Ill. Admin. Code tit. 89, § 140.84 - Long Term Care Provider Fund
a)
Purpose and Contents
1) The Long Term Care
Provider Fund was created in the State Treasury on July 1, 1992, July 14, 1993
and July 1, 1995 (see Section 5B-8 of the Code). Interest earned by the Fund
shall be credited to the Fund. The Fund shall not be used to replace any funds
appropriated to the Medicaid program by the General Assembly.
2) The Fund is created for the purpose of
receiving and disbursing monies in accordance with this Section and Sections
5B-2 and 5B-8 of the Code.
3) The
Fund shall consist of:
A) All monies collected
or received by the Department under subsection (b);
B) All federal matching funds received by the
Department as a result of expenditures made from the Fund;
C) Any interest or penalty levied in
conjunction with the administration of the Fund;
D) All other monies received for the Fund
from any other source, including interest earned thereon; and
E) All monies transferred from the Tobacco
Products Tax Act [35 ILCS 143].
b) License Fee and Provider Assessment
1) Beginning on July 1, 1993, and ending on
June 30, 2022, a nursing home license fee is imposed upon each nursing home
provider in an amount equal to $1.50 for each licensed nursing bed day for the
calendar quarter in which the payment is due. All nursing beds subject to
licensure under the Nursing Home Care Act or the Hospital Licensing Act, with
the exception of swing-beds, as defined in subsection (k)(11) will be used to
calculate the licensed nursing bed days for each quarter. This license fee
shall not be billed or passed on to any resident of a nursing home operated by
the nursing home provider. Changes in the number of licensed nursing beds will
be reported to the Department quarterly, as described in subsection (d)(1). The
Department reserves the right to audit the reported data.
2) Beginning July 1, 2011 and ending on June
30, 2022, an assessment is imposed upon each long term care provider in an
amount equal to $6.07 times the number of occupied bed days due and payable
each month. This assessment shall be construed as a tax, but shall not be
billed or passed on to any resident of a nursing home operated by the nursing
home provider.
3) Beginning July 1,
2022, an assessment is imposed upon each long-term care provider in an amount
varying with the number of paid Medicaid resident days per annum in the
facility with the following schedule of occupied bed tax amounts. This
assessment is due and payable each month and shall be construed as a tax but
shall not be billed or passed on to any resident of a nursing home operated by
the nursing home provider.
A) The tax shall
follow the schedule below and be rebased by the Department on an annual basis.
i) 0-5,000 paid Medicaid resident days per
annum, $10.67.
ii) 5,001-15,000
paid Medicaid resident days per annum, $19.20.
iii) 15,001-35,000 paid Medicaid resident
days per annum, $22.40.
iv)
35,001-55,000 paid Medicaid resident days per annum, $19.20.
v) 55,001-65,000 paid Medicaid resident days
per annum, $13.86.
vi) 65,001+ paid
Medicaid resident days per annum, $10.67.
vii) Any non-profit nursing facilities
without Medicaid-certified beds, $7 per occupied bed day.
B) The Department shall publish each
facility's rebased tax rate according to the schedule in this subsection 30
days prior to the beginning of the 6-month period beginning July 1, 2022 and
thereafter 30 days prior to the beginning of each calendar year which shall
incorporate the number of paid Medicaid days used to determine each facility's
rebased tax rate. The notice shall include the number of paid Medicaid days
broken down by days paid by each Managed Care Organization, Fee for Service,
and each contracted MMAI plan. The notice shall also specify the dates of
service used for the determination and the date on which the data was
queried.
C) For each new calendar
year and for the 6-month period beginning July 1, 2022, a facility's paid
Medicaid resident days per annum shall be determined using the Department's
Medicaid Management Information System to include Medicaid resident days for
the year ending 9 months earlier. The Department will query the MMIS to make
this determination as late as is reasonably possible subject to the publication
deadline in subsection (b)(3)(B) and will adjust the number of paid Medicaid
resident days per annum, if necessary, using the Department's nursing home
provider tax database to more accurately distinguish Medicare and Medicaid
payment. The number of paid Medicaid days shall also include hospice days and
provisional days, if applicable.
