LeadingAge Illinois eNews

The Lead October 16 2025

From the Desk of Angela Schnepf, President and CEO

Top Stories
Send us your MCO Issues
IDPH Monthly Association Meeting Updates
CDC Adopts ACIP Vaccine Recommendations
IDPH Releases Independent Vaccine Recommendations and Standing Orders
CMS Issues Guidance on Government Shutdown Procedures
Upcoming IDPH Training

Nursing and Rehabilitation
Regulatory Rule Review – Assurance of Financial Security
Revised MDS Definition for Falls
IDPH Recommends Enhanced Precautions as ARI Outbreaks Increase
OIG Investigation Finds Nursing Home Falls Significantly Underreported
Staffing Standard Litigation Update: DOJ Moves to Dismiss Its Appeals
Advancing Excellence in Long-Term Care Collaborative Webinar on Effective Psychotropic Reduction in Post-Acute and Long-Term Care
Regulatory Review Article – F571 – Charges for Medicaid & Medicare Covered Services

Housing
LeadingAge RAD for PRAC Webinar Series: Preserving Your Aging HUD Property

HCBS
OASIS E-2: What Home Health Agencies Need to Know for 2026
CMS Updates Training on Achieving a Full APU for Hospice Programs

Other
Ask the Expert
Become a 2025 LeadingAge Illinois PAC Partner

From the Desk of Angela Schnepf, President and CEO

Newsweek recently released their listing of America’s Best Nursing Homes. Congratulations to the following members for making the list:

Kindest Regards

Angela

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Send us your MCO Issues

LeadingAge Illinois is working with the Illinois Department of Healthcare and Family Services (HFS) and the MCOs to resolve MCO billing issues. If you have a pattern of claims issues (not single claims) that you have not been able to resolve using the normal channels, such as working with your provider relations representative or through the use of the complaint portal, we can help by raising attention to these issues.

If you have issues, please contact Jason Speaks.

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IDPH Monthly Association Meeting Updates

On September 25, the Illinois Department of Public Health Office of Healthcare Regulation met with the long-term care associations for a regular monthly update. The associations continue to advocate for nursing home members regarding the staffing violations for the first quarter. IDPH was unable to discuss a lot related to the staffing violations as many providers have submitted appeals and they cannot discuss anything that may impede that process. However, IDPH indicated they still feel that their calculations of the 10% variation are correct. Additionally, the associations submitted questions related to the unforeseen circumstances waiver and RN waivers that nursing homes may request to comply with the staffing requirements. Earlier in 2025, IDPH released a SIREN including details on how to apply for unforeseen circumstances and RN waivers.

IDPH confirmed during the meeting that they are working with the Centers for Medicare & Medicaid Services (CMS) on the Nursing Home Staffing Campaign initiative and have dedicated an unspecified amount of Civil Monetary Penalty Funds to the program.

LeadingAge Illinois submitted several questions on behalf of members. IDPH responded to a majority of the questions prior to the meeting requesting additional information and provided general answers, to which we replied with as much information as we could without releasing identifying information. Here are the questions that were submitted along with information on where we are in determining the answers:

