Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.300 - Reimbursement for Program (Active Treatment) Costs in Small Scale Residential Facilities

Current through Register Vol. 48, No. 28, July 12, 2024
Small scale residential facilities (ICF/MR) with four or six
				beds for clients 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 three determinants which
				in combination will result in a total facility program per diem amount. These
				three 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
A) Reimbursement for direct services is based
			 on a direct service staffing pattern which is specific to small scale ICF/MR
			 facilities. Facilities must be in compliance with minimum average daily
			 staffing standards relative to client population according to each individual's
			 overall level of functioning. The overall level of functioning for each client
			 is determined according to the method described in Section
			 144.275(a)(1)(A)(i)
			 and (ii), and Sections 144.Tables D and E.
			 The direct service staffing patterns based on the size of the residential
			 setting and the overall level of functioning of the client population are:
Overall Level of Client Functioning
FTE* Staff
4-Person ICF/MR
Mild
2.13
Moderate
3.88
Severe/Profound
5.93
6-Person ICF/MR
Mild
3.2
Moderate
5.02
Severe/Profound
6.84
*FTE = Full time Equivalent
B) Reimbursement will be calculated according
			 to the total direct service FTE staff derived from the weighted average of the
			 FTE staff for levels of functioning in the moderate and severe/profound range
			 within the small scale facility. After the total FTE staff are determined, the
			 per diem amount is obtained according to the method in Section
			 144.275(a)(1)(C)(i).
C) The reimbursement for a client residing in
			 a small scale ICF/MR who has been found to be ineligible for ICF/MR services,
			 as a result of the facility's Interdisciplinary Team (IDT) process or an IOC
			 determination, will be at the mild level of overall functioning for not more
			 than one year from the quarter following the determination of ineligibility. If
			 the client has not been discharged in accordance with Section
			 144.250
			 by the end of the one year period, reimbursement will be made at the
			 Department's sheltered care rate. The sheltered care rate will be payment in
			 full for all program, capital and support costs for such clients.
D) Reimbursement for a client admitted to a
			 small scale ICF/MR who is determined to be ineligible, or who is without a
			 determination of eligibility by the preadmission screening process, will be set
			 at the sheltered care rate. The sheltered care rate will be payment in full for
			 all program, capital and support costs. Payment for services for each client
			 who has not been found eligible for the ICF/MR program upon admission will
			 terminate 30 days following the date of admission. Reimbursement for
			 residential services for such a client which is paid to the facility beyond the
			 30 day period following admission will be recouped by the Department from the
			 next facility payment or other contractual time period.
E) The facility rate paid will be the
			 weighted average of the total per diem (including capital and support)
			 calculated for eligible clients with mild, moderate and severe/profound levels
			 of overall functioning and the Department's sheltered care rate for clients
			 admitted without previously determined ICF/MR eligibility, or who are
			 ineligible for ICF/MR services as determined by the IDT or IOC process, and
			 remain in the facility for more than one year following the date of the
			 determination of ineligibility.