Section 147.5  Minimum Data Set-Mental Health (MDS-MH) Based Reimbursement System (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.15  Comprehensive Resident Assessment (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.25  Functional Needs and Restorative Care (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.50  Service Needs (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.75  Definitions (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.100  Reconsiderations (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.105  Midnight Census Report

 

a)         The census recorded must reflect the complete activities which took place in the 24 hour period from midnight.  Midnight is defined as the last minute of the last hour of the day.

 

b)         The facility is required to compile a midnight census report daily.  The information to be contained in the report includes:

 

1)         Total licensed capacity.

 

2)         Current number of residents in-house.

 

3)         Names and disposition of residents not present in facility, i.e. therapeutic home visit, home visit, hospital (payable bedhold), hospital (non-payable bedhold), other.

 

(Source:  Amended at 18 Ill. Reg. 4271, effective March 4, 1994)

 

Section 147.125  Nursing Facility Resident Assessment Instrument (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.150  Minimum Data Set (MDS) Based Reimbursement System (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.175  Minimum Data Set (MDS) Integrity (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.200  Minimum Data Set (MDS) On-Site Review Documentation (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.205  Reimbursement for Ventilator Dependent Residents (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.250  Costs Associated with the Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203) (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.300  Payment to Nursing Facilities Serving Persons with Mental Illness

 

a)         Reimbursement rates for nursing facilities (ICF and SNF) for program costs associated with the delivery of psychiatric rehabilitation services to residents with mental illness will remain at the level in effect on January 1, 2001, except as may otherwise be provided by 305 ILCS 5/5-5.4 and 89 Ill. Adm. Code 153.

 

b)         Payment for services provided by nursing facilities for residents who have a primary diagnosis of mental illness will be dependent upon the facility meeting all criteria specified in 77 Ill. Adm. Code 300.4000 through 300.4090.

 

(Source:  Amended at 26 Ill. Reg. 3093, effective February 15, 2002)

 

Section 147.301  Sanctions for Noncompliance

 

Based on a finding of noncompliance by the Department of Public Health on the part of a nursing facility with any requirement for providing services to persons with mental illness pursuant  to 77 Ill. Adm. Code 300.4000 through 300.4090, the Department may take action to terminate or suspend the facility pursuant to 89 Ill. Adm. Code 140.16 and 140.19 or recommend to the Department of Public Health imposition of any of the remedies or penalties available under the Nursing Home Care Act [220 ILCS 45/3-101].

 

(Source:  Added at 26 Ill. Reg. 3093, effective February 15, 2002)

 

Section 147.305   Psychiatric Rehabilitation Service Requirements for Individuals With Mental Illness in Residential Facilities (Repealed)

 

(Source:  Repealed at 26 Ill. Reg. 3093, effective February 15, 2002)

 

Section 147.310  Implementation of a Case Mix System

 

P.A. 98-0104 requires the Department to implement, effective January 1, 2014, an evidence-based payment methodology for the reimbursement of nursing services.  The methodology shall take into consideration the needs of individual residents, as assessed and reported by the most current version of the nursing facility Minimum Data Set (MDS), adopted and in use by the federal government.

 

a)         This Section establishes the method and criteria used to determine the resident reimbursement classification based upon the assessments of residents in nursing facilities.  All formulas, data sources, data sources, and collection periods specific to the base rate, addons, pass through allocations, incentives and adjustments specified in this section shall be published in sufficient detail to make an appropriate estimation of appropriate payment in the Department's rate handbook no later than July 20, 2022, and posted on the Department's website.  Within 24 hours of publishing, the Department shall issue a provider notice to direct them to the website.  Each nursing facility shall be notified in advance of the beginning of each quarter of its nursing component rate and all add-ons and adjustments stated as a per diem except retention, promotion, and quality incentive add-ons, which shall be stated as a quarterly lump sum payment.  The notice shall clearly state the amount attributed to each addon or adjustment and in the case of the variable staffing add-on any adjustment resulting from the application of 147.310(c)(3)(I).  The notice shall also clearly state the percent of Medicaid bed days used to determine eligibility for the Medicaid Access Adjustment.

 

1)         Effective January 1, 2014, resident reimbursement classification shall be established utilizing the 48-group, Resource Utilization Groups IV (RUG-IV) classification scheme and weights as published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). 

 

2)         Effective July 1, 2022, resident reimbursement classification shall be established utilizing the Patient Driven Payment Model (PDPM) nursing component classification methodology and associated weights, as published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), as of March 1, 2022, multiplied by 0.7858 and rounded to the nearest four decimal places.

 

3)         An Illinois specific default group of AA1 is established in subsection (c)(5) of this Section and with an assigned weight equal to the weight assigned to group PA1.

 

b)         The statewide nursing base per diem rate effective on:

 

1)         January 1, 2014 shall be $83.49.

 

2)         July 1, 2014 shall be increased by $1.76, and is $85.25.

 

3)         July 1, 2022 shall be increased by $7.00 to $92.25.

 

c)         Nursing Component Per Diem:

 

1)         For services provided on or after January 1, 2014, the Department shall compute and pay a facility-specific nursing component of the per diem rate as the arithmetic mean of the resident-specific nursing components assigned to Medicaid-enrolled residents on record, as of 30 days prior to the beginning of the rate period, in the Department's Medicaid Management Information System (MMIS), or any successor system, as present in the facility on the last day of the second quarter preceding the rate period.

 

A)        Effective January 1, 2014, and until September 30, 2023, the RUG-IV nursing component per diem for a nursing facility shall be the product of the statewide nursing base per diem rate, the facility average case mix index as identified in subsection (a)(1) to be calculated quarterly, and the regional wage adjustor, and then add the Medicaid access adjustment as defined in subsection (c)(4).

 

B)        Effective July 1, 2022, the PDPM nursing component per diem for a nursing facility shall be the product of the statewide nursing base per diem rate, the facility average case mix index as identified in subsection (a)(2), to be calculated quarterly, and the regional wage adjustor, and then add the Medicaid access adjustment as defined in subsection (c)(4).

 

C)        Transition rates for services provided between July 1, 2022, and October 1, 2023, shall be the greater of the PDPM nursing component per diem, defined in subsection (c)(1)(B) or:

 

i)          for the quarter beginning July 1, 2022, the RUG-IV nursing component per diem, defined in subparagraph (c)(1)(A).

 

ii)         for the quarter beginning October 1, 2022, the sum of the RUG-IV nursing component per diem as defined in (c)(1)(A) multiplied by 0.80 and the PDPM nursing component per diem as defined in (c)(1)(B) multiplied by 0.20.

 

iii)        for the quarter beginning on January 1, 2023, the sum of the RUG-IV nursing component per diem as defined in (c)(1)(A) multiplied by 0.60 and the PDPM nursing component per diem as defined in (c)(1)(B) multiplied by 0.40.

 

iv)        for the quarter beginning on April 1, 2023, the sum of the RUG-IV nursing component per diem as defined in (c)(1)(A) multiplied by 0.40 and the PDPM nursing component per diem as defined in (c)(1)(B) multiplied by 0.60.

 

v)         for the quarter beginning on July 1, 2023, the sum of the RUG-IV nursing component per diem as defined in (c)(1)(A) multiplied by 0.20 and the PDPM nursing component per diem as defined in (c)(1)(B) multiplied by 0.80.

 

D)        For the quarter beginning on October 1, 2023, and each subsequent quarter, nursing facilities shall be paid 100% of the PDPM nursing component per diem as defined in (c)(1)(B).

 

2)         Effective for dates of service on or after July 1, 2014, a per diem add-on to the RUGS methodology will be included as follows:

 

A)        $0.63 for each resident who scores I4200 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.

 

B)        $2.67 for each resident who scores "1" or "2" in any items S1200A through S1200I and also scores in the RUG groups PA1, PA2, BA1 and BA2.

 

3)         Effective for dates of service on or after July 1, 2022, a variable per diem staffing per diem add-on shall be paid to facilities with at least 70% of the staffing indicated by the Centers for Medicare and Medicaid Services' Staff Time and Resource Intensity Verification Study (STRIVE study) (2021), available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/TimeStudy. The add-on will be based on information from the most recent available federal staffing report, currently the Payroll Based Journal (PBJ), adjusted for acuity using the same quarter's MDS. Specifically, that percentage will reflect "Reported total nurse staffing hours per resident per day" divided by "Case-mix total nurse staffing hours per resident per day" from the Provider Information files published on https://data.cms.gov/provider-data and available through the Federal COMPARE website, https://data.cms.gov/provider-data/search?theme=Nursing%20homes%20including%20rehab%20services.

 

A)        Facilities at 70% of the staffing indicated by the STRIVE study shall be paid a per diem of $9, increasing by equivalent steps for each whole percentage point of improvement until the facilities reach a per diem of $14.88.

 

B)        Facilities at 80% of the staffing indicated by the STRIVE study shall be paid a per diem of $14.88, increasing by equivalent steps for each whole percentage point of improvement until the facilities reach a per diem of $23.80.

 

C)        Facilities at 92% of the staffing indicated by the STRIVE study shall be paid a per diem of $23.80, increasing by equivalent steps for each whole percentage point of improvement until the facilities reach a per diem of $29.75.

 

D)        Facilities at 100% of the staffing indicated by the STRIVE study shall be paid a per diem of $29.75, increasing by equivalent steps for each whole percentage point of improvement until the facilities reach a per diem of $35.70.

 

E)        Facilities at 110% of the staffing indicated by the STRIVE study shall be paid a per diem of $35.70, increasing by equivalent steps for each whole percentage point of improvement until the facilities reach a per diem of $38.68.

 

F)         Facilities at or above 125% of the staffing indicated by the STRIVE study shall be paid a per diem of $38.68.

 

G)        For the transition period quarters beginning July 1, 2022, and October 1, 2022, no facility's variable per diem staffing add-on shall be calculated at a rate lower than 85% for the staffing indicated by the STRIVE study.  For the quarter beginning January 1, 2023, all facilities shall begin at their actual staffing indicated for that period.

 

H)        No facility below 70% of the staffing indicated by the STRIVE study shall receive a variable per diem staffing add-on after December 31, 2022.

 

I)         Beginning April 1, 2023, no nursing facility's variable per diem staffing add-on shall be reduced by more than 5 percent in 2 consecutive quarters.

 

J)         When the Centers for Medicare and Medicaid Services waives or modifies PBJ submission rules for any provider due to extenuating circumstances outside the provider's control, the Department shall assign the previous quarter's rate if comparable or substitute data is not available directly from the provider in time for the current quarter's rate determination.

 

K)        If the Department is notified by a facility prior to or within an applicable rate quarter of missing or inaccurate Payroll Based Journal data or an incorrect calculation of staffing, the Department must make a correction as soon as the error is verified.

 

L)        Payment determinations in this Section may be appealed under the terms under Section 140.830(b) and Section 140.830(c).

 

4)         Effective July 1, 2022, and until December 31, 2027, a Medicaid Access Adjustment shall be paid to all facilities with annual Medicaid bed days of at least 70% of all occupied bed days.

 

A)        The adjustment shall be $4 per day and adjusted for the facility average PDPM case mix index for Medicaid, as identified in subsection (a)(2), calculated on a quarterly basis.

 

B)        The qualifying Medicaid percentage shall be calculated quarterly based upon a rolling 12-month period of historical data ending 9 months prior.  For each new quarter beginning July 1, 2022, a facility's percentage of Medicaid bed days shall be paid Medicaid resident days per annum as determined by adding the number of Medicaid, Medicaid MLTSS and MMAI days (inclusive of hospice and provisional days, if applicable) divided by the number of total occupied days found in the most recent 12 months of Long Term Care Provider Assessment Reports for the facility that are available to the Department.

 

C)        If a facility's Medicaid percentage increases by 15% points or more and the facility's most recent Medicaid percentage for a quarter is at least 70%, that facility may be eligible to receive the payments described in this section.  If a facility's Medicaid percentage decreases by 15% points or more and that facility's most recent Medicaid percentage for a quarter is no longer at least 70%, that facility may no longer be eligible to receive the payments described in this section.

