il-v50i43-89-ill-adm-code-146: 89 Ill. Adm. Code 146 — Specialized Health Care Delivery Systems

1) Heading of the Part: Specialized Health Care Delivery Systems 2) Code Citation: 89 Ill. Adm. Code 146 3) Section Number: Adopted Action: 146.910 Amendment 4) Statutory Authority: Implementing and authorized by Articles III, IV, V and VI and Section 12-13 of the Illinois Public Aid Code [305 ILCS 5]. 5) Effective Date of Rule: October 6, 2026 6) Does this rulemaking contain an automatic repeal date? No 7) Does this rulemaking contain incorporations by reference? No 8) A copy of the Adopted Rule, including any materials incorporated by reference, is on file in the Agency's principal office and is available for public inspection. 9) Notice of Proposal Published in the Illinois Register: 50 Ill. Reg. 5308; April 17, 2026 10) Has JCAR issued a Statement of Objection to this rulemaking? No 11) Differences between Proposal and Final Version: Language was changed as follows: • In section 146.910(e)(4), all added language is italicized; "$15.00" was changed to "$15"; and "[210 ILCS 49/5-107]" was added after the period. • In section 146.910(e)(5), added language is italicized; "$10.00" was changed to "$10"; and "[210 ILCS 49/5-107]" was added the period. • In section 146.910(e)(6), all added language is italicized. • In section 146.910(e)(7), all added language is italicized; and "[210 ILCS 49/5- 107]" was added after the period. • In section 146.910(e)(10), all added language is italicized. • In section 146.910(e)(10)(A), added language is italicized. DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT • In section 146.910(e)(10)(B), added language is italicized. • In section 146.910(e)(10)(C), all added language is italicized; and "[210 ILCS 49/5-113]" was added after the period. • In section 146.910(e)(11), "July 1, 2025" was changed to "October 1, 2026"; a carriage return and an indent was added after "rooms.", and the remaining text was changed to as follows: "A) Such interim rate shall be determined by: i) The necessary reduction in licensed beds during the transition to single occupant rooms; ii) The length of time necessary to transition individuals to community settings; and iii) The difference between the current daily rate and the single occupancy rate. B) Receipt of the additional interim rate will be dependent on continued compliance with an agreed upon transition plan. C) The interim rate will increase the facility rate each quarter by the pro-rated difference between the provider's current rate and the single occupancy rate. The pro-rated amount will be dependent on the estimated amount of time necessary to transition residents to the community and reduce the number of licensed beds. Failure to maintain compliance with the bed reduction plan will result in forfeiture of the interim rate increases." 12) Have all the changes agreed upon by the agency and JCAR been made as indicated in the agreements issued by JCAR? Yes 13) Will this rulemaking replace an emergency rule currently in effect? No 14) Are there any other rulemakings pending on this Part? No DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT 15) Summary and Purpose of Rulemaking The adopted rulemaking amends 89 Ill. Adm. Code Sections 146.910 which details reimbursement for providers licensed under the Specialized Mental Health Rehabilitation Act of 2013. Pursuant to Public Act 103-102, beginning on January 1, 2024, the previously established add on rate for single room occupancy is being increased from $15.00 to $25.50 per day, and the previously established add on rate for dual room occupancy is being increased from $10.00 to $14.50 per day. Pursuant to Public Act 103-0593, beginning on January 1, 2025, the previously established add on rate for single room occupancy is being increased from $25.50 to $35.50 per day, and the previously established add on rate for dual room occupancy is being increased from $14.50 to $23.25 per day. Also pursuant to Public Act 103-0593, this rulemaking also includes the addition of section 5-113 of The Specialized Mental Health Rehabilitation Act of 2013 to establish a separate per diem add-on paid solely and exclusively to facilities listed under this act that are licensed for only single occupancy rooms and have reduced their licensed capacity. Rates will vary based on number of licensed beds in the facility and range from a total payment between $220 to $240 per resident day. No facility licensed under this Act shall be eligible for these payments if the facility contains any rooms that house more than a single occupant and have failed to reduce the facilities' licensed capacity. 