Skilled Nursing Facilities for Pediatrics (SNF/Peds) Exceptional Care Issues

Purpose

The purpose of this Information Bulletin is to inform all interested parties of changes or clarifications in the Division of Developmental Disabilities' (DDD) procedures related to Exceptional Care Program funding for Skilled Nursing Facilities for Pediatrics (SNFs/Ped).

Process and Procedure

• Issue 1

  The Division at times has approved individuals over the age of 22 for the Exceptional Care Program; at other times, such individuals have not been approved. Individuals who are enrolled in the Exceptional Care Program prior to the age of 22, but who remain in the facility after their 22nd birthday, are authorized to remain in the program if eligible.

• Clarification

  The Division will authorize individuals over the age of 22 for the Exceptional Care Program if they are otherwise eligible. This is consistent with 89 Illinois Administrative Code 144. Providers may request retroactive authorizations and payments under the Exceptional Care Program for individuals admitted on or after July 1, 2013, through the effective date of this bulletin. Payments for requests for individuals admitted on or after the effective date of this bulletin will be effective with the date of approval.

• Issue 2

  During the annual on-site visits, the Division currently reviews life safety code matters, a process that appears to be duplicative with Department of Public Health (DPH) surveys.

• Process Change

  The Division will accept and use the DPH results rather than complete duplicate reviews of life safety code matters, e.g., emergency drills and building issues, during the annual reviews for exceptional care.

• Issue 3

  In reviewing requests for the Exceptional Care Program, in rare cases, a question on the part of the DDD regarding ICF/MR eligibility of an individual resulted in issues with the Exceptional Care approval.

• Clarification

  Once an individual is admitted to a SNF/Ped through the Pre-Admission Screening process, basic ICF/MR eligibility will not be an issue that impacts the Exceptional Care Program reviews. ICF/MR eligibility and the proper application of the Pre-Admission Screening process remain issues that may be reviewed during the DPH survey process or DDD administrative activities.

• Issue 4

  The review process has become cumbersome and resource intensive for both providers and Division staff.

• Process Change

  The Division is streamlining the review process. It will complete annual reviews on site as required by 89 Illinois Administrative Code 144.100. Other reviews will consist of desk reviews, with the providers submitting a properly completed Facility Roster, Licensed Labor Cost Analysis, and Facility Attestation in the required format for the quarter. The Division will waive quarterly reviews as allowed by IL Administrative Code 144.100 j)2). The Division will modify its review protocol tool to be consistent with these agreements. In modifying the review protocol tool, the Division will accept and use DPH survey results where possible.

Effective Date

These changes are effective immediately with the posting of this bulletin. Facility Roster, Licensed Labor Cost Analysis, and Facility Attestation forms are now available.