Section 145.30  Definitions

For purposes of this Part, the following terms shall be defined as follows:

"IMD" means a nursing facility that is considered to be an Institution for Mental Diseases (IMD) under Section 1905(i) of the Social Security Act (42 USC 1396d(i)). Federal regulations provide that:  An IMD is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.  An IMD has an overall character of a facility established and maintained primarily for the care and treatment of individuals with mental diseases.  An institution for the mentally retarded (ICF/MR) is not an IMD (see 42 CFR 435.1009).

"Class I IMD" means a nursing facility determined to be an IMD during the initial review conducted pursuant to Section 145.40.

"Class II IMD" means a nursing facility determined to be an IMD in a subsequent review conducted pursuant to Section 145.50.

"IMD Guidelines" means the Guidelines in Section 4390 of the CMMS State Medicaid Manual relating to Institutions for Mental Diseases (Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore MD 21244-1850 (1994, no later amendments or editions included)). Criteria used in determining whether the overall character of a facility is that of an IMD include whether the current need for institutionalization for more than 50 percent of all the patients in the facility results from mental diseases and whether the facility specializes in providing psychiatric/psychological care and treatment.

"Mental Disease" means mental disease or mental illness as defined in the IMD Guidelines.  Mental disease includes those diseases listed as mental disorders in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) until implementation of the International Classification of Diseases, 10^th Revision, Clinical Modification (ICD-10-CM) and its classifications for mental disorders, with the exception of mental retardation, senility and organic brain syndrome.

"Current need for nursing facility care results from mental disease" means that a review of the resident's diagnoses, the character and nature of his or her problems, functional status, and his or her care needs indicates that the resident's need for nursing facility care results from his or her mental disease and not a physical or medical reason.

(Source:  Amended at 38 Ill. Reg. 23759, effective December 2, 2014)