reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.539 - Reimbursement for Basic Nursing Assistant, Developmental Disabilities Aide, Basic Child Care Aide and Habilitation Aide Training and Nursing Assistant Competency Evaluation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Training
				Reimbursement
1) Long term care facilities
				shall be reimbursed for the reasonable costs of assistant and aide training.
				Upon the individual's successful completion of a course which has been approved
				by the Department of Public Health (77 Ill. Adm. Code
				395.110 ),
				the facility may claim reimbursement for the following costs, provided that
				they are actually incurred:
A) tuition, up to
				the prevailing community college rate in the health service area for a six
				credit hour course;
B)
				instructional materials, up to $25.00; and
C) salary and fringe benefits (fringe
				benefits are payroll taxes, unemployment insurance, worker's compensation,
				health insurance and meals if provided) up to the prevailing entry level for
				the health service area.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.540 - Costs Associated With Nursing Home Care Reform Act and Implementing Regulations

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Facilities shall be reimbursed for reasonable expenses necessarily incurred to
				comply with regulations promulgated by the Department of Public Health pursuant
				to the Nursing Home Care Reform Act of 1979 (Ill. Rev. Stat. 1981, ch. 1111/2,
				pars. 4151-101 et seq.) The estimates per patient, per day are as follows:
1) License fees (Division 1, Section 2) -
				$.004
2) Resident advisory council
				(Division 3, Section 4) - $.013
3)
				Patient account management (Division 16, Section 6) - $.023
4) Denture Marking - $.001
5) Patient Identification - $.001
Total - $.042
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.541 - Salaries Paid to Owners or Related Parties

Current through Register Vol. 48, No. 28, July 12, 2024
a) Salaries (and other forms of compensation)
				paid to owners and related parties are allowable costs, subject to the
				following:
1) A figure for administrative
				salary costs paid to an owner is determined up to the following annual limits:
A) the 90th percentile of updated salaries
				paid to non-owner administrators for homes of that size and location
				group;
B) $50,000 for full time
				work (at least 35 hours per week) for one person performing management services
				for more than one home (in such cases, the salary costs used as the basis for
				comparison to the $50,000 limit will be those salary costs reported on the
				individual facility cost reports which are being used to set the rate for that
				year).
C) $50,000 for full time
				work (at least 35 hours per week) or a percentage thereof for part time
				work.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.542 - Cost Reports-Filing Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
Long term care (SNF/ICF) and residential (ICF/MR) facilities,
				  and developmental training (DT) programs shall file cost reports with the
				  Department of Public Aid in accordance with the following requirements:
a) All schedules contained in the cost
				reports must be completed with the exception of those schedules specified in
				the cost report instructions as optional. Substitution of cost report schedules
				with provider records or other documents may not be made without written prior
				approval from the Department. Approval will be granted if the provider's
				documents contain the same information as the cost report schedule and the
				provider is not and does not anticipate serving public aid clients.
b) The cost report is not complete until all
				required schedules are filed and all inquiries to the provider are
				satisfactorily resolved. A provider will be notified by the Department in
				writing when the cost report is complete.
c) If the cost report is prepared by other
				than the provider's administrator or officer, the certification must be signed
				by the preparer as well as the officer or administrator. The preparer's
				declaration is based upon all information of which the preparer has any
				knowledge.
d) All financial data
				contained in the cost report must be accounted for on the accrual basis of
				accounting, except that governmental institutions operating on a cash method of
				accounting may submit data based on such a method.
e) Once a cost report has been correctly
				filed, no changes for the purpose of maximizing reimbursement shall be
				permitted. For example, it is not allowable to capitalize items which had been
				expensed on the cost report (or vice versa) unless the original method was
				clearly inconsistent with instructions for completion of cost reports and the
				Department has mandated the change.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.543 - Time Standards for Filing Cost Reports

