investigation conducted by the Department, the following procedures shall be
				used based on whether the non-compliance is determined to result in immediate
				jeopardy or non-immediate jeopardy.
c) Non-Compliance Involving Immediate
				Jeopardy
1) In the event that it is determined
				that the findings of non-compliance result in immediate jeopardy that poses a
				current risk to the health and safety of the residents, Department staff shall
				notify the SLF of the non-compliance and Department staff may stay on-site
				until the area or areas of non-compliance have been abated.
2) For non-compliance involving immediate
				jeopardy where health and safety of residents is not currently at risk, the
				Department shall provide a written notice to the SLF within five working days
				after the conclusion of the on-site review.
3) The SLF shall have five calendar days from
				receipt of the written notice to refute the findings or submit a plan of
				correction.
4) If no refutation is
				submitted, the SLF shall have ten calendar days from receipt of the written
				notice to correct the non-compliance issue or issues. No extension of the ten
				day period shall be granted.
5) If
				a refutation is submitted, the ten day correction period is stayed until a
				Department decision is made.
6)
				Department staff shall conduct a follow-up review within ten working days after
				the conclusion of the ten day correction period to verify compliance. If the
				follow-up review continues to show the potential for immediate jeopardy, the
				Department shall take action to suspend or terminate the SLF's provider
				agreement.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.285 - Voluntary Surrender of Certification

Current through Register Vol. 48, No. 28, July 12, 2024
An SLF shall inform the Department in writing if it intends
				  to voluntarily surrender its certification from the Medicaid program. The
				  notification shall be received by the Department at least 90 days prior to the
				  date of surrender. The Department will make SLF payments only through the day
				  prior to the effective date of voluntary surrender. Notice by the SLF shall be
				  given to residents pursuant to Section
				  146.255.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.290 - Geographic Groups

Current through Register Vol. 48, No. 28, July 12, 2024
These geographic groups define boundaries, according to
				  counties, that are used in rate setting for supportive living
				  facilities.
a) Chicago - Cook
				(including the city of Chicago), DuPage, Kane, Lake and McHenry.
b) South Suburb - Grundy, Kankakee, Kendall
				and Will.
c) South - Alexander,
				Clay, Crawford, Edwards, Effingham, Fayette, Franklin, Gallatin, Hamilton,
				Hardin, Jackson, Jasper, Jefferson, Johnson, Lawrence, Marion, Massac, Perry,
				Pope, Pulaski, Randolph, Richland, Saline, Union, Wabash, Washington, Wayne,
				White and Williamson.
d) St. Louis
				- Bond, Clinton, Madison, Monroe and St. Clair.
e) Central - Bureau, Champaign, Clark, Coles,
				Cumberland, DeWitt, Douglas, Edgar, Ford, Fulton, Henderson, Iroquois, Knox,
				LaSalle, Livingston, Macon, Marshall, McDonough, McLean, Moultrie, Peoria,
				Piatt, Putnam, Shelby, Stark, Tazewell, Vermilion, Warren and
				Woodford.
f) West Central - Adams,
				Brown, Calhoun, Cass, Christian, Greene, Hancock, Jersey, Logan, Macoupin,
				Mason, Menard, Montgomery, Morgan, Pike, Sangamon, Schuyler and
				Scott.
g) Northwest - Boone,
				Carroll, DeKalb, Henry, Jo Daviess, Lee, Mercer, Ogle, Rock Island, Stephenson,
				Whiteside and Winnebago.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.295 - Emergency Contingency Plan

Current through Register Vol. 48, No. 28, July 12, 2024
For the purpose of this Section, "emergency" means an event,
				  as a result of a mechanical failure or natural force such as water, wind, fire
				  or loss of electrical power, that poses a threat to the safety and welfare of
				  residents, personnel, and others present in the SLF.
a) Each SLF shall have a written plan, which
				shall be part of the SLF's Quality Assurance Plan, for protection of all
				persons in the event of mechanical failure or natural force emergency, for
				keeping persons in place, for evacuating persons to areas of refuge, and for
				evacuating persons from the building when necessary. The plan shall:
1) address the physical and cognitive needs
				of residents and include special staff response, including the procedures
				needed to ensure the safety of any resident. The plan shall be amended or
				revised whenever any resident with unusual needs is admitted;
2) provide for the temporary relocation of
				residents for any emergency requiring relocation;
3) provide for the movement of residents to
				safe locations within the SLF in the event of a tornado warning or severe
				thunder storm warning issued by the National Weather Service;
4) provide for the health, safety, welfare
				and comfort of all residents when the heat index/apparent temperature, as
				established by the National Oceanic and Atmospheric Administration, inside the
				residents' living, dining, activities, or sleeping areas of the SLF exceeds a
				heat index/apparent temperature of 80°F, or falls below 55°F, for 12
				hours or more;
5) address power
				outages, including how residents call for help, how resident safety is
				monitored, and how food spoilage is checked while power is out;
6) include contingencies in the event of
				flooding, if located in a flood plain; and
7) be reviewed by local emergency response
				entities, such as fire department, ambulance and EMT services. The emergency
				response entities shall direct recommendations to the SLF concerning the SLF's
				plan and any issues that could be life threatening, and the SLFs shall make
				changes to the plan, as appropriate.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart B - SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS › Section 146.300 - Waivers

