Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 1126 - SPECIALIZED MENTAL HEALTH REHABILITATION FACILITIES (SMHRFs) › Subpart A - AUTHORITY › Section 1126.130 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Act" means the Illinois Health Facilities Planning Act [20
				  ILCS 3960 ].
"Adverse Action" means a disciplinary action taken by IDPH,
				  federal Centers for Medicare and Medicaid Services (CMMS), or any other State
				  or federal agency against a person or entity that owns and/or operates a
				  licensed or Medicare or Medicaid certified SMHRF in the State of Illinois.
				  These actions include, but are not limited to, a financial penalty, probation,
				  revoked license, restricted license or the inability to be licensed or
				  relicensed as set forth in SMHRA Section 4-109 and 77 Ill. Adm. Code
				  380.750.
"Agency" or "IDPH" means the Illinois Department of Public
				  Health.
"Applicant" means one or more persons, as defined in the Act,
				  who apply for a permit or exemption. (See 77 Ill. Adm. Code
				  1130.220
				  to determine what parties must jointly apply for an application.)
"Authorized Representative" means a person who has authority
				  to act on behalf of the legal entity or person that is the applicant or permit
				  holder. Authorized representatives are, in the case of a:
corporation, any of its officers or members of its board of
				  directors;
limited liability company, any of its managers or members (or
				  the sole manager or member when two or more managers or members do not
				  exist);
partnership, any of its general partners (or the sole general
				  partner when two or more general partners do not exist);
estate or trust, any of its beneficiaries (or the sole
				  beneficiary when two or more beneficiaries do not exist); and
sole proprietor, the individual who is the proprietor.
"Capital Expenditure"
means an expenditure made by or
				  on behalf of
a SMHRF
(as such a facility is defined
				  in
the
Act)
that
, under generally accepted
				  accounting principles, is not properly chargeable as an expense of operation
				  and maintenance, or is made to obtain by lease or comparable arrangement any
				  facility or part thereof or any equipment for a facility or part, and
that
exceeds the capital expenditure minimum. For purposes of
				  this
definition
, the cost of any studies, surveys, designs,
				  plans, working drawings, specifications, and other activities essential to the
				  acquisition, improvement, expansion, or replacement of any plant or equipment
				  with respect to which an expenditure is made shall be included in determining
				  if
the
expenditure exceeds the capital expenditure minimum.
				  Donations of equipment or facilities to
a SMHRF that,
if
				  acquired directly by
that
facility would be subject to review
				  under
the
Act shall be considered capital expenditures, and a
				  transfer of equipment or facilities for less than fair market value shall be
				  considered a capital expenditure if a transfer of the equipment or facilities
				  at fair market value would be subject to review.
[20 ILCS
				  3960/3 ]
"Capital Expenditure Minimum" means the dollar amount or
				  value that would require a permit for capital projects and major medical
				  equipment. Capital expenditure minimums are annually adjusted to reflect the
				  increase in construction costs due to inflation under 77 Ill. Adm. Code
				  1130.310.
"CMMS" means the federal Centers for Medicare and Medicaid
				  Services.
"Chairman" means the presiding officer of HFSRB.
"Change of Ownership" means a change in the person who has
				  operational control of an existing SMHRF or
a change in the person who
				  has ownership or control of
a SMHRF's
physical plant and
				  capital assets. A change of ownership is indicated by,
but not limited
				  to,
the following transactions: sale, transfer, acquisition, leases,
				  change of sponsorship or other means of transferring control.
[20 ILCS
				  3960/3] Examples of change of ownership include:
a transfer of stock or assets resulting in a person obtaining
				  majority interest (i.e., over 50%) in the person who is licensed or certified
				  (if the facility is not subject to licensure), or in the person who owns or
				  controls the SMHRF's physical plant and capital assets;
the issuance of a license by IDPH to a person different from
				  the current licensee;
a change in the membership or sponsorship of a not-for-profit
				  corporation;
a change of 50% or more of the voting members of a
				  not-for-profit corporation's board of directors, during any consecutive 12
				  month period, that controls a SMHRF's operations, license, certification (when
				  the facility is not subject to licensing), or physical plant and capital
				  assets;
a change in the sponsorship or control of the person who is
				  licensed or certified (when the facility is not subject to licensing) to
				  operate, or who owns the physical plant and capital assets of a governmental
				  SMHRF; or
any other transaction that results in a person obtaining
				  control of a SMHRF's operations or physical plant and capital assets, including
				  leases.
"Charity Care"
means care provided by
a
				  SMHRF
for which the provider does not expect to receive payment from
				  the patient
/resident
or a third party payer
. [20 ILCS
				  3960/3]
"Clinical Service Area" means a department and/or service
				  that is directly related to the diagnosis, treatment, or rehabilitation of
				  persons receiving services from the SMHRF. A clinical service area's physical
				  space shall include those components required under the facility's licensure or
				  Medicare and/or Medicaid certification, and/or as outlined by documentation
				  from the facility as to the physical space required for appropriate clinical
				  practice.
