Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 140 - MEDICAL PAYMENT
Subpart E - GROUP CARE
Section 140.530 - Basis of Payment for Long Term-Care Services
Universal Citation: 89 IL Admin Code ยง 140.530
Current through Register Vol. 48, No. 38, September 20, 2024
a) The amount approved for payment for long term care services is based on the type and amount of services required by and actually being furnished to a resident and is determined in accordance with the Department's rate schedule.
b) Costs not related to patient care, as well as costs in excess of those required for the efficient and economical delivery of care, will not be reimbursed.
c) Rates and payments
1) Rates for long term care services shall be
the sum of the reimbursable costs of capital, support, and nursing, as defined
in this Part and 89 Ill. Adm. Code 147.
2) Additionally, for county-owned or operated
nursing facilities, rates shall include allowable costs incurred in excess of
the reimbursable costs defined in this Part and 89 Ill. Adm. Code 147. Costs in
excess of reimbursable costs shall be certified from the signed annual cost
report submitted by the county to the Department.
3) Payment for long term care services is on
a per diem basis. In determining the number of days for which payment can be
made, the day of admission to the facility is counted. The day of discharge
from the facility is not counted, unless it is the day of death and death
occurs in the facility or a reserved bed has been authorized for that
day.
4) Payments by the Department
for long term care services shall not exceed reimbursable costs as defined in
this Part and 89 Ill. Adm. Code 147 less what is contributed by third party
liability.
d) Definitions
1) "Allowable costs" are those
which are appropriate patient care expenditures as defined in this Part and 89
Ill. Adm. Code 147.
2)
"Reimbursable costs" are determined by the application of statistical
standardizations of allowable costs for all providers within various defined
groups to the costs of individual providers within such groups.
3) "County-owned nursing facility" is a
nursing facility owned and operated by an Illinois county.
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