Current through Register Vol. 48, No. 28, July 12, 2024
a) Except as provided in subsections (b) and
				(c) below, the cost report must be filed within 90 days of the end of the
				fiscal year of long term care (ICF/SNF) and residential (ICF/MR) facilities and
				developmental training (DT) agencies. One extension up to 30 days shall be
				granted for circumstances which will not allow a cost report to be properly
				completed before the due date of the report. The written request for an
				extension must be submitted to the Department of Public Aid (DPA) Office of
				Health Finance prior to the original due date. All requests shall be judged
				based upon the individual circumstances to determine the length of the
				extension.
b) Change of Ownership -
				The new owner or lessee must file a cost report 9 months after acquisition
				(covering the first 6 months of operation). A change of ownership is dated from
				the closing of the sale or from the date of the oldest lease agreement between
				the present incumbents of a lease. The facility must also file a cost report
				within 90 days of the close of its first complete fiscal year.
1) A change of corporate stock ownership does
				not constitute a change in ownership.
2) The Department will not recognize any
				subsequent transaction by the lessee as a new acquisition for purposes of
				capital reimbursement. Capital costs are allowed only when a facility is
				constructed, sold or leased for the first time. The Department will recognize
				the one lease as a new acquisition.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.545 - Penalty for Failure to File Cost Reports

Current through Register Vol. 48, No. 28, July 12, 2024
No funds shall be expended by the Department (DPA) for the
				  maintenance of any resident in a long term care or residential facility which
				  has failed to file an annual cost report. No funds shall be expended by the
				  Department for developmental training (DT) services provided by any DT program
				  which has failed to file an annual cost report.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.550 - Update of Operating Costs

Current through Register Vol. 48, No. 28, July 12, 2024
The reported, allowable operating costs will be updated on a
				  facility by facility basis for inflation experienced since this cost report was
				  filed and for inflation anticipated during the rate year pursuant to Sections
				  140.551
				  through
				  140.555.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.551 - General Service Costs Updates

Current through Register Vol. 48, No. 28, July 12, 2024
General Service costs (hotel costs - food, dietary, laundry,
				  utilities, maintenance - see Section
				  140.531 )
				  shall be updated by using nationally published indices specific to nursing home
				  costs. (Health Care Cost Review, a publication of the Cost Information
				  Forecasting Service, published quarterly by DRI-WEFA, Inc., a Global Insight
				  Company, 24 Hartwell Avenue, Lexington, Massachusetts 02421 (2001). This
				  incorporation by reference does not include any later amendments or
				  editions.).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.552 - Nursing and Program Costs

Current through Register Vol. 48, No. 28, July 12, 2024
Beginning July 1, 1991, nursing and program costs (mostly
				  salary costs for direct care staff, but also including some supplies and other
				  realted expenses, see Section
				  140.532 ) will
				  be updated by DRI average hourly earnings production workers for nursing and
				  personal care facilities.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.553 - General Administrative Costs Updates

Current through Register Vol. 48, No. 28, July 12, 2024
General Administrative costs (see Section
				  140.533
				  ) shall be updated by using nationally published indices specific to nursing
				  home costs. (Health Care Cost Review, a publication of the Cost Information
				  Forecasting Service, published quarterly by DRI-WEFA, Inc., a Global Insight
				  Company, 24 Hartwell Avenue, Lexington, Massachusetts 02421 (2001). This
				  incorporation by reference does not include any later amendments or editions.)
				  Prior to any updating, fringe benefits and payroll taxes will be prorated to
				  General Service and Program areas on the basis of salaries paid in those areas.
				  (The prorated amount will be updated at the same rate as the other portions of
				  those cost centers.)
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.555 - Minimum Wage

Current through Register Vol. 48, No. 28, July 12, 2024
In the event of minimum wage increases, it may be necessary
				  to make further adjustments when the legislatively mandated change has an
				  impact greater than the increase in costs projected by used of the above
				  inflation projections. The specific adjustment for this change will be
				  calculated as follows:
a) The average
				nurses' aide salary for each geographic area will be updated for inflation as
				specified in Section
				140.552.
b) The number will be compared to the new
				hourly minimum wage figure plus ten cents.
c) If the minimum wage plus ten cents is less
				than the updated average nurses' aide salary, no adjustment will be made. If it
				exceeds the updated, average nurses' aide salary, the difference between the
				two will be divided by the updated nurses' aide salary. That will yield a
				percentage shortfall which will be adjusted by the statewide average of
				nonadministrative salary costs as a percentage of total operating costs and
				applied as an additional inflation factor to all facilities in that geographic
				area.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.561 - Support Costs Components

