Provider Notice issued 11/30/09

Payment for Ventilator-Dependent Residents

This process will resolve concerns from the nursing facility industry that credit is not received for a ventilator-dependent resident when the resident is not in the facility on the "snapshot day" (last day of the quarter) used for the quarterly calculation of the nursing rate component from the MDS. Additionally, the process will resolve delays with entering admits to the Recipient Data Base (RDB), which cause facilities to not receive credit for a ventilator-dependent resident. By setting an individual rate for a ventilator-dependent resident, the facility will get paid for the actual days the resident was in the facility receiving ventilator services.

A rate for ventilator-dependent residents will consist of a facility’s support, capital and nursing components plus an average geographic area rate determined from the ventilator minutes obtained from facility MDS plus $150 for supply costs. Following are the average geographic area dollars assigned to the MDS ventilator minutes plus $150 supply cost for the quarter beginning October 1, 2009. Add the following amount to your Medicaid per diem to obtain the ventilator rate that will be paid to your facility for qualifying residents.

While ventilator minutes will be pulled from the calculation for a facility’s nursing rate component, other services coded by a facility on the MDS for a ventilator-dependent resident shall continue to be applied toward the nursing component of the nursing facility rate.

For purposes of this payment, ventilators are defined as any type of electrical or pneumatical powered closed mechanical system for residents who are, or who may become, unable to support their own respiration. It does not include Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BIPAP) devices.

All staff caring for ventilator-dependent residents must have documented in-service training in ventilator care prior to providing such care. In-service training must be conducted at least annually by a certified respiratory therapy technician or registered respiratory therapist or a qualified registered nurse who has at least one-year experience in the care of ventilator- dependent persons. In-service training documentation must include name and qualification of the in-service director, duration of presentation, content of presentation and signature and position description of all participants.

Note: Training for licensed nursing staff must include, but is not limited to, assessing the respiratory status/needs of the resident, infection control techniques, providing respiratory care to the resident, and operating/understanding the mechanism of the ventilator system.

 

Training for unlicensed staff must include, but is not limited to, assisting the resident with activities of daily living, infection control techniques and communicating with the ventilator resident.

In order for an applicable rate to be assigned to a ventilator-dependent resident, a nursing facility must notify the department by submitting Form HFS 106, Nursing Facility Ventilator Notification. This form must be submitted initially to identify residents on a ventilator as of October 1, 2009, and after October 1, 2009, when a ventilator-dependent resident is admitted, put on a ventilator, discharged from the facility, dies or is no longer on a ventilator. Notification in any instance, other than initial identification, shall occur within five days of the admission, discharge, death or removal from the ventilator. Discharge is defined as the resident leaving the facility with no intention of returning. It does not mean an admission to a hospital. Incomplete forms or forms submitted without required physician order sheet identifying need for ventilator services will be returned. The form must be faxed to 217-524-7114 or mailed to the following address:

Illinois Department of Healthcare and Family Services
Bureau of Long Term Care
201 S. Grand Avenue East
Springfield, IL 62763

The form must be submitted to HFS twice, identifying vents as of October 1, 2009, and after October 1, 2009, at admission or when resident is put on a ventilator and again at discharge, death or removal from the ventilator. The form should be sent to the department even if the RDB has not been updated with the resident’s admit. It will be held until an admission to the RDB is completed.

The form referenced in this notice is available on the department's Medical Forms Web site.

Questions can be directed to the Bureau of Long Term Care at 217-524-0372.

Theresa A. Eagleson, Administrator
Division of Medical Programs