 

D)        Payment determinations in this Section may be appealed under the terms under Section 140.830(b) and Section 140.830(c)

 

5)         A resident for whom resident identification information is missing, or inaccurate, or for whom there is no current MDS record for that quarter, shall be assigned to default group AA1.  A resident for whom an MDS assessment does not meet the federal CMS edit requirements as described in the Long Term Care Resident Assessment Instrument (RAI) Users Manual or for whom an MDS assessment has not been submitted within 14 calendar days after the time requirements in Section 147.315 shall be assigned to default group AA1.

 

6)         The assessment used for the purpose of rate calculation shall be identified as an Omnibus Budget Reconciliation Act (OBRA) assessment on the MDS following the guidance in the RAI Manual.

 

7)         The MDS used for the purpose of rate calculation shall be determined by the Assessment Reference Date (ARD) identified on the MDS assessment.

 

8)         Effective January 1, 2020, the regional wage adjustor referenced in subsection (c)(1) cannot be lower than 0.95.

 

9)         Effective July 1, 2020, the regional wage adjustor referenced in subsection (c)(1) cannot be lower than 1.0.

 

10)       Effective July 1, 2022, the regional wage adjustor referenced in subsection (c)(1) cannot be lower than 1.06.

 

d)         The Department shall provide each nursing facility with information that identifies the PDPM group to which each resident has been assigned, and until September 30, 2023 the Department shall continue to provide each RUG-IV group to which each resident has been assigned.

 

e)         Rate determination in this Section may be appealed under the terms under Section 140.830.

 

(Source:  Amended at 46 Ill. Reg. 19682, effective November 28, 2022)

 

Section 147.315  Nursing Facility Resident Assessment Instrument

 

a)         A facility shall conduct and electronically submit a Minimum Data Set (MDS) assessment that conforms with the assessment schedule and guidance defined by Code of Federal Regulations, Title 42, section 483.20, and in the RAI Manual, published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (federal CMS), and subsequent updates when issued by federal CMS. 

 

b)         A facility shall complete the MDS Comprehensive Item Set form that includes all items Section A-Z, for each resident quarterly, regardless of the resident's payment source.  The Comprehensive Item Set refers to the MDS items that are active on a particular assessment type or tracking form.  While a Comprehensive Item Set is required for all assessments including quarterlies, a comprehensive assessment is not required on a quarterly basis.  A comprehensive assessment is defined as both the completion of a Comprehensive Item Set as well as completion of the Care Area Assessment (CAA) process and care planning.  When completing the Comprehensive Item Set for the quarterly MDS, the CAA process is not required.  The federal regulatory requirements at 42 CFR 483.20(d) requires nursing facilities to maintain all resident assessments completed within the previous 15 months in the resident's active clinical record.

 

c)         A facility shall electronically transmit to the federal CMS database the following MDS assessments in the timeframes identified.

 

1)         The Omnibus Budget Reconciliation Act (OBRA) regulations require nursing facilities that are Medicare or Medicaid certified to conduct initial and periodic assessments for all their residents.  The MDS 3.0 is part of that assessment process and is required by federal CMS.  The assessment that will be used for the purpose of rate calculations shall be identified as an OBRA assessment on the MDS following the guidance in the RAI Manual.2)            Admission, Annual, Significant Change in Status, and Significant Correction to Prior Comprehensive Assessments shall be completed and transmitted to the federal CMS database no later than 14 calendar days after the care plan completion date.  The quarterly assessment shall identify the MDS was transmitted to the federal CMS database no later than 14 calendar days after the MDS completion date.

 

3)         An MDS admission assessment and CAAs shall be completed by the 14^th calendar day from the resident's admission date.  This assessment shall include completion of the MDS Comprehensive Item Set as well as completion of the CAA process and care planning.  Care plan completion date is 7 calendar days after the MDS/CAA completion date. Transmission date is within 14 calendar days after the care plan completion date.

 

4)         An annual assessment shall have an assessment reference date (ARD) within 366 calendar days of the ARD identified on the last comprehensive assessment. This assessment shall include completion of the MDS Comprehensive Item Set as well as completion of the CAA process and care planning.  The MDS/CAA completion date is the ARD plus 14 calendar days.  The care plan completion date is MDS/CAA completion date plus 7 calendar days.  Transmission date is care plan date plus 14 calendar days.

 

5)         A significant change assessment shall be completed within 14 calendar days after the identification of a significant change.  This assessment shall include completion of the MDS Comprehensive Item Set as well as completion of the CAA process and care planning.  The MDS/CAA completion date is 14 calendar days after the determination date plus 7 calendar days.  Transmission date is care plan date plus 14 calendar days.

 

6)         All quarterly assessments shall have an ARD within 92 calendar days after the previous OBRA assessment.  This assessment includes the completion of the MDS Comprehensive Item Set, but does not include the completion of the CAA process and care planning.  MDS completion date is ARD plus 14 calendar days.  Transmission date is completion date plus 14 calendar days.

 

7)         The significant correction to a prior comprehensive assessment or significant correction to a prior quarterly assessment shall be completed when the interdisciplinary team determines that a resident's prior assessment contains a significant error that has not been corrected by more recent assessments as required by the RAI Manual.  Nursing facilities shall document the initial identification of a significant error in a prior assessment in the progress notes.

 

d)         A facility shall comply with the following:

 

1)         All staff completing any portion of the MDS shall enter their signatures, titles, section or portions of sections they completed and the date completed.

 

2)         The signature attests that the information entered by them, to the best of their knowledge, most accurately reflects the resident's status during the timeframes identified.

 

3)         Federal regulations require the RN assessment coordinator to sign and thereby certify that the assessment is completed.

 

4)         When the electronic MDS record submitted to the state from the federal CMS database does not match the facility's copy of the MDS, the items on the MDS submitted will be used for purposes of validation.

 

5)         It is the facility's responsibility to create an electronic transmission file that meets the requirements detailed in the current MDS Data Specification Manual.  The facility shall submit MDS assessments under the appropriate authority and timely as defined in the RAI Manual. In addition, the facility is responsible to access the federal CMS database to receive and review validation reports.  Records that are rejected or contain errors must be dealt with 30 days prior to the rate period and appropriately to avoid default rate.

 

(Source:  Old Section 147.315 repealed at 26 Ill. Reg. 3093, effective February 15, 2002; new Section 147.315 added at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.320  Definitions

 

For purposes of this Part, the following terms shall be defined as follows:

 

"Active Disease Diagnosis" means a physician documented diagnosis (or by a nurse practitioner, physician assistance, or clinical nurse specialist if allowable under State licensure laws) that have a direct relationship to the resident's current functional status, cognitive status, mood or behavior, medical treatments, nursing monitoring or risk of death.

 

"Assessment Reference Date" means the last day of the Minimum Data Set (MDS) look-back period.  The date sets the designated endpoint of the look-back period in the MDS process, and all MDS items refer back in time from that point.  This period of time is also called the observation or assessment period.

 

"Case Mix" means a method of classifying care that is based on the intensity of care and services provided to the resident.

 

"Case Mix Index" means the weighting factors assigned to each RUG-IV classifications.

 

"Case Mix Reimbursement System" means a payment system that measures the intensity of care and services required for each resident, and translates these measures into the amount of reimbursement given to the facility for care of a resident.

 

"Continuous Positive Airway Pressure" or "CPAP" means a respiratory support device that prevents the airways from closing by delivering slightly pressurized air through a mask continually or via electronic cycling throughout the breathing cycle.  The mask enables the individual to support his or her own respirations by providing enough pressure when the individual inhales to keep his or her airway open.

 

"Department" means the Illinois Department of Healthcare and Family Services (HFS).

 

"Fraud" means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person.  It includes any act that constitutes fraud under applicable federal or State law.

 

"Index Maximization" means a method to classify a resident who could be assigned to more than one category, to the category with the highest case mix index.

 

"Minimum Data Set" or "MDS" means the assessment instrument specified by the Centers for Medicare and Medicaid Services (federal CMS) and designated by the "Department". A core set of screening, clinical, and functional status elements, including common definitions and coding categories, forms the foundation of a comprehensive assessment.

 

"Monitoring" means the ongoing collection and analysis of information (such as observations and diagnostic test results) and comparison to baseline and current data in order to ascertain the individual's response to treatment and care, including progress or lack of progress towards a goal.  Monitoring can detect any improvements, complications or adverse consequences of the condition or of the treatments, and support decisions about adding, modifying, continuing or discontinuing any interventions.

 

"Nursing Monitoring" means clinical monitoring (e.g., serial blood pressure evaluations, medication management, etc.) by a licensed nurse.

 

"Resource Utilization Group" or "RUG" means the system for grouping a nursing facility's residents according to their clinical and functional status identified in MDS data supplied by a facility.

 

"Significant Error" means an error in an assessment where a resident's overall clinical status in not accurately represented and the error has not been corrected via submission of a more recent assessment.

 

"Ventilator or Respirator" means a type of electronically or pneumatically powered closed system mechanical ventilator support devices that ensures adequate ventilation in the resident who is, or who may become, unable to support his or her respirations.

 

(Source:  Old Section 147.320 repealed at 26 Ill. Reg. 3093, effective February 15, 2002; new Section 147.320 added at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.325  Resident Reimbursement Classifications and Requirements  

 

a)         Resident reimbursement classification shall be based on the Minimum Data Set (MDS), Version 3.0 assessment instrument mandated by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (federal CMS) that nursing facilities are required to complete for all residents.  When later guidance or clarifications are released by federal CMS that contradicts or augments guidance provided in this Section, the more current information becomes the accepted standard and shall become effective as of the date required by federal CMS.  The Department shall establish resident classification according to the 48-group, Version IV or RUG-IV model.  Resident classification shall be established based on the individual items identified on the MDS and shall be completed according to the RAI Manual. 

 

b)         Each resident shall be classified based on the information from the MDS submitted according to the categories as identified in Section 147.330 and as defined in the RAI Manual. 

 

c)         General Documentation Requirements

 

1)         A facility shall maintain resident records on each resident in accordance with acceptable professional standards and practices.

 

2)         Supportive documentation in the clinical record used to validate the MDS item responses shall be dated during the specified look-back period or other timeframe as identified in the RAI Manual.  Records shall be retained for at least three years from the date of discharge.

 

3)         Supportive documentation entries shall be dated and their authors identified by signature or initials.  Signatures are required to authenticate all documentation utilized to support MDS item responses.  At a minimum, the signature shall include the first initial, last name, and title/credentials.  Any time a facility chooses to use initials in any part of the record for authentication of an entry, there shall also be corresponding full identification of the initials on the same form or on a signature legend.  Initials may never be used where a signature is required by law (i.e., on the MDS).  When electronic signatures are used, the facility shall have policies in place to identify those who are authorized to sign electronically and have safeguards in place to prevent unauthorized use of electronic signatures.

 

4)         Each page or individual document in the clinical record shall contain the resident's identification information.

 

5)         A multi-page supportive documentation form completed by one staff member may be signed and dated at the end of the form, provided that each page is identified with the resident's identification information and the dates are clearly indentified on the form.

 

6)         Corrections/Obliterations/Errors/Mistaken Entries.  At a minimum, there shall be one line through the incorrect information, the staff's initial, the date of correction was made, and the corrected information.  Information that is deemed illegible by Department reviews will not be considered for validation purposes.

 

7)         An error correction in the electronic record applies the same principles as for the paper clinical record.  Some indication that a previous version of the entry exists shall be evident to the caregiver or other person viewing the entry.

 

8)         Late entries shall be clearly labeled as a late entry and contain the current date, time and authorized signature.  Amendments are a form of late entry.  Amendments shall be clearly labeled as an addendum or amendment and include the current date, time and authorized signature.

 

9)         Facilities shall have a written policy and procedures that states who is authorized to make amendments, late entries, and correct errors in the electronic health records (EHRs) and clearly dictate how these changes to the EHR are made.

 

10)        Resident records shall be complete, accurately documented, readily accessible to Department staff, and systematically organized.  At a minimum, the record shall contain sufficient information to identify the resident, a record of the resident's assessments, care plan, record of services provided, and progress notes.

 

11)        Documentation from all disciplines and all portions of the resident's clinical record may be used to validate an MDS item response.  All supporting documentation shall be produced by a facility during an onsite visit.

