Current through Register Vol. 48, No. 38, September 20, 2024
a) For
services provided on or after July 1, 2010, daily rates for qualifying ICFs/MR
shall have their own reimbursement rates adjusted pursuant to this
Section.
b) Qualifying Criteria
In order to receive rate adjustments under this Section,
facilities must meet the following criteria:
1) Be a licensed ICF/MR, as defined in 77
Ill. Adm. Code 350, with more than 16 licensed beds and is not:
A) An SNF/PED, as defined in 77 Ill. Adm.
Code 390; or
B) A campus facility,
as defined under 89 Ill. Adm. Code
140.583.
2) For the immediately preceding
month, as documented in the remittance advice report, have:
A) An occupancy level of at least 93 percent
of licensed ICFDD bed capacity; and
B) At least 93 percent of the ICFDD residents
eligible for, and enrolled in, medical assistance under 89 Ill. Adm. Code
120.
3) Based on the
most recently conducted annual inspection of care survey, at least 50 percent
of the residents of the facility must qualify as Medical Level III.
c) Adjustment Methodology
The program and support components of the per diem rate for
qualifying facilities shall be replaced with the adjusted program and support
components, determined as follows:
1)
Adjustment Factor
The adjustment factor for a facility shall be the product of
the difference between the Medical Level III percentage and 50 percent
and:
A) For facilities with a Medical
Level III percentage less than 80 percent - 3.9; or
B) For all other facilities - 5.0.
2) Adjusted Program Component
The adjusted program component shall equal the product of the
following:
A) The program component of
the per diem rate, as determined under Section
144.275;
and
B) The sum of 1.000 plus the
adjustment factor for the facility, as determined in subsection
(c)(1).
3) Adjusted
Support Component
The adjusted support component shall equal the SNF/PED ceiling
for the geographic area in which the facility is located.
4) Subsequent Adjustments
A) Adjusted program and support components
shall be redetermined when:
i) Changes to the
program or support rate components are required in accordance with 89 Ill. Adm.
Code 153; and
ii) The percentage of
the residents who are classified as Medical Level III changes as a result of
the facility's annual inspection of care survey. The adjusted program component
shall be recalculated and effective the first day of the month following the
Medical Level III determinations.
B) All high medical/high personal care rates
for residents classified as Medical Level III will be reviewed and updated for
changes in the facility population at least once annually upon issuance of
respective facility Inspection of Care surveys.