Current through Register Vol. 48, No. 28, July 12, 2024
Support Costs Components (includes laundry, dietary,
				  housekeeping, utility and administrative expenses)
a) The Department shall reimburse each
				facility for support costs associated with the provision of long term care on
				the basis of the relationship between the facility's per diem allowable support
				costs and referent values determined for each geographic area from the
				distribution of per diem allowable support costs for all long term care
				facilities with adequate cost report data. For all facilities with a Department
				of Public Health license classification SNF/ICF (Skilled Nursing Facility,
				Intermediate Care Facility) or ICF/DD (Intermediate Care Facility for the
				Developmentally Disabled), the support rate will be computed as follows for the
				rate year to begin July 1, 1989 and subsequent years:
1) If a facility's per diem allowable support
				costs are less than the 35th percentile value for
				per diem allowable support costs in the geographic area, the support rate will
				be equal to the facility's per diem allowable support costs plus 50% of the
				difference between the 75th percentile value for per
				diem allowable support costs in the geographic area and the facility's per diem
				allowable support costs, up to a ceiling. The ceiling shall be equal to 50% of
				the difference between the 75th percentile value of
				allowable per diem support costs for the geographic area and the
				35th percentile value of allowable per diem support
				costs for the geographic area plus $.05.
2) If a facility's per diem allowable support
				costs are greater than or equal to the 35th
				percentile value of per diem allowable support costs for the geographic area
				and less than the 75- percentile value of per diem allowable support costs for
				the geographic area, the support rate will be equal to the facility's per diem
				allowable support costs plus 50% of the difference between the
				75th percentile value of per diem allowable support
				costs for the geographic area and the facility's per diem allowable support
				costs.
3) If a facility's per diem
				allowable support costs are equal to or greater than the
				75th percentile value of per diem allowable support
				costs for the geographic area, the support rate will be equal to the
				75th percentile value of per diem allowable support
				costs for the geographic area.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.562 - Nursing Costs

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department reimburses for nursing costs based on geographic area in which the
				facility is based, and the level of care the facility (or distinct part
				thereof) is licensed to provide. Nursing costs also include an increment to
				reimburse for patients requiring skilled care for differences in support cost
				areas statistically related to variable patient conditions. For residents in
				Skilled Nursing Facilities (SNF) and Intermediate Care Facilities (ICF), the
				Department reimburses for nursing costs according to Sections
				140.900
				through
				140.907;
				for residents in Skilled Nursing Facilities for Pediatrics (SNF/PED) or
				Intermediate Care Facilities for the Medically Retarded (ICF/MR), the
				Department reimburses for nursing costs according to Sections
				140.850
				through
				140.885.
b) For the period July 1, 1986, through
				December 31, 1986, no facility's rate of reimbursement for Nursing Services
				shall be less than 90% of the rate of reimbursement for Nursing Services that
				facility received for the period January 1, 1986, through June 30,
				1986.
c) For the period July 1,
				1986 through December 31, 1986, the Department shall perform an additional
				computation for the rate of reimbursement for Nursing Services.
1) For intermediate and skilled care
				facilities, the additional computation is as follows:
A) Unadjusted nursing rates will be computed
				according to Section
				140.905.
B) The unadjusted nursing rate will be
				compared to 90 percent of the previous effective rate for Nursing Services for
				each facility. The greater of the two rates will be the "hold harmless" nursing
				rate.
C) The mean difference
				between the "hold harmless" nursing rates and the previous effective nursing
				rates will be computed for each HSA area. This difference will be an interim
				base for the HSA area.
D) The
				adjusted nursing rate will be the sum of the "hold harmless" nursing rate and
				the interim base rate.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.563 - Capital Costs

Current through Register Vol. 48, No. 28, July 12, 2024
The Department reimburses for capital costs on a group basis
				  related to location and base year. Effective for the rate year beginning July
				  1, 1984, a base year is defined as follows:
a) For facilities built or purchased prior to
				January 1, 1978, the later of year of construction or year of
				purchase;
b) For facilities built
				January 1, 1978, or later, the year of construction;
c) For facilities purchased on or after
				January 1, 1978, the base year established under (a) above will not
				change.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.565 - Kosher Kitchen Reimbursement