  • During a recent survey, the provider was cited for employee pre-employment health screenings as they were completed by a registered nurse. The code at 295.3030(d) and 300.655(d) do not specify the credentials of the individual who must complete the employee physical examination. The department indicated that this must be completed by a physician, physician’s assistant or a nurse practitioner. They don’t feel that it is within the scope of practice of a registered nurse. LeadingAge Illinois staff are doing some additional work on this response as the requirements outlined in the code include items that we believe are within the RNs scope of practice.
  • Several members expressed concerns with surveys being initiated on-site and then the surveyor completing the rest of the survey remotely, including asking the provider to submit numerous documents via email. This specific concern was identified in an assisted living setting and LeadingAge Illinois cited several areas in the code where it indicates the survey will be conducted “on-site”. However, the department asked for specific details on which survey this was so they could look into further, to which LeadingAge Illinois staff responded that several communities expressed similar concerns and we felt like it was more of an overall problem than specific to one survey. IDPH indicated that there may be variables that would allow for off-site survey activity. In this circumstance, LeadingAge Illinois staff verified that the surveyor’s email address is secure if you are requested to email protected health information to the surveyor. If there are specific concerns that you would like us to address, please email Kellie Van Ree, director of clinical services.
  • Additionally, several members expressed concern with the exit conference conducted remotely over the telephone and the surveyor is not allowing the community to submit additional documents or evidence that would prove they are complying with the requirements. In response to our comments, the department asked for additional information and examples. Our response was again that this was more than one community expressing concerns and may be an overall concern rather than an isolated incident. During the meeting other association representatives expressed similar concerns and LeadingAge Illinois staff expressed that these were the same concerns that we expressed in our questions. The department is going to look into this further.
  • Members in assisted living expressed concern regarding the duration of time from the exit to when they receive their statement of deficiencies or violations. According to the assisted living code, the department is to issue this report within 10 business days after exiting the on-site survey. The department is going to look at this and attempt to correct it. If you have specific concerns, please email Kellie and we can help facilitate discussion with the department on the survey findings.
  • Assisted living members also questioned the public LLCS portal as 2567 reports are being placed on the portal, but they did not see the plan of correction posted and felt this was important for the public to see. Kellie reviewed several providers and the 2567 reports that don’t include a plan of correction did not have any deficiencies or violations cited. We believe this is a new process for the department, so if you have a specific survey that is accessible to the public that you would like a plan of correction posted, please let Kellie know.
  • A member indicated that during a recent survey, the surveyor told them that the LLCS portal does not date or time stamp when the incident was reported and encouraged them to email the incident to the department at the same time to ensure they receive credit for when it was reported. IDPH indicated that this statement is inaccurate and the portal includes the date/time the incident was reported, and the portal is the preferred method for reporting incidents.
  • During a recent life safety code survey, a member reported that the surveyor requested all employee training since their hire date and that the information was placed in a spreadsheet format. For this community, they did not have the documentation in a spreadsheet format, so this was very administratively burdensome for them. We verified with the department that there isn’t a requirement to have this in a specific format. However, the provider should ensure that the information is organized and easy to read for the surveyor. If the information is provided to them in an organized manner, a spreadsheet would not be necessary. If there are specific incidents that you would like me to share with the department, please email Kellie.
  • Finally, one member had concerns regarding an allegation of abuse that was self-reported to the department as a resident with Lewy Body Dementia reported the allegation. Following the interview, the resident was physically upset for the rest of the day. This member asked if there was something that could be done to prevent the surveyor from interviewing the resident in this circumstance. The department’s response is that the surveyor is expected to conduct a thorough investigation into the allegation (as well as law enforcement) which would include an interview of the victim. LeadingAge Illinois would encourage providers to share any concerns they may have with the surveyor to possibly identify if different strategies can be implemented to reduce any resident upset or psychosocial distress. However, we cannot restrict them from interviewing the resident.

Do you have questions or concerns regarding IDPH and survey processes? Please email Kellie Van Ree, director of clinical services with your questions.

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CDC Adopts ACIP Vaccine Recommendations

The Centers for Disease Control & Prevention (CDC) officially adopted the recommendations of the Advisory Committee for Immunization Practices (ACIP) to update the adult and child vaccine schedules for 2025/2026 on October 6. With COVID-19 vaccination, this means that individuals ages 6 months and older are recommended to undertake shared decision-making with a clinician when considering whether to receive a COVID-19 vaccination. It is also recommended that these informed consent conversations include a discussion about the risks, benefits, and uncertainties of COVID vaccination, and for individuals 6 months to 64 years, there is an emphasis during these conversations that the benefits of COVID vaccination are greatest for those who are at risk for severe illness.

At this time, we are uncertain if CDC will release a revised definition of up to date for the National Healthcare Safety Network (NHSN) reporting for resident and employee COVID-19 vaccination status. Historically, NHSN has only updated the definitions at the beginning of a quarter, which occurred late September.

