Section 230.100  Definitions

 

The following terms shall have the meanings ascribed to them here whenever the term is used in this Part.

 

Act – the Civil Administrative Code of Illinois.

 

Applicant – the health care facility or program applying for initial Medicare or Medicaid certification.

 

Department – the Illinois Department of Public Health.

 

Health care facility or program – an entity applying to be certified to participate in the Medicare program under Title XVIII of the federal Social Security Act or in the Medicaid program under Title XIX of the federal Social Security Act.  (Section 55.82 of the Civil Administrative Code of Illinois [20 ILCS 2310/55.82])

 

Inspection or survey – the examination, by the Department, of compliance with requirements for participation in the Medicare or Medicaid program.

 

Section 230.200  Costs and Fees

 

a)         The Department may charge a fee to any health care facility or program applying to be certified to participate in the Medicare program or in the Medicaid program to cover the costs associated with the application, inspection and survey of the facility or program and processing of the application, including personnel costs.  The Department's decision to charge a fee will be based on whether the inspection and survey and processing costs are reimbursed to the State by the federal government.  (Section 55.82 of the Act)

 

b)         The costs associated with conducting health care facility or program initial certification inspections shall be calculated based on the following:

 

1)         Number of hours to conduct survey for facility or program type, i.e., long-term care facility, home health agency, rural health clinic, end-stage renal dialysis center, hospice program, hospital, physical or occupational therapist in independent practice, occupational therapy, speech therapy, outpatient physical therapy, ambulatory surgical treatment center, portable x-ray unit;

 

2)         Personnel costs (i.e., average salaries of surveyors and retirement, insurance, and social security benefits);

 

3)         Travel costs;

 

4)         Processing of the application. (Section 55.82 of the Act)

 

c)         The fee charged to a health care facility or program for an initial certification inspection shall be determined by the actual average cost for conducting surveys for that type of program or facility during the previous 12 months.

 

d)         If a fee is charged, it shall be reduced by the amount reimbursed to the State by the federal government for surveys for that type of program or facility during the previous quarter of the federal fiscal year.

 

e)         The Department shall notify the applicant of the amount of any fee to be charged within 30 calendar days after receiving a completed application.

 

f)         The fee shall be paid by the facility or program before the application is processed.  (Section 55.82 of the Civil Administrative Code of Illinois) If the applicant does not submit the fee to the Department within 30 calendar days after receipt of the notice, the applicant shall be considered to have declined the certification inspection.

 

g)         The Department shall not refund initial certification inspection fees.

 

h)         If unforeseen circumstances affecting the facility or program occur after the fee has been paid, the Department shall postpone the inspection and shall not charge an additional fee.  Such circumstances may include, but not be limited to, a natural disaster or a loss of essential services.

 

Section 230.300  Application Processing

 

a)         An application for initial Medicare or Medicaid certification shall be submitted to the Department  in accordance with instructions from the Health Care Financing Administration (HCFA), if required.  Information requested may include, but is not limited to:

 

1)         Applicant information, including whether the applicant is an individual or organization, Board Certification, and professional licensure;

 

2)         Location information, including billing address and location of patient records;

 

3)         Exclusion/sanction information;

 

4)         Prior practice information;

 

5)         Managing/directing employee information;

 

6)         Ownership information;

 

7)         Chain organization information;

 

8)         Parent/joint venture/subsidiary information;

 

9)         Contractor information;

 

10)       Electronic submission information.

 

b)         The Department shall process the application and conduct an initial certification inspection within 30 calendar days after receipt of the initial certification inspection fee.

 

Section 230.400  Health Care Facility and Program Survey Fund

 

The fees received by the Department under this Part shall be deposited into the Health Care Facility and Program Survey Fund in the State Treasury. (Section 55.82 of the Act)