Current through Register Vol. 48, No. 28, July 12, 2024
Effective July 1, 1991, for reimbursement to skilled and
				  intermediate care facilities with rabbinically approved or certified fully
				  kosher kitchen and food service operations, the Department will determine
				  eligibility according to the following procedures:
a) Qualified Providers
The facility must have a fully kosher kitchen and food
				  service operation that is, at least annually, rabbinically approved or
				  certified and sixty percent (60%) or more of the residents in the facility
				  request kosher foods or food products prepared in accordance with Jewish
				  religious dietary requirements.
b) Enrollment
1) The facility must notify the Department,
				in writing, of its request to be considered for kosher kitchen
				reimbursement.
2) Department staff
				may visit the facility to determine that the facility has a fully kosher
				kitchen and that at least sixty percent (60%) of its residents are requesting
				kosher foods or products.
3) The
				facility will be required to supply a list to the Department of current
				residents and identify which residents request kosher foods or products and
				sign a form certifying that the percentage of residents requesting kosher foods
				or products is at least sixty percent (60%). The rabbi will be required to sign
				the same form certifying that the fully kosher kitchen is rabbinically approved
				or certified at least annually.
4)
				Upon receipt of the certification form, the additional reimbursement will be
				added to the support component of the facility per diem rate and will become
				effective on the first day of the month subsequent to the month the facility
				request was received. The support rate ceiling established in Section
				140.561(a)(1)
				 may be exceeded as a result of this kosher
				kitchen rate factor.
5) The
				facility must notify the Department of any change in the percentage of
				residents requesting kosher foods or products if that number drops below the
				required sixty percent (60%). Upon notification, the Department will adjust the
				support component of the facility per diem accordingly.
6) Annually, the facility must complete the
				certification form and submit it to the Department with their cost
				report.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.566 - Out-of-State Placement

Current through Register Vol. 48, No. 28, July 12, 2024
Residents of Illinois who have been determined as requiring
				  long term care placement should be placed in an Illinois facility.
a) The Department of Public Aid (DPA) or the
				Department of Mental Health and Developmental Disabilities (DMHDD) may make
				payment for care of a client in an out-of-state facility if:
1) the client is a resident of Illinois in
				accordance with DPA residency requirements, and
2) placement within Illinois cannot be
				obtained, and
3) prior approval has
				been given by the agency which will fund the placement, whether DPA or DMHDD,
				or the funding agency's designee.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.569 - Clients With Exceptional Care Needs

Current through Register Vol. 48, No. 28, July 12, 2024
a) Exceptional Care Program
1) Effective January 1, 2007, exceptional
				care services shall be covered under the MDS-based reimbursement methodology as
				described in 89 Ill. Adm. Code 147.Table A. As long as the nursing facility's
				case mix, as determined by total minutes from 89 Ill. Adm. Code 147.Table A,
				does not decrease in excess of five percent when compared to the case mix as of
				June 30, 2006, exceptional care reimbursement shall be converted to a per diem
				computed as the sum of all exceptional care daily payments less the residential
				rate made to the facility on June 30, 2006 divided by the total number of
				residents that are paid nursing and exceptional care rates as of June 30, 2006.
				No new residents will be accepted into the Exceptional Care Program after
				December 31, 2006. All facility exceptional care contracts will be terminated
				December 31, 2006. The provisions of this Section governing the Exceptional
				Care Program remain in place through December 31, 2006.
2) Pursuant to Section 5-5.8a of the Illinois
				Public Aid Code [305 ILCS 5/5-5.8a ],
				the Department may make payments for exceptional care services to nursing
				facilities ("providers") that meet licensure and certification requirements as
				may be prescribed by the Department of Public Health and are enrolled in and
				meet participation requirements of the Medical Assistance Program pursuant to
				Sections
				140.11
				and
				140.12.
3) Exceptional medical care is defined as the
				level of care with extraordinary costs related to services which may include
				physician, nurse, ancillary specialist services, and medical equipment and/or
				supplies that have been determined to be a medical necessity. This shall apply
				to 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 to persons who are in need of exceptional
				care services who would otherwise be in an alternative setting at a higher cost
				to the Department and Medicaid eligible residents transitioning from Medicare
				to Medicaid while in the nursing facility. This includes but is not limited to
				head-injured persons, ventilator dependent persons or persons with
				HIV/AIDS.
4) The Department shall
				negotiate rates with facilities requesting payment for exceptional care
				services (see Section 5-5.8a of the Public Aid Code [305 ILCS 5/5-5.8a]). In
				determining the rates of payment, the Department shall consider data collected
				from exceptional care providers during fiscal year 1994, any intervening rate
				adjustments (including any updates for inflation) and the average cost of each
				service category for the geographic area in which the facility is located.
				After approval of negotiated rates, the Department shall annually update a
				facility's rates for inflation.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.571 - Capital Rate Calculation