"Combined Service Area Project" means a project that consists
				  of both clinical service areas and nonclinical service areas.
"Completion Date" or "Project Completion Date" means the date
				  established by the applicant for the completion of the project, as stated in
				  the CON permit application.
"Construction" or "Modification"
means the
				  establishment, erection, building, alteration, reconstruction, modernization,
				  improvement, extension, discontinuation, change of ownership of or by
				  a
SMHRF
, or the purchase or acquisition by or through
a SMHRF
of equipment or service for diagnostic or therapeutic purposes
				  or for facility administration or operation or any capital expenditure made by
				  or on behalf of
a SMHRF that
exceeds the capital expenditure
				  minimum; however, any capital expenditure made by or on behalf of
a
				  SMHRF
for the construction or modification of a facility licensed under
				  the Assisted Living and Shared Housing Act
[210 ILCS 9 ]
or a
				  conversion project undertaken in accordance with Section 30 of the Older Adult
				  Services Act
[320 ILCS 42 ]
shall be excluded from any
				  obligations under the Act.
[20 ILCS
				  3960/3 ]
"Contested Case" has the meaning ascribed in Section 1-30 of
				  the Illinois Administrative Procedure Act [5 ILCS 100 ].
"Control" means a person possesses any of the following
				  discretionary and nonministerial rights or powers:
In the case of an entity, the ability to direct the
				  management and policies of the entity, whether through the voting of
				  securities, corporate membership, contract or otherwise. Examples of control
				  include, without limitation:
holding 50% or more of the outstanding voting securities of
				  an issue;
in the case of an entity that has no outstanding voting
				  securities, having the right to 50% or more of the profits or, in the event of
				  dissolution, the right to 50% or more of the assets of the entity;
having the power to appoint or remove 50% or more of the
				  governing board members of an entity;
having the power to require or approve the use of funds or
				  assets of the entity; or
having the power to approve, amend or modify the entity's
				  bylaws or other governance documents.
In the case of capital assets or real property, the power to
				  direct or cause the direction of the personal property, real property or
				  capital assets that are components of the project (i.e., fixed equipment,
				  mobile equipment, buildings and portions of buildings). Examples of control
				  include, without limitation:
ownership of 50% or more in the property or asset; serving as
				  lessee or sublessee.
"Director" means the Director of the Department of Public
				  Health.
"Due Diligence" means to take actions toward the completion
				  of a project for which a permit has been issued with that diligence and
				  foresight that persons of ordinary prudence and care commonly exercise under
				  like circumstances. An accidental or unavoidable cause that cannot be avoided
				  by the exercise of due diligence is a cause that reasonably prudent and careful
				  persons, under like circumstances, do not and would not ordinarily anticipate,
				  and whose effects under similar circumstances they do not and would not
				  ordinarily avoid.
"Entity" means any corporation, company, partnership, joint
				  venture, association, trust, foundation, fund or other legally recognized
				  organization, public body or municipality.
"Establish" or "Establishment"
means the construction
				  of a
new SMHRF
,
the licensing of unlicensed buildings
				  or structures as a SMHRF, the
replacement of an existing
SMHRF
on another site, or the initiation of a category of service
defined by the Board
.
[20 ILCS 3960/3]
"Estimated Project Cost" or "Project Cost" means the sum of
				  all costs, including the fair market value of any equipment or other real
				  property (whether acquired by lease, donation or gift) necessary to complete a
				  project, including:
preplanning costs;
site survey and soil investigation fees;
site preparation costs;
off-site work;
construction contracts and contingencies (including
				  demolition);
capital equipment included in construction contracts;
architectural and engineering fees;
consultant and other professional fees that are related to
				  the project;
capital equipment not in construction contracts;
bond issuance expenses;
net interest expense during construction; and
all other costs that are to be capitalized.
"Ex Parte Communication"
means a communication
				  between a person who is not a State Board member or employee that reflects on
				  the substance of a
formally filed
State Board proceeding and
				  that takes place outside the record of the proceeding. Communications regarding
				  matters of procedure and practice, such as the format of a pleading, number of
				  copies required, manner of service, and status of proceedings, are not
				  considered ex parte communications. Technical assistance with respect to an
				  application, not intended to influence any decision on the application, may be
				  provided by
State Board
employees to the applicant. Once an
				  application is filed and deemed complete, a written record of any communication
				  between staff and an applicant shall be prepared by staff and made part of the
				  public record, using a prescribed, standardized format, and shall be included
				  in the application file.
