Section 140.530  Basis of Payment for Long Term-Care Services

a)         The amount approved for payment for long term care services is based on the type and amount of services required by and actually being furnished to a resident and is determined in accordance with the Department's rate schedule.

b)         Costs not related to patient care, as well as costs in excess of those required for the efficient and economical delivery of care, will not be reimbursed.

c)         Rates and payments

1)         Rates for long term care services shall be the sum of the reimbursable costs of capital, support, and nursing, as defined in this Part and 89 Ill. Adm. Code 147.

2)         Additionally, for county-owned or operated nursing facilities, rates shall include allowable costs incurred in excess of the reimbursable costs defined in this Part and 89 Ill. Adm. Code 147.  Costs in excess of reimbursable costs shall be certified from the signed annual cost report submitted by the county to the Department.

3)         Payment for long term care services is on a per diem basis.  In determining the number of days for which payment can be made, the day of admission to the facility is counted.  The day of discharge from the facility is not counted, unless it is the day of death and death occurs in the facility or a reserved bed has been authorized for that day.

4)         Payments by the Department for long term care services shall not exceed reimbursable costs as defined in this Part and 89 Ill. Adm. Code 147 less what is contributed by third party liability.

d)         Definitions

1)         "Allowable costs" are those which are appropriate patient care expenditures as defined in this Part and 89 Ill. Adm. Code 147.

2)         "Reimbursable costs" are determined by the application of statistical standardizations of allowable costs for all providers within various defined groups to the costs of individual providers within such groups.

3)         "County-owned nursing facility" is a nursing facility owned and operated by an Illinois county.

(Source:  Amended at 34 Ill. Reg. 3761, effective March 14, 2010)