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Determination of Blended Value
1) The capital
				rate will be calculated through a blending of:
A) the uniform building value and
B) the building specific historical cost per
				bed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.572 - Total Capital Rate

Current through Register Vol. 48, No. 28, July 12, 2024
The total capital rate will be the rate from Section
				  140.571(b)(4),
				  plus the property tax rate from Section
				  140.578(b).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.573 - Other Capital Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
a) If at
				the time of field audit, the auditors find that the records to support capital
				costs are not adequate to issue an unqualified opinion, that facility's capital
				reimbursement will not be allowed to exceed the rate calculated from use of the
				uniform building value. The 120% blending factor in Section
				140.571(a)(3)
				 will not be allowed.
b) For any change of ownership after July 18,
				1984, the cost basis of any asset shall be the lesser of the allowable
				acquisition cost of such asset of the first owner of record on or after July
				18, 1984, or the acquisition cost of such asset to the new owner.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.574 - Capital Rates for Rented Facilities

Current through Register Vol. 48, No. 28, July 12, 2024
Capital rates for facilities rented pursuant to arms-length
				  transactions shall be reimbursed in the following manner:
a) Facilities which have been rented on or
				after January 1, 1978 will have their capital rate calculated in accordance
				with Sections
				140.570,
				140.571
				and
				140.572.
b) Facilities which have been rented
				continuously from an unrelated party since prior to January 1, 1978 or since
				the first day of operation for facilities constructed January 1, 1978 or later
				will not have a blended value calculated. The uniform building value will be
				substituted for the blended value in Section
				140.571(a)(1).
c) The base year for facilities rented prior
				to January 1, 1978, will be the year of the initial rental agreement for the
				nursing home operator in existence on December 31, 1977. Purchase or lease on
				or after January 1, 1978, will not change the base year for the facility. If
				the building was owned prior to January 1, 1978, and was subsequently rented,
				the base year will be determined based upon provisions in Section
				140.570(b)(2).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.579 - Specialized Living Centers

Current through Register Vol. 48, No. 28, July 12, 2024
Specialized Living Centers (SLC's) shall divide their
				  reimbursement for capital expenses with the State. The facility shall be
				  reimbursed for actual capital expenses up to a maximum of $3.50 per day for
				  services provided on or after October 1, 1991. The balance of the capital
				  reimbursement shall be retained by the State. In addition, for SLC's incurring
				  necessary major capital improvements due to correction of original construction
				  deficiencies or necessary major construction improvements mandated by the
				  Department of Public Health, the expenses of such improvements will be paid up
				  to a maximum of $2.00 per day.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.582 - Cost Adjustments