 

12)        Documentation shall support all conditions or treatments were present or occurred within the look-back period ending on, and including the ARD period.   The look-back period shall include observations and events through the end of the day (midnight) of the ARD.  Documentation shall apply to the appropriate look-back period and reflect the resident's status on all shifts.

 

13)        Documentation in the clinical record shall consistently support the item response and reflect care related to the symptom or problem.  Documentation shall reflect the resident's status on all shifts.

 

14)         Problems that are identified by the MDS item responses that affect the resident's status shall be addressed on the care plan when deemed appropriate by the interdisciplinary team (IDT) as identified in the RAI Manual.

 

15)        Insufficient or inaccurate documentation may result in a determination that the MDS item submitted was not validated.

 

16)        Documentation shall support that the services delivered were medically necessary.

 

17)        Documentation shall support an individualized care plan was developed based on the MDS and other assessments and addressed the resident's strengths and needs.  In addition, documentation, observation and/or interview shall support services were delivered as identified by the care plan.

 

18)        Clinical documentation that contributes to identification and communication of a resident's problems, needs and strengths that monitors his or her condition on an ongoing basis and that records treatments and response to treatment is a matter of clinical practice and is an expectation of trained and licensed health care professional.

 

19)         When there is a significant change in status assessment done, documentation shall include the identification of the significant change in status in the clinical record.

 

d)         Disease Diagnosis Requirements

 

1)         The disease condition shall require a physician-documented diagnosis in the clinical record during the 60 days prior to and including the ARD.

 

2)         The diagnosis shall be determined to be active as defined in the RAI Manual during the 7-day look-back period.  Conditions that have been resolved or no longer affect the resident's current functioning or care plan during the 7-day look-back period shall not be included.

 

3)         Documentation shall support that the active diagnoses have a direct relationship to the resident's current functional status, cognitive status, mood or behavior, medical treatments, nursing monitoring, or risk of death during the look-back period.

 

4)         There shall be specific documentation in the record by a physician stating the disease is active. Including a disease/diagnosis on the resident's clinical record problem list is not sufficient for determining active or inactive status.  In the absence of specific documentation that a disease is active, the following indicators may be used to confirm active disease.

 

A)        Recent onset or acute exacerbation of the disease or condition indicated by a positive study, test or procedure, hospitalization for acute symptoms and/or recent change in therapy during the 7-day look-back period.

 

B)        Symptoms and abnormal signs indicating ongoing or decompensating disease in the last 7-day look-back period.

 

C)        Ongoing therapy with medication or other interventions to mange a condition that requires monitoring for therapeutic efficacy or to monitor potentially severe side effects in the 7-day look-back period.  A medication indicates active disease if that medication is prescribed to manage an ongoing condition that requires monitoring or is prescribed to decrease active symptoms associated with a condition.

 

D)        When documentation of conditions that are generally short term in nature (i.e., fever, septicemia, pneumonia, etc.) are noted over a long period of time by the facility staff, the physician may be interviewed to determine accuracy of the diagnosis.  In addition, when questions regarding the validity of the diagnosis are found during review of the documentation the physician may be interviewed.

 

(Source:  Old Section 147.325 repealed at 26 Ill. Reg. 3093, effective February 15, 2002; new Section 147.325 added at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.330  Resource Utilization Groups (RUGs) Case Mix Requirements

 

a)         Activities of Daily Living (ADL)

 

1)         Documentation shall support the ADL coded level as defined in the Resident Assessment Instrument (RAI) Manual.

 

2)         Documentation of ADLs shall support the RAI requirement was met for coding Self Performance and Support during the look-back period.  It is the responsibility of the person completing the assessment to consider all episodes of the activity that occurred over a 24-hour period during each day of the 7-day look-back period. There shall be signatures/initials of staff providing the ADL assistance and dates to authenticate the services were provided as coded during the look-back period. If using an ADL grid for supporting documentation, the key for self-performance and support provided shall be equivalent to definitions to the MDS key. 

 

3)         The ADL scores for residents lacking documentation shall be reset to zero.

 

b)         Extensive Services. Documentation shall support that the following requirements were met during the look-back period based on the MDS items identified.

 

1)         Documentation shall support tracheostomy care was completed during the look-back period while a resident in the facility.

 

2)         Documentation shall support the use of a ventilator or respirator during the look-back period while a resident in the facility.  Documentation shall support the device was an electrically or pneumatically powered closed-system mechanical ventilator support device that ensures adequate ventilation in the resident who is, or who may become, unable to support his or her own respiration.  This does not include BiPAP or CPAP devices or a ventilator or respirator that is used only as a substitute for BiPAP or CPAP.

 

3)         Documentation supports the need for and use of isolation during the look-back period while a resident is in the facility.

 

4)         Documentation shall support the following conditions for "strict isolation" were met during the look-back period:

 

A)        The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission;

 

B)        Precautions are over and above standard precautions.  That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect; and

 

C)        The resident is in a room alone because of active infection and cannot have a roommate even if the roommate has a similar active infection that requires isolation.  The resident must remain in his/her room.  This requires that all services be brought to the resident (e.g., rehabilitation, activities, dining, etc.).

 

5)         Treatment and/or procedures the resident received shall be care planned and reevaluated to ensure continued appropriateness.

 

6)         Extensive services are defined as indicated in the following chart.

 

Category (Description)	ADL Score	End Splits or Special Requirements	IL RUG-IV GROUP
Extensive Services − At least one of the following: Tracheostomy Care while a resident (O0100E2) Ventilator or Respirator while a resident (O0100F2) Infection Isolation while a resident O0100M2)	≥ 2     ≥ 2     ≥ 2	Tracheostomy care and Ventilator/Respirator Tracheostomy care OR Ventilator/Respirator   Infection Isolation: ·         Without trach ·         Without Ventilator /Respirator	ES3   ES2     ES1

 

c)         Rehabilitation.  Documentation shall support the following requirements were met during the look-back period based on the MDS items identified.

 

1)         All RAI Manual requirements and definitions shall be met, including the qualifications for therapists.

 

2)         Documentation shall support medically necessary therapies that occurred after admission or readmission to the facility that were:

 

A)        Ordered by a physician based on a qualified therapist's (i.e., one who meets Medicare requirements) assessment and treatment plan;

 

B)        Documented as delivered in the clinical record; and

 

C)        Care planned and periodically evaluated to ensure the resident receives needed therapies and the current treatment plans are effective.  Any service provided at the request of the resident or family that is not medically necessary shall not be included, even when performed by a therapist or a therapy assistant.  It does not include the services performed when a facility elects to have licensed professionals perform repetitive exercises and other maintenance treatments or to supervise aides performing these maintenance services that are considered restorative care.

 

3)         Documentation shall support the therapies were provided while the individual was living and being cared for at the long-term care facility.  It does not include therapies that occurred while the person was an inpatient at a hospital or recuperative or rehabilitation center or other long-term care facility, or recipient of home care or community based services.

 

4)         Documentation shall support the services were directly and specifically related to an active written treatment plan that is approved by the physician after any needed consultation with a qualified therapist and is based on an initial evaluation performed by a qualified therapist prior to the start of these services in the facility.

 

5)         Documentation shall support the services were a level of complexity and sophistication, or the condition of the resident shall be of a nature that requires the judgment, knowledge, and skills of a therapist.

 

6)         Documentation shall support the services were provided with expectation, based on the assessment of the resident's restoration potential made by the physician, that the condition of the patient will improve materially in a reasonable and generally predictable period of time, or the services shall be necessary for the establishment of a safe and effective maintenance program.

 

7)         Documentation shall support the services are considered under accepted standards of medical practice to be specific and effective treatment for the resident's condition.

 

8)         Documentation shall support that services are medically necessary for the treatment of the resident's condition.  This includes the requirement that the amount, frequency, and duration of the services shall be reasonable and they must be furnished by qualified personnel.

 

9)         Documentation shall include the actual minutes of therapy.  Minutes shall not be rounded to the nearest 5^th minute and conversion of units to minutes or minutes to units is not acceptable.

 

10)        Documentation shall identify the different modes of therapy (i.e., individual, concurrent, group) and the documentation shall support the criteria for the mode identified is met.

 

11)        Documentation shall support that the restorative program include nursing interventions that promote the residents ability to adapt and adjust to living as independently and safely as possible.  The program actively focuses on achieving and maintaining optimal physical, mental, and psychosocial functioning.

 

12)        Documentation shall include the following components for a restorative program is met:

 

A)        There are measurable objectives/interventions established for the performance of the activity;

 

B)        A licensed nurse shall evaluate and document the results of the evaluation related to the program on a quarterly basis. 

 

C)        Documentation includes the actual number of minutes the activity were performed and supports at least 15 minutes in a 24-hour period for a minimum of 6 days; and

 

D)        Individuals who implement the program shall be trained in the interventions and supervised by a nurse.

 

13)        Documentation shall support the requirements identified for coding ADL were met.

 

14)       Rehabilitation is defined as indicated in the following chart.

Category (Description)	ADL Score	End Splits or Special Requirements	IL Rug-IV Group
At least 5 distinct calendar days (15 min per day minimum) in any combination of Speech, Occupational or Physical Therapy in the last 7 days.  (O0400A4, O0400B4, O0400C4) AND 150 minutes or greater of any combination of Speech, Occupational or Physical Therapy in the last 7 days (O0400A1, O0400A2, O0400A3, O0400B1, O0400B2, O0400B3, O0400C1, O0400C2, O0400C3) OR At least 3 distinct calendar days (15 min per day minimum) in any combination of Speech, Occupational, or Physical Therapy in the last 7 days (O0400A4, O0400B4, O0400C4) AND 45 minutes or greater in any combination of Speech, Occupational or Physical Therapy in the last 7 days (O0400A1, O0400A2, O0400A3, O0400B1, O0400B2, O0400B3, O0400C1, O0400C2, O0400C3) AND at least 2 nursing rehabilitation services.   See description of Restorative in subsection (h)	15-16   11-14   6-10   2-5   0-1	None   None   None   None   None	RAE   RAD   RAC   RAB   RAA

 

d)         Special Care High-Documentation shall support the following requirements were met during the look-back period based on the MDS items identified.

 

1)         Documentation shall support the requirements and criteria for coding an active disease diagnosis were met.

 

2)         Documentation shall support the ADL scores met the requirements and criteria for coding.

 

3)         Documentation shall include the date completed and the staff member completing the Mood interview when indicated.  Documentation shall demonstrate the presence and frequency of clinical mood indicators when staff assessment of mood is utilized.  This shall include date observed, a brief description of the symptoms, staff observing, and any interventions.

 

4)         Documentation shall support a diagnosis of coma or persistent vegetative state.

 

5)         Documentation shall support an active diagnosis of Septicemia. Interventions and/or treatments for the diagnosis shall be documented upon delivery.

 

6)         Documentation shall support an active diagnosis of diabetes, and shall support insulin injections were given the entire 7 days of the look-back period and there were orders for insulin changes on 2 or more days during the look-back period.

 

7)         Documentation shall support the active diagnosis of Quadriplegia.

 

8)         Documentation shall support the active diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and/or asthma with shortness of breath while lying flat.  Interventions and/or treatments for the condition shall be documented upon delivery.

 

9)         Documentation to support fever shall include a recorded temperature of at least 2.4 degrees higher than the previous recorded baseline temperature and documentation shall support one of the following: pneumonia, vomiting, weight loss, and/or feeding tube with at least 51% of total calories or if 26-50% of the calories there is also fluid intake of 501cc or more per day.  Interventions and/or treatments for the condition shall be documented upon delivery.

 

10)        Documentation shall support the intervention of parenteral or IV feedings. Documentation shall support the intervention was administered for nutrition or hydration purposes.

 

11)        Documentation of respiratory therapy shall include the following:

 

A)        Physician orders that include a statement of frequency, duration, and scope of treatment;

 

B)        The actual minutes the therapy was provided while a resident is in the facility;

 

C)        Evidence that the services are provided by a qualified professional; and

 

D)        Evidence that the services are directly and specifically related to an active written treatment plan that is based on an initial evaluation performed by qualified personnel. 

 

12)        Special Care High is defined as indicated in the following chart.