16) Information and questions regarding this adopted rulemaking shall be directed to: Chris Gange Acting General Counsel Illinois Department of Healthcare and Family Services 201 South Grand Avenue East, 3 Floor Springfield IL 62763-0002 217-782-1233 HFS.Rules@Illinois.gov The full text of the Adopted Amendment begins on the next page: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT TITLE 89: SOCIAL SERVICES CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES SUBCHAPTER d: MEDICAL PROGRAMS PART 146 SPECIALIZED HEALTH CARE DELIVERY SYSTEMS SUBPART A: AMBULATORY SURGICAL TREATMENT CENTERS Section 146.100 General Description 146.105 Definitions 146.110 Participation Requirements 146.115 Records and Data Reporting Requirements 146.125 Covered Ambulatory Surgical Treatment Center Services 146.130 Reimbursement for Services SUBPART B: SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS Section 146.200 General Description 146.205 Definitions 146.210 Structural Requirements 146.215 SLP Participation Requirements 146.220 Resident Participation Requirements 146.225 Reimbursement for Medicaid Residents 146.230 Services 146.235 Staffing 146.240 Resident Contract 146.245 Assessment and Service Plan and Quarterly Evaluation 146.250 Resident Rights 146.255 Discharge 146.260 Grievance Procedure 146.265 Records and Reporting Requirements 146.270 Quality Assurance Plan 146.275 Monitoring 146.280 Non-Compliance Action 146.285 Voluntary Surrender of Certification 146.290 Geographic Groups DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT 146.295 Emergency Contingency Plan 146.300 Waivers 146.305 Reporting of Suspected Abuse, Neglect and Financial Exploitation 146.310 Facility Management of Resident Funds SUBPART C: STATE HEMOPHILIA PROGRAM Section 146.400 Definitions 146.410 Patient Eligibility 146.420 Hemophilia Treatment Centers 146.430 Comprehensive Care Evaluation 146.440 Home Transfusion Arrangements 146.450 Obligations of the Department SUBPART D: CHILDREN'S COMMUNITY-BASED HEALTH CARE CENTERS Section 146.500 General Description 146.510 Definitions 146.520 Participation Requirements 146.530 Records and Data Reporting Requirements 146.540 Covered Children's Community-Based Health Care Center Services 146.550 Reimbursement for Services 146.560 Individuals Eligible for Services Provided in a Children's Community-Based Health Care Center 146.570 Prior and Post Approval of Services SUBPART E: SUPPORTIVE LIVING PROGRAM (SLP) SETTINGS WITH DEMENTIA CARE UNITS Section 146.600 General Description 146.610 Structural Requirements 146.620 Participation Requirements 146.630 Resident Participation Requirements 146.640 Services 146.650 Reimbursement for Medicaid Residents 146.660 Staffing DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT 146.670 Assessment and Service Plan and Quarterly Evaluation 146.680 Monitoring 146.690 Reporting Requirements 146.700 Resident Rights 146.710 Discharge SUBPART F: BIRTH CENTERS Section 146.800 General Description 146.810 Participation Requirements 146.820 Record Requirements 146.830 Covered Birth Center Services 146.840 Reimbursement of Birth Center Services SUBPART G: SPECIALIZED MENTAL HEALTH REHABILITATION FACILITIES Section 146.900 General Provisions 146.910 Reimbursement SUBPART H: MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES Section 146.1000 Applicability of This Part 146.1001 MC/DD Service Criteria 146.1005 Determination of Program (Active Treatment) Costs 146.1010 Inspection of Care and Rate Setting Appeal Process 146.1015 Exceptional Care Needs of Clients with Developmental Disabilities 146.1020 Specialized Care – Behavior Development Programs 146.1025 Specialized Care – Health and Sensory Disabilities 146.1030 Functional Needs 146.1035 Reimbursement