Current through Register Vol. 48, No. 28, July 12, 2024
a) Cost
				adjustments will be made on a minimum occupancy standard. Facilities having
				utilization levels below the standard will have their per patient day cost
				adjusted as if occupancy were at the standard.
1) For capital costs, a standard of 93
				percent occupancy or actual, whichever is larger, shall be used.
2) For operating costs (support and nursing),
				a standard of actual or one-third of the difference between the actual
				occupancy and 93 percent, if the
3)
				The number of licensed beds in the cost reporting year shall be used in the
				calculation of the minimum occupancy standard.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.583 - Campus Facilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
				"campus facility" is defined as an entity which consists of a long term care
				facility (or group of facilities if the facilities are on the same contiguous
				parcel of real estate) which meets all of the following criteria as of May 1,
				1987:
1) The entity provides care for both
				children and adults.
2) Residents
				of the entity reside in three or more separate buildings with congregate and
				small group living arrangements on a single campus.
3) The entity provides three or more separate
				licensed levels of care on the same campus. One of these licensed levels of
				care must be ICF/MR and the entity must receive funding from the Department of
				Mental Health and Developmental Disabilities. The facility must also be
				licensed as a child care institution by the Department of Children and Family
				Services (see 89 Ill. Adm. Code 404).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.584 - Illinois Municipal Retirement Fund (IMRF)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section applies to long term care facilities which are
				  owned and operated by county or municipal governments and which make payments
				  into the Illinois Municipal Retirement Fund (IMRF).
a) For purposes of this Section, a facility
				shall be deemed to have paid into the IMRF any and all sums paid into said fund
				on account of persons employed in the facility, regardless of whether or not
				such payments were made out of funds specifically designated by the county or
				municipal government for the facility, other specific funds, county or
				municipal general funds, or any other funds controlled or expended by the
				county or municipal governing body.
b) The cost report for the county or
				municipal facility must separately identify IMRF costs in the section of the
				cost report which requests details regarding employee benefits and payroll
				taxes.
c) No facility receiving
				reimbursement for IMRF costs under this Section shall receive reimbursement for
				the same costs under Section
				140.533(g).
d) The IMRF addition to the support rate will
				be calculated as follows:
1) The total IMRF
				costs will be divided by adjusted patient days to obtain IMRF per diem cost.
				The adjusted patient days will be determined in accordance with Section
				140.582.
2) The IMRF per diem costs is adjusted for
				inflation. The inflation factors will be determined in accordance with the
				provisions of Section
				140.550.
3) The inflated IMRF per diem cost from
				subsection (d)(2) will be added to the support rate determined in accordance
				with Section
				140.561.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.590 - Audit and Record Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				All audits shall be conducted according to audit principles set forth in the
				Department's audit guidelines.
b)
				Maintenance of records
1) All accounting,
				financial, medical and other relevant records of the provider and related
				organizations shall be kept for a minimum of 3 years following the date of the
				filing of the cost report. This must include a copy of the general ledger trial
				balance indicating how ledger entries were allocated to specific schedules and
				lines. Records relating to all fixed asset transactions must be maintained for
				a minimum of three years following the year in which the assets are last
				recorded in the cost report.
2) The
				records must be kept in good order in an auditable form.
3) All provider and related organization
				records shall be made available to the State auditors or their designees and
				furnished on their request at a single location. If a facility is selected for
				field audit and some records are maintained at a location outside the State of
				Illinois, it is the responsibility of the facility to pay for the expense of
				transporting the records to one location in Illinois or to pay for the expense
				of transporting the audit team to the out-of-state location. This would include
				the expense of lodging and meals.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.642 - Screening Assessment for Nursing Facility and Alternative Residential Settings and Services

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Beginning July l, l996, any individual, except those identified in subsection
				(c) of this Section, seeking admission to a nursing facility licensed under the
				Nursing Home Care Act [210 ILCS 45 ] for nursing facility services must be
				screened to determine his or her need for those services pursuant to this
				Section. Any individual, except those identified in subsection (c) of this
				Section, who is seeking admission to a nursing facility that operates under the
				Hospital Licensing Act [210 ILCS 85 ] must be screened to determine his or her
				need for those services except when Medicaid funds will not be used for nursing
				facility services for any part of the stay. For the purposes of this Section,
				"nursing facility" or "facility" means a location licensed under the Nursing
				Home Care Act or the Hospital Licensing Act as a skilled nursing facility or an
				intermediate care facility.
b)
				Screening Assessment
1) The Level I ID Screen
				is the first phase of the preadmission screening process for nursing facility
				services described in subsection (a) of this Section. The Level I ID Screen is
				conducted to determine if there is a reasonable basis for suspecting that an
				individual has developmental disabilities (DD), as defined in subsection
				(b)(1)(A) of this Section, or severe mental illness (MI), as defined in
				subsection (b)(1)(B) of this Section. This determination is required to assure
				that individuals with DD or severe MI are placed into settings which provide
				the services they require. Entities authorized to complete the Level I ID
				Screen are agents of DPA, Department of Human Services (DHS), Department on
				Aging (DoA), Department of Public Health (DPH), hospitals or nursing
				facilities.
A) A developmental disability is
				a disability that is attributable to a diagnosis of mental retardation (mild,
				moderate, severe, profound), or a related condition. A related condition is
				attributable to: cerebral palsy or epilepsy, or any other condition, other than
				mental illness, 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 persons with mental retardation, and requires
				treatment or services similar to those required for persons with mental
				retardation. In addition, this condition is manifested before the age of 22; is
				likely to continue indefinitely; and results in substantial functional
				limitations in three or more of the following areas of major life activity:
i) self-care;
ii) understanding and use of
				language;
iii) learning;
iv) mobility;
v) self-direction;
vi) capacity for independent
				living.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.643 - In-Home Care Program