What does this mean?

Several states, including Illinois, released separate guidance on vaccine recommendations including all adults 18 years and older are recommended to be vaccinated for COVID-19. We don’t anticipate that Iowa will release guidance separate from the CDC.

It is expected that State and Federal health programs such as Medicare and Medicaid and ACA plans will cover the vaccine and private health insurances have expressed intention to cover the vaccines. If you’re unsure about coverage for a particular individual, you should contact their health insurance plan to identify if the vaccine is covered or not.

With federal regulation, F887, nursing home providers must educate and offer COVID-19 vaccine to all residents and employees. The education information should reflect as much information as possible to allow the individuals to make an informed decision. If the individual declines vaccination, the declination should be included in the resident record or employee file to provide to the surveyors reviewing compliance.

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IDPH Releases Independent Vaccine Recommendations and Standing Orders

On September 23, the Illinois Department of Public Health (IDPH) issued a Dear Colleague letter regarding IDPH vaccine recommendations for the upcoming respiratory virus season.

Please note that these recommendations do not necessarily align with the federal recommendations which will be used for reporting to the National Healthcare Safety Network (NHSN). The current quarter for NHSN reporting ends on September 28 which is when new guidance may be issued on the “up to date” definitions for reporting. The Advisory Committee for Immunization Practices (ACIP) provided vaccine recommendations to the CDC, but at this time, CDC has not endorsed these recommendations. You can find the latest CDC vaccine schedules here.

The Illinois guidance is as follows:

  • Influenza vaccination for all people 6 months and older.
  • RSV vaccination is recommended for:
  • COVID-19 vaccination is recommended for:
    • All children ages 6 months through 23 months.
    • Children ages 2 years through 17 years who have at least one underlying risk factor, have weakened immune systems, who have never been previously vaccinated for COVID-19, who live in congregate settings or in households with those at risk for severe COVID-19.
    • Children ages 2 years through 17 years without underlying risk factors whose parents/guardians want them to get a COVID-19 vaccine.
    • All pregnant individuals and those who are planning pregnancy, are postpartum, or during lactation.
    • All adults 18 years and older.

Additionally, IDPH Director, Sameer Vohra signed a statewide standing order for the vaccines which will allow eligible health care providers in pharmacies and other clinical settings to administer COVID-19 vaccines in accordance with IDPH’s recommendations. The Dear Colleague Letter indicates that all Federal insurance programs, fully-insured plans subject to the Affordable Care Act, and state regulated insurance programs will cover COVID-19 vaccines. Private insurances have also indicated their intention to cover the vaccines.

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CMS Issues Guidance on Government Shutdown Procedures

On October 1, the Centers for Medicare & Medicaid Services (CMS) issued a QSO memo (QSO-26-01-ALL) on survey activities based on the federal government shutdown. Within the memo, CMS outlined the following survey activities which will and will not occur based on contingency plans. Here is a summary of survey activities and enforcement action plans during the shutdown:

CLIA – Since survey and certification functions are funded through fees, they will not be impacted.

CMS or State Vendor Contracts Awarded on or before September 30, 2025, will not be impacted by the shutdown. However, if the contractor’s current contract funding expires and/or the option period is not exercised, the contractor must follow the terms and conditions related to stopping work due to the availability of funds. CMS notes that these vendors should contact their Contracting Officer (CO) or Contracting Officer Representative (COR) for further guidance.

State-funded surveys – States that are using state-only funding to complete surveys may continue those surveys. (i.e. Assisted Living)

Surveys of Medicaid-only providers – States may conduct surveys of Medicaid-only provider types during the shutdown as the 1st quarter of Medicaid funding will not be impacted. Medicaid funding remains available and is considered mandatory funding. CMS will advise survey agencies to maintain communication with their State Medicaid agency regarding the availability of Medicaid funds for Medicaid-only survey functions.

Hospice Surveys funded through the Consolidated Appropriations Act (CAA) of 2021 is also considered mandatory and is not impacted by the shutdown.

