TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115 STANDARDS AND LICENSURE REQUIREMENTS FOR COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.710 RATE COMPONENTS


 

Section 115.710  Rate components

 

The components of Department reimbursement for CILA services for persons with developmental disabilities may include, but shall not be limited to, the following, using costs as reported on the Interagency Statistical and Financial Report, or its successor, and other sources as deemed appropriate by the Department:

 

a)         Base support costs including allowances for "room and board", "program", "transportation", and "administration". Base support costs are considered to be those that are incurred in the delivery of CILA supports to individuals with developmental disabilities for the purchase of services that are common to all CILA recipients with similar living arrangements and direct service staffing and transportation needs.

 

1)         Room and board cost centers

            The "room and board" allowance includes costs incurred in keeping a home in normal operation. Cost centers under the room and board major allowance category may include:

 

A)        Housing;

 

B)        Utilities;

 

C)        Telephone;

 

D)        Building and Property Insurance;

 

E)        Maintenance and Housekeeping;

 

F)         Food Supplies;

 

G)        Nonfood Supplies; and

 

H)        Other, not elsewhere classified.

 

2)         Program cost centers

            The program allowance includes costs incurred in providing habilitation services and supports to the extent allowed by the CILA rate model.  Cost centers under the program major category may include:

 

A)        Direct care staff and supervision;

 

B)        Fringe benefits;

 

C)        Other supplies;

 

D)        Miscellaneous consultant services; and

 

E)        Other, not elsewhere classified.

 

3)         Transportation

            Transportation cost may be incurred while providers assist and/or train the persons living in the CILA home in the activities of daily living.

 

4)         Administration

            All administrative costs associated with community agency overhead expenses as they relate to the delivery of CILA supports are included within the "administration" cost center reimbursement. Community agency overhead is assumed to include all the costs associated with administrative staff, administrative clerical staff, office space costs, office operating expenses, insurance, management consultants, accounting, the cost of hiring staff, staff physical examinations, staff travel and training, conferences, conventions, association fees, and all other costs incurred in the overhead associated with the delivery of CILA supports.

 

b)         Nonbase support costs are expenses incurred due to the special added services required by specific persons living in CILAs to the extent allowed by the CILA rate model.  Nonbase supports can include other individually required supports such as nursing, special dietary needs, and therapies.  Nonbase support additions to the rate generated by the CILA rate model must be indicated as necessary by the interdisciplinary team (IDT), are not common to all individuals residing in CILAs, and may be required more intensely soon after an individual moves into a CILA, with decreasing need for them over time.  Department staff review all requests for individual nonbase supports and must approve any hourly reimbursements added to an individual's CILA rate. Nonbase support hours must be periodically reaffirmed by professional assessment.

 

c)         An individual CILA rate includes reimbursement for costs associated with providing day programs to individuals living in CILA homes.  For persons receiving day program supports that do not fit the definition of those with fixed rates, an "other day program" option is available.  Community agencies that indicate the "other day program" selection must submit a description of the supports to be provided and a proposed annual budget for Department review. Individuals between the ages of 18 and 59 are expected to be participating in out-of-home, work-oriented day programs, unless there are medical or behavioral issues that prevent such participation.

 

d)         Third party payment information concerning an individual's earned and unearned income is obtained from the "Community Reimbursement Subsystem Financial Questionnaire", and used to calculate the third party payment.  The third party payment may be subtracted from the top line rate to produce the bottom line rate, or the rate paid by the Department to the community provider agency.

 

(Source:  Renumbered from Section 115.510 and amended at 27 Ill. Reg. 5376, effective March 17, 2003)