Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.100 - Exceptional Care Needs of Clients with Developmental Disabilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) Exceptional Care
			 Program
1) The Department of Human Services
			 (Department) may make payments to facilities that meet licensure and
			 certification requirements for skilled nursing facilities - under age 22
			 (SNF/Ped as may be prescribed by the Department of Public Health (DPH) (see the
			 Department of Public Health's rules at 77 Ill. Adm. Code 390). A participating
			 facility must maintain its licensure and certification and be in compliance
			 with the applicable conditions of participation and licensing and certification
			 standards to be eligible for exceptional care. If DPH notifies the facility, in
			 writing, of a need for a plan of correction for non-compliance with one or more
			 conditions of participation, or that an imposed plan of correction for an A or
			 B licensure finding is required, or if DPH notifies the facility because it has
			 been declared an "immediate and serious threat" to the welfare of any
			 resident(s), that facility will not be allowed to receive exceptional care
			 reimbursement for any additional individuals from the date of DPH's written
			 notification until the date DPH officially determines any and all of the
			 conditions leading to the notification have been satisfactorily resolved. No
			 payment for exceptional care shall be made retroactively for any residents
			 admitted to the facility while the facility was in violation of DPH's rules at
			 77 Ill. Adm. Code 390. Exceptional care payment for such individuals shall
			 commence when all such violations have been corrected, if such individuals are
			 approved for exceptional care.
2)
			 Exceptional medical care is defined as the level of care with extraordinary
			 costs related to services which may include nurse, ancillary specialist
			 services, and medical equipment and/or supplies that have been determined to be
			 a medical necessity. This may apply to Medicaid clients who currently are
			 residing in SNF/Ped facilities, Medicaid patients who are being discharged from
			 the hospital or other setting where Medicaid reimbursement is at a rate higher
			 than the exceptional care rate for related services, or persons who are in need
			 of exceptional care services and who would otherwise be in an alternative
			 setting at a higher cost to the Department or the Department of Public Aid.
			 This includes but is not limited to persons with complex respiratory illness,
			 ventilator-dependent persons or persons with high medical needs for whom the
			 SNF/Ped provides a cost-effective living arrangement. High medical needs is
			 defined as licensed staffing costs 50 percent above the level III medical
			 add-on licensed staffing reimbursement rate.
3) The Department shall recommend rates to
			 the Department of Public Aid (DPA) for DPA approval in accordance with the
			 provisions of Section 18.2 of the Mental Health and Developmental Disabilities
			 Administrative Act [20
			 ILCS 1705/18.2 ] and Section 5-11 of the Illinois
			 Public Aid Code [305
			 ILCS 5/5-11 ]. The Department will calculate the rates
			 for exceptional care service categories by using data collected from SNF/Ped
			 exceptional care providers.