Illinois Skilled Nursing Services Provider Policy Manual

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The Illinois Skilled Nursing Services Provider Policy Manual establishes a comprehensive framework for agencies delivering skilled nursing care to individuals with complex medical needs in home and community-based settings. This manual aligns with the Illinois Administrative Code (Title 89, Part 140), the Nurse Practice Act (225 ILCS 65), and Medicaid Home and Community-Based Services (HCBS) Waiver regulations (42 CFR 441.301), ensuring compliance with state and federal requirements.
The manual provides detailed guidance for implementing skilled nursing services under programs administered by the Illinois Department of Healthcare and Family Services (IDHFS) and the Illinois Department of Human Services (IDHS). Skilled nursing services are designed to support individuals requiring medical care that must be performed or supervised by licensed nurses. 
Key areas covered include:
Eligibility and Service Access: Policies outline eligibility criteria for individuals with medical conditions requiring skilled nursing care, including those enrolled in Medicaid HCBS Waiver programs or receiving services through Medicaid State Plan benefits.
Service Delivery Standards: Skilled nursing services include wound care, medication administration, intravenous therapy, chronic disease management, respiratory care, and other medically necessary interventions.
Care Planning: Develops individualized care plans based on physician orders and interdisciplinary assessments to address each client’s medical needs and goals.
Staff Qualifications and Licensing: Licensed Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) licensure requirements under the Illinois Nurse Practice Act and completion of ongoing training in areas such as infection control, emergency response, and patient rights.
Health and Safety: Policies emphasize adherence to infection control protocols, medication safety standards, emergency preparedness plans, and reporting procedures for adverse events.
Client Rights: Safeguards for individuals receiving skilled nursing services are treated with dignity, respect, and autonomy while maintaining their privacy and confidentiality.
Funding and Reimbursement: The manual includes information on Medicaid reimbursement processes, billing procedures for skilled nursing services, and documentation requirements for compliance.
Quality Assurance: Implementation of quality improvement measurement in monitoring service effectiveness, client satisfaction, and adherence to regulatory standards.
Coordination of Care: Policies encourage collaboration between skilled nursing providers and other healthcare professionals, including physicians, therapists, case managers, and home health aides.
This manual serves as a vital resource for providers delivering skilled nursing services in Illinois.