Section 140.539  Reimbursement for Basic Nursing Assistant, Developmental Disabilities Aide, Basic Child Care Aide and Habilitation Aide Training and Nursing Assistant Competency Evaluation

a)         Training Reimbursement

1)         Long term care facilities shall be reimbursed for the reasonable costs of assistant and aide training.  Upon the individual's successful completion of a course which has been approved by the Department of Public Health (77 Ill. Adm. Code 395.110), the facility may claim reimbursement for the following costs, provided that they are actually incurred:

A)        tuition, up to the prevailing community college rate in the health service area for a six credit hour course;

B)        instructional materials, up to $25.00; and

C)        salary and fringe benefits (fringe benefits are payroll taxes, unemployment insurance, worker's compensation, health insurance and meals if provided) up to the prevailing entry level for the health service area.

2)         The Department will reimburse for actual approved hours up to 130 hours.

3)         Facilities shall also receive an additional factor of five percent of the total claim to recognize costs for those who do not successfully complete the course.

4)         The Department shall reimburse on a pro rata basis according to the percentage of Medicaid residents in the facility at the time the request for reimbursement is submitted to the Department.

5)         Successful completion of a course by each individual for whom reimbursement is being requested shall be verified through the Department of Public Health Nurse Aide Registry.  In the event that an individual's name does not appear on the Registry within three months after the Department's receipt of the reimbursement request, the Department reserves the right to request documentation that shows proof of:

A)        submittal of the individual's name for entry on the Nurse Aid Registry (for example, a copy of the notification to the Department of Public Health), if applicable, and

B)        successful completion of the course by the individual (for example, an instructor signed attendance form or other instructor certification).

6)         No individual who is employed by, or who has received an offer of employment from, a facility on the date on which the individual begins a Basic Nursing Assistant, Developmental Disabilities Aide, Basic Child Care Aide or Habilitation Aide training program may be charged for any portion of the program (including any fees for textbooks or other required course materials).  This provision applies whether or not the facility requests Medicaid reimbursement for the training, the individual fails the competency exam or the individual subsequently leaves employment.

b)         Basic Nursing Assistant Competency Evaluation

1)         Nursing facilities shall be reimbursed for the reasonable costs for basic nursing assistant competency evaluations. Only evaluations approved by the Department of Public Health are reimbursable. The facility may claim reimbursement for the cost of each approved competency evaluation successfully completed with a passing grade.

2)         Payment will not be made under this Section for costs incurred in administering tests not approved by the Department of Public Health, or for any additional tests administered by the facility during or subsequent to basic nursing assistant training.

3)         Payment will be made for all competency evaluations successfully completed with a passing grade after October 1, 1989.

4)         The maximum reimbursable cost per competency evaluation successfully completed with a passing grade is the current fee charged by the Department of Public Health approved evaluation service. The Department will reimburse on a pro rata basis according to the percentage of Medicaid residents in the facility at the time the request for reimbursement is submitted to the Department.  The Department will not pay any other costs associated with the evaluation process.

5)         No payment will be made for any competency evaluation in which a failing grade is received for any part of the evaluation. An individual must pass both the demonstration of manual skills and written components of the evaluation before reimbursement may be claimed.

6)         Passage of the competency evaluation for each individual for whom reimbursement is being requested shall be verified through the Department of Public Health Nurse Aide Registry.  In the event that an individual's name does not appear on the Registry, the Department reserves the right to request documentation of such passage before authorizing payment.  Competency evaluations do not apply to Basic Child Care Aides, Habilitation Aides or Developmental Disabilities Aides.

7)         Facilities shall receive an additional factor of five percent of the total claim to recognize costs for those who do not successfully pass the evaluation.

8)         No individual who is employed by, or who has received an offer of employment from, a facility on the date on which the individual begins a basic nursing assistant program may be charged for any costs associated with competency evaluation.  This provision applies whether or not the facility requests Medicaid reimbursement for the competency evaluation, the individual fails the competency evaluation or the individual subsequently leaves employment.

(Source:  Amended at 22 Ill. Reg. 10606, effective June 1, 1998)