Current through Register Vol. 48, No. 28, July 12, 2024
The State of Illinois shall operate an In-Home Care Program
				  designed to promote proper utilization of long term care services and prevent
				  unnecessary institutionalization. The programs will be operated by the
				  Departments on Aging (clients 60 and older), Rehabilitation Services
				  (physically disabled) and Mental Health and Developmental Disabilities
				  (developmentally disabled). The Department of Public Aid, as the single state
				  agency under Medicaid, is responsible for claiming Federal Financial
				  Participation and is the State of Illinois' contact with the Federal government
				  in relation to the In-Home Care Program. Specific eligibility criteria and all
				  other relevant factors of the In-Home Care Program are contained in the Rules
				  of the operating agencies - the Department on Aging (89 Ill. Adm. Code Section
				  04-60.000 et seq.), the Department of Rehabilitation Services (89 Ill. Adm.
				  Code, Chapter IV, Subchapter d) and the Department of Mental Health and
				  Developmental disabilities (proposed 59 Ill. Adm. Code 120).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.646 - Reimbursement for Developmental Training (DT) Services for Individuals with Developmental Disabilities Who Reside in Long Term Care (ICF and SNF) and Residential (ICF/MR) Facilities

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Residential providers are responsible for ensuring the provision of a
				continuous program of active treatment services for each resident (
				42 CFR
				483.410(d) and
				42 CFR
				483.440 ). The Department (DPA) will
				reimburse SNF, ICF and ICF/MR facilities (including ICF/MR-15 Specialized
				Living Centers (SLC), and ICF/MR-SNF/PED) through a separate component of the
				per diem for DT services provided to residents who have developmental
				disabilities. Such individuals would be identified as needing DT by the
				facility's interdisciplinary team. The facilities may contract for these
				services from community providers whose programs are certified by the
				Department of Mental Health and Developmental Disabilities (DMHDD) or may
				provide their own (DT) if the DT Program is certified by the (DMHDD) and
				conducted by staff of the DT program. The DT program is defined as the distinct
				part of a long term care or residential facility, and/or independent business
				entity certified by DMHDD to provide DT services.
b) Billing by the facility and payment by the
				Department for each month of active treatment services provided by the facility
				includes DT services.
c) Timely
				Billing Flow-Through for DT Services
1) Claims
				for reimbursement for DT services must be received by the Department no later
				than the close of business on the 16th day of the
				month following the previous month of DT services. If the
				16th day of the month falls on a weekend, billing
				must be received by the Department no later than the close of business of the
				Friday before that weekend.
2) If
				the billing for DT services is not received by the Department as specified in
				subsection (c)(1) above, a hold will be placed on the processing of the
				facility's claims for reimbursement and subsequent payment for services. The
				hold on processing of facility billing and payment for services will be lifted
				once the DT billing has been received.
3) The turnaround of DT attendance records
				from the DT provider to the facility must also be timely. These records are
				utilized by the facility to complete billing forms for DT services. DT
				attendance records should be received by the facility by the
				7th day of the month following the previous month of
				DT services. The facility must notify the Department five (5) working days
				before the 16th day of the month if the attendance
				records regarding DT services have not been returned to the facility. When DT
				billing is late due to a delay by the DT agency in submitting attendance
				records, no hold will be placed on facility billings or payments.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.647 - Description of Developmental Training (DT) Services

Current through Register Vol. 48, No. 28, July 12, 2024
Developmental training (DT) provides services to individuals
				  with developmental disabilities and major functional skill deficits in one or
				  more developmental areas with the goal of helping such individuals achieve
				  functional independence.
a) General
				Specifications
1) Developmental training
				refers to specific programs, interventions, therapies and activities. DT is
				usually conducted in nonresidential settings, but shall be conducted in
				residential settings for individuals having physical/medical impairments so
				severe that nonresidential participation is prohibited. A DT program conducted
				in a residential setting shall be conducted by staff of the DT program, and be
				certified by the Department of Mental Health and Developmental Disabilities
				(DMHDD) (Section
				140.646
				a). Developmental training services provide continuity and integration of the
				Individual Program Plan (IPP) as required for a continuous active treatment
				program for each individual (
				42 CFR
				483.440(1989) and 89 Ill.
				Adm. Code
				144.25
				and Section
				144.105
				). DT shall also include services designed to improve an individual's ability
				to engage in productive work activities, whose impairment is so severe as to
				make the individual's production capacity inconsequential as defined in
				29 CFR 525.2(c)
				(1984).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.649 - Effective Dates of Reimbursement for Developmental Training (DT) Programs

