Section 146.205 Definitions

Section 146

TITLE 89: SOCIAL SERVICES

CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SUBCHAPTER d: MEDICAL PROGRAMS

PART 146 SPECIALIZED HEALTH CARE DELIVERY SYSTEMS

SECTION 146.205 DEFINITIONS

Section 146.205  Definitions

For purposes of this Part, the

following terms shall be defined as follows:

"Abuse"

means the willful infliction of injury, unreasonable confinement, intimidation,

or punishment with resulting physical harm, pain or mental anguish (42 CFR

488.301).

"Activities

of Daily Living" or "ADL" means eating, bathing, dressing,

transferring, toileting, walking and grooming.

"Advance

Directive" means a power of attorney that gives a designated individual

decision-making powers upon a person's incompetence.  The Department of Public

Health is required to make available a Uniform Do Not Resuscitate Advance Directive

that may be used in all settings, the Statutory Will Declaration form, the

Illinois Statutory Short Form Power of Attorney for Health Care, the statutory

Declaration of Mental Health Treatment Form, and the summary of advance directives

law in Illinois (Section 2310-600 of the Department of Public Health Powers and

Duties Law of the Civil Administrative Code of Illinois [20 ILCS 2310-600].

"Bank

Nursing Facility Beds" means a choice by SLP providers to participate by

converting a distinct part of a nursing facility.  Such facilities shall be

allowed to retain the Certificate of Need for nursing beds that were converted.

"Complaint"

means a phone call, letter or personal contact to the Department from a

resident, family member, resident representative or any other interested person

expressing a concern related to the health, safety or well-being of one or more

SLP residents.

"Comprehensive

Resident Assessment Instrument" or "RAI" means the Department

designated resident assessment instrument designed for use in SLP settings

ns a phone call, letter or personal contact to the Department from a

resident, family member, resident representative or any other interested person

expressing a concern related to the health, safety or well-being of one or more

SLP residents.

"Comprehensive

Resident Assessment Instrument" or "RAI" means the Department

designated resident assessment instrument designed for use in SLP settings.

"Declaration of Mental Health

Treatment" means a document that lets a person state he or she wants to

receive electroconvulsive treatment (ECT) or psychotropic medicine when the

person has a mental illness and is unable to make decisions for himself or

herself.  It also allows a person to say whether he or she wishes to be

admitted to a mental health facility if unable to make that decision.

"Department"

means the Illinois Department of Healthcare and Family Services.

"Determination of Need"

or "DON" means the assessment tool used by the Department or the

Department's authorized representative to determine functional needs of a

resident or prospective resident of the SLP in which the resident or

prospective resident has been found to be in need of a nursing facility level of

care.  A minimum score of 29 is required on the DON, which indicates a nursing

facility level of care, before payment may be authorized for the SLP resident.

"Developmental

Disability" or "DD" means a disability that is attributable to a

diagnosis of mental retardation or related condition such as cerebral palsy or

epilepsy that results in impairment of general intellectual functioning or

adaptive behavior.  This condition is manifested before the age of 22 and is

likely to continue indefinitely.  It results in substantial functional

limitations in three or more areas of major life activities, such as self-care,

understanding and use of language, learning, mobility, self-direction, and

capacity for independent living

results in impairment of general intellectual functioning or

adaptive behavior.  This condition is manifested before the age of 22 and is

likely to continue indefinitely.  It results in substantial functional

limitations in three or more areas of major life activities, such as self-care,

understanding and use of language, learning, mobility, self-direction, and

capacity for independent living.

"Direct

Care Staff" means staff that provides professional nursing services,

assistance with activities of daily living or other personal needs or

maintenance, or general supervision and oversight of the physical and mental well

being of an individual.

"Distinct

Part" means a separate building or an entire wing or other physically

identifiable space of an existing nursing facility licensed under the Nursing

Home Care Act or the Hospital Licensing Act that is operated as an SLP setting distinguishable

from the rest of the facility.  The distinct part of a nursing facility will

not be subject to provisions of the Nursing Home Care Act.  The distinct part

of a hospital will be subject to provisions of the Hospital Licensing Act while

complying with provisions of this Subpart B.  Distinct part does not include

the conversion of an entire nursing facility or hospital.

"Do Not Resuscitate" or "DNR"

means a medical treatment order that says cardiopulmonary resuscitation (CPR)

will not be attempted if a person's heart and/or breathing stops.

"Durable Power of

Attorney" means power of attorney given to a person designated as another

person's agent giving broad powers to make health care decisions, including

power to require, consent to or withdraw any type of personal care or medical

treatment for any physical or mental condition, and to admit or discharge a

person from any hospital, home or other institution

d/or breathing stops.

