illinois department of healthcare and family …...page 2 illinois department of healthcare and...

17
Page 1 ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES BUREAU OF RATE DEVELOPMENT AND ANALYSIS MEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs) Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date 6000012 A MERKLE C KNIPPRATH N H 4 4 CLIFTON $9.07 $46.85 $62.09 $118.01 10/1/2017 6000020 ABBINGTON REHAB NURSING CENTER 7 7 ROSELLE $14.60 $49.47 $89.13 $153.20 10/1/2017 6012595 ABINGTON OF GLENVIEW NURSING & 7 7 GLENVIEW $23.30 $55.98 $88.43 $167.71 10/1/2017 6016810 ADDISON REHAB & LIVING CTR 8 8 ELGIN $19.48 $45.20 $90.20 $154.88 1/5/2017 6000046 ADDOLORATA VILLA 7 7 WHEELING $13.92 $55.98 $97.28 $167.18 10/1/2017 6016869 ALDEN COURTS OF SHOREWOOD, INC 9 9 SHOREWOOD $19.21 $45.68 $89.32 $154.21 6/8/2017 6015507 ALDEN COURTS OF WATERFORD, LLC 8 8 AURORA $19.48 $45.20 $90.20 $154.88 3/20/2017 6000103 ALDEN DEBES REHABILITATION AND 1 1 ROCKFORD $14.99 $49.65 $94.01 $158.65 10/1/2017 6014757 ALDEN DES PLAINES REHAB HHC 7 7 DES PLAINES $22.20 $55.98 $121.12 $199.30 10/1/2017 6003735 ALDEN ESTATES OF BARRINGTON 7 7 BARRINGTON $23.27 $55.98 $145.50 $224.75 10/1/2017 6013429 ALDEN ESTATES OF EVANSTON 7 7 EVANSTON $21.67 $55.98 $130.59 $208.24 10/1/2017 7/1/2015 6007033 ALDEN ESTATES OF NAPERVILLE 7 7 NAPERVILLE $16.88 $53.32 $114.58 $184.78 10/1/2017 6014500 ALDEN ESTATES OF NORTHMOOR 6 6 CHICAGO $22.43 $51.87 $118.46 $192.76 10/1/2017 6014922 ALDEN ESTATES OF ORLAND PARK 7 7 ORLAND PARK $18.80 $55.98 $112.09 $186.87 10/1/2017 6016695 ALDEN ESTATES OF SHOREWOOD 9 9 SHOREWOOD $19.22 $45.68 $114.90 $179.80 10/1/2017 6006886 ALDEN ESTATES OF SKOKIE 7 7 SKOKIE $22.33 $55.98 $84.28 $162.59 7/1/2014 6005193 ALDEN LAKELAND REHAB AND HCC 6 6 CHICAGO $14.99 $48.50 $142.95 $206.44 10/1/2017 7/1/2015 6009849 ALDEN LINCOLN PARK REHAB 6 6 CHICAGO $11.23 $52.87 $98.24 $162.34 10/1/2017 6005714 ALDEN LONG GROVE REHAB 8 8 LONG GROVE $14.63 $50.21 $106.86 $171.70 10/1/2017 6014765 ALDEN NORTH SHORE REHAB AND HC 7 7 SKOKIE $21.70 $55.98 $106.88 $184.56 10/1/2017 6014773 ALDEN OF WATERFORD 8 8 AURORA $19.48 $55.98 $110.15 $185.61 10/1/2017 6007165 ALDEN PARK STRATHMOOR 1 1 ROCKFORD $12.80 $49.65 $99.49 $161.94 10/1/2017 6001366 ALDEN POPLAR CR REHAB AND HCC 7 7 HOFFMAN ESTATES $18.21 $52.08 $111.53 $181.82 10/1/2017 6008304 ALDEN TERRACE OF MCHENRY REHAB 8 8 MCHENRY $10.10 $43.65 $109.36 $163.11 10/1/2017 6013353 ALDEN TOWN MANOR REHAB AND HCC 7 7 CICERO $20.74 $49.73 $107.45 $177.92 10/1/2017 6000459 ALDEN VALLEY RIDGE REHAB HCC 7 7 BLOOMINGDALE $12.68 $51.37 $106.08 $170.13 10/1/2017 6003529 ALEDO REHAB HEALTH CARE CTR 10 10 ALEDO $10.44 $38.14 $72.62 $121.20 10/1/2017 7/1/2016 6004014 ALHAMBRA CARE CENTER 11 11 ALHAMBRA $10.44 $28.46 $65.39 $104.29 10/1/2017 6000087 ALL AMERICAN NURSING HOME 6 6 CHICAGO $11.97 $45.18 $78.45 $135.60 10/1/2017 6000129 ALPINE FIRESIDE HEALTH CENTER 1 1 ROCKFORD $15.30 $47.68 $71.63 $134.61 10/1/2017 6000152 ALTON MEM HOSP HATCH SNF UNIT 11 11 ALTON $5.44 $46.71 $62.24 $114.39 1/1/2017 6000186 AMBASSADOR NURSING REHAB CTR 6 6 CHICAGO $14.37 $50.93 $125.20 $190.50 10/1/2017 7/1/2015 6001267 AMBERWOOD CARE CENTRE 1 1 ROCKFORD $14.19 $40.82 $106.75 $161.76 10/1/2017 7/1/2015 6005730 APERION CARE AMBOY 1 1 AMBOY $11.60 $40.92 $94.60 $147.12 10/1/2017 6001010 APERION CARE BLOOMINGTON 4 4 BLOOMINGTON $9.88 $49.89 $94.50 $154.27 10/1/2017 6001150 APERION CARE BRIDGEPORT 5 5 BRIDGEPORT $9.39 $43.93 $99.14 $152.46 10/1/2017 6007207 APERION CARE BURBANK 7 7 BURBANK $19.73 $55.98 $126.23 $201.94 10/1/2017 7/1/2016 6008064 APERION CARE CHICAGO HEIGHTS 7 7 CHICAGO HEIGHTS $14.05 $43.24 $90.23 $147.52 10/1/2017 6002547 APERION CARE DOLTON 7 7 DOLTON $18.79 $49.25 $117.47 $185.51 10/1/2017 6005847 APERION CARE ELGIN 8 8 ELGIN $11.47 $54.20 $109.91 $175.58 10/1/2017 6006845 APERION CARE EVANSTON 7 7 EVANSTON $23.84 $48.47 $125.14 $197.45 10/1/2017 7/1/2016