Current through Register Vol. 48, No. 28, July 12, 2024
Section
				  146.300
				  Waivers
a) The Department may
				grant a waiver from specified provisions of this Subpart B if the applicant or
				SLF can demonstrate that an alternative is available to ensure the residents'
				health, safety and welfare.
b) An
				applicant or SLF shall submit a written request for a waiver that includes:
1) The applicant's or SLF's name and
				address;
2) The specific Section of
				this Part for which the applicant or SLF is requesting a waiver;
3) The reason or reasons why an applicant or
				SLF is not able to comply with the requirements;
4) An alternative, if applicable, that
				ensures that the health, safety and welfare of residents are protected;
				and
5) The duration of the
				waiver.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.305 - Reporting of Suspected Abuse, Neglect and Financial Exploitation

Current through Register Vol. 48, No. 28, July 12, 2024
a) SLF staff shall
				make a report when there is suspected abuse, neglect or financial exploitation
				of the SLF resident. A person making a report in the belief that it is in the
				alleged victim's best interest shall be immune from criminal or civil liability
				or professional disciplinary action on account of making the report,
				notwithstanding any requirements concerning the confidentiality of information
				with respect to the eligible adult that might otherwise be
				applicable.
b) The SLF manager or
				employee shall contact local law enforcement authorities immediately when
				suspected abuse, neglect or financial exploitation involving physical injury,
				sexual abuse, a crime or death occurs to a resident as the result of actions by
				a staff member, family member, visitor, or another resident. SLFs serving
				persons age 22 through 59 may also contact the Department of Human Services,
				Office of Inspector General Hotline at 1-800-368-1463, for an investigation of
				allegations of abuse, neglect or financial exploitation.
c) Facility staff shall be trained at staff
				orientation and at least annually thereafter on the definitions of abuse,
				neglect and financial exploitation; on appropriate interventions; on how and to
				whom to report suspected abuse, neglect and financial exploitation; and
				emphasizing that reporting should be immediate.
d) Residents, family members and residents'
				designated representative shall be made aware of the SLF's policy relating to
				reporting of suspected abuse, neglect and financial exploitation.
e) Upon the occurrence of suspect abuse,
				neglect or financial exploitation that results in contact with local law
				enforcement, the SLF manager or designee must provide a preliminary report to
				the Department by fax within 24 hours after the occurrence. This includes, but
				is not limited to, suspected abuse of any nature, allegations of theft,
				elopement of residents or missing residents, and any crime that occurs on
				facility property. This preliminary report shall include, at a minimum:
1) name and location of the SLF;
2) description of situation, including what
				is alleged, what steps have been taken to immediately protect the residents
				involved, and any injury;
3) number
				and names of residents involved; and
4) other State or local agencies notified
				about the abuse, neglect or financial exploitation.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.310 - Facility Management of Resident Funds