Complaint Investigations Alleging Harm – complaints triaged as credible allegations of immediate jeopardy (IJ) or harm to an individual should continue to be assessed and investigated according to standard CMS protocols except that, for the duration of the shutdown, it is not necessary for the survey agency to obtain prior CMS approval for conducting complaint investigations for deemed providers (i.e. Home Health).

Revisit Surveys – survey agencies may request approval to conduct a revisit when:

  • The provider or supplier has alleged compliance with CMS requirements (pursuant to a prior determination of noncompliance) and
  • The revisit survey is necessary to determine compliance and prevent the scheduled Medicare termination of a provider or supplier, and
  • The Medicare termination is likely to occur due to timing or specific circumstances.

Immediate threats to life or safety (emergencies and natural disasters) – Survey agencies should take action to prevent or mitigate any other immediate threats to the life or safety of a beneficiary even if the situation does not fit into any of the preceding categories, such as survey and certification activities that may be necessary during a declared public health emergency to prevent injury or harm to beneficiaries.

Other Tasks – Survey Agencies may complete other tasks begun prior to September 30, 2025, if such completion is necessary to ensure an orderly shutdown, provided that the tasks can be accomplished within four hours of CMS notification to the survey agency of a federal shutdown (such as uploading completed surveys). Surveys completed before the shutdown and the CMS-2567 has not been completed prior to the shutdown will generally remain valid if completed after the shutdown. CMS plans to issue special instructions for completion of such reporting.

The following activities are not supported during a Federal Government Shutdown:

  • Standard surveys, including statutorily mandated surveys.
  • Certain revisit surveys including both onsite and desk revisits that are not required to prevent termination of Medicare participation within the subsequent 45 days. This includes revisits that would end per day CMPs or denial of payments for new admissions. CMS will issue guidance to survey agencies on how these situations will be handled.
  • Initial surveys, unless otherwise included above.
  • Initial certification via deemed status
  • Certain complaint investigations – no complaint investigations are to be completed except those alleging immediate jeopardy or actual harm.
  • MDS or OASIS activities, except those necessary to maintain provider reporting.
  • Informal dispute resolutions – No IDRs or Independent IDRs should be conducted unless they are pursuant to the excepted complaint investigations for which there is an immediate adverse action that will be taken against the provider during the period of shutdown.
  • New CMP-Funded improvement projects – No new CMP improvement projects shall be implemented unless approval has already been granted by the CMS location. Projects already approved by CMS are not affected and may continue since these projects require no further federal action.

If the shutdown persists more than a few weeks, CMS may communicate further instructions with regard to special provisions that are appropriate for Survey & Certification activities. CMS is also expecting to release additional guidance to address timelines impacted by the shutdown included in the State Performance Standards Systems.

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Upcoming IDPH Training

How Clean is Your Environment? An infection prevention and control webinar on fluorescent marking of the environment. Friday October 24, from 1 – 2 p.m. CT

Register for OHCR November, December & January Monthly Trainings here

Top Sited Deficiencies in Long-Term Facilities on November 12, from 1 – 2 p.m. CT

Life Safety & Construction on December 17, from 1 – 2 p.m. CT

Writing Plans of Corrections on January 21, 2026 from 1 – 2 p.m. CT

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Regulatory Rule Review – Assurance of Financial Security

The last regulation in the residents’ rights section pertaining to resident trust funds includes F570. In this regulation, the Centers for Medicare and Medicaid Services (CMS) requires nursing homes who have a resident trust fund to provide financial security for those funds in the event someone misappropriates those funds. Compliance with this requirement is generally in the form of a surety bond, but can also be other methods as long as the nursing home is able to provide documentation of financial security. The amount of the surety bond must be at least the amount of funds that are deposited within the resident trust fund. For example, if you have a balance of $9,000 total, the surety bond would not be compliant if the value was only $5,000.