4) Appeals of Tax Rate Determinations
A) Appeals of tax rate determinations shall
be submitted in writing to the Department. Appeals received within 30 days
after tax rate notification shall, if upheld, be made effective as of the
beginning of the tax year. The effective date of all upheld appeals filed after
the initial 30-day period shall be the first day of the month after the date
the complete appeal was received. Payments shall be made based on the
Department's determination pending the results of the appeal.
B) Appeals of tax rate determinations under
this Section shall be submitted in writing to the Chief, Bureau of Long Term
Care. The Department shall rule on all appeals within 120 days after the date
of appeal, except that if the Department requires additional information from
the facility the period shall be extended until such time as the information is
provided. Appeals for any tax year must be filed before the close of the first
quarter of the tax year. Amounts owed as a result of an upheld appeal shall be
applied as a credit towards future taxes owed and payable.
c) Payment of License Fee and
Assessment Due
1) The license fee described in
subsection (b) shall be due and payable in quarterly installments, on September
10, December 10, March 10, and June 10 of the year, modified to accommodate
weekends and holidays. Providers will be notified, in writing, of the quarterly
due dates. License fee payments postmarked on the due date will be considered
as paid on time.
2) The assessment
described in subsection (b) shall be due and payable monthly, on the last State
business day of the month for occupied bed days reported for the preceding
third month prior to the month in which the tax is payable and due. A facility
that has its payments from the State delayed, due to problems related to State
cash flow, may request an extension on the due date for payment pursuant to
subsection (b) and shall pay each extended assessment payment within 30 days
after each reimbursement for services by the Department.
A) The Department shall provide for an
electronic submission process for each long term care facility to report the
number of occupied bed days of the long term care facility for the reporting
period and other reasonable information the Department requires for the
administration of its responsibilities. To the extent practicable, the
Department shall coordinate the assessment reporting requirements with other
reporting required of long term care facilities.
B) Beginning July 1, 2013, a separate
electronic submission shall be completed for each long term care facility in
this State operated by a long term care provider. The Department shall prepare
an assessment, based on the reported occupied beds, and will bill the facility
stating the amount due and payable each month and submit it to each long term
care facility via an electronic process. Each assessment payment shall be
accompanied by a copy of the assessment bill sent to the long term care
facility by the Department.
C) The
provider assessment imposed by this Section shall not be due and payable until
after the Department notifies the long term care providers, in writing, that
the payment methodologies to long term care providers required under Section
5-5.4 of the Public Aid Code have been approved and the waivers under
42 CFR
433.68, if necessary, have been granted by
CMMS.
3) All payments
received by the Department shall be credited first to unpaid installment
amounts (rather than to penalty or interest), beginning with the most
delinquent installments.
4) County
nursing homes directed and maintained pursuant to Section 5-1005 of the
Counties Code [55 ILCS 5] may meet their license fee or assessment obligation
by the county government certifying to the Department that county expenditures
have been obligated for the operation of the county nursing home in an amount
at least equal to the amount of the license fee or assessment. County
governments wishing to provide such certification must:
A) Sign a certification form certifying that
the funds represent expenditures eligible for federal financial participation
under Title XIX of the Social Security Act (42 U.S.C.
1396), and that these funds are not federal
funds, or are federal funds authorized by federal law to be used to match other
federal funds;
B) Submit the
certification document to the Department once a year along with a copy of that
portion of the county budget showing the funds appropriated for the operation
of the county nursing home. These documents must be submitted within 30 days
after the final approval of the county budget;
C) Submit the monthly claim form in the
amount of the rate established by the Department minus any third party
liability amount. This amount will be reduced by an amount determined by the
amount certified and the number of months remaining in the fiscal year, prior
to payment because a certification statement was provided in lieu of an actual
license fee or assessment payment; and
D) Make records available upon request to the
Department and/or the United States Department of Health and Human Services
pertaining to the certification of county funds.
d) Reporting Requirements,
Penalty, and Maintenance of Records
1) On or
before the due dates described in subsection (c)(1), each nursing home provider
subject to a license fee under subsection (b) shall file a report with the
Department reflecting any changes in the number of licensed nursing beds
occurring during the reporting quarter. The report shall be on a form prepared
by the Department. The changes will be reported quarterly and shall be
submitted with the revised quarterly license fee payment. For the purpose of
calculating the license fee described in subsection (b), all changes in
licensed nursing beds will be effective upon approval of the change by the
Illinois Department of Public Health. Documentation showing the change in
licensed nursing beds, and the date the change was approved by the Illinois
Department of Public Health, must be submitted to the Department of Healthcare
and Family Services with the licensed nursing bed change form.