Upload: others

Post on 10-Oct-2020

2 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 1

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6000012 A MERKLE C KNIPPRATH N H 4 4 CLIFTON $9.07 $46.85 $62.09 $118.01 10/1/20176000020 ABBINGTON REHAB NURSING CENTER 7 7 ROSELLE $14.60 $49.47 $89.13 $153.20 10/1/20176012595 ABINGTON OF GLENVIEW NURSING & 7 7 GLENVIEW $23.30 $55.98 $88.43 $167.71 10/1/20176016810 ADDISON REHAB & LIVING CTR 8 8 ELGIN $19.48 $45.20 $90.20 $154.88 1/5/20176000046 ADDOLORATA VILLA 7 7 WHEELING $13.92 $55.98 $97.28 $167.18 10/1/20176016869 ALDEN COURTS OF SHOREWOOD, INC 9 9 SHOREWOOD $19.21 $45.68 $89.32 $154.21 6/8/20176015507 ALDEN COURTS OF WATERFORD, LLC 8 8 AURORA $19.48 $45.20 $90.20 $154.88 3/20/20176000103 ALDEN DEBES REHABILITATION AND 1 1 ROCKFORD $14.99 $49.65 $94.01 $158.65 10/1/20176014757 ALDEN DES PLAINES REHAB HHC 7 7 DES PLAINES $22.20 $55.98 $121.12 $199.30 10/1/20176003735 ALDEN ESTATES OF BARRINGTON 7 7 BARRINGTON $23.27 $55.98 $145.50 $224.75 10/1/20176013429 ALDEN ESTATES OF EVANSTON 7 7 EVANSTON $21.67 $55.98 $130.59 $208.24 10/1/2017 7/1/20156007033 ALDEN ESTATES OF NAPERVILLE 7 7 NAPERVILLE $16.88 $53.32 $114.58 $184.78 10/1/20176014500 ALDEN ESTATES OF NORTHMOOR 6 6 CHICAGO $22.43 $51.87 $118.46 $192.76 10/1/20176014922 ALDEN ESTATES OF ORLAND PARK 7 7 ORLAND PARK $18.80 $55.98 $112.09 $186.87 10/1/20176016695 ALDEN ESTATES OF SHOREWOOD 9 9 SHOREWOOD $19.22 $45.68 $114.90 $179.80 10/1/20176006886 ALDEN ESTATES OF SKOKIE 7 7 SKOKIE $22.33 $55.98 $84.28 $162.59 7/1/20146005193 ALDEN LAKELAND REHAB AND HCC 6 6 CHICAGO $14.99 $48.50 $142.95 $206.44 10/1/2017 7/1/20156009849 ALDEN LINCOLN PARK REHAB 6 6 CHICAGO $11.23 $52.87 $98.24 $162.34 10/1/20176005714 ALDEN LONG GROVE REHAB 8 8 LONG GROVE $14.63 $50.21 $106.86 $171.70 10/1/20176014765 ALDEN NORTH SHORE REHAB AND HC 7 7 SKOKIE $21.70 $55.98 $106.88 $184.56 10/1/20176014773 ALDEN OF WATERFORD 8 8 AURORA $19.48 $55.98 $110.15 $185.61 10/1/20176007165 ALDEN PARK STRATHMOOR 1 1 ROCKFORD $12.80 $49.65 $99.49 $161.94 10/1/20176001366 ALDEN POPLAR CR REHAB AND HCC 7 7 HOFFMAN ESTATES $18.21 $52.08 $111.53 $181.82 10/1/20176008304 ALDEN TERRACE OF MCHENRY REHAB 8 8 MCHENRY $10.10 $43.65 $109.36 $163.11 10/1/20176013353 ALDEN TOWN MANOR REHAB AND HCC 7 7 CICERO $20.74 $49.73 $107.45 $177.92 10/1/20176000459 ALDEN VALLEY RIDGE REHAB HCC 7 7 BLOOMINGDALE $12.68 $51.37 $106.08 $170.13 10/1/20176003529 ALEDO REHAB HEALTH CARE CTR 10 10 ALEDO $10.44 $38.14 $72.62 $121.20 10/1/2017 7/1/20166004014 ALHAMBRA CARE CENTER 11 11 ALHAMBRA $10.44 $28.46 $65.39 $104.29 10/1/20176000087 ALL AMERICAN NURSING HOME 6 6 CHICAGO $11.97 $45.18 $78.45 $135.60 10/1/20176000129 ALPINE FIRESIDE HEALTH CENTER 1 1 ROCKFORD $15.30 $47.68 $71.63 $134.61 10/1/20176000152 ALTON MEM HOSP HATCH SNF UNIT 11 11 ALTON $5.44 $46.71 $62.24 $114.39 1/1/20176000186 AMBASSADOR NURSING REHAB CTR 6 6 CHICAGO $14.37 $50.93 $125.20 $190.50 10/1/2017 7/1/20156001267 AMBERWOOD CARE CENTRE 1 1 ROCKFORD $14.19 $40.82 $106.75 $161.76 10/1/2017 7/1/20156005730 APERION CARE AMBOY 1 1 AMBOY $11.60 $40.92 $94.60 $147.12 10/1/20176001010 APERION CARE BLOOMINGTON 4 4 BLOOMINGTON $9.88 $49.89 $94.50 $154.27 10/1/20176001150 APERION CARE BRIDGEPORT 5 5 BRIDGEPORT $9.39 $43.93 $99.14 $152.46 10/1/20176007207 APERION CARE BURBANK 7 7 BURBANK $19.73 $55.98 $126.23 $201.94 10/1/2017 7/1/20166008064 APERION CARE CHICAGO HEIGHTS 7 7 CHICAGO HEIGHTS $14.05 $43.24 $90.23 $147.52 10/1/20176002547 APERION CARE DOLTON 7 7 DOLTON $18.79 $49.25 $117.47 $185.51 10/1/20176005847 APERION CARE ELGIN 8 8 ELGIN $11.47 $54.20 $109.91 $175.58 10/1/20176006845 APERION CARE EVANSTON 7 7 EVANSTON $23.84 $48.47 $125.14 $197.45 10/1/2017 7/1/2016

Page 2: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 2

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6015333 APERION CARE FOREST PARK 7 7 FOREST PARK $21.70 $48.88 $122.59 $193.17 10/1/2017 7/1/20156000434 APERION CARE GALESBURG 2 2 GALESBURG $13.09 $40.51 $104.01 $157.61 10/1/2017 7/1/20156007280 APERION CARE HIGHWOOD 8 8 HIGHWOOD $19.52 $44.78 $117.07 $181.37 10/1/20176014617 APERION CARE INTERNATIONAL 6 6 CHICAGO $22.20 $48.75 $123.93 $194.88 10/1/20176008650 APERION CARE JACKSONVILLE 3 3 JACKSONVILLE $13.28 $39.56 $94.82 $147.66 10/1/2017 7/1/20156000095 APERION CARE LITCHFIELD 3 3 LITCHFIELD $9.67 $40.08 $94.43 $144.18 10/1/20176001077 APERION CARE MIDLOTHIAN 7 7 MIDLOTHIAN $14.70 $45.18 $109.80 $169.68 10/1/20176002646 APERION CARE MOLINE 10 10 EAST MOLINE $12.88 $44.26 $110.43 $167.57 10/1/20176002059 APERION CARE OAK LAWN 7 7 OAK LAWN $18.87 $50.10 $133.63 $202.60 10/1/2017 7/1/20166007520 APERION CARE PLUM GROVE 7 7 PALATINE $20.49 $46.83 $119.50 $186.82 10/1/20176008783 APERION CARE SPRING VALLEY 2 2 SPRING VALLEY $7.72 $48.96 $101.66 $158.34 10/1/20176002661 APERION CARE SPRINGFIELD 3 3 SPRINGFIELD $8.12 $42.00 $94.60 $144.72 10/1/20176004204 APERION CARE ST ELMO 5 5 SAINT ELMO $13.10 $42.14 $106.67 $161.91 10/1/2017 7/1/20156006308 APERION CARE TOLUCA 2 2 TOLUCA $8.57 $48.85 $88.93 $146.35 10/1/20176008312 APERION CARE WILMINGTON 9 9 WILMINGTON $14.50 $44.03 $97.69 $156.22 10/1/2017 7/1/20156000384 APOSTOLIC CHRISTIAN HOME 2 2 ROANOKE $14.69 $50.44 $82.64 $147.77 10/1/20176002885 APOSTOLIC CHRISTIAN HOME 2 2 EUREKA $16.41 $49.92 $72.00 $138.33 10/1/2017 7/1/20156000400 APOSTOLIC CHRISTIAN RESTMOR 2 2 MORTON $16.85 $50.44 $72.24 $139.53 10/1/20176000426 APOSTOLIC CHRISTIAN SKYLINES 2 2 PEORIA $13.82 $49.59 $82.27 $145.68 10/1/20176008155 ARBOUR HEALTH CARE CENTER 6 6 CHICAGO $13.16 $44.39 $86.18 $143.73 10/1/20176009823 ARCOLA HEALTH CARE CENTER 4 4 ARCOLA $9.63 $36.01 $75.26 $120.90 10/1/20176000517 ARTHUR HOME 4 4 ARTHUR $9.51 $47.66 $79.16 $136.33 10/1/20176016729 ASBURY GARDENS NSG AND REHAB 8 8 NORTH AURORA $19.48 $55.98 $104.86 $180.32 10/1/20176008205 ASPEN REHAB AND HEALTH CARE 10 10 SILVIS $12.20 $50.96 $67.01 $130.17 10/1/2017 7/1/20156016273 ASSISI HCC AT CLARE OAKS 7 7 BARTLETT $18.18 $55.98 $87.10 $161.26 10/1/20176006662 ASTORIA PLACE LIVING & REHAB 6 6 CHICAGO $17.76 $56.24 $120.71 $194.71 10/1/20176003834 ATRIUM HEALTH CARE CENTER 6 6 CHICAGO $13.80 $45.27 $91.22 $150.29 10/1/2017 7/1/20156007181 AUBURN REHAB AND HCC 3 3 AUBURN $8.78 $35.60 $76.35 $120.73 10/1/20176001317 AUTUMN MEADOWS OF CAHOKIA 11 11 EAST SAINT LOUI $14.07 $42.39 $90.77 $147.23 10/1/20176014344 AVANTARA LONG GROVE 8 8 LONG GROVE $19.87 $47.61 $120.42 $187.90 10/1/2017 7/1/20166009096 AVANTARA PARK RIDGE 7 7 PARK RIDGE $18.89 $55.98 $120.70 $195.57 10/1/20176003214 AVANTI WELLNESS AND REHAB 7 7 NILES $16.75 $49.29 $110.64 $176.68 10/1/20176011340 AVISTON COUNTRYSIDE MANOR 11 11 AVISTON $13.24 $42.38 $83.75 $139.37 10/1/20176000640 BALLARD RESPIRATORY AND REHAB 7 7 DES PLAINES $17.48 $55.82 $158.10 $231.40 10/1/20176000657 BALMORAL NURSING HOME 6 6 CHICAGO $11.01 $32.49 $93.43 $136.93 10/1/20176000731 BARRY COMMUNITY CARE 3 3 BARRY $9.06 $40.29 $75.89 $125.24 10/1/20176008171 BATAVIA REHAB HEALTH CARE CTR 8 8 BATAVIA $12.76 $55.98 $104.35 $173.09 10/1/2017 7/1/20166001176 BEACON CARE CENTER 6 6 CHICAGO $14.61 $52.58 $97.23 $164.42 10/1/2017 7/1/20156000806 BEECHER MANOR NURSG AND RHB CT 9 9 BEECHER $19.71 $53.08 $104.87 $177.66 10/1/20176000822 BELHAVEN NURSING REHAB CTR 6 6 CHICAGO $18.25 $55.98 $134.72 $208.95 10/1/2017 7/1/20156000889 BELLA TERRA MORTON GROVE 7 7 MORTON GROVE $19.84 $49.44 $118.72 $188.00 10/1/2017