The interpretive guidance provides a couple key compliance tips:

  • The nursing home cannot self-insure the funds.
  • Funds deposited in a bank account that is protected by the Federal Deposit Insurance Corporation (FDIC) does not fulfill the financial security requirement.
  • The nursing home cannot be listed as the beneficiary – it must be the residents or the state.
  • If a multi-site provider has one policy, there must be separate declaration pages for each location that accepts resident funds.
  • Refundable deposit fees must be included in the financial assurance compliance.

During survey, the surveyors will generally ask providers to show documentation of the surety bond which can be fulfilled by providing a copy of the declaration page from your bond. This regulation is rarely cited, but instances of deficiency generally related to the value of the surety bond not being adequate to cover the entirety of deposited funds.

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Revised MDS Definition for Falls

In the latest version of the Resident Assessment Instrument (RAI) Manual, the Centers for Medicare and Medicaid Services (CMS) revised the definition of a fall. In the RAI manual for previous years, the definition indicated that a fall was not the result of an overwhelming external force such as a resident pushes another resident. However, in the current RAI manual, CMS revised the definition to include these incidents.

For reference the old definition stated: A fall is an unintentional change in position coming to rest of the ground, floor, or onto the next lower surface (e.g. onto a bed, chair, or bedside mat). The fall may be witnessed, reported by the resident or an observer or identified when a resident is found on the floor or ground. Falls include any fall, no matter whether it occurred at home, while out in the community, in an acute hospital, or a nursing home. Falls are not the result of an overwhelming external force (e.g. a resident pushes another resident). An intercepted fall occurs when the resident would have fallen if they had not caught themselves or had not been intercepted by another person – this is still considered a fall. CMS understands that challenging a resident’s balance and training them to recover from a loss of balance is an intentional therapeutic intervention and does not consider anticipated losses of balance that occur during supervised therapeutic interventions as intercepted falls.

The new definition states: A fall is an unintentional change in position coming to rest on the ground, floor, or onto the next lower surface (e.g. onto a bed, chair, or bedside mat) or the result of an overwhelming external force (e.g. resident pushes another resident). An intercepted fall occurs when the resident would have fallen if they had not caught themselves or had not been intercepted by another person – this is still considered a fall.

What does this mean?

  • There may be more falls counted on the MDS that previously were not. However, falls because of another resident pushing them would be reportable as resident-to-resident abuse and are hopefully not common.
  • Previously, you would have completed an incident report if a resident pushed another resident which resulted in the resident being on the floor or a lower surface. Now, you will need to complete a fall investigation and follow your policy for follow-up assessments.
  • Appendix PP of the State Operations Manual aligns with the old definition. However, it also references the RAI manual which makes me believe that the surveyors will use the latest definition when reviewing falls after October 1, 2025. Rather than possibly having confusion on whether it is a fall for MDS coding purposes or regulatory purposes, it may be easiest to adapt the latest definition and procedures.

Additionally, the definitions have changed of a fall that results in a major injury. J1900 definition of a major injury now includes (but is not limited to) traumatic bone fractures, joint dislocations, subluxations, internal organ injuries, amputations, spinal cord injuries, head injuries, and crush injuries. The guidance in the RAI indicates that fractures confirmed to be pathologic (vs. traumatic) are not considered a major injury resulting from a fall.

What does this mean?

  • The change in the RAI definition does not alter the state reporting requirements. Continue to report incidents, including falls, as you were previously.
  • The terminology “but is not limited to” isn’t well defined and may be subjective and problematic until we know more. We’ve asked LeadingAge National to try to seek clarification with CMS. You will likely need to use your best clinical judgement on whether a fall with an injury is coded under J1900C that may be considered a major injury under the “but not limited to” clause. It will likely be helpful for you to document why you did or did not include the fall with injury that could be included in this category, that way when the state or other auditors are reviewing the coding to your MDS and the supporting documentation, you can provide your justification for how you coded the item set.
  • There were no updates yet to the Quality Measures, therefore, it is likely that more individuals could be included in your numerator for falls with major injuries.

