Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 144 - DEVELOPMENTAL DISABILITIES SERVICES
Section 144.50 - Inspection of Care and Rate Setting Appeal Process
Universal Citation: 89 IL Admin Code ยง 144.50
Current through Register Vol. 48, No. 38, September 20, 2024
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 include level of
functioning (IQ, results of functional assessments and existence of related
conditions), medical add-ons, behavioral add-ons, major life area limitations,
special transportation needs, special care nursing and information on the
developmental training agency attended. Differences between the facility and
the IOC team regarding the conditions of the residents will be addressed using
a three-step approach:
A) exit conference
discussion between the facility and the IOC team;
B) informal review involving the Department
of Public Health (DPH) regional supervisor and/or central office staff upon
request by the facility; and
C)
formal review to be heard by the Department of Mental Health and Developmental
Disabilities' (DMHDD) management.
2) Incomplete Assessments - In order for an
assessment to be appealable, the assessment must be completed prior to the exit
conference to be included in the IOC.
b) Examples of Appealable Situations
1) If the facility believes the surveyor has
misinterpreted the regulations, or the facility disagrees with the surveyor's
recommendations pertinent to the resident's condition (examples are included in
subsection (a)(1)), the facility may request an appeal.
2) If the facility believes that all
assessment data pertinent to the individual's status/condition have not been
reviewed, the facility may bring that data to the attention of the surveyor
through the appeal process. Such information must have been part of the
resident's record at the time of the assessment to be considered.
3) The facility has been surveyed because of
a 25 percent Medicaid eligible population change, a State Developmental Center
admission or because it is a new facility, and there is disagreement with the
findings.
c) Process and Time Frames
1) Exit Conference - At the exit
conference, the facility may state the service needs that it disputes. The
facility is responsible for providing supporting data to the IOC team at the
exit conference. When the differences are not reconciled through discussion,
the facility may request an appeal. The facility shall submit the written
appeal request stating the service needs in dispute. The appeal request and the
supporting documentation provided by the facility shall be submitted to the IOC
regional supervisor (with a copy of the appeal request to DPH's Division of
Long Term Care (DLTC) Field Operations) within 14 calendar days after the IOC
exit date.
2) Informal Review -
Within 30 calendar days after receipt of the IOC appeal request and supporting
documentation, the IOC regional supervisor and/or DPH central office staff will
review the documentation and either uphold or overturn the surveyor's findings
and shall provide written notification of the decision to the
facility.
3) Formal Review - The
facility may request a formal review of the informal review decision. Within
ten calendar days after receipt of the decision from the regional supervisor,
the facility shall submit a written request for a formal review to the
Associate Director of the Division of Developmental Disabilities within DMHDD
with a copy to the DLTC Field Operations within DPH.
A) The formal review shall be conducted not
more than 30 days after the facility's request for such a review. Not fewer
than 14 days prior to the scheduled review date, the Division of Developmental
Disabilities will notify the facility in writing of the review date, with
necessary instructions for the facility to request rescheduling if the date is
not feasible for the facility.
B)
The Associate Director and/or his or her designee will preside over the formal
review. During the review, DPH representatives shall present the basis for the
decision reached at the informal level of the review. The facility shall
present its documentation and DMHDD shall apply policy as it relates to the
findings under dispute. The Associate Director shall send to the facility a
written decision rendered as a result of the formal review within ten calendar
days after the hearing with a copy to DPH. The decision of the Associate
Director is final.
4)
Continuation of an appeal is contingent upon following the steps and timeframes
established in this Section.
d) Use of IOC Data in Rate Calculation
DMHDD will explain the use of IOC data in rate calculations upon written or telephone requests and/or personal visits. DMHDD will correct any errors in processing or using this IOC data to calculate rates. Rate methodology is promulgated by rulemaking according to the Illinois Administrative Procedure Act and is subject to review only through the formal rulemaking comment and hearing process.
Disclaimer: These regulations may not be the most recent version. Illinois may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.