Illinois Administrative Code

Section 144.275 Reimbursement for Program (Active Treatment) Costs in Residential Facilities for Clients with Developmental Disabilities Residential facilities, including distinct parts of facilities, for clients with developmental disabilities (ICF/MR certification with licensur…

Section 144.30 Developmental Disability Provider Rate Adjustments a) Adjustments in FY 18 and FY 19 Pursuant to PA 100-23 and PA 100-587, providers of services to individuals with developmental disabilities shall ensure that all wages earned by front-line direct care personnel ar…

Section 144.300 Reimbursement for Program (Active Treatment) Costs in Small Scale Residential Facilities 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 clien…

Section 144.325 Capital Rate Calculation a) Capital rates for ICF/MR facilities with four or six beds will be calculated by the Department according to this Section, which provides calculation methods for rates for various capital categories. Rate charts will be prepared each yea…

Section 144.5 Determination of Program (Active Treatment) Costs a) The Department reimburses residential facilities for program costs associated with the delivery of active treatment to individuals with developmental disabilities, according to information obtained during each fac…

Section 144.50 Inspection of Care and Rate Setting Appeal Process a) Inspection of Care Appeal Process 1) Resident Assessment – A facility may request an appeal of the resident assessment conducted by the Inspection of Care (IOC) team. Examples of conditions which may be appealed…

Section 144.75 Comprehensive Functional Assessments and Reassessments (Repealed) (Source: Repealed at 18 Ill. Reg. 16619, effective October 27, 1994)

Section 144.TABLE B Staff Intensity Scale Client Name Client Identification Residential Facility Client Birthdate Day Program Assessment Date Assessor Once or More Per: Day Week Month Year a) Coercive Sexual Behavior 1) Touches or grabs others' genitals without their consent and/…

Section 147.100 Reconsiderations (Repealed) (Source: Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.105 Midnight Census Report a) The census recorded must reflect the complete activities which took place in the 24 hour period from midnight. Midnight is defined as the last minute of the last hour of the day. b) The facility is required to compile a midnight census re…

Section 147.125 Nursing Facility Resident Assessment Instrument (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.15 Comprehensive Resident Assessment (Repealed) (Source: Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.150 Minimum Data Set (MDS) Based Reimbursement System (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.175 Minimum Data Set (MDS) Integrity (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.200 Minimum Data Set (MDS) On-Site Review Documentation (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.205 Reimbursement for Ventilator Dependent Residents (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.25 Functional Needs and Restorative Care (Repealed) (Source: Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.250 Costs Associated with the Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203) (Repealed) (Source: Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.300 Payment to Nursing Facilities Serving Persons with Mental Illness a) Reimbursement rates for nursing facilities (ICF and SNF) for program costs associated with the delivery of psychiatric rehabilitation services to residents with mental illness will remain at the …

Section 147.301 Sanctions for Noncompliance Based on a finding of noncompliance by the Department of Public Health on the part of a nursing facility with any requirement for providing services to persons with mental illness pursuant to 77 Ill. Adm. Code 300.4000 through 300.4090,…

Section 147.305 Psychiatric Rehabilitation Service Requirements for Individuals With Mental Illness in Residential Facilities (Repealed) (Source: Repealed at 26 Ill. Reg. 3093, effective February 15, 2002)

Section 147.310 Implementation of a Case Mix System P.A. 98-0104 requires the Department to implement, effective January 1, 2014, an evidence-based payment methodology for the reimbursement of nursing services. The methodology shall take into consideration the needs of individual…

Section 147.315 Nursing Facility Resident Assessment Instrument a) A facility shall conduct and electronically submit a Minimum Data Set (MDS) assessment that conforms with the assessment schedule and guidance defined by Code of Federal Regulations, Title 42, section 483.20, and …

Section 147.320 Definitions For purposes of this Part, the following terms shall be defined as follows: "Active Disease Diagnosis" means a physician documented diagnosis (or by a nurse practitioner, physician assistance, or clinical nurse specialist if allowable under State licen…

Section 147.325 Resident Reimbursement Classifications and Requirements a) Resident reimbursement classification shall be based on the Minimum Data Set (MDS), Version 3.0 assessment instrument mandated by the United States Department of Health and Human Services, Centers for Medi…