2) After December 31 of each year, and on or
before March 31 of the succeeding year, every long term care provider subject
to assessment under subsection (c)(2) shall file a report with the Department.
The report shall be in a form and manner prescribed by the Department and shall
state the revenue received by the long term care provider, reported in such
categories as may be required by the Department, and other reasonable
information the Department requires for the administration of its
responsibilities.
3) If a provider
operates or maintains more than one nursing home, a separate report shall be
filed for each facility. In the case of a provider existing as a corporation or
legal entity other than an individual, the report filed by it shall be signed
by its president, vice president, secretary or treasurer or by its properly
authorized agent.
4) If the
provider fails to file its report for a State fiscal year on or before the due
date of the report, there shall, unless waived by the Department for reasonable
cause, be added to the license fee or assessment imposed in subsection (b) a
penalty fee equal to 25% of the assessment or license fee imposed for the year.
After July 1, 2013, no penalty will be assessed if the Department has not
established a process for the electronic submission of information as it
pertains to the assessment.
5)
Every provider subject to a license fee or assessment under subsection (b)
shall keep records and books that will permit the determination of licensed
nursing bed days on a quarterly basis and occupied beds on a monthly basis. All
such books and records shall be maintained for a minimum of three years
following the filing date of each report and shall, at all times during
business hours of the day, be subject to inspection by the Department or its
duly authorized agents and employees.
6) Amended License Fee and Assessment
Reports. With the exception of amended license fee or assessment reports filed
in accordance with this subsection (d)(6), an amended license fee report or
monthly assessment report must be filed within 30 calendar days after the
original report due date. The amended report must be accompanied by a letter
identifying the changes and the justification for the amended report. The
provider will be advised of any adjustments to the original annual license fee
or assessment amount through a written notification from the Department.
Penalties may be applied to the amount underpaid due to a filing
error.
7) Reconsideration of
Adjusted License Fee or Assessment. If the Department, through an audit
conducted by the Department or its agent within three years after the end of
the fiscal year in which the license fee or assessment was due, changes the
license fee or assessment liability of a provider, the provider may request a
review or reconsideration of the adjusted license fee or assessment within 30
days after the Department's notification of the change in license fee or
assessment liability. Requests for reconsideration of the license fee or
assessment adjustment shall not be considered if those requests are not
postmarked on or before the end of the 30 day review period. Penalties may be
applied to the amount underpaid due to a filing error.
8) Effective January 1, 2023, all providers
operating or maintaining a long-term care facility shall notify the Department
of all individual owners and any individuals or organizations that are part of
a limited liability company with ownership of that facility, and the percentage
ownership of each owner. This ownership reporting requirement does not include
individual shareholders in a publicly held corporation. Submission of the
information as part of the Department's cost reporting requirements shall
satisfy this request.
e)
Procedure for Partial Year Reporting/Operating Adjustments
1) Cessation of business during the period in
which the license fee or assessment is being paid and the closure date has been
set. A provider who ceases to conduct, operate, or maintain a facility for
which the person is subject to the license fee or assessment imposed under
subsection (b) of this Section, and for which the closure date for the facility
has been set, shall file a final report with the Department on or before the
due date for the period in which the closure is to occur. The report will
reflect the adjusted number of days the facility is open during the reporting
period and shall be submitted with the final quarterly license fee or monthly
assessment payment. Example: A facility is set to close on September 24. On or
before the due date for the reporting quarter of July 1 through September 30,
the facility will submit a final report reflecting 86 days of operation (July 1
through September 24) and the corresponding quarterly license fee
payment.
2) Cessation of business
after the monthly or quarterly due date. A provider who ceases to conduct,
operate, or maintain a facility for which the person is subject to the license
fee or assessment imposed under subsection (b), and for which closure occurs
after the due date for the reporting period, but prior to the last day of the
reporting period, shall file an amended final report with the Department within
30 days after the closure date. The amended report will reflect the number of
days the facility was operational during the reporting period and the revised
license fee or assessment amount. Upon verifying the data submitted on the
amended report, the Department will issue a refund for the amount overpaid.
