The Illinois Medical Assistance Program makes reimbursement for the following categories of service (levels of care) provided by long term care (LTC) facilities to Medicaid-eligible residents who are eligible for such services:
Skilled Nursing Facility Services (SNF)
Intermediate Care Facility Services (ICF)
Intermediate Care Facility Services for the Developmentally Disabled (ICF/DD) including Specialized Living Centers (ICF/DD SLC), and
Intermediate Care Facility Services for the Developmentally Disabled Skilled Nursing Pediatric Care (ICF/DD SNF/PED license)
Supportive Living Facility Services (SLF)
For consideration to be given by the department for payment for long term care facility services, the services must be provided by a participating facility that is enrolled to provide the specific category of service (level of care) for which charges are made, and the services must be provided in full compliance with policy and procedures contained in the various sections of the Handbook for Nursing Facilities.
To participate in the Illinois Medical Assistance Program and receive payment from the department for services to residents, a long term care facility must comply with the provisions of Topic 110, Provider Participation, and Topic 111, Provider Requirements, in general Provider Handbook, Section I, Chapter 100 and, in addition, meet the following specific requirements:
The facility must hold a valid license issued by the Illinois Department of Public Health (IDPH), or the appropriate state agency for facilities located out of state, that specifies the level(s) of care the facility is licensed to provide. SLFs do not require a license from the Department of Public Health.
The facility must be certified by the Illinois Department of Public Health as being in compliance with applicable federal regulations for Title XIX (Medicaid) participation. Out of state facilities must have a Medicaid provider agreement with the Title XIX agency in the state of location. SLFs must be certified by the Illinois Department of Healthcare and Family Services as being in compliance with applicable regulations.
The facility must agree to accept the department's reimbursement rates and comply with all requirements contained in the Handbook for Nursing Facilities. Out of state facilities must negotiate an acceptable rate for the services being provided by the facility.
The facility must have a current, completed and signed Form HFS 1432 (pdf)
, Long Term Care Provider Agreement Nursing Facilities (Provider Type 33), HFS1432A (pdf)
, Long Term Care Provider Agreement ICF/DD (Provider Type 29), or HFS 1432B (pdf)
, Long Term Care provider Agreement SLF (Provider Type 28), on file with the department.
For more information contact the Department of Healthcare and Family Services, Bureau of Long Term Care. Phone: 217-524-7245 Fax: 217-524-7114 or E-mail: Bureau of Long Term Care