 

Category (Description)	ADL Score	End Splits or Special Requirements	IL RUG-IV Group
Special Care High (ADL Score of ≥ 2 or more and at least one of the following: Comatose (B0100) and completely ADL dependent or ADL did not occur (G0110A1, G0110B1, G0110H1, G0110I1 all =  4 or 8) Septicemia (I2100) Diabetes (I2900) with both of the following: •   Insulin injections for all 7 days (N0350A = 7)   •  Insulin order changes on 2 or more days (N0350B ≥ 2) Quadriplegia (I5100) with ADL score ≥ 5(ADLs as above) Asthma or COPD (I6200) AND shortness of breath while lying flat (J1100C) Fever (J1550A) and one of the following: •  Pneumonia (I2000) •  Vomiting (J1550B) •  Weight Loss (K0300 = 1 or 2) •  Feeding Tube (K0510B1 or K0510B2) with at least 51% of total calories (K0710A3 = 3) OR 26% to 50% through parenteral/enteral intake (K0710A3 = 2) and fluid intake is 501cc or more per day (K0710B3 = 2) Parenteral/IV Feeding (K0510A1 or K0510A2) Respiratory Therapy for all 7 days (O0400D2 = 7) If a resident qualifies for Special Care High but the ADL score is a 1 or less, then the resident classifies as Clinically Complex	15-16   15-16   11-14   11-14   6-10   6-10   2-5   2-5	Depression   No Depression   Depression   No Depression   Depression   No Depression   Depression   No Depression   (Note:  See description of depression indicators in subsection (k))	HE2   HE1   HD2   HD1   HC2   HC1   HB2   HB1

 

e)         Special Care Low – Documentation shall support the following requirements were met during the look-back period based on the MDS items identified.

 

1)         Documentation shall support the requirements and criteria for coding disease diagnosis were met.  This includes an active diagnosis of Cerebral Palsy, Multiple Sclerosis, or Parkinson's.

 

2)         Documentation shall support an active diagnosis of respiratory failure and the administration of oxygen therapy while a resident.  Documentation shall include the date and method of delivery.  Documentation shall support a need for the use of oxygen.

 

3)         Documentation shall support the requirements and criteria for coding ADLs were met.

 

4)         Documentation shall include the date, and staff completing the Mood interview.  Documentation shall demonstrate the presence and frequency of clinical mood indicators when staff assessment of mood is utilized.  This shall include date observed, a brief description of the symptom, any interventions implemented and identification of staff observing.

 

5)         Documentation shall support the presence of a feeding tube and the proportion of calories received through the tube feeding.

 

6)         Documentation shall support the presence of 2 or more Stage 2 pressure ulcers or any Stage 3 or 4 pressure ulcer as defined in the RAI Manual.  Documentation shall include observation date, location, and measurement and description of the ulcer.  Other factors related to the ulcer shall be noted including: condition of the tissue surrounding the area (color, temperature, etc.), exudates and drainage present, fever, presence of pain, absence or diminished pulses, and origin of the wound (such as pressure, injury or contributing factors) if known.  Interventions and/or treatments for the ulcer shall be documented as delivered.

 

7)         Documentation shall support the presence of 2 or more venous or arterial ulcers as defined in the RAI Manual.  Documentation shall include observation date, location, and measurement and description of the ulcer.  Interventions and/or treatment for the ulcer shall be documented as delivered.

 

8)         Documentation shall support the presence of a Stage 2 pressure ulcer and a venous or arterial ulcer.  Documentation shall include observation date, location, and measurement and description of the ulcer. Interventions and/or treatments for the ulcer shall be documented as delivered.

 

9)         Documentation shall support 2 or more of the following interventions when ulcers are noted:  pressure relieving devices, turning and repositioning, nutrition and/or hydration, ulcer care, application of dressing and/or application of ointments.  Documentation shall support the interventions identified were implemented during the look-back period.

 

10)         Documentation and/or observation shall support the use of pressure relieving devices for the resident.  This does not include egg crate cushions, doughnuts or rings.

 

11)         Documentation for a turning and repositioning program shall include specific approaches for changing the resident's position and realigning the body and the frequency it is to be implemented.  Documentation shall support the program was implemented and is monitored and reassessed to determine the effectiveness of the intervention.

 

12)         Documentation shall support the nutrition and/or hydration interventions were delivered.  These shall be based on an individual assessment of the resident's nutritional deficiencies and needs.  Vitamins and mineral supplements shall only be coded on the MDS when noted through a thorough nutritional assessment.

 

13)         Documentation for ulcer care shall support the care was delivered. Documentation shall include the date delivered, type of care delivered, and identification of the staff delivering the care.

 

14)         Documentation shall support the application of non-surgical dressing and shall include date applied and identification of the staff delivering the care. This does not include application of a band-aid.

 

15)         Documentation shall support the application of ointments or medications were actually applied to somewhere other than the feet.  This includes only ointments or medications used to treat and/or prevent skin conditions. Documentation shall include name and description of the ointment used, date applied, and identification of the staff delivering the care.

 

16)         Documentation of infections of the foot and/or presence of diabetic foot ulcers or open lesions to the foot shall include a description of the area.

 

17)         Documentation shall support interventions and/or treatments for the problems noted were implemented.  Documentation shall define the intervention and treatment, the date delivered and the identification of the staff delivering the care.

 

18)         Documentation shall support the application of dressing to the feet was actually delivered.  Documentation shall include the date applied and identification of the staff delivering the care.

 

19)         Documentation shall support the reason for and the administration of radiation while a resident.  Documentation shall include the date of administration and identification of the staff delivering the care.

 

20)         Documentation shall support dialysis was administered while a resident. Documentation shall include type of dialysis, date delivered, and identification of the staff delivering the care.

 

21)         Special Care Low is defined as indicated in the following chart.

 

Category (Description)	ADL Score	End Splits or Special Requirements	IL RUG- IV Group
Special Care Low-ADL score of 2 or more and at least one of the following: Cerebral Palsy (I4400) with ADL score ≥ 5 Multiple Sclerosis (I5200) with ADL score ≥ 5 Parkinson's disease (I5300) with ADL score ≥ 5 Respiratory Failure (I6300) and oxygen therapy while a resident (O0100C2) Feeding Tube (K0510B1 or K0510B2) with at least 51% of total calories (K0710A3 = 3) OR 26% to 50% through parenteral/enteral intake (K0710A3 = 2) and fluid intake is 501cc or more per day (K0710B3 = 2) 2 or more Stage 2 pressure ulcers (M0300B1) with 2 or more skin treatments •    Pressure relieving device for chair (M1200A) and/or bed (M1200B) •    Turning/Repositioning (M1200C) •    Nutrition or hydration intervention (M1200D) •    Ulcer care (M1200E) •    Application of dressing (M1200G) •    Application of ointments (M1200H) Any Stage 3 or 4 pressure ulcer (M0300C1, D1, F1) with 2 or more skin treatments-See above list 2 or more venous/arterial ulcers (M1030) with 2 or more skin treatments-See above list One Stage 2 pressure ulcer (M0300B1) and one venous/arterial ulcer (M1030) with 2 or more skin treatments-See above list Foot infection (M1040A), Diabetic foot ulcer (M1040B) or other open lesion of foot (M1040C) with application of dressing to feet (M1200I) Radiation treatment while a resident (O0100B2) Dialysis treatment while a resident (O0100J2)   If a resident qualifies for Special Care Low but the ADL score is 1 or less-then the resident classifies as Clinically Complex	15-16   15-16   11-14   11-14   6-10   6-10   2-5   2-5	Depression   No Depression   Depression   No Depression   Depression   No Depression   Depression   No Depression     Note: See description of depression indicators	LE2   LE1   LD2   LD1   LC2   LC1   LB2   LB1

 

f)         Clinically Complex – Documentation shall support the following requirements were met during the look-back period based on the MDS items identified.

 

1)         Documentation shall support the requirements and criteria for coding disease diagnosis were met.  This shall include documentation of an active diagnosis of pneumonia that includes current symptoms and any interventions.

 

2)         Documentation shall also support an active diagnosis of hemiplegia or hemiparesis.

 

3)         Documentation shall support the requirements and criteria for coding ADLs were met.

 

4)         Documentation shall include the date completed, and staff completing the Mood interview when indicated. Documentation shall demonstrate the presence and frequency of clinical mood indicators when staff assessment of mood is utilized.  This shall include date observed, brief description of the symptom, any interventions, and identification of staff observing.

 

5)         Documentation shall support the presence of open lesions other than ulcers.  The documentation shall include, but is not limited to, an entry noting the observation date, location, measurement and description of the lesion and any interventions.  Documentation of interventions shall include at least one of the following: surgical wound care, application of non-surgical dressing to an area other than the feet and/or application of ointments to an area other than the feet.  Documentation shall include all the types of interventions, dates delivered, and the staff delivering the interventions.

 

6)         Documentation shall support the presence of a surgical wound.  The documentation shall include an entry noting the observation date, origin of the wound, location, measurement and description, and any interventions.  Documentation of interventions shall include at least one of the following: surgical wound care, application of non-surgical dressing to an area other than the feet and/or application of ointments to an area other than the feet.  Documentation shall include the type of intervention, dates delivered, and the staff delivering the interventions.

 

7)         Documentation shall support the presence of a burn.  Documentation shall include an entry noting the observation date, location, measurement and description, and any interventions.

 

8)         Documentation shall support the administration of a chemotherapy agent while a resident in the facility.  Documentation shall include the name of the agent, date delivered and the staff delivering.

 

9)         Documentation shall support the administration of oxygen while a resident in the facility.  This shall include the date and method of delivery. Additionally, documentation shall support a need for the use of oxygen.

 

10)        Documentation shall support the administration of an IV medication while a resident in the facility.  The documentation shall include the name of the medication, date delivered, method of delivery, and identification of staff delivering.

 

11)        Documentation shall support the resident received a transfusion while a resident was at the facility.  Documentation shall include the date received, reason and identification of staff delivering the care.

 

12)        Clinically Complex is defined as indicated in the following chart.

 

Category (Description)	ADL Score	End Splits or Special Requirements	IL RUG -IV Group
Clinically Complex-At least one of the following: Pneumonia (I2000) Hemiplegia/hemiparesis (I4900) with ADL score ≥ 5 Surgical wounds (M1040E) or open lesion (M1040D) with any of the following selected skin treatments: •   Surgical wound care (M1200F) •   Application of non-surgical dressing (M1200G) not to feet •   Application of ointment (M1200H) not to feet Burns (M1040F) Chemotherapy while a resident (O0100A2) Oxygen therapy while a resident (O0100C2) IV Medication while a resident (O0100H2) Transfusions while a resident (O0100I2)   If a resident qualifies for Special Care High or Special Care Low, but the ADL score of 1 or 0, then the resident classifies in Clinically Complex CA1 or CA2	15-16   15-16   11-14   11-14   6-10   6-10   2-5   2-5   0-1   0-1	Depression   No Depression   Depression   No Depression   Depression   No Depression   Depression   No Depression   Depression   No Depression	CE2   CE1   CD2   CD1   CC2   CC1   CB2   CB1   CA2   CA1

 

g)         Behavioral Symptoms and Cognitive Performance – Documentation shall support the following requirements were met during the look-back period based on the MDS items identified.

 

1)         Documentation shall include the date completed, and staff completing the Mood interview.  Documentation shall demonstrate the presence and frequency of clinical mood indicators when staff assessment of mood is utilized. This shall include date observed, brief description of the symptom, any interventions and identification of staff observing.

 

2)         Documentation shall include the date and staff completing the Brief Interview for Mental Status (BIMS).

 

3)         Documentation shall support the occurrence of a hallucination and/or delusion that include the date observed, description, and name of staff observing.

 

4)         Documentation shall include the date observed, staff observing, frequency, and description of resident's specific physical, verbal or other behavioral symptom. Documentation shall include any interventions and the resident's response.

 

5)         Documentation shall include the date observed, staff observing, frequency and description of the behavior of rejection of care.  Rejection of care shall meet all of the coding requirements.  Residents, who have made an informed choice about not wanting a particular treatment, procedure, etc., shall not be identified as "rejecting care".  Documentation shall include any interventions and the resident's response.