Page 3: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 3

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6000855 BEMENT HEALTH CARE CENTER 4 4 BEMENT $11.34 $41.46 $73.26 $126.06 10/1/20176005391 BENTON REHAB HEALTH CARE CTR 5 5 BENTON $9.26 $43.31 $76.70 $129.27 10/1/20176010110 BERKELEY NURSING REHAB CENTER 7 7 OAK PARK $18.15 $55.98 $101.90 $176.03 10/1/20176000863 BETHALTO CARE CENTER 11 11 BETHALTO $9.57 $44.50 $87.11 $141.18 10/1/20176014872 BETHANY REHAB AND HCC 1 1 DEKALB $18.85 $51.52 $81.97 $152.34 10/1/20176006688 BETHESDA REHAB AND SENIOR CARE 6 6 CHICAGO $14.88 $55.98 $79.93 $150.79 10/1/2017 7/1/20166000962 BIG MEADOWS 1 1 SAVANNA $13.91 $48.57 $85.79 $148.27 10/1/20176000988 BIRCHWOOD PLAZA 6 6 CHICAGO $13.51 $39.49 $96.90 $149.90 10/1/2017 7/1/20166000996 BLOOMINGTON REHAB AND HCC 4 4 BLOOMINGTON $9.66 $50.44 $104.39 $164.49 10/1/20176001101 BREESE NURSING HOME 11 11 BREESE $10.21 $41.54 $83.29 $135.04 10/1/20176001119 BRENTWOOD NORTH HC REHAB CTR 8 8 RIVERWOODS $15.79 $55.98 $125.73 $197.50 10/1/2017 7/1/20166005474 BRIA OF BELLEVILLE 11 11 BELLEVILLE $14.56 $41.92 $99.45 $155.93 10/1/2017 7/1/20156007983 BRIA OF CAHOKIA 11 11 EAST SAINT LOUI $10.50 $38.76 $89.67 $138.93 10/1/20176007991 BRIA OF CHICAGO HEIGHTS 7 7 SOUTH CHICAGO H $17.19 $40.26 $111.02 $168.47 10/1/20176000954 BRIA OF FOREST EDGE 6 6 CHICAGO $11.79 $36.89 $115.35 $164.03 10/1/20176003503 BRIA OF GENEVA 8 8 GENEVA $11.25 $55.98 $119.74 $186.97 10/1/20176010086 BRIA OF PALOS HILLS 7 7 PALOS HILLS $22.82 $45.78 $120.33 $188.93 10/1/2017 7/1/20166001283 BRIA OF RIVER OAKS 7 7 BURNHAM $16.05 $36.83 $108.16 $161.04 10/1/20176009930 BRIA OF WESTMONT 7 7 WESTMONT $19.17 $44.26 $114.66 $178.09 10/1/2017 7/1/20166001143 BRIAR PLACE 7 7 INDIAN HEAD PAR $14.95 $44.40 $66.48 $125.83 10/1/2017 7/1/20166001168 BRIDGEVIEW HEALTH CARE CENTER 7 7 BRIDGEVIEW $15.05 $45.78 $120.13 $180.96 10/1/20176000353 BRIDGEWAY SENIOR LIVING 7 7 BENSENVILLE $16.52 $55.98 $100.04 $172.54 10/1/2017 7/1/20156001242 BUCKINGHAM PAVILION INC 6 6 CHICAGO $14.49 $41.32 $85.06 $140.87 10/1/20176001259 BURGESS SQUARE HEALTHCARE CTR 7 7 WESTMONT $11.90 $51.15 $85.67 $148.72 10/1/20176001275 BURGIN MANOR 5 5 OLNEY $11.71 $38.61 $99.00 $149.32 10/1/20176001291 BURNSIDE COMMUNITY HEALTH CTR 4 4 MARSHALL $11.67 $46.84 $80.82 $139.33 10/1/20176014674 CALHOUN NURSING AND REHAB CTR 3 3 HARDIN $14.76 $39.41 $81.56 $135.73 10/1/2017 7/1/20166001333 CALIFORNIA GARDENS NURSING & R 6 6 CHICAGO $15.24 $44.14 $85.64 $145.02 10/1/2017 7/1/20156008635 CAMBRIDGE NURSING REHAB CENTER 7 7 SKOKIE $17.64 $50.53 $118.07 $186.24 10/1/2017 7/1/20166001424 CARE CENTER OF ABINGDON 2 2 ABINGDON $12.34 $43.92 $73.56 $129.82 10/1/20176009336 CARLINVILLE REHAB AND HLTC 3 3 CARLINVILLE $11.97 $43.24 $78.87 $134.08 10/1/20176001473 CARLYLE HEALTHCARE CENTER INC 11 11 CARLYLE $14.18 $44.61 $85.37 $144.16 10/1/20176016539 CARMI MANOR 5 5 CARMI $11.55 $43.35 $77.80 $132.70 10/1/2017 7/1/20166001507 CARRIER MILLS NURSING & REHABI 5 5 CARRIER MILLS $12.50 $40.09 $87.25 $139.84 10/1/20176000970 CASEY HEALTH CARE CENTER 4 4 CASEY $11.55 $48.94 $69.34 $129.83 10/1/2017 7/1/20166010227 CASEYVILLE NRSG AND REHAB CTR 11 11 CASEYVILLE $13.23 $40.07 $82.88 $136.18 10/1/20176002869 CEDAR RIDGE HEALTH REHAB CTR 11 11 LEBANON $12.66 $46.71 $92.62 $151.99 10/1/20176001523 CENTER HOME HISPANIC ELDERLY 6 6 CHICAGO $15.97 $54.41 $106.98 $177.36 10/1/2017 7/1/20166001564 CENTRAL BAPTIST VILLAGE 7 7 NORRIDGE $17.23 $55.98 $79.92 $153.13 10/1/2017 7/1/20166001580 CENTRAL NURSING HOME 6 6 CHICAGO $9.44 $27.73 $101.58 $138.75 10/1/20176012355 CENTRALIA MANOR 5 5 CENTRALIA $16.97 $41.30 $85.19 $143.46 10/1/2017

