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Proposed Changes In Methods And Standards 

 

State of Illinois
Healthcare and Family Services

Proposed Changes In Methods And Standards For Establishing Medical Assistance Payment Rates for Certain Institutional Services

The Department of Healthcare and Family Services (HFS) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medical Assistance program. These changes are being made in order to assure that reimbursement for services rendered by these classes of providers are consistent with the State’s fiscal years 2006 and 2007 budgets while maintaining access to necessary medical services.

Home and Community-Based (Waiver) Services

Effective June 1, 2006, the rate of reimbursement for homemaker services will be increased by $1.00 per hour. It is estimated that these changes will result in an annual increase in Medicaid liability of $22.3 million ($3.3 million by the Department of Human Services and $19.0 million by the Department on Aging).

Effective June 1, 2006, the community integrated living arrangement (CILA) options available to an individual participating in the home-and community-based services waiver for persons with a developmental disability will include a “host family CILA”—i.e., one- and two-person settings arranged through community agencies licensed by the Department of Human Services to provide such services. The residential rate for host family CILA will address the cost of program administration and management, program supplies, basic nursing care, transportation, professional consultation, the host family care giver, and services provided by relief staff and qualified mental retardation professionals. The per diem residential rate for an individual resident will be based upon the specific support needs of that individual resident and will range from $99.03 to $116.61. It is estimated that this programmatic change will result in no net change in Medicaid liability.

Long Term Care Services

Effective July 1, 2006, a socio-development component will be added to the per diem rate paid to facilities that are both (a) licensed by the Department of Public Health as intermediate care facilities and (b) classified by the HFS as institutions for mental diseases. The rate for that component shall be set at 6.6 percent of the nursing component of the per diem rate that was in effect on January 1, 2006. It is estimated that the change will result in an annual increase in Medicaid liability of $5.3 million.

Time, place and manner in which interested persons may comment on the proposed changes

Any interested party may submit comments, data, views, or arguments concerning these proposed. All comments must be in writing and should be addressed to:

Bureau of Program and Reimbursement Analysis
Division of Medical Programs
Healthcare and Family Services
201 South Grand Avenue East
Springfield, Illinois 62763-0001
E-mail address: bpra@idpa.state.il.us

Interested persons may review these proposed changes on the Internet at HFS Public Notices. Local access to the Internet is available through any local public library. In addition, this material may be viewed at the local offices (except in Cook County) operated by the Department of Human Services. In Cook County, the changes may be reviewed at the Office of the Director, Healthcare and Family Services, 100 West Randolph Street, Chicago, Illinois. The changes may be reviewed at all offices Monday through Friday from 8:30 a.m. until 5 p.m. This notice is being provided in accordance with federal requirements found at 42 CFR 447.205.