 

6)         Documentation shall include the date observed, staff observing, frequency and description of any wandering behavior.  Documentation shall support a determination for the need for environmental modifications (door alarms, door barriers, etc.) that enhance resident safety and the resident's response to any interventions.  Care plans shall address the impact of wandering on resident safety and disruption to others and shall focus on minimizing these issues.

 

7)         Documentation shall identify how the coded behavior affected the resident, staff and/or others.  Care plan interventions shall address the safety of the resident and others and be aimed at reducing distressing symptoms.

 

8)         Documentation supports presence of a restorative program.  This shall include, but is not limited to, the following:  Documentation of the actual number of minutes the program was provided that equals 15 minutes, in a 24-hour period, a restorative care plan that contains measurable objectives, and goals that are specific, realistic and measurable.  In addition, documentation shall support the programs are delivered 6-7 days a week, supervised by a licensed nurse, a quarterly evaluation is completed by a licensed nurse, and staff are trained in skilled techniques to promote the resident's involvement in the activity.

 

9)         Behavioral Symptoms and Cognitive Performance is defined as indicated in the following chart.

 

Category (Description)	ADL Score	End Splits or Special Requirements	IL RUG- IV GROUP
Behavioral Symptoms and Cognitive Performance BIMS score of 9 or less AND an ADL score of 5 or less OR Defined as Impaired Cognition by Cognitive Performance Scale AND an ADL score of 5 or less Hallucinations (E0100A) Delusions (E0100B) Physical Behavioral symptom directed toward others (E0200A = 2 or 3) Verbal behavioral symptom directed towards others (E0200B = 2 or 3) Other behavioral symptom not directed towards others (E0200C = 2 or 3) Rejection of care (E08002 or 3) Wandering (E0900 = 2 or 3)	2-5   2-5   0-1   0-1	2 or more Restorative Nursing Programs 0-1 Restorative Nursing Programs   2 or more Restorative Nursing Programs 0-1 Restorative Nursing Programs	BB2   BB1   BA2   BA1

 

h)         Reduced Physical Function

 

1)         Documentation shall support the ADL coded level.

 

2)         Documentation shall support presence of a restorative program.  This shall include, but is not limited to, documentation of the actual number of minutes the program was provided that equals 15 minutes, in a 24-hour period, 6-7 days a week, a restorative care plan that contains measureable objectives, and goals that are specific, realistic and measurable, documentation that supports the programs are supervised by a licensed nurse, a quarterly evaluation is completed by a licensed nurse and staff are trained in skilled techniques to promote the resident's involvement in the activity.

 

3)         Reduced Physical Function is defined as indicated in the following chart.

 

Category (Description)	ADL Score	End Splits or Special Requirements	IL RUG- IV Group
Reduced Physical Function List of Restorative Programs Passive (O0500A = 6 or 7) or Active (O0500B = 6 or 7) ROM Splint or brace assistance (O0500C = 6 or 7) Bed Mobility (O0500D = 6 or 7) and/or walking training (O0500F = 6 or 7) Transfer training (O0500E = 6 or 7) Dressing and/or grooming training (O0500G = 6 or 7) Eating and/or swallowing training (O0500H = 6 or 7) Amputation/prostheses care (O0500I = 6 or 7) Communication training (O0500J = 6 or 7) Urinary (H0200C) and/or bowel training (H0500)   No Clinical Conditions   These programs count as one service even if both are provided	15-16   15-16   11-14   11-14   6-10   6-10   2-5   2-5   0-1   0-1	2 or more Restorative   0-1  Restorative   2 or more Restorative   0-1  Restorative   2 or more Restorative   0-1  Restorative   2 or more Restorative   0-1  Restorative   2 or more Restorative   0-1 Restorative	PE2   PE1   PD2   PD1   PC2   PC1   PB2   PB1   PA2   PA1

 

i)          Illinois Specific Classification – This is assigned to a resident for whom RUGs resident identification information is missing or inaccurate, or for whom there is no current MDS record for that quarter.  In addition, a resident for whom an assessment is necessary to determine group classification is incomplete or has not been submitted within 14 calendar days of the time requirements in Section 147.315 shall be assigned the default group.

 

An assessment that is missing and/or submitted more than 14 days late from the due date

N/A

AA1

 

j)          Additional Scoring Indicators

 

ADL	Self-Performance	Support	ADL Score
Bed Mobility (G0110A) Transfer (G0110B) Toilet Use (G0110I)	Coded  -, 0, 1, 7, or 8   Coded 2   Coded 3   Coded 4   Coded 3 or 4	Any Number   Any Number   -,0, 1, or 2   -,0,1 , or 2   3	0   1   2   3   4
Eating (G0110H)	Coded -, 0, 1, 2, 7 or 8   Coded -, 0, 1, 2, 7 or 8   Coded 3 or 4   Coded 3   Coded 4	-, 0, 1 or 8   2 or 3   -, 0 or 1   2 or 3   2 or 3	0   2   2   3   4

 

k)         Depression – Additional Scoring Indicator − The depression end split is determined by either the total severity score from the resident interview in Section D0200 (PHQ-9) or from the total severity score from the caregiver assessment of Mood D0500 (PHQ9-OV).

 

Resident	Staff	Description
D0200A	D0500A	Little interest or pleasure in doing things
D0200B	D0500B	Feeling down, depressed or hopeless
D0200C	D0500C	Trouble falling or staying asleep, sleeping too much
D0200D	D0500D	Feeling tired or having little energy
D0200E	D0500E	Poor appetite or overeating
D0200F	D0500F	Feeling bad or failure or let self or others down
D0200G	D0500G	Trouble concentrating on things
D0200H	D0500H	Moving or speaking slowly or being fidgety or restless
D0200I	D0500I	Thoughts of better off dead or hurting self
	D0500J	Short tempered, easily annoyed
Residents that were interviewed D0300 (Total Severity Score) ≥ 10 but not 99
Staff Assessment-Interview not conducted D0600 (Total Severity Score ) ≥ 10

 

l)          Restorative Nursing – Additional Scoring Indicators

Activities that are individualized to the resident's needs, planned, monitored, evaluated, and documented in the resident's clinical record.  These are nursing interventions that promote the resident's ability to adapt and adjust to living as independently and safely as possible.  The concept actively focuses on achieving and maintaining optimal physical, mental, and psychosocial functioning.  The program shall be performed for a total of at least 15 minutes during a 24 hour-period.  Measurable objective and interventions shall be documented in the care plan. There shall be evidence of periodic evaluation by the licensed nurse.  A registered nurse or licensed practical nurse shall supervise the activities.  This does not include groups with more than 4 residents per supervising staff.

 

 

m)        Cognitive Impairment – Additional Scoring Indicators

Cognitive impairment is determined by either the summary score from the resident interview in Section C0200-C0400 (BIMS) or from the calculation of Cognitive Performance Scale if the BIMS is not conducted.

 

Brief Interview for Mental Status (BIMS)

BIMS summary score (C0500 ≥ 9)

 

n)         Cognitive Performance Scale – Additional Scoring Indicators

 

 

(Source:  Old Section 147.330 repealed at 26 Ill. Reg. 3093, effective February 15, 2002; new Section 147.330 added at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.335  Enhanced Care Rates

 

An additional enhanced rate is applied for certain categories of residents that are in need of more resources.

 

a)         Ventilator Services – The following criteria shall be met to be eligible for enhanced rates.

 

1)         Ventilators are defined as any type of electrical or pneumatically powered closed mechanical system for residents who are, or who may become, unable to support their own respiration.  It does not include Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP) devices. When ventilators are used to deliver CPAP or BiPAP they shall not be counted as ventilator services for enhanced rates.

 

2)         Ventilators set to PEEP or CPAP to aid in weaning a resident from the ventilator are included.  The weaning process shall be documented in the clinical record.  Ventilators used to deliver CPAP or BiPAP services for the resident with Sleep Apnea are not included.

 

3)         Nursing facility shall notify the Department using a Department designated form that includes a physician order sheet that identifies the need and delivery of ventilator services. A facility shall also use the designated form to notify the Department when a resident is no longer receiving ventilator services. In addition, a Section S item response of the MDS may be used.

 

4)         The following criteria shall be met in order for a facility to qualify for ventilator care reimbursement.

 

A)        A facility shall establish admission criteria to ensure the medical stability of patients prior to transfer from an acute care setting.

 

B)        Facilities shall be equipped with technology that enables it to meet the respiratory therapy, mobility and comfort needs of its patients.

 

C)        Clinical assessment of oxygenation and ventilation-arterial blood gases or other methods of monitoring carbon dioxide and oxygenation shall be available on-site for the management of residents.  Documentation shall support clinical monitoring of oxygenation stability was completed at least twice a day.

 

D)        Emergency and life support equipment, including mechanical ventilators, shall be connected to electrical outlets with back-up generator power in the event of a power failure.

 

E)        Ventilators shall be equipped with internal batteries to provide a short term back-up system in case of a total loss of power.

 

F)         An audible, redundant ventilator alarm system shall be required to alert staff of a ventilator malfunction, failure or resident disconnect.  A back-up ventilator shall be available at all times.

 

G)        Facilities licensed under the Nursing Home Care Act [210 ILCS 45] shall have a minimum of one RN on duty for 8 consecutive hours, 7 days per week, as required by 77 Ill. Adm. Code 300.1240. For facilities licensed under the Hospital Licensing Act, an RN shall be on duty at all times, as required by 77 Ill. Adm. Code 250.910.  Additional RN staff may be determined necessary by the Department, based on the Department's review of the ventilator services.

 

H)        Licensed nursing staff shall be on duty in sufficient numbers to meet the needs of residents as required by 77 Ill. Adm. Code 300.1230.  For facilities licensed under the Nursing Home Care Act, the Department requires that an RN shall be on call, if not on duty, at all times.

 

I)         No less than one licensed respiratory care practitioner licensed in Illinois shall be available at the facility or on call 24-hours a day to provide care, monitor life support systems, administer medical gases and aerosol medications, and perform diagnostic testing as determined by the needs and number of the residents being served by a facility.  The practitioner shall evaluate and document the respiratory status of a ventilator resident on no less than a weekly basis.

 

J)         A pulmonologist, or physician experienced in the management of ventilator care, shall direct the care plan for ventilator residents on no less than a twice per week basis.

 

K)        At least one of the full-time licensed nursing staff members shall have successfully completed a course in the care of ventilator dependent individuals and the use of the ventilators, conducted and documented by a licensed respiratory care practitioner or a qualified registered nurse who has at least one-year experience in the care of ventilator dependent individuals.

 

L)        All staff caring for ventilator dependent residents shall have documented in-service training in ventilator care prior to providing such care.  In-service training shall be conducted at least annually by a licensed respiratory care practitioner or qualified registered nurse who has at least one-year experience in the care of ventilator dependent individuals.  Training shall include, but is not limited to, status and needs of the resident, infection control techniques, communicating with the ventilator resident, and assisting the resident with activities.  In-service training documentation shall include name and title of the in-service director, duration of the presentation, content of presentation, and signature and position description of all participants.

 

M)       Documentation shall support the resident has a health condition that requires medical supervision 24-hours a day of licensed nursing care and specialized services or equipment.

 

N)        The medical records shall contain physician's orders for respiratory care that includes, but is not limited to, diagnosis, ventilator settings, tracheostomy care and suctioning, when applicable.

 

O)        Documentation shall support the resident receive tracheostomy care at least daily.

 

5)         To be eligible to receive ventilator add-on, facilities shall also be required to implement the established written protocols on the following areas:

 

A)        Pressure Ulcers.  A facility shall have established policies and procedures on assessing, monitoring and prevention of pressure ulcers, including development of a method of monitoring the occurrence of pressure ulcers.  Staff shall receive in-service training on those areas.

 

i)          Documentation shall support the resident has been assessed quarterly for their risk for developing pressure ulcers.

 

ii)         Documentation shall support that interventions for pressure ulcer prevention were implemented and include, but are not limited to, a turning and repositioning schedule, use of pressuring reducing devices, hydration and nutritional interventions and daily skin checks.

 

B)        Pain. A facility shall have established policies and procedures on assessing the occurrence of pain, including development of a method of monitoring the occurrence of pain. Staff shall receive in-service training on this area.