Page 4: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 4

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6008601 CHALET LIVING & REHAB 6 6 CHICAGO $15.94 $55.98 $108.38 $180.30 10/1/20176001457 CHAMPAIGN URBANA NURSING REHAB 4 4 SAVOY $14.96 $50.44 $93.26 $158.66 10/1/20176001358 CHARLESTON REHAB HEALTH CARE 4 4 CHARLESTON $10.19 $42.27 $73.39 $125.85 10/1/2017 7/1/20156010367 CHATEAU NURSING AND REHAB 7 7 WILLOWBROOK $16.27 $51.15 $117.39 $184.81 10/1/20176001697 CHICAGO RIDGE NURSING CENTER 7 7 CHICAGO RIDGE $13.89 $36.49 $88.63 $139.01 10/1/20176001739 CHRISTIAN NURSING HOME 3 3 LINCOLN $16.84 $44.38 $77.65 $138.87 10/1/2017 7/1/20156001770 CISNE REHAB AND HEALTH CENTER 5 5 CISNE $7.72 $43.93 $89.46 $141.11 10/1/20176000277 CITADEL CARE CENTER-ELGIN 8 8 ELGIN $16.04 $55.98 $109.50 $181.52 10/1/20176000269 CITADEL CARE CENTER-KANKAKEE 9 9 KANKAKEE $14.72 $48.06 $107.68 $170.46 10/1/20176006563 CITADEL CARE CENTER-WILMETTE 7 7 WILMETTE $18.26 $55.98 $120.19 $194.43 10/1/20176009948 CITY VIEW MULTICARE CENTER LLC 7 7 CICERO $14.84 $39.14 $100.23 $154.21 10/1/20176005144 CLARIDGE HEALTHCARE CENTER 8 8 LAKE BLUFF $10.83 $40.10 $120.40 $171.33 10/1/20176001796 CLARK MANOR CONVALESCENT CENTE 6 6 CHICAGO $16.68 $40.10 $111.51 $168.29 10/1/20176001887 CLINTON MANOR LIVING CENTER 11 11 NEW BADEN $11.34 $45.93 $66.45 $123.72 10/1/20176007496 COLLINSVILLE REHAB HEALTH CARE 11 11 COLLINSVILLE $11.15 $38.29 $77.56 $127.00 10/1/20176001945 COLONIAL HLTHCARE AND REHAB CT 2 2 PRINCETON $11.17 $46.28 $82.74 $140.19 10/1/20176001952 COLONIAL MANOR 4 4 DANVILLE $16.24 $50.44 $82.19 $148.87 10/1/20176002026 COMMUNITY CARE CENTER 6 6 CHICAGO $12.60 $39.06 $82.23 $133.89 10/1/2017 7/1/20166006175 COMMUNITY NRSG AND REHAB CTR 7 7 NAPERVILLE $15.71 $50.90 $104.40 $171.01 10/1/20176016711 CONCORDIA VILLAGE CARE CENTER 3 3 SPRINGFIELD $16.85 $40.28 $79.09 $136.22 10/1/20176002075 CONTINENTAL NURSING REHAB CTR 6 6 CHICAGO $14.90 $50.31 $109.86 $175.07 10/1/2017 7/1/20156003420 CORNERSTONE REHAB AND HC 2 2 PEORIA HEIGHTS $11.84 $50.44 $77.36 $139.64 10/1/20176015200 COULTERVILLE REHAB AND HCC 5 5 COULTERVILLE $18.18 $43.93 $74.71 $136.82 10/1/20176002141 COUNTRY HEALTH 4 4 GIFFORD $22.50 $50.44 $70.86 $143.80 10/1/20176002190 COUNTRYSIDE NURSING AND REHAB 7 7 DOLTON $16.11 $41.83 $103.40 $161.34 10/1/20176005631 COUNTRYVIEW CARE CTR OF MACOMB 2 2 MACOMB $9.68 $47.66 $59.50 $116.84 10/1/20176003008 COURTYARD HEALTHCARE CENTER 7 7 BERWYN $17.93 $50.15 $115.61 $183.69 10/1/20176001093 COVENANT HEALTH CARE CENTER 7 7 NORTHBROOK $14.88 $55.98 $88.21 $159.07 10/1/20176002208 COVENANT HEALTH CARE CENTER 8 8 BATAVIA $17.23 $55.98 $83.91 $157.12 10/1/20176016778 CRAWFORD MEMORIAL HOSPITAL LTC 5 5 ROBINSON $16.84 $43.93 $73.47 $134.24 2/1/20176002273 CRESTWOOD TERRACE NURSING CTR 7 7 CRESTWOOD $13.11 $35.07 $67.28 $115.46 10/1/20176010136 CROSSROADS CARE CTR WOODSTOCK 8 8 WOODSTOCK $11.80 $48.90 $108.71 $169.41 10/1/20176002299 CRYSTAL PINES REHAB AND HCC 8 8 CRYSTAL LAKE $15.09 $53.62 $98.18 $166.89 10/1/20176002307 CUMBERLAND REHAB HEALTH CARE 4 4 GREENUP $9.41 $44.13 $76.38 $129.92 10/1/20176002364 DANVILLE CARE CENTER LTD 4 4 DANVILLE $10.98 $46.64 $86.71 $144.33 10/1/20176010342 DAYSTAR NURSING AND REHAB CTR 5 5 CAIRO $12.77 $42.46 $83.16 $138.39 10/1/2017 7/1/20166003081 DECATUR REHAB HEALTH CARE CTR 4 4 DECATUR $10.04 $50.44 $88.70 $149.18 10/1/20176005276 DIXON REHAB AND HCC 1 1 DIXON $11.18 $45.42 $91.10 $147.70 10/1/2017 7/1/20166002521 DOBSON PLAZA NURSING & REHAB 7 7 EVANSTON $16.41 $48.15 $106.14 $170.70 10/1/2017 7/1/20166002539 DOCTORS NURSING AND REHAB CTR 5 5 SALEM $13.36 $38.22 $101.59 $153.17 10/1/20176002570 DOUGLAS NURSING AND REHAB CTR 4 4 MATTOON $15.09 $44.20 $83.59 $142.88 10/1/2017

Page 5: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 5

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6002943 DUQUOIN NURSING & REHABILITATI 5 5 DU QUOIN $13.69 $37.19 $80.23 $131.11 10/1/2017 7/1/20166003222 EAST BANK CENTER 1 1 LOVES PARK $5.37 $48.05 $93.37 $146.79 10/1/20176007025 EASTSIDE HEALTH CARE CENTER 3 3 PITTSFIELD $10.49 $43.90 $77.72 $132.11 10/1/20176009237 EASTVIEW TERRACE 4 4 SULLIVAN $10.96 $44.46 $82.61 $138.03 10/1/2017 7/1/20156002679 EDEN VILLAGE 11 11 GLEN CARBON $12.09 $44.73 $67.93 $124.75 10/1/20176002729 EDWARDSVILLE NRSNG REHAB CTR 11 11 EDWARDSVILLE $12.27 $42.28 $96.80 $151.35 10/1/20176009559 EFFINGHAM REHAB HEALTH CARE CT 5 5 EFFINGHAM $10.27 $41.70 $67.75 $119.72 10/1/2017 7/1/20156002745 EL PASO HEALTH CARE CENTER 2 2 EL PASO $12.05 $45.14 $79.00 $136.19 10/1/20176003248 ELDORADO REHAB AND HEALTHCARE 5 5 ELDORADO $11.85 $30.18 $64.88 $106.91 10/1/20176002810 ELIZABETH NURSING HOME 1 1 ELIZABETH $7.07 $44.08 $79.92 $131.07 10/1/20176002828 ELMHURST EXTENDED CARE CENTER 7 7 ELMHURST $11.94 $54.24 $86.66 $152.84 10/1/20176005961 ELMWOOD NURSING AND REHAB CTR 11 11 MARYVILLE $13.40 $41.32 $81.10 $135.82 10/1/20176002844 ELMWOOD TERRACE HEALTHCARE CTR 8 8 AURORA $11.11 $51.77 $103.10 $165.98 10/1/20176002851 ELSTON NURSING AND REHAB CENTR 6 6 CHICAGO $14.24 $50.36 $108.93 $173.53 10/1/20176005425 ENFIELD REHAB HEALTH CARE 5 5 PEORIA $8.70 $43.93 $75.96 $128.59 10/1/20176004667 ESTATES OF HYDE PARK 6 6 CHICAGO $14.72 $43.56 $88.74 $147.02 10/1/2017 7/1/20166002877 EUNICE C SMITH HOME 11 11 ALTON $5.44 $46.71 $83.18 $135.33 10/1/20176002901 EVENGLOW LODGE 4 4 PONTIAC $13.82 $48.31 $72.80 $134.93 10/1/2017 7/1/20156002133 EVERGREEN NURSING AND REHAB CT 5 5 EFFINGHAM $10.62 $38.12 $82.58 $131.32 10/1/20176002950 FAIR HAVENS CHRISTIAN HOME 4 4 DECATUR $12.09 $50.22 $89.06 $151.37 10/1/20176002976 FAIR OAKS HEALTH CARE CENTER 8 8 CRYSTAL LAKE $15.55 $55.98 $108.68 $180.21 10/1/20176002984 FAIR OAKS REHAB AND HCC 1 1 SOUTH BELOIT $13.77 $50.75 $81.39 $145.91 10/1/20176003024 FAIRHAVEN CHRISTIAN RET HOME 1 1 ROCKFORD $16.41 $51.52 $75.25 $143.18 10/1/20176001051 FAIRMONT CARE CENTRE 6 6 CHICAGO $21.39 $49.59 $112.54 $183.52 10/1/2017 7/1/20156003040 FAIRVIEW HAVEN NURSING HOME 4 4 FAIRBURY $13.93 $50.44 $68.98 $133.35 10/1/20176003099 FAIRVIEW NURSING CENTER 5 5 DU QUOIN $10.58 $36.15 $61.13 $107.86 10/1/2017 7/1/20156003107 FAITH CARE CENTER 11 11 HIGHLAND $16.84 $46.44 $82.82 $146.10 10/1/20176004824 FARMER CITY REHAB AND HC 4 4 FARMER CITY $12.11 $47.43 $84.08 $143.62 10/1/2017 7/1/20166003115 FARMINGTON COUNTRY MANOR 2 2 FARMINGTON $12.37 $49.24 $75.56 $137.17 10/1/20176003123 FAYETTE COUNTY HOSPITAL NH 5 5 VANDALIA $6.15 $43.93 $65.46 $115.54 10/1/20176001614 FIRESIDE HOUSE OF CENTRALIA 5 5 CENTRALIA $10.38 $40.52 $74.01 $124.91 10/1/20176000939 FLANAGAN REHAB HEALTH CARE 4 4 FLANAGAN $10.95 $50.44 $86.29 $147.68 10/1/20176003172 FLORA GARDENS CARE CENTER 5 5 FLORA $10.68 $41.19 $86.84 $138.71 10/1/20176003156 FLORA REHAB HEALTH CARE CTR 5 5 FLORA $11.82 $43.93 $84.02 $139.77 10/1/20176003180 FLORENCE NURSING HOME 8 8 MARENGO $12.61 $49.25 $98.54 $160.40 10/1/20176003198 FONDULAC REHAB HEALTH CARE CTR 2 2 EAST PEORIA $12.22 $50.44 $76.43 $139.09 10/1/20176001135 FOREST CITY REHAB AND NRSG CTR 1 1 ROCKFORD $12.58 $35.60 $76.89 $125.07 10/1/20176000483 FOREST VIEW REHAB NURSING CTR 7 7 ITASCA $14.27 $47.27 $119.65 $181.19 10/1/20176000137 FOSTER HEALTH AND REHAB CENTER 6 6 CHICAGO $14.85 $47.14 $104.36 $166.35 10/1/20176012413 FRANCISCAN VILLAGE 7 7 LEMONT $13.46 $55.98 $89.82 $159.26 10/1/20176003289 FRANKFORT HEALTHCARE REHAB CTR 5 5 WEST FRANKFORT $8.80 $40.24 $68.11 $117.15 10/1/2017