"Durable Power of

Attorney" means power of attorney given to a person designated as another

person's agent giving broad powers to make health care decisions, including

power to require, consent to or withdraw any type of personal care or medical

treatment for any physical or mental condition, and to admit or discharge a

person from any hospital, home or other institution.

"Financial Exploitation"

means the act of obtaining control over a resident or his or her property

and/or resources through deception or intimidation to the disadvantage of the

resident and/or the profit of another and/or the intent of depriving the

resident of the use, benefit or possession of his or her property and/or

resources.

"Follow-up

Care" means the response to, and documentation of, the service plan that

is discussed with, and agreed to by, the resident and/or the resident's guardian.

It may include, but is not limited to, physician referrals, revision of the

service plan to incorporate nursing services, health promotion counseling and

teaching self care in meeting health needs.

"Freestanding

Facility" means a separate building that is not part of an existing

nursing facility or hospital.  Freestanding facility includes new construction,

an existing building or conversion of an entire nursing facility or hospital

into an SLP setting.

"Immediate Jeopardy"

means a situation in which a provider's noncompliance with one or more

requirements of participation has caused, or is likely to cause, serious

injury, harm, impairment or death to a resident (42 CFR 488.301).

"Instrumental Activities of

Daily Living" or "IADL" means activities related to independent

living and includes preparing meals, managing money, shopping for groceries or

personal items, performing light or heavy housework, and using a telephone

ne or more

requirements of participation has caused, or is likely to cause, serious

injury, harm, impairment or death to a resident (42 CFR 488.301).

"Instrumental Activities of

Daily Living" or "IADL" means activities related to independent

living and includes preparing meals, managing money, shopping for groceries or

personal items, performing light or heavy housework, and using a telephone.

"Licensed

Nurse" means a person whose services are paid for by an SLP and who is

licensed as a registered nurse, registered professional nurse, practical nurse

or licensed practical nurse under the Nurse Practice Act [225 ILCS 65].

"Living Will" means a

document that tells a person's health care professional whether the person

wants death-delaying procedures used if the person has a terminal condition,

and the person is unable to state his or her wishes.  A terminal condition

means an incurable and irreversible condition such that death is imminent, and

the application of any death delaying procedures serves only to prolong the

dying process.  A living will allows for the administration of medication,

sustenance, or the performance of any medical procedure deemed necessary by the

person's attending physician to provide the person with comfort care.

"Mandated Reporter" is

anyone identified in the Elder Abuse and Neglect Act [320 ILCS 20] that shall

report suspected abuse while engaged in carrying out professional duties.  A

mandated reporter includes, but is not limited to, a professional or

professional's designee while engaged in social services and the care of an

adult age 60 and over.  It also includes, but is not limited to, any occupation

required to be licensed under the Dietetic and Nutrition Services Practice Act

[225 ILCS 30], Nurse Practice Act, and Nursing Home Administrator Licensing and

Disciplinary Act [225 ILCS 70], and field personnel of the Departments of

Healthcare and Family Services, Public Health and Human Services and any county

or municipal health department

lso includes, but is not limited to, any occupation

required to be licensed under the Dietetic and Nutrition Services Practice Act

[225 ILCS 30], Nurse Practice Act, and Nursing Home Administrator Licensing and

Disciplinary Act [225 ILCS 70], and field personnel of the Departments of

Healthcare and Family Services, Public Health and Human Services and any county

or municipal health department.

"Medicaid"

means the Department's Medical Assistance Program.

"Medicaid

Resident" means a person with a physical disability (as determined by the

Social Security Administration) age 22 years and over or a person who is age 65

years and over, who has been determined eligible for Medicaid payment for SLP

services. Eligibility for a person residing in an SLP setting shall be

determined in accordance with 89 Ill. Adm. Code 120.10 and 120.61 (excluding

subsection (f) of Section 120.61).  Provisions for property transfers as

described at 89 Ill. Adm. Code 120.387 shall apply to a person residing in an SLP

setting.  Provisions for the prevention of spousal impoverishment as described

at 89 Ill. Adm. Code 120.379 shall apply to a person residing in an SLP setting.

"Medical

Assistance Program" means the program administered under Article V of the

Illinois Public Aid Code [305 ILCS 5/Art. V] or successor programs and Title

XIX of the Social Security Act (42 USC 1396) and related federal and State

rules and regulations.

"Medication Error"

includes, but is not limited to, incorrect dosage, medication given at

incorrect time, wrong medication given, wrong route used or missed medication.

"Neglect" means a

failure by the SLP provider to notify the appropriate health care professional,

to provide or arrange necessary services to avoid physical or psychological

harm to a resident, or to terminate the residency of a resident whose needs can

no longer by met by the SLP provider, causing an avoidable decline in

function.  Neglect may be either passive (non-malicious) or willful

on.

