Ill. Admin. Code tit. 89, § 153.126 - Long Term Care Facility Medicaid Per Diem Adjustments
a) Notwithstanding the provisions set forth
in Section
153.100,
the socio-development component for facilities that are federally defined as
Institutions for Mental Disease (see 89 Ill. Adm. Code
145.30
) shall be increased by 253 percent beginning with services provided on and
after March 1, 2008.
b)
Notwithstanding the provisions set forth in Section 153.100, daily residential
rates effective on March 1, 2008, for intermediate care facilities for persons
with developmental disabilities (ICF/DD), including skilled nursing facilities
for persons under 22 years of age (SNF/Ped), for which a patient contribution
is required, shall be increased by 2.2 percent.
c) Notwithstanding the provisions set forth
in Section 153.100, developmental training rates effective on March 1, 2008
shall be increased by 2.5 percent.
d) Notwithstanding the provisions set forth
in Sections
153.100
and
153.125,
for dates of services provided on or after July 1, 2012, the $10 per day per
individual payment for individuals with developmental disabilities in nursing
facilities, described in 89 Ill. Adm. Code
147.350,
shall be eliminated.
e)
Notwithstanding the provisions set forth in Sections
153.100
and 153.125, on or after July 1, 2012, nursing facilities not designated as
Institutions for Mental Disease shall have rates effective May 1, 2011 (see
Section 153.125) adjusted as follows:
1)
Individual nursing rates for residents classified in Resource Utilization
Groups IV (RUG-IV) PA1, PA2, BA1 and BA2, during the quarter ending March 31,
2012, shall be reduced by 10 percent;
2) Individual nursing rates for residents
classified in all other RUG-IV groups shall be reduced by 1.0 percent;
and
3) Facility rates for the
support and capital components shall be reduced by 1.7 percent.
f) Notwithstanding the provisions
set forth in Sections
153.100
and 153.125, on or after July 1, 2012, nursing facilities designated as
Institutions for Mental Disease and facilities licensed under the Specialized
Mental Health Rehabilitation Act shall have the nursing, socio-development,
capital and support components of their reimbursement rate effective May 1,
2011 (see Section 153.125), reduced in total by 2.7 percent.
g) Notwithstanding the provisions set forth
in Sections
153.100
and 153.125, on or after July 1, 2012, supported living facilities, as defined
in 89 Ill. Adm. Code
146.205, shall have
rates reduced by 2.7 percent.
h)
Notwithstanding the provisions set forth in Sections
153.100
and
153.125
and 89 Ill. Adm. Code
140.560
and
140.561,
for services provided on or after July 1, 2014, the support component of a
nursing facility's rate for facilities licensed under the Nursing Home Care Act
as skilled or intermediate care facilities (SNF/ICF) shall be the rate in
effect on June 30, 2014, increased by 8.17 %.
i) Long Term Care Facilities for Persons
under 22 Years of Age Serving Clinically Complex Residents
1) Effective for dates of service on or after
July 1, 2013, long term care facilities for persons under 22 years of age
serving clinically complex residents means facilities licensed by the
Department of Public Health as long term care facilities for persons under 22
years of age that serve severely and chronically ill pediatric patients
requiring exceptional care, if the facility has 30% or more of its patients
receiving ventilator care.
2) For
dates of services starting July 1, 2013, long term care facilities for persons
under 22 years of age serving clinically complex residents shall receive
Medicaid reimbursement on 30-day expedited schedule.
3) Effective for dates of service on or after
July 1, 2014, for purposes of this Section, a person under 22 years of age is
considered clinically complex if the person requires at least one of the
following medical services:
A) Tracheostomy
care with dependence on mechanical ventilation for a minimum of six hours each
day.
B) Tracheostomy care requiring
suctioning at least every six hours, room air mist or oxygen as needed, and
dependence on one of the treatment procedures listed under subsection (i)(4),
excluding the procedure listed in subsection (i)(4)(B).
C) Total parenteral nutrition or other
intravenous nutritional support and one of the treatment procedures listed
under subsection (i)(4).
4) The following treatment procedures apply
to the conditions in subsections (i)(3)(B) and (C):
A) Intermittent suctioning at least every
eight hours and room air mist or oxygen as needed.
B) Continuous intravenous therapy, including
administration of therapeutic agents necessary for hydration or of intravenous
pharmaceuticals; or intravenous pharmaceutical administration of more than one
agent via a peripheral or central line, without continuous infusion.
C) Peritoneal dialysis treatments requiring
at least four exchanges every 24 hours.
D) Tube feeding via nasogastric or
gastrostomy tube.
E) Other medical
technologies required continuously, which in the opinion of the attending
physician require the services of a professional nurse.
5) Reimbursement
A) Notwithstanding the provisions set forth
in 89 Ill. Adm. Code 140, 144 and 147, and subject to federal approval of
changes to the Title XIX State Plan, for dates of service starting July 1, 2014
through implementation of a new reimbursement system, long term care facilities
for persons under 22 years of age serving clinically complex residents shall
receive a per diem rate of $304 for clinically complex residents.
B) Notwithstanding the provisions set forth
in 89 Ill. Adm. Code 140, 144 and 147, and subject to federal approval of
changes to the Title XIX State Plan, for dates of service starting July 1,
2014, long term care facilities for persons under 22 years of age serving
clinically complex residents that have a policy documenting their method of
routine assessment of a resident's potential for being weaned from a
ventilator, with interventions implemented noted in the resident's record,
shall receive a per diem rate of $669 for clinically complex residents on a
ventilator.
Notes
Amended at 37 Ill. Reg. 10529, effective June 27, 2013
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