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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 Services

Pending enactment of the budget for fiscal year 2009, 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. 

For dates of service on or after August 1, 2008, the socio-developmental component of the reimbursement rate for nursing facilities that are classified as institutions for mental diseases shall equal 6.6% of the facility's nursing component rate as of January 1, 2006, multiplied by 3.53. This will result in an average increase of $3.12 in the per diem rate. Implementation of this change will increase spending by approximately $5.2 million on an annual basis.


Effective for dates of service on or after July 1, 2008, the Department of Human Services, Division of Developmental Disabilities, is terminating the reimbursement methodology for host family community integrated living arrangement (CILA) that has been in place since June 1, 2006, as a distinct and separate approach to funding individuals in certain one and two-person settings approved as host family. The division will now fund these settings using the existing CILA rate methodology for 24-hour supports that has remained in place for other one and two-person non-host family settings. The per diem residential rate for individuals funded under the host family CILA that is terminating will increase on average by $27.05 to $134.79. The estimated annual cost of this change is approximately $450,000.


Pursuant to any implementation of federal rules affecting targeted case management (CMS 2237-IFC), the department will modify the payment methodology as necessary to meet such federal requirements. This may involve limiting case management services received by a client to a single case manager and establishing a new rate methodology based on a 15 minute billing unit. The implementation date of such changes has not yet been established by the federal Centers for Medicare and Medicaid Services (CMS).  Any change in payment methodology that may be ultimately imposed by the CMS is not anticipated to result in a net change in provider payments.


Effective for dates of service on or after July 1, 2008, vendors of homemaker services will have their rates increased by $1.70 per hour in order to increase the wages of their employees who provide homemaker services by at least $1.00 per hour. Payments to such vendors shall also be increased by $1.33 per hour to provide for health insurance for employee families who provide homemaker services.  The estimated annual cost of this increase is about $79 million. 

Reimbursement rates for personal care services will be increased for dates of service on or after each July first, as follows:

For 2008, hourly rates will increase by $0.50 to $9.85

For 2009, hourly rates will increase by $0.60 to $10.45

For 2010, hourly rates will increase by $0.75 to $11.20

For 2011, hourly rates will increase by $0.35 to $11.55

The annual cost for this increase will be $19 million in State fiscal year 2009.

For dates of service on or after July 2, 2008, the reimbursement rate for adult day care services will increase by $2.00 to $9.02 per hour. The annual cost for this increase will be $5.2 million in State fiscal year 2009.

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 changes. 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:

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 DHS local offices (except in Cook County). 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.