Section 146.215 SLP Participation Requirements

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 146.215 SLP PARTICIPATION REQUIREMENTS

Section 146.215  SLP

Participation Requirements

a)         Facilities or distinct parts of facilities that are certified in

the SLP and are in good standing with provisions contained in this Subpart B and,

when applicable, Subpart E are exempt from the provisions of the Nursing Home

Care Act [210 ILCS 45], the Illinois Health Facilities Planning Act [20 ILCS

3960] and the Assisted Living and Shared Housing Act [210 ILCS 9].  Nursing

facilities rehabilitating a portion of the facility to conform with this

Subpart B shall be allowed to retain their Certificate of Need for the nursing

facility beds that were converted until the conclusion of the project or until

the facility wishes to withdraw from the project and convert the SLP setting

beds back to NF beds.

b)         An SLP setting does not include:

1)         A home, institution, or other place operated by the federal

government or agency thereof, or by the State of Illinois;

2)         A "long term care facility" licensed by the Nursing

Home Care Act or Hospital Licensing Act.  However, a nursing facility licensed

under the aforementioned Acts can convert a distinct part to an SLP setting;

3)         Any "facility for child care" as defined in the

Child Care Act of 1969 [225 ILCS 10];

4)         Any "Community Living Facility" as defined in the

Community Living Facilities Licensing Act [210 ILCS 35];

5)         Any "community residential alternative" as defined

in the Community Residential Alternatives Licensing Act [405 ILCS 30];

6)         Any nursing home or sanitarium operated solely by and for

persons who rely exclusively upon treatment by spiritual means through prayer,

in accordance with the creed of any well recognized church or religious

denomination;

7)         Any facility licensed by the Department of Human Servi

l alternative" as defined

in the Community Residential Alternatives Licensing Act [405 ILCS 30];

6)         Any nursing home or sanitarium operated solely by and for

persons who rely exclusively upon treatment by spiritual means through prayer,

in accordance with the creed of any well recognized church or religious

denomination;

7)         Any facility licensed by the Department of Human Services as a

community-integrated living arrangement as defined in the Community Integrated

Living Arrangements Licensure and Certification Act [210 ILCS 135];

8)         Any "Supportive Residence" licensed under the

Supportive Residences Licensing Act [210 ILCS 65];

9)         Any freestanding hospice facility [210 ILCS 60];

10)         Any "life care facility" as defined in the Life

Care Facilities Act [210 ILCS 40]; or

11)         Any

"assisted living and shared housing establishment" licensed under the

Assisted Living and Shared Housing Act [210 ILCS 9].

c)         In order to participate in the Supportive Living Program, the

building structure must be certified by the Department.  To become certified,

an SLP provider shall:

1)         Submit an application to proceed toward certification.

A)        Except in the case of a rehabilitated nursing facility, the

Department shall only accept applications for sites where all apartments are

devoted to SLP residents.

B)        The Department shall evaluate each application according to

factors including, but not limited to, geographic distribution, waiver limits,

market feasibility, the needs of the population being served, the compliance

histories of other facilities owned or operated in the State of Illinois by the

applicant or a related party, community support from local government,

environmental issues, operational experience with assisted living and financial

stability

actors including, but not limited to, geographic distribution, waiver limits,

market feasibility, the needs of the population being served, the compliance

histories of other facilities owned or operated in the State of Illinois by the

applicant or a related party, community support from local government,

environmental issues, operational experience with assisted living and financial

stability.  Applications that are found to be incomplete or inaccurate shall be

returned to the applicant for completion and/or correction and must be resubmitted

before the Department will evaluate them. The Department shall notify the

applicant in writing that the application has been approved.

C)        Direct

and indirect owners of five percent or more of the entity designated as the

operator shall be disclosed to the Department.