Page 6: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 6

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6003297 FRANKFORT TERRACE NURSING CTR 9 9 FRANKFORT $10.80 $38.53 $71.10 $120.43 10/1/20176003305 FRANKLIN GROVE LIVING REHAB 1 1 FRANKLIN GROVE $14.12 $46.91 $77.34 $138.37 10/1/2017 7/1/20166003321 FREEBURG CARE CENTER 11 11 FREEBURG $11.93 $36.01 $77.30 $125.24 10/1/2017 7/1/20156003388 FRIENDSHIP MANOR 10 10 ROCK ISLAND $13.83 $50.35 $66.98 $131.16 10/1/20176015895 FRIENDSHIP MANOR HEALTH CARE 5 5 NASHVILLE $10.06 $38.41 $74.72 $123.19 10/1/20176005979 FRIENDSHIP SKILLED NSG REHAB 3 3 CARLINVILLE $10.32 $44.49 $79.75 $134.56 10/1/20176003404 FRIENDSHIP VILLAGE OF SCHAUMBU 7 7 SCHAUMBURG $16.97 $55.98 $105.82 $178.77 10/1/20176003438 GALENA STAUSS NURSING HOME 1 1 GALENA $7.78 $51.11 $69.14 $128.03 10/1/20176009567 GARDENVIEW MANOR 4 4 DANVILLE $11.95 $37.42 $101.04 $150.41 10/1/20176000467 GENERATIONS AT APPLEWOOD 7 7 MATTESON $18.21 $49.08 $120.88 $188.17 10/1/2017 7/1/20166002067 GENERATIONS AT COLUMBUS PARK 6 6 CHICAGO $17.30 $40.15 $79.54 $136.99 10/1/20176008270 GENERATIONS AT ELMWOOD PARK 7 7 ELMWOOD PARK $18.63 $41.81 $141.18 $201.62 10/1/20176006514 GENERATIONS AT NEIGHBORS 1 1 BYRON $18.07 $48.47 $86.66 $153.20 10/1/2017 5/1/20176006837 GENERATIONS AT OAKTON PAVILLIO 7 7 DES PLAINES $18.01 $39.50 $111.95 $169.46 10/1/2017 7/1/20166007793 GENERATIONS AT REGENCY 7 7 NILES $21.04 $48.46 $110.19 $179.69 10/1/20176008130 GENERATIONS AT ROCK ISLAND 10 10 ROCK ISLAND $13.59 $40.61 $96.07 $150.27 10/1/20176006076 GENESIS SENIOR LIVING ALEDO 10 10 ALEDO $12.09 $47.02 $62.64 $121.75 10/1/20176003552 GIBSON COMMUNITY HOSPITAL ANNE 4 4 GIBSON CITY $15.97 $50.44 $69.53 $135.94 10/1/20176003578 GILMAN HEALTHCARE CENTER 4 4 GILMAN $13.97 $44.51 $101.09 $159.57 10/1/20176006191 GLEN BRIDGE NURSING AND REHAB 7 7 NILES $17.36 $45.95 $124.83 $188.14 10/1/2017 7/1/20156003586 GLEN OAKS NURSING REHAB CENTER 7 7 NORTHBROOK $14.22 $44.61 $95.79 $154.62 10/1/20176008833 GLEN SAINT ANDREW LIVING COMM 7 7 NILES $12.75 $55.98 $114.10 $182.83 10/1/20176003610 GLEN VIEW TERRACE NURSING CTR 7 7 GLENVIEW $18.90 $53.28 $114.22 $186.40 10/1/20176003594 GLENCREST HLTHCR AND REHAB CTR 6 6 CHICAGO $16.29 $49.38 $130.53 $196.20 10/1/2017 7/1/20156006647 GLENLAKE TERRACE NURSING REHAB 8 8 WAUKEGAN $11.79 $42.52 $116.33 $170.64 10/1/20176007918 GLENSHIRE NURSING REHAB CENTRE 7 7 RICHTON PARK $18.34 $51.25 $130.82 $200.41 10/1/20176003628 GLENWOOD HEALTHCARE AND REHAB 7 7 GLENWOOD $18.71 $48.77 $115.36 $182.84 10/1/2017 7/1/20166003636 GOLDEN GOOD SHEPHERD HOME 3 3 GOLDEN $10.43 $43.06 $59.97 $113.46 10/1/20176007637 GOOD SAM PROPHETS RIVERVIEW 1 1 PROPHETSTOWN $12.52 $51.52 $75.73 $139.77 10/1/20176003495 GOOD SAM SOC GENESEO VILLAGE 10 10 GENESEO $14.24 $48.44 $69.09 $131.77 10/1/20176001515 GOOD SAM SOCIETY MT CARROLL 1 1 MOUNT CARROLL $14.24 $48.25 $71.23 $133.72 10/1/20176003677 GOOD SAMARITAN FLANAGAN 4 4 FLANAGAN $12.09 $50.44 $81.91 $144.44 10/1/20176003685 GOOD SAMARITAN HOME OF QUINCY 3 3 QUINCY $16.84 $44.49 $71.13 $132.46 10/1/20176005573 GOOD SAMARITAN PONTIAC 4 4 PONTIAC $10.80 $49.55 $68.24 $128.59 10/1/20176003727 GOTTLIEB MEMORIAL HOSPITAL 7 7 MELROSE PARK $7.85 $55.98 $81.78 $145.61 10/1/20176060524 GRAHAM HOSP EXT CARE FACILITY 2 2 CANTON $8.22 $50.44 $81.32 $139.98 10/1/20176001986 GRANITE NURSING AND REHAB CTR 11 11 GRANITE CITY $17.95 $38.49 $92.21 $148.65 10/1/20176015499 GREEK AMERICAN REHAB CARE CTR 7 7 WHEELING $17.26 $53.43 $115.01 $185.70 10/1/20176016570 GREENFIELDS OF GENEVA 8 8 GENEVA $18.18 $55.98 $122.62 $196.78 10/1/20166003511 GROSSE POINTE MANOR 7 7 NILES $19.37 $51.62 $126.92 $197.91 10/1/20176000574 GROVE OF FOX VALLEY 8 8 AURORA $19.36 $44.74 $114.35 $178.45 10/1/2017 7/1/2016