for Program (Active Treatment) Costs in Residential Facilities for Clients with Developmental Disabilities 146.TABLE A Guidelines for Determining Levels of Functioning 146.TABLE B Standardized Adaptive Functional Assessment DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT AUTHORITY: Implementing and authorized by Articles III, IV, V, VI and Section 12-13 of the Illinois Public Aid Code [305 ILCS 5]. SOURCE: Old Part repealed at 14 Ill. Reg. 13800, effective August 15, 1990; new Part adopted at 20 Ill. Reg. 4419, effective February 29, 1996; emergency amendment at 21 Ill. Reg. 13875, effective October 1, 1997, for a maximum of 150 days; amended at 22 Ill. Reg. 4430, effective February 27, 1998; emergency amendment at 22 Ill. Reg. 13146, effective July 1, 1998, for a maximum of 150 days; amended at 22 Ill. Reg. 19914, effective October 30, 1998; amended at 23 Ill. Reg. 5819, effective April 30, 1999; emergency amendment at 23 Ill. Reg. 8256, effective July 1, 1999, for a maximum of 150 days; amended at 23 Ill. Reg. 13663, effective November 1, 1999; amended at 24 Ill. Reg. 8353, effective June 1, 2000; emergency amendment at 26 Ill. Reg. 14882, effective October 1, 2002, for a maximum of 150 days; amended at 27 Ill. Reg. 2176, effective February 1, 2003; emergency amendment at 27 Ill. Reg. 10854, effective July 1, 2003, for a maximum of 150 days; amended at 27 Ill. Reg. 18671, effective November 26, 2003; emergency amendment at 28 Ill. Reg. 12218, effective August 11, 2004, for a maximum of 150 days; emergency amendment at 28 Ill. Reg. 14214, effective October 18, 2004, for a maximum of 150 days; amended at 29 Ill. Reg. 852, effective January 1, 2005; emergency amendment at 29 Ill. Reg. 2014, effective January 21, 2005, for a maximum of 150 days; amended at 29 Ill. Reg. 4360, effective March 7, 2005; expedited correction at 29 Ill. Reg. 14127, effective March 7, 2005; amended at 29 Ill. Reg. 6967, effective May 1, 2005; amended at 29 Ill. Reg. 14987, effective September 30, 2005; amended at 30 Ill. Reg. 8845, effective May 1, 2006; amended at 31 Ill. Reg. 5589, effective April 1, 2007; emergency amendment at 31 Ill. Reg. 5876, effective April 1, 2007, for a maximum of 150 days; amended at 31 Ill. Reg. 11681, effective August 1, 2007; amended at 33 Ill. Reg. 11803, effective August 1, 2009; emergency amendment at 36 Ill. Reg. 6751, effective April 13, 2012, for a maximum of 150 days; amended at 36 Ill. Reg. 13885, effective August 27, 2012; amended at 37 Ill. Reg. 17624, effective October 28, 2013; expedited correction at 38 Ill. Reg. 4518, effective October 28, 2013; amended at 38 Ill. Reg. 13255, effective June 11, 2014; amended at 38 Ill. Reg. 13893, effective June 23, 2014; amended at 38 Ill. Reg. 15152, effective July 2, 2014; emergency amendment at 38 Ill. Reg. 15713, effective July 7, 2014, for a maximum of 150 days; amended at 38 Ill. Reg. 23768, effective December 2, 2014; emergency amendment at 39 Ill. Reg. 6945, effective May 1, 2015 through June 30, 2015; emergency amendment at 42 Ill. Reg. 13733, effective July 2, 2018, for a maximum of 150 days; emergency amendment to emergency rule at 42 Ill. Reg. 16311, effective August 13, 2018, for the remainder of the 150 days; emergency expired November 28, 2018; amended at 42 Ill. Reg. 16731, effective August 28, 2018; emergency amendment at 42 Ill. Reg. 17935, effective September 24, 2018, for a maximum of 150 days; emergency expired February 20, 2019; amended at 43 Ill. Reg. 6803, effective May 28, 2019; Subpart B and Subpart E recodified at 43 Ill. Reg. 7014; amended at 44 Ill. Reg. 2331, effective January 15, 2020; emergency amendment at 44 Ill. Reg. 12825, effective July 17, 2020, for a maximum of 150 days; amended at 44 Ill. Reg. 19760, effective December 11, 2020; amended at 45 Ill. Reg. 5877, effective April 26, 2021; amended at 45 Ill. Reg. 8319, effective June 28, 2021; amended at 45 Ill. Reg. 10015, effective July 26, 2021; amended at 47 Ill. Reg. 18051, effective November 21, 2023; amended at 48 Ill. Reg. 895, effective December 27, 2023; amended at 49 Ill. Reg. 10270, effective July 23, 2025; amended at 50 Ill. Reg. 13864, effective September 2, 2026; amended at 50 