Section 147.330 Resource Utilization Groups (RUGs) Case Mix Requirements a) Activities of Daily Living (ADL) 1) Documentation shall support the ADL coded level as defined in the Resident Assessment Instrument (RAI) Manual. 2) Documentation of ADLs shall support the RAI requiremen…

Section 147.335 Enhanced Care Rates An additional enhanced rate is applied for certain categories of residents that are in need of more resources. a) Facility Approval for Ventilator Services Enhanced Care Rate. Requests for the ventilator services enhanced care rate must be subm…

Section 147.340 Minimum Data Set On-Site Reviews a) The Department shall conduct reviews to determine the accuracy of the resident assessment information transmitted in the Minimum Data Set (MDS) that are relevant to the determination of reimbursement rates. The MDS data used by …

Section 147.345 Quality Incentives Effective January 1, 2015, the Department shall allocate an amount for quality incentive payments. To establish baselines for these measures, the information shall be submitted beginning January 1, 2014. These measures may be included as part of…

Section 147.346 Appeals of Nursing Rate Determination a) Appeals must be submitted in writing to the Department no later than 30 days after the date of the Department's notice to the facility of the rate calculation resulting from the on-site review. The revised rate shall be pro…

Section 147.350 Reimbursement for Additional Program Costs Associated With Providing Specialized Services for Individuals with Developmental Disabilities in Nursing Facilities a) Nursing facilities (ICF and SNF) providing specialized services to individuals with developmental dis…

Section 147.355 Reimbursement for Residents with Exceptional Needs (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.5 Minimum Data Set-Mental Health (MDS-MH) Based Reimbursement System (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.50 Service Needs (Repealed) (Source: Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.75 Definitions (Repealed) (Source: Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.TABLE B MDS-MH Staff Time (in Minutes) and Allocation by Need Level (Repealed) (Source: Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 149.10 Applicability of Other Provisions Effective for dates of discharge on or after July 1, 2014, the following provisions, in addition to those provisions specifically cited in this Part, shall apply to hospitals reimbursed under the Diagnosis Related Grouping Prospect…

Section 149.100 Methodology for Determining DRG PPS Payment Rates Effective for dates of discharge on or after July 1, 2014: a) Inpatient hospital services that are not excluded from the DRG PPS pursuant to Section 149.50(b) shall be reimbursed as determined in this Section. b) T…

Section 149.105 Payment For Outlier Cases Effective for dates of discharge on or after July 1, 2014: a) Outlier adjustment determination. Except as provided in subsection (b), the Department may provide for additional payment, approximating a hospital's marginal cost of covered i…

Section 149.125 Special Treatment of Certain Facilities (Repealed) (Source: Repealed at 38 Ill. Reg. 15477, effective July 2, 2014)

Section 149.140 Methodology for Determining Primary Care Access Health Care Education Payments (Repealed) (Source: Repealed at 19 Ill. Reg. 10674, effective July 1, 1995)

Section 149.150 Payments to Hospitals Under the DRG Prospective Payment System (Repealed) (Source: Repealed at 38 Ill. Reg. 15477, effective July 2, 2014)

Section 149.175 Payments to Contracting Hospitals (Repealed) (Source: Repealed at 16 Ill. Reg. 6195, effective March 27, 1992)

Section 149.200 Admitting and Clinical Privileges (Repealed) (Source: Repealed at 16 Ill. Reg. 6195, effective March 27, 1992)

Section 149.205 Inpatient Hospital Care or Services by Non-Contracting Hospitals Eligible for Payment (Repealed) (Source: Repealed at 16 Ill. Reg. 6195, effective March 27, 1992)

Section 149.225 Payment to Hospitals for Inpatient Services or Care not Provided under the ICARE Program (Repealed) (Source: Repealed at 16 Ill. Reg. 6195, effective March 27, 1992)

Section 149.25 General Provisions Effective for dates of discharge on or after July 1, 2014: a) Basis of Payment 1) Payment on a Per Discharge Basis A) Under the DRG PPS, hospitals are paid a predetermined amount per discharge for inpatient hospital services furnished to persons …

Section 149.250 Contract Monitoring (Repealed) (Source: Repealed at 16 Ill. Reg. 6195, effective March 27, 1992)

Section 149.275 Transfer of Recipients (Repealed) (Source: Repealed at 16 Ill. Reg. 6195, effective March 27, 1992)

Section 149.300 Validity of Contracts (Repealed) (Source: Repealed at 16 Ill. Reg. 6195, effective March 27, 1992)