Ill. Admin. Code tit. 89, § 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 disabilities, excluding state operated facilities for the
developmentally disabled, will be reimbursed for providing a specialized
services program for each client with developmental disabilities as specified
in 89 Ill. Adm. Code
144.50
through
144.250.
b) Beginning February 1, 1990, facility
reimbursement for providing specialized services to individuals with
developmental disabilities will be made upon conclusion of resident reviews
that are conducted by the state's mental health authority or their contracted
agent. Facility reimbursement for providing specialized services as a result of
resident reviews concluded prior to February 1, 1990, will begin with the
facility's February billing cycle.
c) The additional reimbursement for costs
associated with specialized services programs is based upon the presence of
three (3) determinants. The three determinants are:
1) Minimum Staffing
A) Direct Services - Facilities must be in
compliance with the Health Care Financing Administration's (HCFA) ( 42 CFR
442.201 or 42 CFR 442.302(1989) ) and the Illinois Department of Public
Health's (IDPH) (77 Ill. Adm. Code
300.1230 )
minimum staffing standards relative to facility type.
B) The number of additional direct services
staff necessary for delivering adequate specialized services programs for
individuals with developmental disabilities is based upon a full time
equivalent (FTE) staff to client ratio of 1:7.5.
2) Qualified Mental Retardation Professional
Services
A) Each individual's specialized
services program must be integrated, coordinated and monitored by a Qualified
Mental Retardation Professional (QMRP). Any facility required to provide
specialized services programs to individuals with developmental disabilities
must provide QMRP services. Delivery of these services is based upon a
full-time equivalent ratio of one (1) QMRP to thirty (30) individuals being
served.
B) A Qualified Mental
Retardation Professional (QMRP) is a person who has at least one year of
experience working directly with persons with mental retardation and is one of
the following:
i) A doctor of medicine or
osteopathy;
ii) A registered
nurse;
iii) An individual who holds
at least a bachelor's degree in one of the following professional categories:
Occupational Therapist; Occupational Therapy Assistant, Physical Therapist,
Physical Therapy Assistant, Psychologist, Master's Degree; Social Worker;
Speech-Language Pathologist or Audiologist; Recreation Specialist; Registered
Dietitian; and Human Services, including but not limited to Sociology, Special
Education, Rehabilitation Counseling, and Psychology (
42 CFR
483.430(1989) ).
3) Assessment and Other
Program Services
A) A comprehensive functional
assessment that identifies an individual's needs must be performed as needed to
supplement any preliminary evaluations conducted prior to admission to a
nursing facility.
B) A
Comprehensive Assessment must include:
i)
physical development and health;
ii) dental examination that includes an
assessment of oral hygiene practices;
iii) nutritional status;
iv) sensorimotor development/auditory
functioning;
v) social
development;
vi) speech and
language development;
vii) adaptive
behaviors or independent living skills necessary for the individual to be able
to function in the community (Scales of Independent Behavior (SIB) or the
Inventory for Client and Agency Planning (ICAP) are the assessment instruments
that must be used for this assessment);
viii) vocational or educational skills (if
applicable);
ix) cognitive
development;
x) medication and
immunization history;
xi)
psychological evaluation (within 5 years) that includes an assessment of the
individual's emotional and intellectual status;
xii) capabilities and preferences relative to
recreation/leisure activities;
xiii) other assessments indicated by the
individual's needs, such as physical and occupational therapy
assessments;
xiv) seizure disorder
history (if applicable) with information regarding frequency of occurrence and
classification; and
xv) screenings
(the facility performs or obtains) in the areas of nutrition, vision, auditory
and speech/language.
d) Costs associated with specialized services
programs reimbursement includes other program costs, such as consultants,
inservice training, and other items necessary for the delivery of specialized
services to clients in accordance with their individual program
plans.
e) Total program
reimbursement for the additional costs associated with the delivery of
specialized services to individuals with developmental disabilities residing in
nursing facilities will be ten dollars ($10) per day, per individual being
served. Facility eligibility for specialized services program reimbursement is
dependent upon the facility meeting all criteria specified in Sections
147.5
through
147.205,
147.350
and
144.25
through 144.250.
Notes
Amended at 16 Ill. Reg. 17332, effective November 6, 1992
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