Ill. Reg. 15569, effective October 6, 2026. SUBPART G: SPECIALIZED MENTAL HEALTH REHABILITATION FACILITIES Section 146.910 Reimbursement a) Facilities licensed under Specialized Mental Health Rehabilitation Act of 2013 shall be reimbursed at: 1) The rate in effect on June 30, 2014, less $7.07 for each facility previously licensed under the Nursing Home Care Act on June 30, 2013; 2) The rate in effect on June 30, 2013 for each facility licensed under the Specialized Mental Health Rehabilitation Act on June 30, 2013; 3) Effective for services provided on or after July 1, 2017, the rate in effect on June 30, 2017 increased by 2.8%; 4) Effective for services provided on or after July 1, 2018, the rate in effect on June 30, 2018 increased by 4%; or, 5) Effective for services provided on or after July 1, 2022, the rate in effect on June 30, 2022, increased by 5%. 6) Effective for services provided on or after October 1, 2022, providers outside of the Chicago metro area will have their rates increased to reflect the Chicago area regional wage factor. b) Any adjustment in the support component or the capital component for facilities licensed by the Department of Public Health under the Nursing Home Care Act shall apply equally to facilities licensed by the Department of Public Health under the Specialized Mental Health Rehabilitation Act of 2013. 1) Beginning January 1, 2025, the real estate tax component of the payment rate shall be updated using the 2022 long term care site property tax bill included with the facility's 2023 cost report that has been filed with the Department. 2) The per diem rate shall be computed by dividing the allowable facility 2022 real estate tax bill costs reported in the 2023 cost report inflated to the midpoint of the rate year by the total number of patient days reported in the same cost report. Computation of the real estate tax component shall be based on capital days as defined in Section 140.570(b)(3). c) Notwithstanding the provisions set forth in 89 Ill. Adm. Code 153, facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall receive a payment in the amount of $29.43 per licensed bed, per day, for the period beginning June 1, 2014 and ending June 30, 2014. d) Facilities licensed or provisionally licensed under the Specialized Mental Health Rehabilitation Act of 2013 on or before June 1, 2018 will be reimbursed for therapeutic visits that have been indicated by an interdisciplinary team as therapeutically beneficial at the following: 1) Effective for dates of service June 4, 2018 through July 26, 2018, therapeutic visits are reimbursed at a rate of 75% of the facility's rate as of June 4, 2018. 2) Effective for dates of service on or after July 27, 2018 through June 30, 2020, therapeutic visits are reimbursed at a rate of 75% of the facility's rate as of July 27, 2018. 3) Effective for dates of service on or after July 1, 2020, therapeutic visits are reimbursed at a rate of 75% of the facility's current rate. 4) Facilities may not be reimbursed for more than 10 consecutive days of therapeutic visits and no more than 20 days of therapeutic visits per State fiscal year. e) Notwithstanding the provisions set forth in 89 Ill. Adm. Code 153 and in addition to the rate for recovery and rehabilitation, facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall receive an additional payment in the amount, as follows: 1) Effective for dates of service on or after July 1, 2019, a payment of no less than $10 per day, per single room occupancy rate. 2) Effective for dates of service on or after July 1, 2022, an additional payment of no less than $5 per day, per single room occupancy will be added to the existing $10 additional per day, per single room occupancy rate for a total of at least $15 per day, per single room occupancy. 