Page 7: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 7

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6003933 HALLMARK HOUSE NURSING CENTER 2 2 PEKIN $13.16 $49.37 $75.67 $138.20 10/1/20176003974 HAMILTON MEM REHAB AND HCC 5 5 MC LEANSBORO $13.26 $43.93 $77.80 $134.99 10/1/20176004006 HAMMOND HENRY DISTRICT HOSPITA 10 10 GENESEO $16.84 $53.08 $68.69 $138.61 10/1/20176004048 HARBOR CREST HOME 1 1 FULTON $5.80 $47.43 $57.90 $111.13 10/1/20176013684 HARMONY NURSING AND REHAB CTR 6 6 CHICAGO $20.50 $51.74 $122.17 $194.41 10/1/20176004089 HAVANA HEALTH CARE CENTER 3 3 HAVANA $13.24 $41.19 $78.71 $133.14 10/1/2017 7/1/20156015317 HAWTHORNE INN OF DANVILLE 4 4 DANVILLE $15.75 $41.96 $70.49 $128.20 10/1/20176009310 HEARTHSTONE MANOR 8 8 WOODSTOCK $14.54 $55.98 $76.75 $147.27 10/1/20176013437 HEARTLAND CHRISTIAN VILLAGE 4 4 NEOGA $14.24 $46.85 $84.69 $145.78 10/1/20176004121 HEARTLAND MANOR 4 4 CASEY $12.09 $49.76 $56.63 $118.48 10/1/2017 7/1/20166011597 HEARTLAND OF CANTON 2 2 CANTON $14.56 $49.02 $79.47 $143.05 10/1/20176000301 HEARTLAND OF CHAMPAIGN 4 4 CHAMPAIGN $11.11 $50.44 $81.25 $142.80 10/1/20176000285 HEARTLAND OF DECATUR 4 4 DECATUR $15.59 $47.67 $82.91 $146.17 10/1/20176003446 HEARTLAND OF GALESBURG 2 2 GALESBURG $17.02 $50.44 $79.38 $146.84 10/1/20176011613 HEARTLAND OF HENRY 2 2 HENRY $14.85 $48.47 $71.41 $134.73 10/1/20176005649 HEARTLAND OF MACOMB 2 2 MACOMB $15.73 $50.44 $85.35 $151.52 10/1/20176006233 HEARTLAND OF MOLINE 10 10 MOLINE $14.50 $48.19 $102.10 $164.79 10/1/20176000244 HEARTLAND OF NORMAL 4 4 NORMAL $14.04 $50.44 $74.96 $139.44 10/1/20176011571 HEARTLAND OF PAXTON 4 4 PAXTON $16.13 $49.50 $77.61 $143.24 10/1/20176000293 HEARTLAND OF PEORIA 2 2 PEORIA $14.35 $49.03 $74.55 $137.93 10/1/20176008056 HEARTLAND OF RIVERVIEW 2 2 EAST PEORIA $16.76 $50.44 $101.58 $168.78 10/1/20176004139 HEATHER HEALTH CARE CENTER 7 7 HARVEY $18.28 $49.69 $83.71 $151.68 10/1/20176004147 HEIGHTS HLTHCARE AND REHAB CTR 2 2 PEORIA HEIGHTS $12.45 $48.20 $78.78 $139.43 10/1/2017 7/1/20156006704 HELIA HEALTHCARE OF BELLEVILLE 11 11 BELLEVILLE $9.81 $46.71 $122.16 $178.68 10/1/20176016091 HELIA HEALTHCARE OF BENTON 5 5 BENTON $3.66 $43.93 $76.42 $124.01 10/1/20176003800 HELIA HEALTHCARE OF CHAMPAIGN 4 4 CHAMPAIGN $9.27 $44.00 $70.36 $123.63 10/1/20176005870 HELIA HEALTHCARE OF ENERGY 5 5 ENERGY $7.78 $36.52 $81.66 $125.96 10/1/20176004493 HELIA HEALTHCARE OF GREENVILLE 5 11 GREENVILLE $5.08 $44.33 $76.64 $126.05 10/1/20176006910 HELIA HEALTHCARE OF OLNEY 5 5 OLNEY $9.36 $26.23 $76.08 $111.67 10/1/20176003255 HELIA SOUTHBELT HEALTHCARE 11 11 BELLEVILLE $11.59 $43.65 $82.33 $137.57 10/1/20176012066 HENDERSON CO RETIREMENT CENTER 2 2 STRONGHURST $12.85 $45.59 $71.17 $129.61 10/1/20176003917 HENRY AND JANE VONDERLIETH CTR 3 3 MOUNT PULASKI $11.67 $44.49 $77.11 $133.27 10/1/20176000756 HERITAGE HEALTH 3 3 JACKSONVILLE $13.79 $44.49 $89.06 $147.34 10/1/20176000780 HERITAGE HEALTH BEARDSTOWN 3 3 BEARDSTOWN $11.88 $44.49 $73.87 $130.24 10/1/20176004261 HERITAGE HEALTH BLOOMINGTON 4 4 BLOOMINGTON $18.46 $50.44 $92.85 $161.75 10/1/20176000723 HERITAGE HEALTH CARLINVILLE 3 3 CARLINVILLE $12.89 $43.01 $83.74 $139.64 10/1/20176007199 HERITAGE HEALTH CHILLICOTHE 2 2 CHILLICOTHE $17.36 $50.41 $88.45 $156.22 10/1/2017 7/1/20166002083 HERITAGE HEALTH DWIGHT 4 4 DWIGHT $15.32 $50.32 $84.31 $149.95 10/1/20176005920 HERITAGE HEALTH EL PASO 2 2 EL PASO $16.72 $50.44 $87.13 $154.29 10/1/20176006902 HERITAGE HEALTH ELGIN 8 8 ELGIN $14.27 $55.33 $119.97 $189.57 10/1/20176003560 HERITAGE HEALTH GIBSON CITY 4 4 GIBSON CITY $13.82 $50.40 $87.12 $151.34 10/1/2017 7/1/2015

Page 8: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 8

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6000681 HERITAGE HEALTH GILLESPIE 3 3 GILLESPIE $12.41 $43.33 $88.28 $144.02 10/1/20176004592 HERITAGE HEALTH HOOPESTON 4 4 HOOPESTON $17.99 $47.75 $71.46 $137.20 10/1/20176000699 HERITAGE HEALTH LITCHFIELD 3 3 LITCHFIELD $13.64 $44.41 $94.64 $152.69 10/1/20176004253 HERITAGE HEALTH MENDOTA 2 2 MENDOTA $11.94 $50.01 $86.64 $148.59 10/1/20176005367 HERITAGE HEALTH MINONK 2 2 MINONK $15.84 $50.44 $106.63 $172.91 10/1/2017 7/1/20156010128 HERITAGE HEALTH MOUNT ZION 4 4 MOUNT ZION $16.56 $49.83 $73.34 $139.73 10/1/20176004287 HERITAGE HEALTH MT STERLING 3 3 MOUNT STERLING $13.68 $44.49 $81.68 $139.85 10/1/2017 7/1/20156008510 HERITAGE HEALTH NORMAL 4 4 NORMAL $16.29 $49.94 $93.16 $159.39 10/1/20176000707 HERITAGE HEALTH PANA 3 3 PANA $13.23 $41.85 $92.31 $147.39 10/1/20176004303 HERITAGE HEALTH PERU 2 2 PERU $15.13 $48.38 $102.17 $165.68 10/1/20176002125 HERITAGE HEALTH ROBINSON 5 5 ROBINSON $13.41 $43.93 $62.97 $120.31 10/1/20176004279 HERITAGE HEALTH SPRINGFIELD 3 3 SPRINGFIELD $15.52 $44.49 $93.18 $153.19 10/1/2017 7/1/20156000715 HERITAGE HEALTH STAUNTON 3 3 STAUNTON $12.01 $44.49 $74.76 $131.26 10/1/20176004311 HERITAGE HEALTH STREATOR 2 2 STREATOR $16.57 $49.16 $90.00 $155.73 10/1/2017 7/1/20156009690 HERITAGE HEALTH WALNUT 2 2 WALNUT $11.90 $49.56 $86.50 $147.96 10/1/20176004337 HERITAGE SQUARE 1 1 DIXON $9.07 $50.53 $76.55 $136.15 10/1/20176004352 HICKORY NURSING PAVILION 7 7 HICKORY HILLS $15.52 $49.25 $79.75 $144.52 10/1/20176016687 HICKORY POINT CHRISTIAN VILL 4 4 FORSYTH $16.85 $46.11 $91.71 $154.67 10/1/20176001663 HIGHLAND HEALTH CARE CENTER 11 11 HIGHLAND $9.69 $46.52 $82.41 $138.62 10/1/20176000392 HIGHLAND OAKS 8 8 ELGIN $14.39 $55.98 $81.08 $151.45 10/1/20176004410 HILLCREST RETIREMENT VILLAGE 8 8 ROUND LAKE BEAC $13.34 $46.74 $103.44 $163.52 10/1/2017 7/1/20166004428 HILLSBORO REHAB AND HLTC 3 3 HILLSBORO $11.14 $42.63 $78.68 $132.45 10/1/20176004451 HILLSIDE REHAB AND CARE CENTER 9 9 YORKVILLE $6.68 $47.72 $87.55 $141.95 10/1/20176004477 HILLTOP SKILLED NURSING REHAB 4 4 CHARLESTON $11.49 $35.29 $81.97 $128.75 10/1/20176004485 HILLVIEW HEALTH CARE CENTER 5 5 VIENNA $8.72 $37.65 $57.02 $103.39 10/1/20176004501 HITZ MEMORIAL HOME 11 11 ALHAMBRA $11.23 $46.71 $64.75 $122.69 10/1/20176004550 HOLY FAMILY VILLA 7 7 PALOS PARK $18.18 $55.98 $79.25 $153.41 10/1/20176004212 ILLINI HERITAGE REHAB AND HC 4 4 CHAMPAIGN $9.69 $41.99 $85.91 $137.59 10/1/20176013023 ILLINI RESTORATIVE CARE 10 10 SILVIS $15.55 $51.52 $79.60 $146.67 10/1/20176004675 ILLINOIS KNIGHTS TEMPLAR HOME 4 4 PAXTON $11.67 $50.44 $60.95 $123.06 10/1/20176012579 IMBODEN CREEK LIVING CENTER 4 4 DECATUR $15.94 $50.44 $71.44 $137.82 10/1/2017 7/1/20166002778 INTEGRITY HC OF ALTON 11 11 ALTON $11.52 $43.69 $94.61 $149.82 10/1/20176001788 INTEGRITY HC OF ANNA 5 5 ANNA $10.12 $40.67 $80.08 $130.87 10/1/20176009203 INTEGRITY HC OF CARBONDALE 5 5 CARBONDALE $10.34 $42.88 $84.41 $137.63 10/1/2017 7/1/20166008841 INTEGRITY HC OF CHESTER 5 5 CHESTER $10.69 $43.38 $79.95 $134.02 10/1/20176004469 INTEGRITY HC OF COBDEN 5 5 COBDEN $9.87 $39.73 $66.57 $116.17 10/1/20176013106 INTEGRITY HC OF COLUMBIA 11 11 COLUMBIA $16.05 $46.24 $87.97 $150.26 10/1/20176001028 INTEGRITY HC OF GODFREY 11 11 GODFREY $12.12 $46.71 $110.58 $169.41 10/1/20176003362 INTEGRITY HC OF HERRIN 5 5 HERRIN $9.00 $37.53 $75.60 $122.13 10/1/2017 7/1/20156003230 INTEGRITY HC OF MARION 5 5 MARION $15.03 $41.60 $79.86 $136.49 10/1/20176007975 INTEGRITY HC OF RIDGWAY 5 5 RIDGWAY $9.27 $34.50 $71.81 $115.58 10/1/2017