 

i)          Documentation shall support the resident has been assessed quarterly for the presence of pain and the risk factors for developing pain.

 

ii)         Documentation shall support an effective pain management regime is in place for the resident.

 

C)        Immobility. A facility shall have established policies and procedures to assess the possible effects of immobility. These shall include, but not be limited to, range of motion techniques, contracture risk. Staff shall receive in-service training on this area.

 

i)          Documentation shall support the resident's risk for contractures were assessed quarterly and interventions are in place to reduce the risk.

 

ii)         Effects of immobility will be monitored and interventions implemented as needed.

 

D)        Risk of infection.  A facility shall have established policies and procedures on assessing risk for developing infection and prevention techniques.  These shall include, but are not limited to proper hand washing techniques, aseptic technique in delivery care to a resident, and proper care of equipment and supplies.  Staff shall receive in-service training on this area.

 

i)          Documentation shall support the resident was given oral care every shift to reduce the risk of infection.

 

ii)         Documentation shall support the facility has a method to monitor and track infections.

 

E)        Social Isolation. A facility shall have a method of assessing a resident's risk for social isolation. Interventions shall be in place to involve a resident in activities when possible.

 

F)         Ventilator Weaning. A facility shall have a method of routinely assessing a resident's weaning potential and interventions implemented as needed.  Documentation shall support the weaning process and the use of mechanical ventilation for a portion of each day for stabilization.

 

G)        Policies shall include monitoring expectations of the ventilator resident, routine maintenance of equipment and specific staff training related to ventilator settings and care.

 

H)        In order to maintain quality standards and reduce cross contamination, the facility shall have a policy for cleaning and maintaining equipment.

 

6)         Department staff shall conduct on-site visits on a random or targeted basis to ensure both facility and resident compliance with requirements.  All records shall be accessible to determine that the needs of a resident are being met and to determine the appropriateness of ventilator services. In addition to the requirements of this subsection (a), Department review shall include, at a minimum, the following:

 

A)        The tracking of Ventilator Associated Pneumonia;

 

B)        Documentation to track hospitalizations, reason for hospitalizations, and interventions aimed at reducing hospitalizations for ventilator residents;

 

C)        Ventilator weaning.

 

7)         An enhanced payment shall be added to the rate determined by the methodology currently in place:

 

A)        Payment shall be made for each individual resident receiving ventilator services;

 

B)        The rate add-on for ventilator service is $208 per day.

 

b)         Traumatic Brain Injury (TBI) – The following criteria shall be met to be eligible for enhanced rates.

 

1)         A facility shall meet all the criteria set forth in this subsection for TBI care to a resident in order to receive the enhanced TBI reimbursement rate identified.

 

2)         TBI is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

 

3)         The following criteria shall be met in order for a facility to qualify for TBI reimbursement.

 

A)        The facility shall have written policies and procedures for care of the residents with TBI and behaviors that include, but are not limited to, monitoring for behaviors, identification and reduction of agitation, safe and effective interventions for behaviors, and assessment of risk factors for behaviors related to safety of residents, staff and staff shall be in-serviced on these policies.

 

B)        The facility shall have staff to complete the required physical (PT), occupational (OT) or speech therapy (SP), as needed. Additionally, a facility shall have staffing sufficient to meet the behavior, physical and psychosocial needs of the resident.

 

C)        Staff shall receive in-service for the care of a TBI resident and dealing with behavior issues identifying and reducing agitation, and rehabilitation for the TBI resident.  In-service training shall be conducted at least annually.  In-service documentation shall include name and title of the in-service director, duration of the presentation, content of presentation, and signature and position description of all participants.

 

D)        The facility environment shall be such that it is aimed at reducing distractions for the TBI resident during activities and therapies. This shall include, but not be limited to, avoiding overcrowding, loud noises, lack of privacy, seclusion and social isolation.

 

E)        Care plans on all residents shall address the physical, behavioral and psychosocial needs of the TBI residents.  Care plans shall be individualized to meet the resident's needs, and shall be revised as necessary.

 

F)         The facility shall use the "Rancho Los Amigos Cognitive Scale" to determine the level of cognitive functioning. The assessment shall be completed quarterly by a trained rehabilitation registered nurse. Based on the level of functioning, and the services and interventions implemented, a resident will be placed in 1 of 3 tiers of payments. Tier 3 is the highest reimbursement. By completing a Department designated form, facilities will be responsible for notifying the Department of the applicable tier in which a resident is placed.

 

G)        Documentation found elsewhere in the resident records shall support the scoring on the Rancho Los Amigos Scale as well as the delivery of coded interventions.

 

4)         Admission Criteria

 

A)        Documentation by a neurologist that the resident has a severe and extensive TBI diagnosis.

 

B)        The diagnosis meets RAI Manual requirements for coding.

 

C)        There shall be documentation the diagnosis has resulted in significant deficits and disabilities that required intense rehabilitation therapy.  In addition, documentation from the neurologist shall identify the resident has the ability to benefit from rehabilitation and a potential for independent living.

 

D)        Diagnostic testing shall support the presence of a severe and extensive TBI as a result of external force as defined in subsection (b)(2).

 

E)        Documentation the resident was assessed using the Rancho Los Amigos Cognitive Scale and scored a Level IV through X.  Residents scoring a Level I, II or III on the Rancho Los Amigos Cognitive Scale shall not be eligible for TBI reimbursement.

 

F)         Documentation the resident is medically stable and has been assessed for potential behaviors and safety risk to self, staff and others.

 

5)         Documentation supports the Tier I requirements are as follows:

 

A)        Tier I shall not exceed 6 months.

 

B)        The resident shall have previously scored in Tier II or Tier III.

 

C)        The resident has received intensive rehabilitation and is preparing for discharge to the community. The resident shall receive intervention and training focusing on independent living skills, prevocational training and employment support.  This includes, but is not limited to, community support options, substance abuse counseling, as appropriate, time management and goal setting.

 

D)        Resident scores a Level VIII through X on the Rancho Los Amigos Cognitive Scale (Purposeful, Appropriate, and stand-by assistance to Modified Independence).

 

E)        No behaviors or Behaviors present, but less than 4 days (E0200A-C<2 AND E0500A-C=0 AND E0800< 2 and E1000A+B=0).  If behaviors are present, resident receives behavior management training to address the specific behaviors identified.

 

F)         Cognition. Brief Interview for Mental Status (BIMS) is 13 through 15 (Cognitively intact, C0500).

 

G)        Activities of daily living (ADL) functioning. All ADL tasks shall be coded less than 3 (Section G).

 

H)        An assessment shall be completed quarterly to identify the resident's needs and risk factors related to independent living. This assessment shall include, but is not limited to, physical development and mobility, communication skills, cognition level, food preparation and eating behaviors, personal hygiene and grooming, health and safety issues, social and behavioral issues, ADL potential with household chores, transportation, vocational skills and money management.

 

I)         Discharge Potential.  There is an active discharge plan in place (Q0400A=1) or referral has been made to the local contact agency (Q0600=1). There shall be weekly documentation by a licensed social worker related to discharge potential and progress.  This shall include working with the resident on community resources and prevocational employment options.

 

J)         The resident shall receive interventions and/or training related to their specific discharge needs.

 

6)         Documentation supports the Tier II requirements are as follows:

 

A)        Tier II shall not exceed 12 months.

 

B)        Resident has reached a plateau in rehabilitation ability, but still requires services related to the TBI. Resident shall have previously scored in Tier III.  The resident continues to receive restorative nursing services.

 

C)        Resident scores a Level IV throughVII on the Rancho Los Amigos Cognitive Scale (Confusion, may or may not be appropriate).

 

D)        Cognition. BIMS is less than 13 (C0500) or Cognitive Skills for decision making are moderately to severely impaired (C1000=2 or 3).

 

E)        Resident has behaviors (E0300=1 or E1000=1) and these behaviors impact resident (E0500A-C=1) or impact others (E0600A-C=1).  Behaviors shall be tracked daily and interventions implemented.  There shall be documentation of weekly meetings with interdisciplinary staff to discuss behaviors, effectiveness of interventions and to implement revisions as necessary.

 

F)         ADL function (Section G) 3 or more ADL require limited or extensive assistance.

 

G)        Resident is on 2 or more of the following restorative: Bed Mobility (O0500D=1), Transfer (O0500E=1), Walking (O0500F=1), Dressing/Grooming (O0500G=1), Eating (O0500H=1) or Communication (O0500J=1).

 

H)        Resident receives either Psychological (O0400E2>1) or Recreational Therapy (O0400F2>1) at least 2 or more days a week.  Documentation shall include a summary of the sessions, resident's progress and potential goals, and identify any revisions needed.

 

I)         Documentation shall support one to one meeting with a licensed social worker at least twice a week to discuss potential needs, goals and any behavior issues.

 

J)         Documentation of at least quarterly oversight of care plan by a neurologist.

 

K)        Documentation the resident has received instruction and training at least twice per week that includes, but is not limited to, behavior modification, anger management, time management goal setting, life skills and social skills.

 

L)        Behavioral rehabilitation assessment and evaluations shall be completed quarterly and shall include cognition, behaviors, interventions and outcomes.

 

M)       Documentation shall support the residents requires intensive counseling, behavioral management and neuro-cognitive therapy.  The resident behaves in such a manner as to indicate an inability, without ongoing supervision and assistance of others, they would be unable to satisfy the need for nourishment, personal care, medical care, shelter, self-protection and safety.

 

7)         Documentation supports the Tier III requirements are as follows:

 

A)        Tier III shall not exceed 9 months.

 

B)        The injury resulting in a TBI diagnosis must have occurred within the prior 6 months to score in Tier III.

 

C)        Includes the acutely diagnosed resident with extensive deficits in physical functioning and identifies intensive rehabilitation needs.

 

D)        Resident scores an IV through VII on the Rancho Los Amigos Cognitive Scale.

 

E)        Cognition. BIMS is less than 13 (C0500) or Cognitive Skills for decision making are moderately to severely impaired (C1000=2 or 3).

 

F)         Documentation shall support the facility is monitoring behaviors and has implemented interventions to identify the risk factors for behaviors and to reduce the occurrence of behaviors.

 

G)        Resident receives Rehabilitation therapy (PT, OT or ST) at least 500 minutes per week and at least one rehabilitation discipline 5 days per week (O0400). The therapy shall meet the RAI Manual guidelines for coding.  The resident shall continue to show the potential for improvement in the therapy programs.

 

H)        The facility shall have trained rehabilitation staff on-site working with the resident on a daily basis. This shall include a trained rehabilitation nurse and rehabilitation aides.  The resident requires a minimum of 6 to 8 hours per day of one-to-one support as a result of functional issues.

 

I)         Documentation shall support there are weekly meetings of the interdisciplinary team to discuss the resident's rehabilitation progress and potential.

 

J)         Resident receives Psychological Therapy (O0400E2>1) at least 2 days per week.  Documentation shall include a summary of the sessions, resident's progress and potential goals, and identify any revisions needed. 

 

K)        There shall be documentation to support monthly oversight by a neurologist.

 

L)        A comprehensive medical and neuro-psychological assessment is done upon admission and quarterly.  It shall include, but is not limited to, the following:

 

i)          Physical ability and mobility;

 

ii)         Motor coordination;

 

iii)        Hearing, vision and speech;

 

iv)        Behavior and impulse control;

 

v)         Social functionality;

 

vi)        Cognition;

 

vii)       Safety and medical needs; and

 

viii)      Communication needs.

 

8)         Rates of payment for each Tier are as follows:

 

A)        The payment amount for Tier I is $264.17 per day.

 

B)        The payment amount for Tier II is $486.49 per day.

 

C)        The payment amount for Tier III is $767.46 per day.

 

9)         Effective for services on or after January 1, 2015, facilities licensed by the Department of Public Health under the Nursing Home Care Act and meeting all the care and services requirements of this Part will receive a per diem add-on of $5.00 for each resident scoring as TBI on the MDS 3.0 but otherwise not qualifying for Tier 1, 2 or 3.

