Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.560 - Components of the Base Rate Determination

Current through Register Vol. 48, No. 28, July 12, 2024
Except as specified otherwise in this Section, rates
				  calculated for the rate year beginning July 1, 1990 and for subsequent years
				  thereafter shall be based on the facility's cost report for the facility's full
				  fiscal year ending at any point in time during the previous calendar year as
				  long as that cost report is filed prior to April 1. Otherwise, the latest cost
				  report available on March 31 will be used to set rates for July 1. For example,
				  if a facility with a December 31, 1989 year end files their cost report prior
				  to April 1, 1990, that cost report will be used to set rates for the rate year
				  to begin on July 1, 1990. In this example, if the December 31, 1989 cost report
				  is not filed until after March 31, 1990, the December 31, 1988 cost report will
				  be used to set rates for the rate year to begin on July 1, 1990.
a) In the case of a change in ownership of a
				previously certified facility, the rate issued to the previous owner will be in
				effect for the remainder of the rate year. A new rate will be calculated for
				the next rate year based on the new owner's cost report if a cost report
				covering a minimum of the first six months of operation is received by the
				Bureau of Health Finance prior to April 1 
				st. If a cost report covering the first
				six or more months of operation for the new owner cannot be filed with the
				Bureau of Health Finance prior to April 1 
				st, the rate will be calculated based
				upon the prior owner's cost report filed in accordance with the opening
				paragraph of this Section. A cost report that has not been completed in
				accordance with the Department's rules and cost report instructions will not be
				considered as received until all cost report pages are properly
				completed.
b) In the case of a new
				facility, capital reimbursement will be assigned on the receipt of the first
				cost report (which may be an abbreviated cost report). The support
				reimbursement will be set at the median for that region. The facility must then
				file a six-month cost report (beginning with the date the first patient was
				admitted) that contains actual historical cost information. The capital and
				support rates will then be recalculated based upon this cost report. Rates so
				calculated will become effective on the first day of the first month after the
				six-month cost report is received by the Department's Bureau of Health Finance.
				The facility must obtain written verification of the initial cost reporting
				periods from the Bureau of Health Finance.
c) When a construction addition to the
				building will increase the licensed bed capacity by ten percent or more, the
				facility may file a revised cost report reflecting the increased capital
				investment. If this revised cost report is filed within 30 days after the date
				of the increase in licensure as determined by the Illinois Department of Public
				Health, any increase in the capital rate will be effective on the effective
				date of licensure increase. If the revised cost report is filed more than 30
				days after the effective date of increase in licensure, any increase in the
				capital rate will be effective on the first day of the first month after the
				report is received by the Bureau of Health Finance.
d) Once a rate for an individual facility has
				been calculated, a new rate will not be calculated during the course of the
				rate year except as provided in subsections (b) and (c) of this
				Section.
e) If a facility incurs
				building construction improvements that increase the total building cost for
				the current owner by ten percent or more and that would raise the base year,
				then the nursing home may file a revised cost report that reports the increased
				capital investment. Only facility building construction improvements completed
				after the end of the period of the report used to calculate the last capital
				rate calculation can be used to meet the ten percent requirement. Purchases of
				buildings for use by the facility and allocations of central office buildings
				and improvements cannot be used to meet the ten percent requirement. The base
				year is defined in Section
				140.570(b)(2).
				If the improvements have been completed and put into use prior to the
				forthcoming rate year and the cost report reflecting increased capital costs is
				filed prior to the beginning of the next rate year, then any increase in the
				capital rate will be effective on the first day of the rate year.
f) In order to accommodate the downsizing to
				close or reduce bed capacity of ICF/MR facilities licensed for ICF/DD or
				SNF/PED Services, the following provisions will apply. These provisions only
				apply for facilities with 17 or more licensed beds that decrease their total
				licensed beds by 20 percent or more due to a decrease in the beds licensed as
				ICF/DD or SNF/PED. The reduced bed capacity must be necessary to achieve one or
				more of the following goals: achieve compliance with ICF/MR regulations, such
				as four or fewer persons per room; achieve compliance with ICF/MR regulations
				in an adverse action as part of a Plan of Correction (see the Department of
				Public Health rules at 77 Ill. Adm. Code
				300.278 );
				increase available space in order to provide active treatment services to
				residents; and permit the voluntary closure of a facility in order to achieve
				community placement to settings of size eight or fewer residents, provided
				sufficient funds are available to the Department of Human Services (DHS).
1) The facility must request pre-approval for
				application of these provisions from the DHS Director of the Division of
				Disability and Behavioral Health Services (DDBHS). The written request must
				describe the necessity to reduce licensed bed capacity. The facility must
				submit a proposed timetable for the downsizing, including the projected dates
				of each decrease in census and the census on that date (the benchmark). Written
				approval may be granted if DHS determines the change will be beneficial for the
				ICF/DD or SNF/PED residents. If approval is granted, DHS will enter into a
				downsizing agreement with the facility with provisions including the downsizing
				plan, benchmarks, rate adjustments and items of compliance regarding the safety
				and placement of residents.
2) The
				reduction in the number of licensed beds must be completed within a one-year
				period following the DDBHS Director's approval, unless a longer reduction
				period is approved by the Deputy Director at the onset of the plan. Not fewer
				than 90 days prior to the projected end date of the downsizing plan, the
				facility must make application to the Department of Public Health (DPH) for a
				formal licensure change to reflect the number of licensed beds, if any, to
				remain at the conclusion of the downsizing plan. The effective date of the
				licensed bed change will be the actual date the final resident benchmark census
				objective is reached.