Example: On December 10 a facility pays the license fee for 92 days covering
the reporting quarter of October 1 through December 31. The facility closes on
December 27. An amended report reflecting 88 days, the actual number of days
the facility was operational during the quarter (October 1 through December 27)
must be filed with the Department.
3) Cessation of business prior to the monthly
or quarterly due date. A provider who ceases to conduct, operate, or maintain a
facility for which the person is subject to the license fee or assessment
imposed under subsection (b), and for which closure occurs prior to the due
date for the reporting period, shall file a final report with the Department
within 30 days after the closure date. The final report will reflect the number
of days the facility was operational during the reporting period and the
corresponding final license fee and assessment amount. Closure dates will be
verified with the Department of Public Health, and if necessary adjustments
will be made to the final license fee and assessment due. Example: Facility
closes on January 17. On or before February 17, the facility must file a final
report for the reporting quarter of January 1 through March 31. The report
would reflect 17 days of operation (January 1 through January 17) during the
quarter and must be accompanied by the final license fee payment for the
facility.
4) Commencing of business
during the fiscal year in which the license fee or assessment is being paid. A
provider who commences conducting, operating, or maintaining a facility for
which the person is subject to the license fee or assessment imposed under
subsection (b) shall file an initial report for the reporting period in which
the commencement occurs within 30 calendar days thereafter and shall pay the
license fee and assessment under subsection (c). In determining the annual
assessment amount for the provider, the Department shall develop hypothetical
annualized occupied bed projections based upon geographic location and
facility. The assessment determination made by the Department is
final.
5) Change in Ownership
and/or Operators. The full monthly/quarterly assessment/license fee must be
paid on the designated due dates regardless of changes in ownership or
operators. Liability for the payment of the assessment/license fee amount
(including past due assessment/license fees and any interest or penalties that
may have accrued against the amount) rests on the provider currently operating
or maintaining the nursing facility regardless if these amounts were incurred
by the current owner or were incurred by previous owners. Collection of
delinquent assessment/license fees from previous providers will be made against
the current provider. Failure of the current provider to pay any outstanding
assessment/license fee liabilities incurred by previous providers shall result
in the application of penalties described in subsection (f)(1).
6) Upon request, the Department will share
with a potential buyer of a facility information on outstanding assessments and
penalties owed by that facility.
f) Penalties
1) Any provider that fails to pay the full
amount of a license fee or assessment when due, or fails to report a change in
licensed nursing beds approved by the Department of Public Health prior to the
due date of the license fee or assessment, shall be charged, unless waived by
the Department for reasonable cause, a penalty equal to five percent of the
amount of the license fee or assessment not paid on or before the due date,
plus five percent of the portion thereof remaining unpaid on the last day of
each monthly period thereafter, not to exceed 100% of the installment or
assessment amount not paid on or before the due date. Reasonable cause may
include but is not limited to:
A) a provider
who has not been delinquent on payment of a license fee or assessment due,
within the last three calendar years from the time the delinquency
occurs;
B) a provider who can
demonstrate to the Department's satisfaction that a payment was made prior to
the due date; or
C) that the
provider is a new owner/operator and the late payment occurred in the reporting
period in which the new owner/operator assumed control of the
facility.
2) Within 30
days after the due date, the Department may begin recovery actions against
delinquent providers participating in the Medicaid Program. Payments may be
withheld from the provider until the entire license fee or assessment,
including any penalties, is satisfied or until a reasonable repayment schedule
has been approved by the Department. If a reasonable agreement cannot be
reached, or if a provider fails to comply with an agreement, the Department
reserves the right to recover any outstanding license fee, assessment, interest
and penalty by recouping the amount or a portion thereof from the provider's
future payments from the Department. The provider may appeal this recoupment in
accordance with the Department's rules at 89 Ill. Adm. Code 104. The Department
has the right to continue recoupment during the appeal process. Penalties
pursuant to subsection (f)(1) will continue to accrue during the recoupment
process. Recoupment proceedings against the same provider two times in a fiscal
year may be cause for termination from the Program. Failure by the Department
to initiate recoupment activities within 30 days shall not reduce the
provider's liabilities nor shall it preclude the Department from taking action
at a later date.