"Neglect" means a

failure by the SLP provider to notify the appropriate health care professional,

to provide or arrange necessary services to avoid physical or psychological

harm to a resident, or to terminate the residency of a resident whose needs can

no longer by met by the SLP provider, causing an avoidable decline in

function.  Neglect may be either passive (non-malicious) or willful.

"Personal Allowance"

means the $90 minimum protected monthly amount of a Medicaid-eligible

resident's income that is retained by Medicaid-eligible residents for their

personal use.

"Progress

Notes" means notes used to document the decline or improvement in a

resident's status.

"Rehabilitated

Nursing Facility" means the conversion of a distinct part of an existing

nursing facility into an SLP setting.

"Related

Parties" means affiliates of an SLP provider; entities for which

investments are accounted for by the equity method by the entire enterprise;

trusts for the benefit of employees, such as pensions and profit-sharing trusts

that are managed by or under the trusteeship of management; any general

partner; management of the SLP setting; members of the immediate families of

principal owners of the SLP setting or its management; and other parties with

which the SLP provider may deal if one party controls or can significantly influence

management or operating policies of the other to an extent that one of the

transacting parties might be prevented from fully pursuing its own separate

interests.  An entity or person shall be deemed by the Department to be a

related party if it can significantly influence management or operating

policies of the transacting parties or if it has an ownership interest in one

of the transacting parties and can significantly influence the other to an

extent that one or more of the transacting parties might be prevented from

fully pursuing its own separate interests

y or person shall be deemed by the Department to be a

related party if it can significantly influence management or operating

policies of the transacting parties or if it has an ownership interest in one

of the transacting parties and can significantly influence the other to an

extent that one or more of the transacting parties might be prevented from

fully pursuing its own separate interests.

"Resident"

means a person living in an SLP setting, including Medicaid residents as

defined in this Section and individuals who are not eligible for Medicaid

payment for SLP services.

"Resident Assessment

Instrument" or "RAI" or "Comprehensive Resident Assessment

Instrument" means the Department designated resident assessment instrument

designed for use in SLP settings.

"Room and

Board" means the housing, utilities and meals provided under the resident

contract. Unless otherwise specified in the resident contract, room and board

does not include phone or cable charges.

"Security Deposit" means

a payment used to secure the payment of rent or compensation for damage to

property for residential property containing 25 units or more (see Security

Deposit Interest Act [765 ILCS 715]).  A security deposit may also include a

pet deposit to secure payment for damage to the residential property.  Damage

to property shall not include normal wear and tear to an apartment or any other

part of the SLP setting.

"Serious

Mental Illness" means:

A diagnosis of a major mental

illness, such as schizophrenia, schizoaffective disorder, bipolar disorder,

major depression, panic disorders, obsessive compulsive disorder, and any other

disorder that could lead to a chronic disability that is not a primary

diagnosis of dementia

include normal wear and tear to an apartment or any other

part of the SLP setting.

"Serious

Mental Illness" means:

A diagnosis of a major mental

illness, such as schizophrenia, schizoaffective disorder, bipolar disorder,

major depression, panic disorders, obsessive compulsive disorder, and any other

disorder that could lead to a chronic disability that is not a primary

diagnosis of dementia.  If the person has both a dementia diagnosis and another

psychiatric condition, the symptoms of dementia must be significantly more

progressed than symptoms of the co-occurring psychiatric condition;

A disorder for which the duration

is a significant life disruption or that required major treatment episodes within

the past two years. This does not necessarily mean that the individual was

hospitalized; and

That the disability or Level of

Impairment is characterized by active behavioral health symptoms, within the

preceding six month period, that significantly interfere with the individual's

ability to interact interpersonally, concentrate, follow through with goals or

needs, and/or adapt effectively to change.

"Services"

means the personal and health care related services provided by an SLP provider

pursuant to Section 146.230.

"Service

Plan" means the written plan of care on the Department designated form that

is developed for each resident based upon the initial assessment, annual

comprehensive resident assessment or quarterly evaluation.

"Significant Change"

means that there has been a decline or improvement in a resident's status that

will not normally resolve itself without intervention by staff or by

implementing standard disease-related clinical interventions, and the decline

or improvement impacts more than one area of the resident's health status and

requires revision of the Service Plan.

"SSI"

means Supplemental Security Income under Title XVI of the Social Security Act

line or improvement in a resident's status that

will not normally resolve itself without intervention by staff or by

implementing standard disease-related clinical interventions, and the decline

or improvement impacts more than one area of the resident's health status and

requires revision of the Service Plan.

"SSI"

means Supplemental Security Income under Title XVI of the Social Security Act.

"Subcontractor"

means any person who assumes any duties and responsibilities from an SLP

provider for the performance of SLP services pursuant to Section 146.230.

"Supportive

Living Program" or "SLP" means a residential setting that meets

the requirements of this Subpart B or, for dementia care settings, the

requirements of this Subpart B and Subpart E.