3) Effective for dates of service on or after July 1, 2022, an additional rate for dual-occupancy rooms will be no less than $10 per day, per Medicaid- occupied bed, in each dual-occupancy room. Under this subsection (e)(3), "dual-occupancy room" means a room that contains 2 licensed beds. [210 ILCS 49/5-107] 4) Beginning on January 1, 2024, a payment of no less than $10.50 per day, per single room occupancy shall be added to the existing $15 additional per day, per single room occupancy rate for a total of at least $25.50 per day, per single room occupancy. [210 ILCS 49/5-107]The add-on amounts under subsections (e)(1), (e)(2), and (e)(3) will not be applied to leave of absence days. 5) Beginning January 1, 2024, a payment of no less than $4.50 per day, per dual-occupancy room shall be added to the existing $10 additional per day, per dual-occupancy room rate for a total of at least $14.50, per Medicaid-occupied bed, in each dual-occupancy room. [210 ILCS 49/5- 107]Effective for dates of service on or after November 1, 2022, a $32 add-on to the facility rate for providers who: A) Prior to November 1, 2022, had at least half of their facility rooms with 3 or more licensed beds; and B) After November 1, 2022, reduced the number of licensed beds in all rooms to 2 licensed beds or fewer. 6) Beginning on January 1, 2025, a payment of no less than $10 per day, per single room occupancy shall be added to the existing $25.50 additional DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT per day, per single room occupancy rate for a total of at least $35.50 per day, per single room occupancy. 7) Beginning January 1, 2025, a payment of no less than $8.75 per day, per dual-occupancy room shall be added to the existing $14.50 additional per day, per dual-occupancy room rate for a total of at least $23.25, per Medicaid-occupied bed, in each dual-occupancy room. [210 ILCS 49/5- 107] 8) The add-on amounts under subsections (e)(1), (e)(2), (e)(3), (e)(4), (e)(5), (e)(6) and (e)(7) will not be applied to leave of absence days. 9) Effective for dates of service on or after November 1, 2022, a $32 add-on to the facility rate for providers who: A) Prior to November 1, 2022, had at least half of their facility rooms with 3 or more licensed beds; and B) After November 1, 2022, reduced the number of licensed beds in all rooms to 2 licensed beds or fewer. 10) Beginning January 1, 2025, there shall be a separate per diem add-on paid solely and exclusively to facilities licensed under this Act that are licensed for only single occupancy rooms and have reduced their licensed capacity. No facility licensed under this Act shall be eligible for these payments if the facility contains any rooms that house more than a single occupant and have failed to reduce the facilities' licensed capacity. The payment shall be a per diem add-on payment. All add-on rates shall be based upon the new licensed capacity. A) For facilities with less than 100 licensed beds, the add-on payment shall result in a rate not less than $240 per day. B) For facilities with 100 licensed beds to 130 licensed beds, the add- on payment shall result in a rate not less than $230 per day. C) For facilities with more than 130 licensed beds, the add-on payment shall result in a rate of not less than $220 per day [210 ILCS 49/5-113]. DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF ADOPTED AMENDMENT 11) Effective for dates of service on or after October 1, 2026, an additional interim payment rate may be negotiated with the Department and paid to any facility that is reducing capacity within the facility to all single occupant rooms. A) Such interim rate shall be determined by: i) The necessary reduction in licensed beds during the transition to single occupant rooms; ii) The length of time necessary to transition individuals to community settings; and iii) The difference between the current daily rate and the single occupancy rate. B) Receipt of the additional interim rate will be dependent on continued compliance with an agreed upon transition plan. C) The interim rate will increase the facility rate each quarter by the pro-rated difference between the provider's current rate and the single occupancy rate. The pro-rated amount will be dependent on the estimated amount of time necessary to transition residents to the community and reduce the number of licensed beds. Failure to maintain compliance with the bed reduction plan will result in forfeiture of the interim rate increases. (Source: Amended at 50 Ill. Reg. 15569, effective October 6, 2026) DEPARTMENT OF HUMAN SERVICES NOTICE OF ADOPTED AMENDMENTS