 

(Source:  Amended at 38 Ill. Reg. 23778, effective December 2, 2014)

 

Section 147.340  Minimum Data Set On-Site Reviews

 

a)         The Department shall conduct reviews to determine the accuracy of the resident assessment information transmitted in the Minimum Data Set (MDS) that are relevant to the determination of reimbursement rates.  The MDS data used by the Department to set the reimbursement rate will be used to conduct the validation reviews.  Such reviews may, at the discretion of the Department, be conducted electronically or onsite in the facility.

 

b)         The Department may select, at random, a number of facilities in which to conduct quarterly on-site reviews.

 

c)         The Department may also select facilities for on-site review based upon facility characteristics, atypical patterns of scoring MDS items, non-submission or late submission of assessments, high percentage of significant corrections, previous history of review changes, or the Department's experience.  The Department may also use the findings of the licensing and certification survey conducted by the Department of Public Health (DPH) indicating the facility is not accurately assessing residents. 

 

d)         In addition, the Department may conduct reviews if the Department determines that circumstances exist that could alter or affect the validity of case mix classifications of residents.  These circumstances include, but are not limited to, the following:

 

1)         Frequent changes in administration or management of the facility;

 

2)         An unusually high percentage of residents in a specific case mix classification or high percentage of change in the number of residents in a specific case mix classification;

 

3)         Frequent adjustments of case mix classification as result of reconsiderations, reviews, or significant corrections submitted;

 

4)         A criminal indictment alleging fraud; and

 

5)         Other similar factors that relate to a facility's ability to conduct accurate assessments.

 

e)         The Department shall provide for a program of delegated utilization review and quality assurance. The Department may contract with medical peer review organizations to provide utilization review and quality assurance.

 

f)         Electronic review.  The Department shall conduct quarterly an electronic review of MDS data for eligible individuals to identify facilities for on-site review.

 

g)         On-site review.  The Department shall conduct an on-site review of MDS data for eligible individuals.  The Department is authorized to conduct unannounced on-site reviews.  On-site reviews may include, but shall not be limited to, the following:

 

1)         Review of the resident records and supporting documentation.

 

2)         Observation and interviews of residents, families and/or staff, to determine the accuracy of data relevant to the determination of reimbursement rates.

 

3)         Review and collection of information necessary to assess the resident's need for a specific service or care area.

 

h)         The Department shall select at least 20 percent, with a minimum of 10 assessments, of the assessments submitted. The number of residents in any selected facility for whom information is reviewed may, at the sole discretion of the Department, be limited or expanded. 

 

i)          If more than 25 percent of the RUG-IV classifications are changed as a result of the initial review, the review may be expanded to a second 25 percent, with a minimum of 10 assessments. If the total changes between the first and second sample exceed 40 percent, the Department may expand the review to all the remaining assessments.

 

j)          If the facility qualifies for an expanded review, the Department may review the facility again within 6 months.  If a facility has 2 expanded reviews within a 24-month period, that facility may be subject to reviews every 6 months for the next 18 months and a penalty may be applied as defined in subsection (s) of this Section.

 

k)         Pursuant to 89 Ill. Adm. Code 140.12(f), the facility shall provide Department staff with access to residents, professional and non-licensed direct care staff, facility assessors, clinical records and completed resident assessment instruments, as well as other documentation regarding the residents' care needs and treatments. Failure to provide timely access to records may result in suspension or termination of a facility's provider agreement in accordance with 89 Ill. Adm. Code 140.l16(a)(4).

 

l)          Department staff shall request in writing the current charts of individual residents needed to begin the review process.  Current charts and completed MDS for the previous 15 months shall be provided to review team within an hour after the request.  Additional documentation regarding reimbursement areas for the identified Assessment Reference Date (ARD) timeframe shall be provided to the review team within 4 hours after the initial request.  The team will request no more than 2 records per reviewer to begin the review process.  If the facility chooses to have HFS staff review the electronic health record, at least 2 computer terminals with read-only access will be made available to the review team within one hour.  Within 4 hours after the team's arrival and for the remainder of the review, the facility shall provide a computer terminal for each reviewer or hard copies shall be provided. 

 

m)        When further documentation is needed by the review team to validate an area, the team shall identify the MDS item requiring additional documentation and provide the facility with the opportunity to produce that information. The facility shall provide the team with additional documentation within 24 hours after the initial request.

 

n)         Facilities shall ensure that clinical records, regardless of form, are easily and readily accessible to Department staff.

 

o)         Throughout the review, the Department shall identify to the facility any preliminary conclusions regarding the MDS items/areas that could not be validated.  If the facility disagrees with those preliminary conclusions they shall present the Department with any and all documentation to support their position. It is up to the facility to determine what documentation is needed to support both the Resident Assessment Instrument (RAI) Manual and rule requirements regarding the MDS items identified.

 

p)         All documentation that is to be considered for validation must be provided to the team prior to exit.  All RAI Manual requirements and requirements identified in this subsection shall be presented to validate the identified area.

 

q)         Corrective Action.  Upon conclusion of the review and the consideration of any subsequent supporting documentation provided by the facility, the Department shall notify the facility of its final conclusions, both with respect to accuracy of data and recalculation of the facility's reimbursement rate. The Department shall reclassify a resident if the Department determines that the resident was incorrectly classified.

 

r)          Data Accuracy.  Final conclusions with respect to inaccurate data may be referred to the appropriate agencies, including, but not limited to, the Department's Office of Inspector General, Illinois State Police or Department of Public Health.

 

s)         Recalculation of Reimbursement Rate. The Department shall determine if the reported MDS data that was subsequently determined to be unverifiable would cause the direct care component of the facility's rate to be calculated differently when using the accurate data. 

 

t)          A facility's rate shall be subject to change if the recalculation of the direct care component rate, as a result of using RUGs-IV data that is verifiable:

 

1)         Decreases the rate by more than one percent. The rate is to be changed, retroactive to the beginning of the rate period, to the recalculated rate.

 

2)         Decreases the rate by more than 10 percent in addition to the rate change specified in this subsection (t). The direct care component of the rate may be reduced, retroactive to the beginning of the rate period, by $1.00 for each whole percentage decrease in excess of 2 percent.

 

u)         Based on the areas identified as reclassified, the nursing facility may request that the Department reconsider the assigned classification.  The request for reconsideration shall be submitted in writing to the Department within 30 days after the date of the Department's notice to the facility.  The request for reconsideration shall include the name and address of the facility, the name of each resident in which reconsideration is requested, the reasons for the reconsideration for each resident, and the requested classification changes for each resident based on the MDS items coded.  In addition, a facility may offer explanations as to how they feel the documentation presented during the review supports their request for reconsideration.  However, all documentation used to validate an area shall be submitted to the Department prior to exit. Documentation presented after exit will not be considered when determining a recalculation request.  If the facility fails to provide the required information with the reconsideration request, or the request is not timely, the request shall be denied.

 

v)         Reconsideration by the Department shall be made by individuals not directly involved in that facility review.  The reconsideration shall be based upon the initial assessment documentation and the reconsideration information sent to the Department by the facility.  The Department shall have 120 days after the date of the request for reconsideration to make a determination and notify the facility in writing of the final decision.

 

(Source:  Old Section 147.340 repealed at 26 Ill. Reg. 3093, effective February 15, 2002; new Section 147.340 added at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.345  Quality Incentives

 

Effective January 1, 2015, the Department shall allocate an amount for quality incentive payments.  To establish baselines for these measures, the information shall be submitted beginning January 1, 2014.  These measures may be included as part of the on-site reimbursement review.  To receive the quality incentive payments for these measures, a facility shall meet the following criteria. 

 

a)         The Department shall allocate an amount for staff retention.  To receive the quality incentive payment for this measure, the facility's staff retention rate shall meet or exceed the threshold established and published by the Department based upon statewide averages and must be at least 80 percent.

 

1)         Retention relates to the extent to which an employer retains its employees and shall be measured as the proportion of employees with a specified length of service expressed as a percentage of overall workforce numbers.

 

2)         The staff retentions shall reflect the percentage of individuals employed by the facility on the last day of the previous calculation period who are still employed by the facility on the last day of the following calculation period. 

 

3)         Staff retention shall be calculated on a semiannual basis.

 

A)        The June 30 calculation will be based on the percentage of full-time (defined as 30 or more hours per week) direct care staff employed by the nursing facility on January 1 and still employed by the nursing facility on June 30.  The deadline for reporting this information shall be July 31.  Direct care staff is defined as Certified Nursing Assistants (CNAs).

 

B)        The December 31 calculation shall be based on the percentage of full-time direct care staff employed by the nursing facility on July 1 and still employed by the nursing facility on December 31. The deadline for reporting this information shall be January 31.

 

4)         The staff retention rate is calculated using full-time direct care staff employed in a facility.

 

5)         Documentation in the employee's record shall support the retention rate submitted.

 

6)         Facilities shall submit the required information to the Department in a format designated by the Department.

 

b)         The Department shall allocate an amount for consistent assignments.  To receive the quality incentive payment for this measure, the facility shall meet the threshold established and published by the Department based upon statewide averages.

 

1)         Consistent assignments shall be calculated on a semiannual basis.  The deadline for reporting this information shall be July 31 and January 31, respectively.

 

2)         The facility shall have a written policy that requires consistent assignment of CNAs and it shall specify a goal of limiting the number of CNAs that provide care to a resident to no more than 8 CNAs per resident during a 30-day period.

 

3)         Documentation shall support that no less than 85 percent of Long Term Care residents received their care from no more than 8 different CNAs during a 30-day period.

 

4)         There shall be evidence the policy has been communicated, and understood, to the staff, residents and family of residents.

 

5)         Facilities shall submit the required information to the Department in a format designated by the Department.

 

c)         The Department shall establish a center for Psychiatric Rehabilitation in Long Term Services and Support to organize and coordinate the provision of training on serious mental illness, psychiatric rehabilitation services and evidence-based informed practices.

 

d)         Optional Certified Nursing Assistant Tenure and Promotion Payments.

 

1)         CNA Tenure Payments will be based on each CNA's years of experience. 

 

A)        These payments will be paid to nursing facilities equal to Medicaid's share of the following tenure wage increments:

 

i)          An additional $1.50 per hour for CNAs with at least one and less than two years of experience; and

 

ii)         An additional $1 per hour for each additional year of experience up to a maximum of $6.50 per hour for CNAs with at least 6 years of experience.

 

B)        Payments will be calculated based on all reported CNA employee hours compensated in accordance with an operative pay scale reflecting tenured increments at least as large as those specified in subsections (d)(1)(A)(i) and (ii), imparting a promise consistent with the definition of an "agreement" found in 56 Ill. Adm. Code 300.450 and posted in a manner consistent with Federal workplace posters (available at dol.gov/general/topics/posters). This pay scale should result in increased compensation, not reductions in compensation, for CNAs.  Postings should convey the pay scale so that employees are reasonably able to apply it to their own circumstances and wage rate.

 

C)        Medicaid's share for each nursing facility shall be the ratio of Medicaid base days divided by total bed days for the same period.  For each new quarter beginning July 1, 2022, a facility's Medicaid share shall be paid Medicaid resident days per annum as determined by adding the number of Medicaid, Medicaid MLTSS and MMAI days (inclusive of hospice and provisional days, if applicable) divided by the number of total occupied days (also inclusive of hospice and provisional days, if applicable) found in the most recent 12 months of Long Term Care Provider Assessment Reports for the facility that are available to the Department.

 

D)        Payments will be made to facilities on a per diem basis based on the number of qualifying CNA hours at each level of experience as published on the Federal COMPARE website or submitted directly to the Department of Public Health, as matched to CNA experience levels determined using information submitted by nursing facilities to the Department and through quarterly PBJs where consistent with employment histories reflected in the Department of Public Health's Health Care Worker Registry. Lump sum payments will consist of the sum per diem of the product of the minimum qualifying tenure wage increment at each level of experience and both the number of qualifying CNA hours at each level of experience and the ratio of Medicaid base days to total bed days for the year ending 9 months prior divided by the number of Medicaid base days.  Payments for managed care qualifying days will be paid through the MCOs.  Nursing facilities are not responsible for the accuracy of qualifying years of experience with another employer if inaccurately reported by an employee beyond what could reasonably be known to the employer.