D)        A

recognized environmental condition found as the result of a Phase 1

Environmental Site Assessment (ESA) report shall result in a Phase 2 ESA to

determine if significant amounts and concentrations of contaminants exist on the

property.  If contamination is found in Phase 2, the Department, prior to

certification, may request subsequent testing, feasibility studies, and/or

remediation.

E)        The Department may withdraw approval of any application if the SLP

building fails to become operational (i.e., ready to admit residents) within 24

months after the Department's approval of the application.  Prior to the

operational deadline, the applicant may make a written request, including

documentation justifying the need for an extension, that the Department grant

an extension to the operational deadline. A request for an extension shall not

exceed 12 months from the original operational deadline.  The Department may

grant an extension to the operational deadline. The Department shall not grant

more than one extension to an approved SLP applicant when construction has not

begun

cumentation justifying the need for an extension, that the Department grant

an extension to the operational deadline. A request for an extension shall not

exceed 12 months from the original operational deadline.  The Department may

grant an extension to the operational deadline. The Department shall not grant

more than one extension to an approved SLP applicant when construction has not

begun.

F)         A

phase-in for opening may be approved upon the written request of the SLP

provider.  The request shall include the anticipated completion date of the

phase-in, a plan to ensure the safety of residents during the phase-in, and the

floors and areas of the SLP setting impacted by the phase-in.  Additionally,

the SLP provider shall assure that all services continue to be available during

the phase-in.  The Department shall approve no more than a single phase-in.

G)        At any time prior to or subsequent to certification, the

applicant shall report to the Department in writing any change to the

application, as soon as such change becomes known to the applicant.  These changes

are subject to Department approval.

2)         Submit a certificate of compliance signed by an architect that

certifies that the project complies with applicable codes and all structural

requirements found in Section 146.210.

3)         Submit for approval prior to use a model of every type of

resident contract to be used by the SLP provider

hange becomes known to the applicant.  These changes

are subject to Department approval.

2)         Submit a certificate of compliance signed by an architect that

certifies that the project complies with applicable codes and all structural

requirements found in Section 146.210.

3)         Submit for approval prior to use a model of every type of

resident contract to be used by the SLP provider.

4)         Submit

for approval all policies that include, but are not limited to:

A)        Waste

removal plan pursuant to Section 146.210(t);

B)        Participation

criteria pursuant to Section 146.220;

C)        Base

rate services pursuant to Section 146.230;

D)        Resident

daily check plan pursuant to Section 146.230(n);

E)        Employee

hiring process pursuant to Section 146.235;

F)         SLP

setting manager experience pursuant to Section 146.235(b);

G)        Staff

training policy pursuant to Section 146.235(e);

H)        Resident

rights pursuant to Section 146.250;

I)         Resident

discharge policy pursuant to Section 146.255;

J)         Grievance

procedure pursuant to Section 146.260;

K)        Quality

assurance plan pursuant to Section 146.270;

L)        Annual

satisfaction survey policy pursuant to Section 146.270(a);

M)       Emergency

contingency plan pursuant to Section 146.295;

N)        Prevention

and reporting of abuse, neglect and financial exploitation policy pursuant to

Section 146.305;

O)        Staff

and resident rules and responsibilities;

P)         Infection

control, including, but not limited to, hand-washing, proper handling and

disposal of sharps, proper handling of linens soiled with body waste, and

cleaning of floors that have been soiled;

Q)        Water

temperature plan pursuant to Section 146.210(s)(5);

R)        Tuberculosis

plan in accordance with the Control of Tuberculosis Code (77 Ill. Adm. Code

696);

S)         Potential

resident inquiry and application for admission policy pursuant to Section

146.220; and

T)         Non-discrimination

policy

inens soiled with body waste, and

cleaning of floors that have been soiled;

Q)        Water

temperature plan pursuant to Section 146.210(s)(5);

R)        Tuberculosis

plan in accordance with the Control of Tuberculosis Code (77 Ill. Adm. Code

696);

S)         Potential

resident inquiry and application for admission policy pursuant to Section

146.220; and

T)         Non-discrimination

policy.

