Section 146.220 Resident Participation Requirements

Section 146.220  Resident

Participation Requirements

a)         The SLP setting may admit or retain residents whose needs can

be met through the services described in Section 146.230.  The following

criteria shall be met prior to admission to the SLP setting:

1)         Be age 22 years or over with a physical disability (as

determined by the Social Security Administration) or elderly (age 65 years or

over);

2)         Be screened by the appropriate Department on Aging contracted

Care Coordination Unit (DoA CCU) or the Department of Human Services Division

of Rehabilitation Services (DHS-DRS) screening agency and found to be in need

of nursing facility level of care.  A new Determination of Need (DON), or

successor tool, screen is not needed for a resident who is transferring between

SLP providers or comes from a nursing facility with no break in service.  It is

the admitting SLP provider's responsibility to ensure that a screening document

is received from the transferring SLP setting or nursing facility. If the

individual is transferring directly from a nursing facility and has a history

of a developmental disability or serious mental illness, as evidenced in the

medical history accompanying the individual, the SLP provider must submit a

referral for a specialized evaluation to be completed by the DHS Division of

Developmental Disabilities (DHS-DDD) Independent Service Coordination (ISC)

agency or the Division of Mental Health (DHS-DMH) Preadmission Screening

Resident Review (PASRR) agency to evaluate for need for active treatment or the

existence of serious functional risks and needs associated with the diagnosis

to determine if they exceed the capacity of the SLP setting

leted by the DHS Division of

Developmental Disabilities (DHS-DDD) Independent Service Coordination (ISC)

agency or the Division of Mental Health (DHS-DMH) Preadmission Screening

Resident Review (PASRR) agency to evaluate for need for active treatment or the

existence of serious functional risks and needs associated with the diagnosis

to determine if they exceed the capacity of the SLP setting.  Private pay

individuals may choose to be admitted into the SLP setting when the screening

assessment does not justify nursing facility level of care;

3)         If further evaluation is necessary due to the suspicion of a

developmental disability or serious mental illness, the developmental

disability or serious mental illness must be determined by a qualified DHS-DDD

ISC agent or DHS-DMH preadmission screening (PAS) agent.  The presence of a

developmental disability does not automatically preclude admission to the SLP

unless there is the need of continuous active treatment for which the

individual should be considered for other DHS-DDD services not available

through the SLP. The presence of a serious mental illness does not

automatically preclude admission to the SLP unless the psychiatric symptoms,

behavioral risk, and major treatment adherence/engagement problem persist at a

sufficiently serious level that exceeds the service capabilities of the SLP

provider. The evaluation and determination of whether the needs are within the

SLP provider capability or beyond the SLP provider capacity is determined by

the DHS-DDD ISC or DHS-DMH PAS agent; and

4)         Have

name checked against the United States Department of Justice Dru Sjodin

National Offender Public Website at

www.nsopr.gov

,

the Illinois Sex Offender Registration website at

www.isp.state.il.us

and the Illinois Department of Corrections registered sex offender database at

www.idoc.state.il.us

.  Refer to Section 146.215 for

facility requirements if a person whose name appears on either registry is

admitted to an SLP setting

States Department of Justice Dru Sjodin

National Offender Public Website at

www.nsopr.gov

,

the Illinois Sex Offender Registration website at

www.isp.state.il.us

and the Illinois Department of Corrections registered sex offender database at

www.idoc.state.il.us

.  Refer to Section 146.215 for

facility requirements if a person whose name appears on either registry is

admitted to an SLP setting.

b)         The SLP provider's assessment to determine if a potential

resident's needs can be met by the SLP provider shall not occur until after the

DON,

or successor tool,

assessment and other required

PAS have been completed and determinations provided to the SLP provider.

c)         Private pay residents seeking to convert to Medicaid while

residing in an SLP setting shall be screened by the Department using the DON or

successor tool, prior to the point of conversion and must be found to be in

need of nursing facility level of care before Medicaid payment may be

authorized.

d)         Each prospective resident shall have a tuberculin skin test in

accordance with the Control of Tuberculosis Code (77 Ill. Adm. Code 696).

e)         A Medicaid resident of the SLP setting shall not participate

in any other federal Home and Community-Based Waiver Program.