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IDPH Recommends Enhanced Precautions as ARI Outbreaks Increase

Due to rising Acute Respiratory Illness (ARI) outbreaks in long-term care buildings, the Illinois Department of Public Health is recommending implementation of enhanced precautions including:

  • Requiring healthcare personnel (HCP) and visitors to wear masks at all times and consider having residents wear masks when outside of their room. If the provider is in an ARI outbreak, residents should be required to mask when outside of their room.
  • Reinforce visitor policies for viral respiratory illness screening and education. This includes screening visitors for symptoms of ARI before entering the building, providing instruction on hand hygiene, limiting movement within the building, encouraging visitors with symptoms of an ARI to defer visiting until symptoms resolve, limit visitation with isolated residents to necessary visits for the resident’s emotional well-being, and consider limiting visitors to those 18 and older as well as limiting the number of visitors to two or fewer.
  • Optimize ventilation by properly maintaining the HVAC system, using a MERV-13 or higher filter and replace as recommended, provide electronic air cleaners/purifiers in common areas, limiting fan usage, open windows and encourage outdoor activities.
  • Review policies for preventing and responding to ARI cases and outbreaks, ensure that staff are educated on current policies and able to implement empiric transmission-based precautions when residents develop symptoms of an ARI, ensure adequate testing supplies, and following IDPH’s guidance for employee return to work.

If you have any questions please contact IDPH Respiratory Surveillance Program at 217-782-2016 or email at DPH.Respiratory@illinois.gov or IDPH Regional Infection Prevention Program at DPH.IP@illinois.gov.

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OIG Investigation Finds Nursing Home Falls Significantly Underreported

The Health & Human Services (HHS) Office of Inspector General (OIG) released a report and related data snapshot on September 18 asserting significant underreporting of falls with major injury in nursing homes. The investigation compared hospital claims data to Minimum Data Set (MDS) assessments submitted for Medicare beneficiaries during a one-year period and found that 43% of falls with major injury reported through hospital Medicare claims data were not congruently coded on residents’ discharge MDS assessments preceding the hospitalization. Noting that MDS data on falls with major injury are used to calculate quality measures on the consumer-facing Nursing Home Care Compare website, OIG recommended that the Centers for Medicare & Medicaid Services (CMS) take steps to ensure the completeness and accuracy of MDS data, and explore whether approaches to improve the quality measures related to falls could similarly be used to improve the accuracy of other quality measures.

A Technical Expert Panel (TEP) was previously convened on this topic and CMS recently made the summary report from the TEP publicly available. The TEP examined ways to improve the cross-setting quality measure by incorporating hospital claims data based on ICD-10 code diagnoses. While CMS has not yet announced any changes to the Falls with Major Injury quality measures, utilized for both nursing home and home health providers, LeadingAge notes that CMS has actively moved to incorporate the use of claims data to improve other quality measures. CMS announced in June 2025 that claims data would be incorporated in the long-stay antipsychotics measure used in nursing homes beginning in January 2026; however, incorporation of claims data in the antipsychotics measure coupled with OIGs recommendations related to the Falls with Major Injury measures could indicate a strong likelihood of CMS taking up this recommendation, as well as continuing to incorporate claims data into other measures.

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Staffing Standard Litigation Update: DOJ Moves to Dismiss Its Appeals

On September 18, the U.S. Department of Justice (DOJ) filed motions to voluntarily dismiss its appeals of both federal court decisions that vacated the Centers for Medicare & Medicaid Services (CMS) minimum staffing standards. In the lawsuit in which LeadingAge is a plaintiff, the U.S District Court for the Northern District of Texas issued an order on April 7, 2025, vacating the hours per resident day and 24/7 registered nurse requirements, and in the suit filed by LeadingAge State Partners and state Attorneys General, the U.S. District Court for the Northern District of Iowa did the same on June 18, 2025.

The U.S. Department of Health & Human Services (HHS) appealed both of these decisions, and the filing of written arguments was scheduled to begin soon in both cases. We are pleased to report that the government now seeks to dismiss these appeals, which represent a win for the plaintiffs in both cases. The respective appellate courts still need to review and respond to these motions, but we expect to see orders of dismissal in the near future.