Current through Register Vol. 48, No. 28, July 12, 2024
a) The effective
				date of reimbursement to the facility for DT services will be the later of the
				dates when the following criteria have been met:
1) receipt by the Department of an addendum
				to the provider agreement containing the assurances specified in Section
				140.652,
				and
2) receipt by the Department of
				a completed Enrollment Form, (Form DPA 2768). The Enrollment Form shall
				specify, in accordance with instructions, the effective date of each
				recipient's enrollment. The Enrollment Form for each recipient shall be signed
				by a representative of both the facility and the DT program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.650 - Certification of Developmental Training (DT) Programs

Current through Register Vol. 48, No. 28, July 12, 2024
In order for a facility to qualify for reimbursement DT
				  services, it must execute a written agreement with a DT program that is
				  certified by the Department of Mental Health and Developmental Disabilities
				  (DMHDD) in accordance with the standards set by that
				  department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.651 - Decertification of Day Programs

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department of Mental Health and Developmental Disabilities (DMHDD) is
				responsible for decertification of DT Programs. When a DT Program has been
				decertified by the DMHDD, it may appeal the decertification in accordance with
				rules of the DMHDD. Facilities having a written agreement with the DT Program
				shall continue to be reimbursed throughout the appeal process.
b) When the DMHDD decertifies a DT Program,
				reimbursement to the facility will be reduced by the amount that is applicable
				to the DT Program effective with the date of decertification.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.652 - Terms of Assurances and Contracts

Current through Register Vol. 48, No. 28, July 12, 2024
A facility requesting reimbursement for developmental
				  training (DT) services provided by a DMHDD certified DT program must submit to
				  the Department an addendum to its provider agreement (Form DPA 1432) containing
				  an assurance that the facility has a signed agreement with a certified (DT)
				  program. This agreement must specify at a minimum:
a) the duration of the agreement;
b) conditions under which the agreement may
				be terminated prematurely by either party;
c) the number of hours per day, consistent
				with DMHDD certification requirements, that (DT) will be provided exclusive of
				transportation time and meal time;
d) a schedule of the days that (DT) services
				will be provided;
e) the
				responsibilities of both parties regarding the joint planning and delivery of
				services and the sharing of progress notes, and
f) the understandings agreed to by both
				parties regarding the documentation of attendance.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.680 - Effective Date of Payment Rate

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Notwithstanding any other provisions of these rules, there shall be no rate
				increase for long term care facilities for Calendar Year 1983, or the first six
				months of Calendar Year 1984.
b)
				For Calendar Year 1984 and subsequent years, the rate established annually
				pursuant to the method described in these rules shall be effective on July
				1st.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart E - GROUP CARE › Section 140.830 - Appeals of Rate Determinations

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Except as indicated in subsection (b) of this Section, the Department shall
				notify all nursing facilities of their support and capital rates for the next
				year no later than 30 days before the beginning of the rate year, which shall
				be the same as the State's fiscal year. Appeals of rate determinations shall be
				submitted in writing to the Department. Except as indicated in subsection (b)
				of this Section, appeals received within 30 days after rate notification shall,
				if upheld, be made effective as of the beginning of the rate year. The
				effective date of all other upheld appeals shall be the first day of the month
				after the date the complete appeal was received.
b) The Department shall notify all nursing
				facilities of their nursing rate no later than 30 days before the beginning of
				the rate quarter pursuant to 89 Ill. Adm. Code
				147.150.
				Appeals shall be submitted to the Department no later than 30 days after the
				date of the Department's notice to the facility of the rate. The results of an
				appeal shall become effective the first day of the applicable
				quarter.
c) Appeals of rate
				determinations under this Section shall be submitted in writing to the Chief,
				Bureau of Long Term Care. The Department shall rule on all appeals within 120
				days after the date of appeal, except that if the Department requires
				additional information from the facility the period shall be extended until
				such time as the information is provided. Except for the rate identified in
				subsection (b) of this Section, appeals for any rate year must be filed before
				the close of the rate year.