3) A facility
				is ineligible for downsizing if the facility has been notified in writing by
				DPH of a need for a Plan of Correction for non-compliance with conditions of
				participation, Type A violations, licensure non-compliance, or because the
				facility has been declared an "immediate and serious threat" to the welfare of
				any resident or residents in the one-year period preceding the date of a
				request for application of these downsizing provisions unless the DDBHS
				Director has granted the facility a waiver of this one year
				requirement.
4) When DPH notifies a
				facility in writing of a need for a Plan of Correction for non-compliance with
				conditions of participation, Type A violations, licensure non-compliance, or
				because the facility has been declared an "immediate and serious threat" to the
				welfare of any resident, the facility may seek DHS approval of a downsizing
				plan concurrently as part of a Plan of Correction to DPH in accordance with the
				time frames and process allotted by DPH. If a downsize application is not made
				at this time and as part of a Plan of Correction, the facility is ineligible
				for downsizing.
5) During the
				downsizing period, the facility may not accept any admissions except with
				explicit permission of DHS. The facility must agree to make every effort to
				insure immediate notification (within 72 hours) to DHS and to the local DHS
				office of all changes in recipient enrollment, eligibility, income, assets,
				earnings and other status. The facility must agree to make available to DHS and
				interested parties such records as necessary to disclose the type and quantity
				of care provided to specific residents, as well as physicians' reports, need
				for care, level of functioning and orders for services. The facility must agree
				to provide access to resident care records and facility records and policies
				concerning resident care throughout the downsizing period.
6) The capital and support rates in effect at
				the time of approval of the downsizing plan (exclusive of any flat add-on rate
				increases) will be modified for downsizing in accordance with subsection (f)(9)
				of this Section.
7) The capital and
				support rates will be revised with the achievement of the benchmarks specified
				in the downsizing agreement during the approved downsizing period.
A) The capital rate will be increased in
				proportion to the agreed on decrease in the census achieved at the end of each
				benchmark period from the census at the start of the downsizing period. For
				example, with an original census of 98 residents at the start of the downsizing
				period and the achievement of a reduction of eight residents to reach the
				benchmark of 90 residents, the initial $7.41 capital rate will be increased to
				$8.07 as follows: (the initial capital rate) is multiplied by (the original
				census that has been divided by the achieved census reduction), or ($7.41) X
				(98/90 or 1.089 ) = $8.07.
B) The
				support rate will be increased in proportion to the decrease in census achieved
				at the end of each benchmark period from the census at the start of the
				downsizing period, with the assumption that 50 percent of the support costs are
				fixed and 50 percent of the support rate is variable (for example, costs vary
				as the number of residents varies). The fixed half of the support rate will be
				increased in proportion to the achieved decrease at the end of each benchmark
				period. For example, with an original support rate of $22, the support rate
				would be [(.5 X $22) X (98/90)] + (.5 X $22) = $22.98.
C) The program rate will be set according to
				the methodology in DHS rules at 89 Ill. Adm. Code 144 (exclusive of any flat
				add-on increases).
8)
				The support rate for ICF/DD facilities may not exceed the facility's geographic
				area ceiling. Facilities having SNF/PED licenses that are reducing facility
				census to comply with ICF/MR regulations that limit the number of persons per
				bedroom to four or fewer may exceed the facility's geographic area ceiling but
				by no more than 125 percent. The exception allowing SNF/PED facilities to
				exceed the support rate geographic area ceiling will only be based on the
				reduction in census to attain four or fewer persons per bedroom. If a SNF/PED
				facility reduces census below that required to attain four persons per bedroom,
				the support rate may not exceed the facility's geographic area
				ceiling.
9) At the conclusion of
				the downsizing period the capital, support and program rates will be determined
				as follows:
A) The capital rate component
				will be fixed at the final downsizing rate and will remain in effect until such
				time as the rate methodology in effect produces a rate based on the downsized
				licensed capacity that surpasses the downsize capital rate amount. The final
				downsize capital rate will be increased by funding changes such as cost of
				living increases, when given. All space in the facility must continue to be
				used as an ICF/DD or SNF/PED. Use of the facility for an on-site developmental
				training program, school services or uses unrelated to the operation of the
				facility as an ICF/DD or SNF/PED, will require the calculation of the capital
				rate according to the methodology of Sections
				140.570
				through
				140.574
				after an adjustment of the facility's capital costs in proportion to the
				involved square footage. This capital rate will be effective the first day of
				the month following the change in space usage. Capital improvements to the
				downsized facility may be made and will be reimbursed as an increase to the
				downsize capital rate determined as the applicable percentage rate of return of
				the capital methodology times the per diem per bed reported amount of the
				improvement. The support rate in effect at the end of the downsizing period
				will remain in effect until a cost report covering the first six months of
				operation of the downsized facility is submitted as would be applicable to a
				new facility in accordance with provisions in subsection (b) of this Section.
				These six-month costs and the corresponding days of care will be used to set
				the support rate in accordance with the support component rate methodology in
				effect.
B) The program rate will be
				set according to the methodology described at 89 Ill. Adm. Code 144.