5)         Pass an on-site review, conducted by the Department, that

includes review of documentation that demonstrates physical plant, health and

sanitation, and food preparation compliance with local and county ordinances

and regulations; compliance with State building codes for the respective

building type; and compliance with Section 146.210.

6)         Enroll

to participate in the Medical Assistance Program in accordance with 89 Ill.

Adm. Code 140.11 and execute a provider agreement with the Department.

d)         The SLP provider shall accept the SSI rate (less the  personal

allowance) for room and board for Medicaid residents.  If the SLP provider

charges a private pay rate higher than the Medicaid rate, the SLP provider

shall reserve not less than 25 percent of its apartments for Medicaid-eligible

residents.  Those SLP settings that set a commensurate rate for both private

pay and Medicaid-eligible residents are not required to reserve apartments for

Medicaid-eligible residents but must accept Medicaid-eligible residents on a

first come, first served basis.

e)         SLP certification is not transferable or applicable to any

location, provider, management agent or ownership other than that indicated on

the provider agreement.

1)         An SLP provider shall notify the Department no fewer than 60

days prior to a change of ownership or management.  The new owner shall

complete an application for the Department's approval prior to the effective

date of the change of ownership.

2)         Pursuant

to 89 Ill. Adm

ny

location, provider, management agent or ownership other than that indicated on

the provider agreement.

1)         An SLP provider shall notify the Department no fewer than 60

days prior to a change of ownership or management.  The new owner shall

complete an application for the Department's approval prior to the effective

date of the change of ownership.

2)         Pursuant

to 89 Ill. Adm. Code 140.11(f), an SLP provider whose investor ownership has

changed by 50 percent or more shall be required to submit a new application for

enrollment in the Medical Assistance Program.

3)         Pursuant

to 89 Ill. Adm. Code 140.12(k), a new owner assumes liability for repayment to

the Department of any overpayment made to the SLP provider, regardless of

whether the overpayment was incurred by a current or previous owner or

operator.

4)         The Department has the right to terminate the provider

agreement with an SLP provider if a change of ownership involves a barred

Medicaid provider.

5)         The new owner shall comply with the applicable certification

requirements found in subsection (c).

6)         The Department shall conduct an on-site certification review no

later than at the date of the next annual certification review or within three

months after the effective date of the change of ownership, whichever is

earlier.

7)         SLP certification shall be deemed to extend to a new owner

until the Department separately certifies the SLP setting under the approved new

owner.

f)         SLP

applicants with an application approved by the Department to proceed toward

certification shall not change ownership without the approval of the

Department.  The approved applicant shall notify the Department no fewer than

60 days prior to a change of ownership or management.  Direct and indirect

owners of five percent or more of the entity designated as the operator shall

be disclosed to the Department

with an application approved by the Department to proceed toward

certification shall not change ownership without the approval of the

Department.  The approved applicant shall notify the Department no fewer than

60 days prior to a change of ownership or management.  Direct and indirect

owners of five percent or more of the entity designated as the operator shall

be disclosed to the Department.  The new owner shall complete an application

for the Department's approval prior to the effective date of the change of

ownership.

g)         A

request for a change in the number of apartments in an operational or approved SLP

setting shall be made with an application to the Department for approval.  A

change in the number of apartments includes both a decrease and increase.  The

Department shall conduct an on-site review prior to issuing a new certificate

for the change in the number of apartments.  In the case of an increase in

apartments, residents shall not be admitted to the apartments until an on-site

review is conducted and the Department issues a revised certificate.

h)         The certificate issued by the Department shall include:

1)         Name and address of the SLP setting;

2)         Maximum number of residents to be served at any time; and

3)         Number of apartments certified in the SLP setting.

