Ill. Admin. Code tit. 89, § 140.561 - Support Costs Components

Support Costs Components (includes laundry, dietary, housekeeping, utility and administrative expenses)

a) The Department shall reimburse each facility for support costs associated with the provision of long term care on the basis of the relationship between the facility's per diem allowable support costs and referent values determined for each geographic area from the distribution of per diem allowable support costs for all long term care facilities with adequate cost report data. For all facilities with a Department of Public Health license classification SNF/ICF (Skilled Nursing Facility, Intermediate Care Facility) or ICF/DD (Intermediate Care Facility for the Developmentally Disabled), the support rate will be computed as follows for the rate year to begin July 1, 1989 and subsequent years:

1) If a facility's per diem allowable support costs are less than the 35^th percentile value for per diem allowable support costs in the geographic area, the support rate will be equal to the facility's per diem allowable support costs plus 50% of the difference between the 75^th percentile value for per diem allowable support costs in the geographic area and the facility's per diem allowable support costs, up to a ceiling. The ceiling shall be equal to 50% of the difference between the 75^th percentile value of allowable per diem support costs for the geographic area and the 35^th percentile value of allowable per diem support costs for the geographic area plus $.05.

2) If a facility's per diem allowable support costs are greater than or equal to the 35^th percentile value of per diem allowable support costs for the geographic area and less than the 75- percentile value of per diem allowable support costs for the geographic area, the support rate will be equal to the facility's per diem allowable support costs plus 50% of the difference between the 75^th percentile value of per diem allowable support costs for the geographic area and the facility's per diem allowable support costs.

3) If a facility's per diem allowable support costs are equal to or greater than the 75^th percentile value of per diem allowable support costs for the geographic area, the support rate will be equal to the 75^th percentile value of per diem allowable support costs for the geographic area.

b) Small scale ICF/MR facilities which are licensed as Intermediate Care Facilities for the Developmentally Disabled with four or six beds (ICF/DD-4, ICF/DD-6) (see 89 Ill. Adm. Code 144.300 and 144.325) are separately licensed facilities. However, for support reimbursement, the per diem is based on a sixteen person capacity and the sum of the support cost components is aggregated over four 4-person ICFs/DD, or one 4-person plus two 6-person ICFs/DD. The set of small scale ICFs/DD used in computing the support per diem will be identified in the provider agreements. All facilities in a set must be within the boundaries of the same geographic area. Removal and/or addition of a small scale ICF/DD which is part of a set requires both a written notice by the provider 90 days before the beginning of a fiscal year (July 1), or upon certification in the case of a new facility which is licensed, and a change in the affected provider agreement that identifies the membership of the set. Each per diem calculated by aggregating allowable support costs over the specified set of small scale ICFs/DD based on a sixteen person capacity will be treated as a single facility licensed as ICF/DD-16, and will be included in the computation of support rates described in subsection (d).

c) For all facilities with a Department of Public Health license classification SNF/PED (Skilled Nursing Facility for Pediatric residents), the support rate will be computed exactly as described for the SNF/ICF and ICF/DD facilities, except that the referent value for each geographic area (i.e., the 35^th percentile values and the 75- percentile values for per diem allowable support costs) will be increased to 120% of the referent values applied in the computation of the support rates for SNF/ICF and ICF/DD facilities.

d) For all facilities with a Department of Public Health license classification ICF/DD-16 (Intermediate Care Facility for the Developmentally Disabled with 16 or fewer residents or a set of small scale ICFs/DD with a sixteen person capacity), the support rate will be computed by regionalizing the 35^th percentile values and the 75 ^th percentile values for per diem allowable support costs based upon cost of facilities or sets of facilities licensed as ICF/DD-16. A set of facilities licensed as ICF/DD-4 or ICF/DD-6 are considered as an ICF/DD-16 for the purpose of support reimbursement and the support rate is computed exactly as described for ICF/DD-16 facilities. All ICFs/DD-16, including sets of ICF/DD-4 and/or ICF/DD-6 facilities, will be used to locate the 35^th percentile and the 75^th percentile values for per diem allowable support costs. Those sets of small scale facilities which have support costs above the 75^th percentile will be reimbursed for support costs up to, but not to exceed, 106.6 % of the 75^th percentile.

e) For all facilities with a Department of Public Health license classification SLC (Specialized Living Center), as determined by the Department of Mental Health and Developmental Disabilities and recognized by the Department of Public Aid, the support rate will be computed exactly as described for the SNF/ICF and ICF/DD facilities, except that the referent values for each geographic area (i.e., the 35^th percentile values and the 75^th percentile values for per diem allowable support costs) will be increased to 152.8 % of the referent values applied in the computation of the support rates for SNF/ICF and ICF/DD facilities.

Notes

Ill. Admin. Code tit. 89, § 140.561

Amended at 20 Ill. Reg. 14845, effective October 31, 1996