Provider Notice issued 04/17/2026

Revised Rule for Ventilator Services Enhanced Care Rate

This notice informs nursing facilities of revisions to 89 Ill. Admin. Code Part 147.335 (a), which relates to the enhanced care rate for ventilator services. The rulemaking was filed for publication on March 9, 2026. The adopted language can be found at Illinois Register Issue 12 on pages 4212 and 4223. The Department will not begin reviewing for compliance until July 1, 2026, to allow providers time to come into compliance with the rule.

Following are summaries of the main points of the rule revisions. These summaries are intended for convenience only; the rules should be consulted for specific requirements.

Section 147.335 (a) Ventilator Services 

• Adds the requirement of 12-month renewals for continuation of existing ventilator services enhanced care rate requests.

Section 147.335 (a)(1) Services that Qualify for Ventilator Services Enhanced Care Rate

• Adds requirement that residents must have a functioning tracheostomy and be dependent on the use of invasive mechanical ventilation for a minimum of 10 hours daily, 7 days a week.

Section 147.335 (a)(2) Services that Do Not Qualify for Ventilator Services Enhanced Care Rate

• Adds Physician Order Sheets with orders such as "PRN" or "as needed", or standby ventilator orders are not eligible for the enhanced care rate.

Section 147.335 (a)(3) Ventilator Weaning Requirements for Ventilator Services Enhanced Rate Approval

• Details eligibility of the weaning process when non-invasive ventilation modes are used in active ventilator weaning that meets the minimum requirement of 10 hours daily on invasive mechanical ventilation as defined in (a)(1)(A).

Section 147.335 (a)(5) Process for Facility to Become Authorized for Ventilator Services Enhanced Care Rate

• Adds that the authorized effective date can be no sooner than 30 calendar days from the application submission date.

Section 147.335 (a)(7) Criteria for Facility Authorization to Bill for Ventilator Services Enhanced Care Rate

• Requires no less than one Illinois licensed respiratory care practitioner (RCP) available to be on duty seven days per week. Previously, this requirement was for the RCP to be on-call. 

• Changes requirements from at least one of the full-time licensed nursing staff members shall have successfully completed a course in the care of ventilator dependent individuals to at least two of the current full-time licensed nursing staff members.

• New section outlines the responsibility and requirements for managing and supporting communication needs of the ventilator resident.

Questions regarding this notice should be directed to HFS.DMP.BLTC@illinois.gov

Laura Phelan, Administrator
Division of Medical Programs