 

2)         Optional CNA Promotion Payments will be paid to nursing facilities equal to Medicaid's share of $1.50 per hour for each qualifying promotion-based wage increment, as follows:

 

A)        To qualify for this payment, the promotion-based wage increment must be at least $1.50 per hour and the Department will only reimburse the Medicaid portion of $1.50 per hour.

 

B)        Qualifying promotions are for CNAs that are assigned intermediate, specialized or added roles which may include but not be limited to: CNA IIs (with Advance Nurse Aide Training), CNA trainers, CNA scheduling captains, CNA dementia or memory care specialist, CNA geriatric specialist, CNA infection control specialist, CNA activities specialist, and CNA CPR educators.

 

C)        Subject to a ceiling of 15% of employed CNAs, as measured on a full-time equivalent basis, payments will be calculated based on all reported CNA employee hours compensated in accordance with a legally posted and operative wage schedule consisting of the promotional wage increase specified in subparagraph A and identifying qualifying promotions consistent with subparagraph B.

 

D)        Medicaid's share for each nursing facility shall be the ratio of Medicaid paid days divided by total bed days for the same period.  For each new quarter beginning July 1, 2022, a facility's Medicaid share shall be paid Medicaid resident days per annum as determined by adding the number of Medicaid, Medicaid MLTSS and MMAI days (inclusive of hospice and provisional days, if applicable) divided by the number of total occupied days found in the most recent 12 months of Long Term Care Provider Assessment Reports for the facility that are available to the Department.

 

E)        Payments will be made to facilities based on the number of qualifying CNA hours published on the Federal COMPARE website or submitted directly to the Department of Public Health, as matched to professional roles for each CNA reported to the Department by each facility. Subject to the limit identified in subparagraph C, lump sum payments will consist of the number of qualifying CNA hours multiplied by both the minimum promotion-based wage increment identified in subparagraph A and the ratio of Medicaid base days to total bed days for the year ending 9 months prior divided by the number of Medicaid base days.  Payments for managed care qualifying days will be paid through the MCOs.

 

e)         Incentive Payments will be paid to nursing facilities determined by facility performance on the specified quality measures in subsection (e)(2). The quality payment methodology described in this Section must be used for at least July 1, 2022, through June 30, 2023. Beginning with the quarter starting July 1, 2023, the Department may add, remove, or change quality metrics and make associated changes to the quality payment methodology by rule. Facilities designated by the Centers for Medicare and Medicaid Services as a special focus facility, or a hospital-based nursing home do not qualify for quality payments. The Department shall publish on its website estimated payments and associated weights for each facility 45 days prior to the beginning of each quarter.

 

1)         The Quality Incentive Pool will initially be no less than $70,000,000 annually or $17,500,000 per quarter.

 

2)         Distribution of the Quality Incentive Pool will be based on a quality weight score for each nursing facility, which is calculated quarterly by multiplying the nursing facility's paid Medicaid days by the nursing facility's star rating weight for the most recent available quarter. Medicaid paid days will be calculated quarterly based upon a rolling 12-month period of historical data from MMIS ending 9 months prior to the payment effective date (inclusive of hospice and provisional days, if applicable and annualized where necessary and appropriate).

 

3)         Star rating weights are assigned based on the nursing facility's star rating for the long stay quality rating as assigned by the Centers for Medicare and Medicaid Services under the Five-Star Quality Rating System for the most recent available quarter. Weights will be assigned as follows:

 

A)        Zero or one star rating has a weight of 0.

 

B)        Two star rating has a weight of 0.75.

 

C)        Three star rating has a weight of 1.5.

 

D)        Four star rating has a weight of 2.5.

 

E)        Five star rating has a weight of 3.5.

 

4)         Each nursing facility's quality weight score is divided by the sum of all quality weight scores to determine the proportion of the Quality Incentive Pool to be paid to each nursing facility.  Until additional quality measures are adopted by the Department as part of the quality incentive payments, the dollar value calculated for each star rating for the implementing quarter shall serve as the floor for each star's dollar value for each quarter thereafter.

 

5)         The final fee-for-service payment amounts will be calculated by applying the percentage of days eligible for quality payments that were reimbursed fee-for-service to total qualifying days eligible for quality payments.  Quality payments for managed care qualifying days will be reimbursed through directed payments through the MCOs.

 

6)         In periods of time when the Centers for Medicare and Medicaid Services freezes the star ratings system, a facility's add-on shall remain at the level it was prior to the freeze taking effect. When necessary, the absence of available data or data limitations will be addressed through Department policy.

 

7)         The Department shall require the MCOs to make directed payments using electronic funds transfers (EFT), if the nursing facility provides the information necessary to process such EFTs, in accordance with directions provided monthly by the Department, within 7 business days of the date the funds are paid to the MCOs, as indicated by the "Paid Date" on the website of the Office of the Comptroller if the funds are paid by EFT and the MCOs have received directed payment instructions.

 

A)        If funds are not paid through the Comptroller by EFT to the MCO, payment must be made within 7 business days of the date actually received by the MCO.

 

B)        If an MCO is late in paying a directed payment as required under the Public Aid Code (including any extensions granted by the Department), it shall pay a penalty, unless waived by the Department for reasonable cause, to the Department equal to 5% of the amount of the directed payment not paid on or before the due date plus 5% of the portion thereof remaining unpaid on the last day of each 30-day period thereafter.

 

C)        Payments to MCOs that would be paid consistent with actuarial certification and enrollment in the absence of the increased capitation payments under this Section shall not be reduced as a consequence of payments made under this subsection.

 

8)         The Department shall publish and maintain on its website for a period of no less than 8 calendar quarters, the quarterly calculation of directed payments to each facility from each MCO. All calculations and reports shall be posted no later than the first day of the quarter for which the payments are to be issued.

 

f)         Payment determinations in this Section may be appealed under the terms under Section 140.830(b) and Section 140.830(c)

 

(Source:  Amended at 46 Ill. Reg. 19682, effective November 28, 2022)

 

Section 147.346  Appeals of Nursing Rate Determination

 

a)         Appeals must be submitted in writing to the Department no later than 30 days after the date of the Department's notice to the facility of the rate calculation resulting from the on-site review.  The revised rate shall be processed into the payment system 30 days after the date of the Department's notice in order to allow time for submission of appeals.

 

b)         The appeal shall contain clear and relevant supportive documentation.  The facility must succinctly address the area being appealed.  Additional documentation not presented to the HFS review team during the review, or at the time of exit, will not be considered in the appeal process.

 

c)         The Department will rule on all appeals within 120 days after the date of appeal, except in rare instances where the Department may require additional information from the facility.  In this case, the response period may be extended.

 

d)         The appeal and supportive documentation will go through several stages of review within the Department to ensure fairness, objectivity and consistency with the appeal determination.  The rate resulting from the appeal determination will become effective the first day of the applicable quarter.

 

(Source:  Added at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.350  Reimbursement for Additional Program Costs Associated With Providing Specialized Services for Individuals with Developmental Disabilities in Nursing Facilities

 

a)         Nursing facilities (ICF and SNF) providing specialized services to individuals with developmental disabilities, excluding state operated facilities for the developmentally disabled, will be reimbursed for providing a specialized services program for each client with developmental disabilities as specified in 89 Ill. Adm. Code 144.50 through 144.250.

 

b)         Beginning February 1, 1990, facility reimbursement for providing specialized services to individuals with developmental disabilities will be made upon conclusion of resident reviews that are conducted by the state's mental health authority or their contracted agent.  Facility reimbursement for providing specialized services as a result of resident reviews concluded prior to February 1, 1990, will begin with the facility's February billing cycle.

 

c)         The additional reimbursement for costs associated with specialized services programs is based upon the presence of three (3) determinants.  The three determinants are:

 

1)         Minimum Staffing

 

A)        Direct Services – Facilities must be in compliance with the Health Care Financing Administration's (HCFA) (42 CFR 442.201 or 42 CFR 442.302 (1989)) and the Illinois Department of Public Health's (IDPH) (77 Ill. Adm. Code 300.1230) minimum staffing standards relative to facility type.

 

B)        The number of additional direct services staff necessary for delivering adequate specialized services programs for individuals with developmental disabilities is based upon a full time equivalent (FTE) staff to client ratio of 1:7.5.

 

2)         Qualified Mental Retardation Professional Services

 

A)        Each individual's specialized services program must be integrated, coordinated and monitored by a Qualified Mental Retardation Professional (QMRP).  Any facility required to provide specialized services programs to individuals with developmental disabilities must provide QMRP services. Delivery of these services is based upon a full-time equivalent ratio of one (1) QMRP to thirty (30) individuals being served.

 

B)        A Qualified Mental Retardation Professional (QMRP) is a person who has at least one year of experience working directly with persons with mental retardation and is one of the following:

 

i)          A doctor of medicine or osteopathy;

 

ii)         A registered nurse;

 

iii)        An individual who holds at least a bachelor's degree in one of the following professional categories:  Occupational Therapist; Occupational Therapy Assistant, Physical Therapist, Physical Therapy Assistant, Psychologist, Master's Degree; Social Worker; Speech-Language Pathologist or Audiologist; Recreation Specialist; Registered Dietitian; and Human Services, including but not limited to Sociology, Special Education, Rehabilitation Counseling, and Psychology (42 CFR 483.430(1989)).

 

3)         Assessment and Other Program Services

 

A)        A comprehensive functional assessment that identifies an individual's needs must be performed as needed to supplement any preliminary evaluations conducted prior to admission to a nursing facility.

 

B)        A Comprehensive Assessment must include:

 

i)          physical development and health;

 

ii)         dental examination that includes an assessment of oral hygiene practices;

 

iii)        nutritional status;

 

iv)        sensorimotor development/auditory functioning;

 

v)                  social development;

 

vi)               speech and language development;

 

vii)             adaptive behaviors or independent living skills necessary for the individual to be able to function in the community (Scales of Independent Behavior (SIB) or the Inventory for Client and Agency Planning (ICAP) are the assessment instruments that must be used for this assessment);

 

viii)           vocational or educational skills (if applicable);

 

ix)        cognitive development;

 

x)         medication and immunization history;

 

xi)        psychological evaluation (within 5 years) that includes an assessment of the individual's emotional and intellectual status;

 

xii)       capabilities and preferences relative to recreation/leisure activities;

 

xiii)      other assessments indicated by the individual's needs, such as physical and occupational therapy assessments;

 

xiv)      seizure disorder history (if applicable) with information regarding frequency of occurrence and classification; and

 

xv)       screenings (the facility performs or obtains) in the areas of nutrition, vision, auditory and speech/language.

 

d)         Costs associated with specialized services programs reimbursement includes other program costs, such as consultants, inservice training, and other items necessary for the delivery of specialized services to clients in accordance with their individual program plans.

 

e)         Total program reimbursement for the additional costs associated with the delivery of specialized services to individuals with developmental disabilities residing in nursing facilities will be ten dollars ($10) per day, per individual being served.  Facility eligibility for specialized services program reimbursement is dependent upon the facility meeting all criteria specified in Sections 147.5 through 147.205, 147.350 and 144.25 through 144.250.

 

(Source:  Amended at 16 Ill. Reg. 17332, effective November 6, 1992)

 

Section 147.355  Reimbursement for Residents with Exceptional Needs (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.TABLE A   Staff Time (in Minutes) and Allocation by Need Level (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

Section 147.TABLE B   MDS-MH Staff Time (in Minutes) and Allocation by Need Level (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 12173, effective May 30, 2014)

 

Section 147.TABLE C  Comprehensive Resident Assessment (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.TABLE D  Functional Needs and Restorative Care (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.TABLE E   Service (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.TABLE F   Social Services (Repealed)

 

 (Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.TABLE G  Therapy Services (Repealed)

 

(Source:  Repealed at 17 Ill. Reg. 13498, effective August 6, 1993)

Section 147.TABLE H   Determinations (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.TABLE I   Activities (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.TABLE J   Signatures (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

 

Section 147.TABLE K  Rehabilitation Services (Repealed)

 

(Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)

Section 147.TABLE L   Personal Information (Repealed)

 

 (Source:  Repealed at 27 Ill. Reg. 18680, effective November 26, 2003)