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Advancing Excellence in Long-Term Care Collaborative Webinar on Effective Psychotropic Reduction in Post-Acute and Long-Term Care

The Advancing Excellence in Long-Term Care Collaborative is hosting a free webinar entitled Effective Psychotropic Reduction in Post-Acute and Long-Term Care. The webinar will review how a large nursing home company systematically reduced their utilization of psychotropic medications and achieved a sustained long-stay antipsychotic quality measure rate of less than 12%. Additionally, the webinar will focus on how to ensure regulatory compliance and accurate diagnoses while achieving this success. The webinar is scheduled for November 12, 2025, at 11:00 a.m. CT. and offers medical, nursing, and administrator continuing education hours. You must register in advance here.

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Regulatory Review Article – F571 – Charges for Medicaid & Medicare Covered Services

F571 in Appendix PP directs the nursing home providers that they are unable to charge a resident for any services that are covered under Medicare or Medicaid services, unless the charge is for deductible or co-insurance. The regulation outlines that covered services include:

  • Nursing services
  • Food and nutrition services
  • Activities programming
  • Maintenance services
  • Routine personal hygiene items or services including but not limited to hair hygiene supplies, comb, brush, bath, soap, disinfecting soaps, or specialized cleansing agents when needed to treat special skin problems or fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, incontinence care and supplies, sanitary napkins, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing assistance, and basic personal laundry.
  • Medically related social socials
  • Hospice services if elected by the resident and paid for under Medicare or Medicaid.

The regulation also includes items or services that can be charged to a resident, if they are not required to achieve goals in the resident’s care plan and payment is not made by Medicare and/or Medicaid for the service. These include:

  • Telephone, including cellular phone (note this would be a personal phone as the resident is able to make or take private calls on the nursing home’s phone line).
  • Television, radio, personal computers, or other electronic devices for personal use.
  • Personal comfort items including smoking materials (if allowed), notions, novelties and confections.
  • Cosmetic and grooming items in excess of those excluded above.
  • Personal clothing
  • Personal reading matter
  • Gifts purchased on behalf of the resident
  • Flowers and plants
  • Cost to participate in special outs or social events that are outside of the scope of the activities program.
  • Non-covered special care services such as privately hired nurses or aides
  • Private rooms (unless it is medically necessary with an example provided of isolation to prevent transmission of infection).
  • Specially prepared or alternate food requested (unless it is generally prepared with the meal)
    • The nursing home may not charge for special foods or meals that are medically prescribed such as dietary supplements that are ordered by the resident’s practitioner
    • The nursing home must take into consideration the residents’ needs and preferences and the overall cultural and religious make-up of the population

Additionally, the nursing home can only charge a resident for a non-covered service if the resident specifically requests the item. (For example, you cannot charge all residents for the use of a personal phone if the resident did not request the personal phone.) You cannot require that the resident use special items or services as a condition of admission or retention and you must inform the resident or their responsible party of any charges and the amount of those charges both orally and in writing.

While this regulation is not frequently cited, there are occasions when it has been. An example would be that a nursing home began charging a resident for a specific item but did not include the item on the admission paperwork as a possible charge and did not notify the resident prior to charging the item that they would receive a charge for it. If the documentation in the resident’s record does not support the nursing home’s due diligence in notifying the resident or their representative of possible charges, then you may be facing non-compliance.

Some examples of when you can charge vs. cannot:

  • General shampoo and conditioner would be an item that could not be charged, but if a resident requested a specific type of shampoo and conditioner that is not medically necessary, the nursing home can require that the resident pay for it.
  • The nursing home cannot charge for items used during a craft that is part of the activity programming, but if the activity programming included an outing to go to a specific restaurant, then the nursing home could require the resident pay for their meal.
  • Specialty diet or food items can get tricky, as you need to allow for cultural and religious needs. For example, if your nursing home admits a Jewish resident, you should expect that the resident will want Kosher foods.