[20 ILCS
				  3960/4.2 ]
"Fair Market Value" means the dollar value of a project or
				  any component of a project that is accomplished by lease, donation, gifts or
				  any other means that would have been required for purchase, construction or
				  acquisition.
"Final Decision" or "Final Administrative Decision" or "Final
				  Determination" means:
the decision by HFSRB to approve or deny an application for
				  permit. Action taken by HFSRB to deny an application for permit is subsequent
				  to an administrative hearing or to the waiver of an administrative hearing;
				  or
the decision by HFSRB on all matters other than the issuance
				  of a permit.
HFSRB NOTE: The decision is final at the close of business of
				  the HFSRB meeting at which the action is taken.
"Final Realized Costs" means all costs that are normally
				  capitalized under generally accepted accounting principles that have been
				  incurred to complete a project for which a permit or exemption was issued.
				  These costs include all expenditures and the dollar or fair market value of any
				  component of the project, whether acquired through lease, donation or
				  gift.
"Financial Commitment" means the commitment of at least 33%
				  of total funds assigned to cover total project cost, which occurs by:
The actual expenditure of 33% or more of the total project
				  cost; or
The commitment to expend 33% or more of the total project
				  cost by signed contracts or other legal means.
"Financial Commitment Date" means the date on which the
				  permit holder expended or committed to expend by contract or other legal means
				  at least 33% of the total project cost.
"Hearing Officer" means the person with authority to conduct
				  public hearings and to take all necessary steps to assure the proper completion
				  of public hearings and to assure compliance with requirements of the Act.
				  Responsibilities include: determining the order and time allotment for public
				  testimony; maintaining order; setting and announcing new hearing dates, times
				  and places, as necessary; determining the conclusion of the hearing and
				  assuring that all documents, exhibits and other written materials presented or
				  requested at the hearing are in the hearing officer's custody; and preparing a
				  report for submittal to HFSRB.
"HFSRB " or "State Board" means the Illinois Health
				  Facilities and Services Review Board.
"HFSRB Inventory" or "Inventory" means the HFSRB Inventory of
				  Health Care Facilities and Services and Need Determinations, located at HFSRB's
				  website (www.hfsrb.illinois.gov [File Link Not Available]).
"IAPA" means the Illinois Administrative Procedure Act [5
				  ILCS 100 ].
"Intent to Deny" means the negative decision of HFSRB,
				  following its initial consideration of an application for permit that failed to
				  receive the number of affirmative votes required by the Act.
"Major Construction Project" means:
Projects for the construction of new
				  buildings;
Additions to existing facilities;
Modernization projects whose cost is in excess of
				  $1,000,000 or 10% of the facility's operating revenue, whichever is less; and
				  such projects as
HFSRB
shall define and prescribe pursuant
				  to
the
Act.
[20
				  ILCS 3960/5 ]
"Medicaid Certified" or "Medicare Certified" or "Medicaid
				  Certification" or "Medicare Certification" means approval for a facility to
				  receive reimbursement under Title XVIII (Medicare) and/or XIX (Medicaid) of the
				  Social Security Act ( 42 USC 1395).
"Modification of an Application" or "Modification" means any
				  change to an application during the review period (i.e., prior to a final HFSRB
				  action). These changes include, but are not limited to:
changing the proposed project's physical size or gross square
				  feet;
the site within a planning area;
the operating entity when the operating entity is not the
				  applicant;
the number of proposed beds;
the categories of service to be provided;
the cost;
the method of financing;
the proposed project completion date;
the configuration of space within the building; or
any change in the person who is the applicant, including the
				  addition or deletion of one or more persons as co-applicants.
HFSRB NOTE: A change of site to a site outside the planning
				  area originally identified in the application is not considered a modification
				  and invalidates the application.
"Newspaper of General Circulation" means newspapers other
				  than those intended to serve a particular, defined population, such as the
				  publications of professional and trade associations.
"Newspaper of Limited Circulation" means a newspaper
				  intended to serve a particular or defined population of a specific geographic
				  area within a Metropolitan Statistical Area such as a municipality, town,
				  village, township or community area, but does not include publications of
				  professional and trade associations.
[20
				  ILCS 3960/8.5(a) ]
"Non-Substantive Projects" means projects that have been
				  classified as nonsubstantive under 77 Ill. Adm. Code
				  1110.40.
				  HFSRB will review a nonsubstantive project within 60 days.
"Notification of HFSRB Action" means the transmittal of HFSRB
				  decisions to the applicant or permit or exemption holder. Notification shall be
				  given to the applicant's or permit holder's designated contact person, legal
				  representative or chief executive officer.
"Operational" means that a permit holder is providing the
				  services approved by HFSRB and, for a new SMHRF, licensure or Medicare and/or
				  Medicaid certification has been obtained and residents/patients are utilizing
				  the facility or equipment or are receiving service.