3) If the provider
does not participate in the Medicaid Program, or is no longer doing business
with the Department, or the Department cannot recover the full amount due
through the claims processing system, within three months after the license fee
or assessment due date, the Department may begin legal action to recover the
monies, including penalties and interest owed, plus court costs.
g) Delayed Payment - Groups of
Facilities
The Department may establish delayed payment of fees/assessment and/or waive the payment of interest and penalties for groups of facilities when:
1) the State delays
payments to facilities due to problems related to State cash flow; or
2) a cash flow bond pool's or any other group
financing plans' requests from providers for loans are in excess of its
scheduled proceeds such that a significant number of facilities will be unable
to obtain a loan to pay the license fee.
h) Delayed Payment - Individual Facilities
In addition to the provisions of subsection (g), the Department may delay license fees or assessments for individual facilities that are unable to make timely payments under this Section due to financial difficulties. No delayed payment arrangements shall extend beyond the last business day of the calendar period or month following the quarter in which the license fee or the assessment payment was to have been received by the Department as described in subsection (c). The Department may not deny a request for delay of payment of the assessment imposed in subsection (b) if the provider has not been paid due to problems related to State cash flow for services provided during the month in which the assessment is levied. The request must be received by the Department prior to the due date of the assessment.
1) Criteria. Delayed
payment provisions may be instituted only under extraordinary circumstances.
Delayed payment provisions shall be made only to qualified facilities who meet
all of the following requirements:
A) the
facility has experienced an emergency that necessitates institution of delayed
payment provisions. Emergency in this instance is defined as a circumstance
under which institution of the payment and penalty provisions described in
subsections (c)(1), (c)(2), (f)(1), (f)(2) and (f)(3) would impose severe and
irreparable harm to the clients served. Circumstances which may create such
emergencies include, but are not limited to, the following:
i) Department system errors (either automated
system or clerical) that have precluded payments, or that have caused erroneous
payments such that the facility's ability to provide further services to
clients is severely impaired;
ii)
cash flow problems encountered by a facility that are unrelated to Department
technical system problems and which result in extensive financial problems to a
facility adversely impacting on its ability to serve its clients.
B) the facility serves a
significant number of clients under the Medical Assistance Program. Significant
in this instance means:
i) 85% or more of
their residents must be eligible for public assistance;
ii) a government-owned facility that meets
the cash flow criterion under subsection (h)(1)(A)(ii);
iii) a provider who has filed for Chapter 11
bankruptcy, which meets cash flow criterion under subsection
(h)(1)(A)(ii).
C) the
facility must ensure that a delay of payment request, as defined under
subsection (h)(3)(A), is received by the Department and the request must
include a Cash Position Statement that is based upon current assets, current
liabilities and other data for a date which is less than 60 days prior to the
date of filing. Any liabilities payable to owners or related parties must not
be reported as current liabilities on the Cash Position Statement. A deferral
of license fee or assessment payments will be denied if any of the following
criteria are met:
i) the ratio of current
assets divided by current liabilities is greater than 2.0;
ii) cash, short term investments and long
term investments equal or exceed the total of accrued wages payable and the
license fee payment. Long term investments that are unavailable for expenditure
for current operations due to donor restrictions or contractual requirements
will not be used in this calculation;
iii) cash or other assets has been
distributed during the previous 90 days to owners or related parties in an
amount equal to or exceeding the license fee or assessment payment for
dividends, salaries in excess of those allowable under Section
140.541 or payments for purchase
of goods or services in excess of cost as defined in Section
140.537.
D) the facility, with the exception of
government owned facilities, must show evidence of denial of an application to
borrow license fee or assessment funds through a cash flow bond pool or
financial institutions such as a commercial bank. The denial must be 90 days
old or less.
