Section 146.1005  Determination of Program (Active Treatment) Costs

a)         The Department reimburses residential facilities for program costs associated with the delivery of active treatment to individuals with developmental disabilities, according to information obtained during each facility's most recent Inspection of Care (IOC) Review.  Facilities affected by this Subpart are those certified as Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) and licensed as long term care facilities for residents with complex or extensive medical needs (hereinafter referred to as MC/DD).

b)         IOC Review assessments of 100% of the Medicaid residents are conducted in these facilities by the Department of Public Health every 12 months. These will be conducted in accordance with federal regulations at 42 CFR 456, Subpart I. Program rate determination is based upon IOC Review criteria and Specialized Care needs as described in Sections 146.1020 and 146.1025 in conjunction with the reimbursement methodology found at Section 146.1035.

c)         Reimbursable services under this Section do not include services to maintain generally independent individuals who are able to function with little supervision or in the absence of a continuous active treatment program.

(Source:  Added at 47 Ill. Reg. 18051, effective November 21, 2023)