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LeadingAge RAD for PRAC Webinar Series: Preserving Your Aging HUD Property

Join LeadingAge for a special mini-series on the Rental Assistance Demonstration (RAD), a critical senior housing preservation tool administered by the Department of Housing and Urban Development (HUD). Many affordable senior housing providers are exploring preservation options for aging PRAC properties with limited opportunities to attract recapitalization and rehabilitation investment; the September webinar series, taught by affordable housing expert Gates Kellett, reviews the basics of RAD and then dives into best practices and pitfalls to avoid. Whether you are just beginning to explore RAD or seeking to refine your approach, this insightful two-part webinar will provide valuable knowledge and practical guidance for making informed decisions and ensuring the long-term success of your housing portfolio.

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OASIS E-2: What Home Health Agencies Need to Know for 2026

To help providers prepare for implementation of OASIS updates on April 1, 2026, LeadingAge prepared a detailed article on what’s changing and how to prepare.

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CMS Updates Training on Achieving a Full APU for Hospice Programs

The Centers for Medicare & Medicaid Services (CMS) released a recorded presentation that provides the latest information about the Annual Payment Update (APU) for the Hospice Quality Reporting Program (HQRP) including what it is, the data submission requirements for Hospice Outcomes and Patient Evaluation (HOPE) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) data, how CMS determines HQRP compliance, and the steps hospices can take if they receive a non-compliance decision. As a reminder, if hospices do not submit 90% of their HOPE records within 30 days of completing the records they risk a 4% reduction APU for CY2027.

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Ask the Expert

A number of member questions come in daily to the association. In this article we will feature unique or recent questions of interest to members.

Q: Are providers expected to offer the Hepatitis B vaccine?

A: Yes, under the OSHA Bloodborne Pathogen Standard providers are expected to offer the Hepatitis B vaccine at no cost to staff members. The standards also state that the vaccine must be made available at a reasonable time and place and performed under the supervision of a licensed physician or other healthcare professional. Consideration must be made for staff members who are minors and receipt of a parent or guardian’s consent for vaccination.

Additionally, the Illinois Nursing Home Code (300.1060(f) & (g)) requires that the nursing home screens residents for risk factors associated with hepatitis B and whether they were immunized against hepatitis B. All persons susceptible to the hepatitis B vaccine must be offered immunization within 10 days after admission to any nursing home.

Have a question? Email yours now.

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Become a 2025 LeadingAge Illinois PAC Partner

We must continue to leverage our PAC to educate legislators, to reduce burdens, and implement solutions that impact YOU.

Each contribution, no matter how small, makes a difference. Like our voices, our contributions collectively make a significant difference in providing the ability to influence public policy related to aging services.

Last year, the PAC was instrumental in helping move forward our public policy priorities to unanimous passage in the Illinois General Assembly.

Become a PAC Partner and help us advance our public policy priorities and defeat harmful and burdensome legislation that would have a negative impact on member communities.

There are a number of ways to engage in the LeadingAge Illinois PAC.

  • Monthly Contribution (most popular). You can contribute smaller amounts each month, spreading your total contribution over the year. Select “make this a monthly donation” when processing your payment.
  • Make a one-time contribution– Visit our webpage online to make a one-time contribution.
  • Chair’s Circle. Along with maintaining a sound presence for the LeadingAge Illinois PAC, an annual contribution of $500 qualifies you for our Chair’s Circle!! Chair Circle members receive special recognition at LeadingAge Illinois events as well as making our PAC the strongest ever. You can make your chair’s circle contribution all at once or monthly by checking the box that says “make this a monthly donation.” Contribute online now.

*Nonprofit 501c(3) organizations cannot by law fund the PAC with a corporate check. Donations must come from individual contributions. We recommend sharing this communication with your staff to encourage personal contributions.

**Contributions to PAC are not deductible as charitable contributions for tax purposes.
***A copy of our report filed with the State Board of Elections is available on the Board’s official website or for purchase from the State Board of Elections, Springfield, Illinois.

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