E) the facility must
sign an agreement with the Department that specifies the terms and conditions
of the delayed payment provisions. The agreement shall contain the following
provisions:
i) specific reasons for
institution of the delayed payment provisions;
ii) specific dates on which payments must be
received and the amount of payment that must be received on each specific date
described;
iii) the interest or a
statement of interest waiver as described in subsection (h)(5) that shall be
due from the facility as a result of institution of the delayed payment
provisions;
iv) a certification
stating that, should the entity be sold, the new owners will be made aware of
the liability and any agreement selling the entity will include provisions that
the new owners will assume responsibility for repaying the debt to the
Department according to the original agreement;
v) a certification stating that all
information submitted to the Department in support of the delayed payment
request is true and accurate to the best of the signator's knowledge; and
vi) other terms and conditions
that may be required by the Department.
2) A facility that does not meet the criteria
in subsection (h)(1) may request a delayed payment schedule, prior to the due
date. The Department may approve the request, notwithstanding the facility not
meeting the above criteria, upon a sufficient showing of financial difficulties
and good cause by the facility. If the request for a delayed payment schedule
is approved, all other conditions of this subsection (h) shall apply.
3) Approval Process
A) In order to receive consideration for
delayed payment provisions, facilities must ensure their request is received by
the Department prior to the payment due date, in writing (telefax requests are
acceptable) to the Bureau of Rate Development and Analysis. The request must be
received by the due date designated by the Department. Providers will be
notified, in writing, of the due dates for submitting delay of payment
requests. Requests must be complete and contain all required information before
they are considered to have met the time requirements for filing a delayed
payment request. All telefax requests must be followed up with original written
requests, postmarked no later than the date of the telefax. The request must
include:
i) an explanation of the
circumstances creating the need for the delayed payment provisions;
ii) supportive documentation to substantiate
the emergency nature of the request including a cash position statement as
defined in subsection (h)(1)(C); a denial of application to borrow the license
fee or assessment as defined in subsection (h)(1)(D) and an explanation of the
risk of irreparable harm to the clients; and
iii) specification of the specific
arrangements requested by the facility.
B) The facility shall be notified by the
Department, in writing prior to the license fee or assessment due date, of the
Department's decision with regard to the request for institution of delayed
payment provisions. An agreement shall be issued to the facility for all
approved requests. The agreement must be signed by the administrator, owner or
other authorized representative and be received by the Department prior to the
first scheduled payment date listed in such agreement.
4) Waiver of Penalties. The penalties
described in subsections (f)(1) and (f)(2) may be waived upon approval of the
facility's request for institution of delayed payment provisions. In the event
a facility's request for institution of delayed payment provisions is approved
and the Department has received the signed agreement in accordance with
subsection (h)(3)(B), the penalties shall be permanently waived for the subject
quarter or month as it pertains to assessment, unless the facility fails to
meet all of the terms and conditions of the agreement. In the event the
facility fails to meet all of the terms and conditions of the agreement, the
agreement shall be considered null and void and such penalties shall be fully
reinstated.
5) Interest. The
delayed payments shall include interest at a rate not to exceed the State of
Illinois borrowing rate. The applicable interest rate shall be identified in
the agreement described in subsection (h)(1)(E). The interest may be waived by
the Department if the facility's current ratio, as described in subsection
(h)(1)(C), is 1.5 or less and the facility meets the criteria in subsections
(h)(1)(A) and (B). Any such waivers granted shall be expressly identified in
the agreement described in subsection (h)(1)(E).
6) Subsequent Delayed Payment Arrangements.
Once a facility has requested and received approval for delayed payment
arrangements, the facility shall not receive approval for subsequent delayed
payment arrangements until such time as the terms and conditions of any current
delayed payment agreement have been satisfied or unless the provider is in full
compliance with the terms of the current delay of payment agreement. The waiver
of penalties described in subsection (h)(4) shall not apply to a facility that
has not satisfied the terms and conditions of any current delayed payment
agreement.
i)
Administration and Enforcement Provisions
The Department shall administer and enforce Section 5B-7 of the Code, and collect the license fees, assessments, interest, and penalty fees imposed under the law, using procedures employed in its administration of this Code generally and, as it deems appropriate, in a manner similar to that in which the Department of Revenue administers and collects the retailers' occupation tax under ROTA.
j) Nothing in Section 5B of the Code shall be
construed to prevent the Department from collecting all amounts due under this
Section pursuant to an assessment imposed before July 1, 1995.
k) Definitions
As used in this Section, unless the context requires otherwise:
1) "Department" means the
Illinois Department of Healthcare and Family Services.