"Permit" means authorization to execute and complete a
				  project related to a SMHRF, as reviewed and approved by HFSRB and as specified
				  in the Act.
"Person"
means any one or more natural persons, legal
				  entities, governmental bodies other than federal, or any combination
				  thereof.
[20 ILCS 3960/3]
"Proposal" or "Project" means any proposed construction or
				  modification of a long term care facility or any proposed acquisition of
				  equipment to be undertaken by an applicant.
"Related Person" means
any person
				  that:
is at least 50% owned, directly or indirectly, by
				  either the
SMHRF
or a person owning, directly or indirectly,
				  at least 50% of the
SMHRF;
owns, directly or indirectly, at least 50% of
				  the
SMHRF [20 ILCS 3960/3];
is otherwise controlled or managed by one or more
				  SMHRFs;
controls or manages the SMHRF; or
is otherwise, directly or indirectly, under common management
				  or control with one or more SMHRFs.
"Review Period" means the time from the date an application
				  for permit or exemption is deemed complete until HFSRB renders its final
				  decision.
"Site" means the physical location of a proposed project and
				  is identified by address or legal property description.
"SMHRA" means the Specialized Mental Health Rehabilitation
				  Act of 2013 [210 ILCS 49 ]
"SMHRF" means Specialized Mental Health Rehabilitation
				  Facility.
"Square Feet" or "SF" or "Square Footage" means a unit of
				  measure of physical service areas or buildings considered by HFSRB.
Departmental Gross Square Feet (DGSF) means the designation
				  of physical areas for departments and services. It consists of the entirety of
				  space dedicated to the use of that department or service, including walls,
				  shafts and circulation.
Building Gross Square Feet (BGSF) means the designation of
				  physical area of an entire building. It includes all exterior walls and space
				  within those walls.
"Substantially Changes the Scope or Changes the Functional
				  Operation of the Facility" means:
the addition of a category of service;
a change of a material representation made by the applicant
				  in an application for permit or exemption subsequent to receipt of a permit
				  that is relied upon by HFSRB in making its decision. Material representations
				  are those that provide a factual basis for issuance of a permit and
				  include:
withdrawal or nonparticipation in the Medicare and/or
				  Medicaid programs;
charge information;
other representations made to HFSRB as stipulated or agreed
				  upon in the public record and specified in the application or the permit
				  approval letter.
"Substantive Projects" means types of projects that are
				  defined in the Act and classified as substantive.
Substantive projects
				  shall include no more than the following:
Projects to construct a new or replacement facility
				  located on a new site or a replacement facility located on the same site as the
				  original facility and the costs of the replacement facility exceed the capital
				  expenditure minimum;
Projects proposing a new service or discontinuation
				  of a service, which shall be reviewed by the Board within 60
				  days;
Projects proposing a change in the bed capacity
				  of
a SMHRF
by an increase in the total number of beds or by a
				  redistribution of beds among various categories of service or by a relocation
				  of beds from one facility to another by more than 20 beds or more than 10% of
				  total bed capacity, as defined by HFSRB, whichever is less, over a 2 year
				  period.
[20
				  ILCS 3960/12 ]
"Technical Assistance" means help provided by an employee of
				  HFSRB to a person, SMHRF or the State Board, and is not considered ex parte
				  communication as defined in Section 4.2 of the Act. Technical assistance may be
				  provided to any person regarding pre-application conferences, the filing of an
				  application, or other request to HFSRB provided that the communication is
not intended to influence any decision on the application.
Technical assistance may be provided for the benefit of HFSRB to clarify issues
				  relevant to an application or other business of HFSRB. The assistance may be in
				  the form of written correspondences, conversations, site visits, meetings,
				  and/or consultations with independent experts.
Once an application or
				  exemption is filed and deemed complete, a written record of any communication
				  between staff and an applicant shall be prepared by staff and made part of the
				  public record, using a prescribed, standardized format, and shall be included
				  in the application file
, within 10 business days after the assistance
				  is provided
.
[20 ILCS 3960/4.2]
"Temporary Suspension of Facility or Category of Service"
				  means a facility that has ceased operation or that has ceased to provide a
				  category of service (see 77 Ill. Adm. Code
				  1100.220 for
				  category of service definition) for a period not to exceed one year, due to
				  unanticipated or unforeseen circumstances (such as the loss of appropriate
				  staff or a natural or unnatural disaster). The time period may be extended upon
				  finding that the resumption of facility operation or category of service has
				  proceeded with due diligence and HFSRB approval of the requested extension. The
				  facility administrator shall file notice to HFSRB of a temporary suspension of
				  service, in compliance with the requirements described in Section
				  1130.240(d).
"Underserved" means a planning area in Illinois that does not
				  have another Specialized Mental Health Rehabilitation
				  Facility.