Section 146.910  Reimbursement

a)         Facilities licensed under Specialized Mental Health Rehabilitation Act of 2013 shall be reimbursed at:

1)         The rate in effect on June 30, 2014, less $7.07 for each facility previously licensed under the Nursing Home Care Act on June 30, 2013;

2)         The rate in effect on June 30, 2013 for each facility licensed under the Specialized Mental Health Rehabilitation Act on June 30, 2013;

3)         Effective for services provided on or after July 1, 2017, the rate in effect on June 30, 2017 increased by 2.8%;

4)         Effective for services provided on or after July 1, 2018, the rate in effect on June 30, 2018 increased by 4%; or,

5)         Effective for services provided on or after July 1, 2022, the rate in effect on June 30, 2022, increased by 5%.

6)         Effective for services provided on or after October 1, 2022, providers outside of the Chicago metro area will have their rates increased to reflect the Chicago area regional wage factor.

b)         Any adjustment in the support component or the capital component for facilities licensed by the Department of Public Health under the Nursing Home Care Act shall apply equally to facilities licensed by the Department of Public Health under the Specialized Mental Health Rehabilitation Act of 2013.

c)         Notwithstanding the provisions set forth in 89 Ill. Adm. Code 153, facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall receive a payment in the amount of $29.43 per licensed bed, per day, for the period beginning June 1, 2014 and ending June 30, 2014.

d)         Facilities licensed or provisionally licensed under the Specialized Mental Health Rehabilitation Act of 2013 on or before June 1, 2018 will be reimbursed for therapeutic visits that have been indicated by an interdisciplinary team as therapeutically beneficial at the following:

1)         Effective for dates of service June 4, 2018 through July 26, 2018, therapeutic visits are reimbursed at a rate of 75% of the facility's rate as of June 4, 2018.

2)         Effective for dates of service on or after July 27, 2018 through June 30, 2020, therapeutic visits are reimbursed at a rate of 75% of the facility's rate as of July 27, 2018.

3)         Effective for dates of service on or after July 1, 2020, therapeutic visits are reimbursed at a rate of 75% of the facility's current rate.

4)         Facilities may not be reimbursed for more than 10 consecutive days of therapeutic visits and no more than 20 days of therapeutic visits per State fiscal year.

e)         Notwithstanding the provisions set forth in 89 Ill. Adm. Code 153 and in addition to the rate for recovery and rehabilitation, facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall receive an additional payment in the amount, as follows:

1)         Effective for dates of service on or after July 1, 2019, a payment of no less than $10 per day, per single room occupancy rate.

2)         Effective for dates of service on or after July 1, 2022, an additional payment of no less than $5 per day, per single room occupancy will be added to the existing $10 additional per day, per single room occupancy rate for a total of at least $15 per day, per single room occupancy.

3)         Effective for dates of service on or after July 1, 2022, an additional rate for dual-occupancy rooms will be no less than $10 per day, per Medicaid-occupied bed, in each dual-occupancy room. Under this subsection (e)(3), "dual-occupancy room" means a room that contains 2 licensed beds.  [210 ILCS 49/5-107]

4)         The add-on amounts under subsections (e)(1), (e)(2), and (e)(3) will not be applied to leave of absence days.

5)         Effective for dates of service on or after November 1, 2022, a $32 add-on to the facility rate for providers who:

A)        Prior to November 1, 2022, had at least half of their facility rooms with 3 or more licensed beds; and

B)        After November 1, 2022, reduced the number of licensed beds in all rooms to 2 licensed beds or fewer.

(Source:  Amended at 48 Ill. Reg. 895, effective December 27, 2023)