2) "Fund" means the Long Term Care Provider
Fund.
3) "Hospital provider" means
a person licensed by the Department of Public Health to conduct, operate, or
maintain a hospital, regardless of whether the person is a Medicaid provider.
For purposes of this definition, "person" means any political subdivision of
the State, municipal corporation, individual, firm, partnership, corporation,
company, limited liability company, association, joint stock association, or
trust, or a receiver, executor, trustee, guardian, or other representative
appointed by order of any court.
4)
"Licensed nursing bed days" means, with respect to a nursing home provider, the
sum for all nursing beds, with the exception of swing-beds, as described in
subsection (k)(11), of the number of days during a calendar quarter on which
each bed is covered by a license issued to that provider under the Nursing Home
Care Act [210 ILCS 45] or the Hospital Licensing Act [210 ILCS 85].
5) "Long term care facility" means a nursing
facility, whether public or private and whether organized for profit or
not-for-profit, that is subject to licensure by the Illinois Department of
Public Health under the Nursing Home Care Act or the ID/DD Community Care Act
[210 ILCS 47], including a county nursing home directed and maintained under
Section 5-1005 of the Counties Code, and a part of a hospital in which skilled
or intermediate long term care services within the meaning of Title XVIII or
XIX of the Social Security Act are provided; except that the term "long term
care facility" does not include a facility operated by a State agency or
operated solely as an intermediate care facility for the developmentally
disabled within the meaning of Title XIX of the Social Security Act.
6) "Long term care provider" means a person
licensed by the Department of Public Health to operate and maintain a skilled
nursing or intermediate long term care facility or a hospital provider that
provides skilled or intermediate long term care services within the meaning of
Title XVII or XIX of the Social Security Act. For purposes of this definition,
"person" means any political subdivision of the State, municipal corporation,
individual, firm, partnership, corporation, company, limited liability company,
association, joint stock association, or trust, or a receiver, executor,
trustee, guardian, or other representative appointed by order of any
court.
7) "Nursing home" means a
skilled nursing or intermediate long term care facility, whether public or
private and whether organized for profit or not-for-profit, that is subject to
licensure by the Illinois Department of Public Health under the Nursing Home
Care Act, including a county nursing home directed and maintained under Section
5-1005 of the Counties Code; and a part of a hospital in which skilled or
intermediate long-term care services within the meaning of Title XVIII or XIX
of the Social Security Act are provided. However, the term "nursing home" does
not include a facility operated solely as an intermediate care facility for the
mentally retarded within the meaning on Title XIX of the Social Security
Act.
8) "Nursing home provider"
means a person licensed by the Department of Public Health to operate and
maintain a skilled nursing or intermediate long term care facility which
charges its residents, a third party payor, Medicaid, of Medicare for skilled
nursing or intermediate long term care services; or a hospital provider that
provides skilled or intermediate long term care services within the meaning of
Title XVIII or XIX of the Social Security Act.
9) "Occupied bed days" shall be computed
separately for each long term care facility operated or maintained by a long
term care provider, and means the sum, for all beds, of the number of days
during the month on which each bed was occupied by a resident, other than a
resident for whom Medicare Part A is primary payer. For a resident whose care
is covered by the Medicare-Medicaid Alignment Initiative demonstration,
Medicare Part A is considered the primary payer to the extent Medicare would
have been the primary payer in the absence of the demonstration.
10) "Person" means, in addition to natural
persons, any political subdivision of the State, municipal corporation,
individual, firm, partnership, corporation, company, limited liability company,
association, joint stock association, or trust, or a receiver, executor,
trustee, guardian, or other representative appointed by order of any
court.
11) "Swing-beds" means those
beds for which a hospital provider has been granted an approval from the
federal Centers for Medicare and Medicaid Services to provide post-hospital
extended care services (42
CFR 409.30, October 1, 1991) and be
reimbursed as a swing-bed hospital (42 CFR 413.114, October 1,
1991).
Notes
Amended at 36 Ill. Reg. 7010, effective April 27, 2012
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No prior version found.