Page 9: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 9

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6007116 INTEGRITY HC OF SMITHTON 11 11 SMITHTON $10.57 $46.71 $61.61 $118.89 10/1/20176009534 INTEGRITY HC OF WOOD RIVER 11 11 WOOD RIVER $14.15 $46.71 $84.10 $144.96 10/1/20176004790 IROQUOIS RESIDENT HOME 4 4 WATSEKA $11.67 $50.44 $72.81 $134.92 10/1/20176004840 JACKSONVILLE SKILLED NRSG REH 3 3 JACKSONVILLE $11.62 $38.22 $95.61 $145.45 10/1/2017 7/1/20156004899 JENNINGS TERRACE 8 8 AURORA $9.69 $45.20 $91.77 $146.66 10/1/20176013312 JERSEYVILLE MANOR 3 3 JERSEYVILLE $18.32 $40.75 $84.10 $143.17 10/1/2017 7/1/20166004907 JERSEYVILLE NSG AND REHAB CTR 3 3 JERSEYVILLE $16.22 $43.79 $86.00 $146.01 10/1/20176004964 JOLIET TERRACE NURSING CTR 9 9 JOLIET $10.57 $37.90 $55.13 $103.60 10/1/20176005433 JONESBORO REHAB HEALTH CARE 5 5 JONESBORO $9.58 $43.92 $72.56 $126.06 10/1/20176006126 KENSINGTON PLACE NRSG REHAB 6 6 CHICAGO $14.06 $45.30 $103.70 $163.06 10/1/20176005011 KEWANEE CARE HOME 10 10 KEWANEE $13.38 $44.88 $84.35 $142.61 10/1/2017 7/1/20166005128 LAHARPE DAVIER HEALTH CARE 3 3 LA HARPE $9.69 $44.23 $74.64 $128.56 10/1/20176005169 LAKEFRONT NURSING & REHAB CENT 6 6 CHICAGO $13.50 $47.53 $83.47 $144.50 10/1/20176005185 LAKELAND REHAB AND HCC 5 5 EFFINGHAM $11.81 $42.62 $75.83 $130.26 10/1/20176005227 LAKEVIEW REHAB NURSING CENTER 6 6 CHICAGO $13.51 $54.89 $126.16 $194.56 10/1/20176005235 LAKEWOOD NURSING AND REHAB CTR 9 9 PLAINFIELD $18.85 $49.99 $116.88 $185.72 10/1/20176001044 LEBANON CARE CENTER 11 11 LEBANON $11.01 $37.58 $83.67 $132.26 10/1/20176005284 LEE MANOR NURSING HM 7 7 DES PLAINES $16.88 $44.33 $110.61 $171.82 10/1/20176014492 LEMONT NURSING AND REHAB CTR 7 7 LEMONT $21.17 $50.59 $114.24 $186.00 10/1/20176005292 LENA LIVING CENTER 1 1 LENA $16.77 $47.56 $73.21 $137.54 10/1/2017 7/1/20166012157 LEROY MANOR 4 4 LE ROY $15.43 $45.75 $77.88 $139.06 10/1/20176005300 LEWIS MEMORIAL 3 3 SPRINGFIELD $16.84 $44.49 $89.44 $150.77 10/1/2017 7/1/20156011993 LEXINGTON HEALTH CARE CENTER O 7 7 BLOOMINGDALE $18.25 $51.26 $108.49 $178.00 10/1/20176005318 LEXINGTON HEALTH CARE CTR INC 7 7 LOMBARD $15.73 $49.10 $109.05 $173.88 10/1/20176012967 LEXINGTON HEALTH CARE OF CHICA 7 7 CHICAGO RIDGE $21.14 $48.71 $106.48 $176.33 10/1/20176013098 LEXINGTON OF ELMHURST 7 7 ELMHURST $17.03 $51.93 $119.07 $188.03 10/1/20176013361 LEXINGTON OF LAGRANGE 7 7 LA GRANGE $23.21 $53.46 $100.80 $177.47 10/1/20176014138 LEXINGTON OF LAKE ZURICH 8 8 LAKE ZURICH $17.94 $50.32 $101.30 $169.56 10/1/20176014682 LEXINGTON OF ORLAND PARK 7 7 ORLAND PARK $21.06 $47.43 $112.47 $180.96 10/1/20176012553 LEXINGTON OF SCHAUMBURG 7 7 SCHAUMBURG $21.18 $49.62 $99.90 $170.70 10/1/20176012975 LEXINGTON OF STREAMWOOD 7 7 STREAMWOOD $21.20 $50.66 $108.40 $180.26 10/1/20176014369 LEXINGTON OF WHEELING 7 7 OTHER $20.99 $50.62 $106.53 $178.14 10/1/20176005359 LIBERTYVILLE MANOR EXT CARE 8 8 LIBERTYVILLE $12.08 $55.55 $40.57 $108.20 10/1/20176005375 LIEBERMAN CENTER FOR HEALTH 7 7 SKOKIE $16.29 $56.24 $103.59 $176.12 10/1/2017 7/1/20166005508 LINCOLN MANOR 4 4 DECATUR $12.92 $39.00 $73.96 $125.88 10/1/20176005563 LITTLE SISTERS OF THE POOR 6 6 CHICAGO $10.11 $55.98 $70.45 $136.54 10/1/20176005599 LUTHERAN CARE CTR 5 5 ALTAMONT $12.16 $43.93 $78.72 $134.81 10/1/20176005607 LUTHERAN HOME FOR THE AGED 7 7 ARLINGTON HGTS $18.18 $55.98 $80.76 $154.92 10/1/20176005615 LUTHERAN HOME INC 2 2 PEORIA $12.52 $50.44 $48.40 $111.36 10/1/20176009013 MADO HEALTHCARE - UPTOWN 6 6 CHICAGO $14.20 $50.55 $59.61 $124.36 10/1/2017 7/1/20166016885 MANOR COURT OF CARBONDALE 5 5 CARBONDALE $23.74 $43.93 $78.45 $146.12 10/1/2017

Page 10: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 10

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6015879 MANOR COURT OF CLINTON 4 4 CLINTON $17.98 $46.11 $88.13 $152.22 10/1/20176016133 MANOR COURT OF FREEPORT 1 1 FREEPORT $17.96 $51.52 $78.38 $147.86 10/1/20176013189 MANOR COURT OF MARYVILLE 11 11 MARYVILLE $13.47 $44.96 $81.28 $139.71 10/1/20176016190 MANOR COURT OF PEORIA 2 2 PEORIA $20.79 $46.11 $83.11 $150.01 10/1/20176015887 MANOR COURT OF PERU 2 2 PERU $17.87 $46.11 $72.62 $136.60 10/1/20176015861 MANOR COURT OF PRINCETON 2 2 PRINCETON $17.87 $46.11 $74.86 $138.84 10/1/20176000228 MANORCARE OF ARLINGTON HEIGHTS 7 7 ARLINGTON HEIGH $18.32 $55.98 $99.22 $173.52 10/1/20176012686 MANORCARE OF ELK GROVE VILLAGE 7 7 ELK GROVE VLG $21.58 $53.57 $109.26 $184.41 10/1/20176006332 MANORCARE OF HINSDALE 7 7 HINSDALE $11.08 $55.98 $97.79 $164.85 10/1/20176012611 MANORCARE OF HOMEWOOD 7 7 HOMEWOOD $21.11 $53.81 $108.56 $183.48 10/1/20176010482 MANORCARE OF LIBERTYVILLE 8 8 LIBERTYVILLE $16.43 $55.40 $94.20 $166.03 10/1/20176000251 MANORCARE OF NAPERVILLE 7 7 NAPERVILLE $14.95 $55.98 $106.37 $177.30 10/1/20176015168 MANORCARE OF NORTHBROOK 7 7 NORTHBROOK $21.70 $53.30 $95.77 $170.77 10/1/20176000236 MANORCARE OF OAK LAWN EAST 7 7 OAK LAWN $19.76 $54.32 $104.88 $178.96 10/1/20176000343 MANORCARE OF OAK LAWN WEST 7 7 OAK LAWN $17.75 $55.08 $116.51 $189.34 10/1/20176010912 MANORCARE OF PALOS HTS EAST 7 7 PALOS HEIGHTS $21.54 $53.48 $96.69 $171.71 10/1/20176014534 MANORCARE OF PALOS HTS WEST 7 7 PALOS HEIGHTS $23.37 $55.98 $117.10 $196.45 10/1/20176000327 MANORCARE OF ROLLING MEADOWS 7 7 ROLLING MEADOWS $19.67 $52.27 $93.73 $165.67 10/1/20176011589 MANORCARE OF SOUTH HOLLAND 7 7 SOUTH HOLLAND $21.20 $54.26 $107.98 $183.44 10/1/20176000335 MANORCARE OF WESTMONT 7 7 WESTMONT $17.31 $55.98 $98.21 $171.50 10/1/20176005706 MAPLE CREST CARE CENTRE 1 1 BELVIDERE $13.70 $46.96 $107.87 $168.53 10/1/20176005748 MAR KA NURSING HOME 11 11 MASCOUTAH $10.11 $43.42 $81.73 $135.26 10/1/20176005797 MARIGOLD REHABILITATION HCC 2 2 GALESBURG $11.91 $46.74 $68.06 $126.71 10/1/20176011688 MASON CITY AREA NURSING HOME 3 3 MASON CITY $15.91 $44.49 $66.13 $126.53 10/1/2017 7/1/20166004691 MASON POINT 4 4 SULLIVAN $9.37 $50.44 $79.83 $139.64 10/1/20176005888 MATTOON REHAB AND HCC 4 4 MATTOON $10.99 $48.76 $78.24 $137.99 10/1/20176005896 MAYFIELD CARE CENTER 6 6 CHICAGO $12.93 $49.50 $117.15 $179.58 10/1/2017 7/1/20156005938 MCKINLEY COURT 4 4 DECATUR $14.32 $47.72 $85.86 $147.90 10/1/20176005417 MCLEANSBORO REHAB HEALTH CARE 5 5 MC LEANSBORO $9.24 $43.93 $92.17 $145.34 10/1/20176005953 MEADOW MANOR SKILLED NRSG REH 3 3 TAYLORVILLE $10.26 $39.30 $74.88 $124.44 10/1/20176013120 MEADOWBROOK MANOR 9 9 BOLINGBROOK $17.07 $46.15 $119.62 $182.84 10/1/20176014518 MEADOWBROOK MANOR NAPERVILLE 7 7 NAPERVILLE $18.61 $48.91 $109.46 $176.98 10/1/20176016281 MEADOWBROOK MANOR OF LAGRANGE 7 7 LA GRANGE $16.22 $44.69 $113.00 $173.91 10/1/20176005987 MEADOWOOD 5 5 GRAYVILLE $9.03 $28.31 $54.81 $92.15 10/1/20176006001 MEADOWS MENNONITE 4 4 CHENOA $14.69 $49.26 $74.40 $138.35 10/1/2017 7/1/20156006019 MEDINA NURSING CENTER 1 1 DURAND $14.27 $48.91 $81.90 $145.08 10/1/20176006035 MEMORIAL CARE CENTER 11 11 BELLEVILLE $6.15 $46.71 $60.70 $113.56 10/1/20176006050 MENDOTA LUTHERAN HOME 2 2 MENDOTA $12.09 $49.20 $74.67 $135.96 10/1/20176016737 MERCY CIRCLE 6 6 CHICAGO $18.18 $55.98 $94.48 $168.64 10/1/20176015697 MERCY HARVARD HOSPITAL CR CTR 8 8 HARVARD $10.15 $55.98 $82.14 $148.27 10/1/20176010391 MERCY REHAB AND CARE CENTER, I 11 11 SWANSEA $13.37 $46.71 $75.04 $135.12 10/1/2017