i)          Providers certified as an SLP provider shall not operate or

maintain SLP housing and SLP setting services in combination with a home

health, home care, nursing home, hospital, residential care setting, congregate

care setting or other type of residence or service agency unless those settings

and services are licensed, maintained and operated as separate and distinct

entities.

j)          At least annually, the Department shall conduct an on-site

review to ensure that the SLP setting is in compliance with the requirements of

certification, which includes review of:

1)         Items listed in subsection (c)(5)

etting or other type of residence or service agency unless those settings

and services are licensed, maintained and operated as separate and distinct

entities.

j)          At least annually, the Department shall conduct an on-site

review to ensure that the SLP setting is in compliance with the requirements of

certification, which includes review of:

1)         Items listed in subsection (c)(5).

2)         Comprehensive Resident Assessments, service plans  and the

provision of services required under Section 146.230.

3)         Staff sufficient in number to meet the needs of residents.

Staff shall demonstrate capacity, within their job responsibilities, to provide

covered services and perform tasks.

4)         Compliance with resident contracts and the Department's

provider agreement.

5)         Protection of individual resident rights and involvement in directing

their own care.

6)         Resident satisfaction surveys as defined in Section 146.270.

k)         The SLP provider shall comply with all applicable enrollment and

participation requirements set forth in Department rules, including, but not

limited to,  89 Ill. Adm. Code 140.11 and 140.12.

l)          The SLP provider shall comply with the Americans With

Disabilities Act of 1990.

m)        The SLP provider shall submit to the Department all marketing

materials prior to their use.  If the Department does not notify the SLP

provider of approval or disapproval of submitted materials within 30 days after

submission, the SLP provider may begin to use those materials.  The Department

reserves the right to disapprove any materials or require changes at any time,

provided that any such changes are consistent with, or required by, applicable

law.

n)         The SLP

provider shall ensure that limited English speaking residents have meaningful

and equal access to benefits and services

30 days after

submission, the SLP provider may begin to use those materials.  The Department

reserves the right to disapprove any materials or require changes at any time,

provided that any such changes are consistent with, or required by, applicable

law.

n)         The SLP

provider shall ensure that limited English speaking residents have meaningful

and equal access to benefits and services.  Steps to ensure access may include,

but are not limited to:

1)         hiring bi-lingual

staff;

2)         hiring staff

interpreters;

3)         contracting for

interpreter services;

4)         engaging community

volunteers;

5)         contracting with a

telephone interpreter service; and

6)         hiring staff

proficient in American Sign Language.

o)         The SLP

provider shall encourage families of residents with impairments that limit the

resident's decision-making ability to arrange to have a responsible party or

guardian represent the resident's interests.  The SLP provider shall provide

all residents with information about advance directives, including the Durable

Power of Attorney for Health Care, Statement of Illinois Law on Advance

Directives, Living Will, Declaration for Mental Health Treatment and Do Not

Resuscitate Advance Directive.  The SLP provider shall maintain in a resident's

file any of these documents authorized by the resident.

p)         Upon

admission of a resident whose name appears on the United States Department of

Justice Dru Sjodin National Offender Public Website, the Illinois State Police

Sex Offender Registration website or the Illinois Department of Corrections

registered sex offender database (see Section 146.220(a)(4)), the SLP provider

shall:

1)         inform

the Department and appropriate county and local law enforcement offices of the

identity of the identified offenders being admitted to the SLP setting;

2)         notify

every SLP resident and resident's guardian or family in writing that such

offenders are residents of the SLP setting;

3)         dev

sex offender database (see Section 146.220(a)(4)), the SLP provider

shall:

1)         inform

the Department and appropriate county and local law enforcement offices of the

identity of the identified offenders being admitted to the SLP setting;

2)         notify

every SLP resident and resident's guardian or family in writing that such

offenders are residents of the SLP setting;

3)         develop

a service plan in accordance with Section 146.245; and

4)         ensure

that the SLP setting has qualified staff to meet the needs of the individual

and required level of supervision at all times.