Current through Register Vol. 48, No. 28, July 12, 2024
a) The SLF may 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. The 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 manager. If the SLF manages
				residents' personal funds, it shall:
1)
				Deposit funds in excess of $50 in an interest bearing account;
2) Establish a separate, written record of
				each resident's account;
3) Provide
				a written record of the account at least quarterly to each resident or
				authorized representative included in the account;
4) Retain all records of managed funds for
				three years for residents currently residing in the facility and for residents
				who have died or been discharged from the facility;
5) Report changes in circumstances to the
				Department of Human Services (DHS) local office;
6) Notify the DHS local office of any lump
				sum payment received;
7) Keep
				resident funds in an account or accounts that 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, 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 residents' funds shall be prorated 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
8) Notify each Medicaid-eligible resident
				when the amount in the resident's account reaches $200 less than the asset
				limit for one person or a couple.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.400 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Available Family Income" means the lesser of:
Base income minus the sum of:
$5,500 and
$3,500 times the number of persons in the family, or
One-half of base income
"Base Income" means the income reported for State income tax
				  purposes of all members of the family.
"Core Team" means a team that includes a board certified
				  hematologist as a Hemophilia Service Director, a full-time board certified
				  pediatric hematologist and/or board certified pediatrician (at a Treatment
				  Center that serves children), a nurse coordinator, and a social worker.
"Extended Team" means a team of medical and support staff
				  available as appropriate, and includes the following: patient's primary
				  physician, physical therapist/physiatrist, orthopedist, infectious disease
				  specialist, hepatologist, psychologist/psychiatrist, dentist/dental
				  hygienist/oral surgeon, genetic counselor, nutritionist,
				  gynecologist/obstetrician, pharmacist, education/vocation counselor and
				  financial counselor.
"Department" means the Illinois Department of Public
				  Aid.
"Eligible Hemophilia Services" means blood transfusions,
				  blood derivatives, out-patient services, physicians' charges, medical supplies
				  and appliances used in the treatment of persons eligible for the State
				  Hemophilia Program.
"Hemophilia" means a bleeding tendency resulting from a
				  genetically determined deficiency in the blood.
"Hemophilia Treatment Center" means a facility that has met
				  the requirements set forth in Section
				  146.420
				  and has been designated as a Hemophilia Treatment Center by the
				  Department.
"Patient" means a person meeting the eligibility requirements
				  for the State Hemophilia Program as defined in Section
				  146.410.
"Patient Participation Fee" means the amount of expenses for
				  eligible hemophilia services that the patient or, in the case of a minor, the
				  patient's parent or guardian will be responsible for on an annual
				  basis.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.410 - Patient Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) An
				eligible person shall:
1) Be a resident of
				the State of Illinois; and
2) Not
				be otherwise eligible for comprehensive benefits under the Public Aid Code [305
				ILCS 5 ] or the Children's Health Insurance Program Act [215 ILCS 106 ];
				and
3) Submit an application form
				accompanied by a copy of the most recent State Income Tax Return (IL 1040) for
				the person or, in the case of a minor, for the person's parents or guardian;
				and
4) Submit the Illinois
				Hemophilia Program Medical Form signed by the medical director of an approved
				Hemophilia Treatment Center to document the person has a diagnosis of
				hemophilia.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.420 - Hemophilia Treatment Centers

Current through Register Vol. 48, No. 28, July 12, 2024
Each Hemophilia Treatment Center must annually, in a format
				  specified by the Department, attest that the services provided by the center
				  include all of the following:
a)
				Twenty-four hour attendance by a physician.
b) A Core Team.
c) An Extended Team readily available and
				accessible for evaluations or referrals.
d) Pediatric hematology services.
e) Dental program.
f) Protocols for the management of
				complications of inherited bleeding disorders.
g) Comprehensive psychosocial services and
				counseling.
h) Genetic counseling
				and testing.
i) Access to
				laboratory services.
j) A
				comprehensive home infusion therapy program that provides instruction, ongoing
				education, monitoring and supervision by medical professionals experienced in
				the management of hemophilia.
k)
				Twenty-four hour emergency services with written treatment protocols and a
				hematologist on-call.
m)
				Twenty-four hour availability of, or accessibility to, all products for
				treating hemophilia and related bleeding disorders as recommended by the
				National Hemophilia Foundation Medical and Scientific Advisory
				Committee.
n) Active collaboration
				with local, State and national hemophilia organizations to provide outreach and
				education.
o) Established linkages
				with private, public and voluntary service organizations and health care
				providers to assure a full-range of services to meet clinical and psychosocial
				needs of the patient and the patient's family.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart C - STATE HEMOPHILIA PROGRAM › Section 146.430 - Comprehensive Care Evaluation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Each
				Hemophilia Treatment Center shall provide comprehensive care evaluations to
				patients. The components of the evaluation, specified in subsection (b) of this
				Section, need not all be performed at the same time or place.
b) A comprehensive care evaluation shall
				include:
1) Examination by a
				hematologist;
2) Examination by a
				physical therapist and/or orthopedic surgeon;
3) Dental examination;
4) Psychosocial assessment by a qualified
				medical social worker or other qualified person;
5) Appropriate radiographs as deemed
				necessary and ordered by the center director, the radiologist or orthopedist;
				and
6) Laboratory studies including
				inhibitor screen test, liver function tests, hepatitis B antigen and antibody
				tests, urinalysis and blood count.