Page 11: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 11

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6015812 MERIDIAN VILLAGE CARE CENTER 11 11 GLEN CARBON $16.85 $46.71 $74.51 $138.07 10/1/20176006118 METROPOLIS REHAB AND HCC 5 5 METROPOLIS $16.62 $43.74 $63.84 $124.20 10/1/20176003826 MIDWAY NEUROLOGICAL REHAB CTR 7 7 BRIDGEVIEW $14.24 $40.03 $108.71 $162.98 10/1/20176001341 MIDWEST REHAB AND RESPIRATORY 11 11 BELLEVILLE $11.34 $44.45 $80.38 $136.17 10/1/20176014294 MILLER HEALTHCARE CENTER 9 9 KANKAKEE $18.18 $49.74 $100.20 $168.12 10/1/20176006258 MOMENCE MEADOWS NURSING AND RE 9 9 MOMENCE $13.57 $50.62 $120.63 $184.82 10/1/2017 7/1/20156006266 MONMOUTH NURSING HOME 2 2 MONMOUTH $12.84 $46.60 $66.02 $125.46 10/1/2017 7/1/20156006316 MONTEBELLO HEALTH CARE CENTER 3 3 HAMILTON $9.52 $38.57 $73.05 $121.14 10/1/20176004444 MONTGOMERY NURSING AND REHAB 3 3 HILLSBORO $11.19 $42.47 $80.79 $134.45 10/1/20176013171 MONTGOMERY PLACE 6 6 CHICAGO $14.39 $55.98 $63.89 $134.26 10/1/20176005698 MOORINGS OF ARLINGTON HEIGHTS 7 7 ARLINGTON HTS $14.39 $54.40 $94.38 $163.17 10/1/20146006407 MORTON TERRACE H AND R CENTRE 2 2 MORTON $11.73 $40.00 $72.21 $123.94 10/1/20176006399 MORTON VILLA HLTH AND REH CTR 2 2 MORTON $11.23 $38.85 $89.10 $139.18 10/1/20176005177 MOSAIC OF LAKESHORE 6 6 CHICAGO $14.60 $49.20 $98.90 $162.70 10/1/20176002489 MOSAIC OF SPRINGFIELD 3 3 SPRINGFIELD $9.91 $40.88 $75.48 $126.27 10/1/20176006134 MOSAIC OF UPTOWN 6 6 CHICAGO $16.10 $47.51 $95.35 $158.96 10/1/2017 7/1/20166012322 MOWEAQUA REHAB AND HEALTH CR 4 4 MOWEAQUA $12.66 $38.65 $73.59 $124.90 10/1/20176012512 MT VERNON COUNTRYSIDE MANOR 5 5 MOUNT VERNON $14.89 $41.16 $76.82 $132.87 10/1/20176001531 MT VERNON HEALTH CARE CENTER 5 5 MOUNT VERNON $8.92 $36.80 $76.65 $122.37 10/1/20176006498 NATURE TRAIL HEALTH CARE CTR 5 5 MOUNT VERNON $10.03 $43.93 $83.42 $137.38 10/1/20176006506 NAZARETHVILLE 7 7 DES PLAINES $11.10 $55.98 $89.49 $156.57 10/1/20176006522 NEW ATHENS HOME FOR THE AGED 11 11 NEW ATHENS $12.09 $44.26 $75.67 $132.02 10/1/2017 7/1/20156002091 NEWMAN REHAB HEALTH CARE CTR 4 4 NEWMAN $10.75 $49.18 $109.52 $169.45 10/1/20176006548 NEWTON CARE CENTER 5 5 NEWTON $6.40 $41.39 $72.35 $120.14 10/1/20176003644 NILES NURSING AND REHAB CTR 7 7 NILES $17.51 $47.23 $117.28 $182.02 10/1/2017 7/1/20156006555 NOKOMIS REHAB HEALTH CARE CTR 3 3 NOKOMIS $11.41 $37.88 $76.54 $125.83 10/1/20176006571 NORRIDGE GARDENS 7 7 NORRIDGE $16.53 $47.35 $116.37 $180.25 10/1/20176006589 NORTH ADAMS HOME 3 3 MENDON $12.95 $40.30 $63.55 $116.80 10/1/20176006605 NORTH AURORA CARE CENTER 8 8 NORTH AURORA $11.24 $49.29 $78.95 $139.48 10/1/20176000210 NORTH LOGAN HEALTHCARE CENTER 4 4 DANVILLE $16.27 $40.03 $87.83 $144.13 10/1/2017 7/1/20166006670 NORTHWOODS CARE CENTRE 1 1 BELVIDERE $14.74 $46.05 $97.27 $158.06 10/1/20176006696 NORWOOD CROSSING 6 6 CHICAGO $15.83 $55.98 $89.58 $161.39 10/1/2017 7/1/20166006779 OAK LAWN RESPIRATORY AND REHAB 7 7 OAK LAWN $13.23 $47.75 $171.95 $232.93 10/1/2017 7/1/20166006720 OAKBROOK HEALTHCARE CENTER 7 7 OAK BROOK $14.07 $51.25 $107.56 $172.88 10/1/20176006829 OAKRIDGE HEALTHCARE CENTER 7 1 HILLSIDE $11.01 $53.21 $85.55 $149.77 10/1/20176003487 OAKVIEW HTS CONT CARE REHAB 5 5 MOUNT CARMEL $15.97 $43.47 $65.10 $124.54 10/1/20176006860 ODD FELLOWS REBEKAH HOME 4 4 MATTOON $12.52 $48.70 $71.92 $133.14 10/1/20176006878 ODIN HEALTH CARE CENTER 5 5 ODIN $11.42 $42.84 $80.15 $134.41 10/1/20176009989 OREGON LIVING AND REHAB CENTER 1 1 OREGON $12.83 $47.39 $97.91 $158.13 10/1/2017 7/1/20156012728 OSF ST ANTHONYS HEALTHCARE SNU 11 11 ALTON $6.15 $46.71 $25.90 $78.76 7/1/20146006985 OTTAWA PAVILION 2 2 OTTAWA $18.14 $46.58 $87.41 $152.13 10/1/2017

Page 12: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 12

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6006993 OUR LADY OF ANGELS RETIREMENT 9 9 JOLIET $14.88 $50.50 $80.15 $145.53 10/1/20176007041 PA PETERSON AT THE CITADEL 1 1 ROCKFORD $15.73 $51.52 $79.25 $146.50 10/1/20176002109 PALM TERRACE OF MATTOON 4 4 MATTOON $11.63 $38.77 $83.19 $133.59 10/1/2017 7/1/20166006795 PARAMOUNT OAK PARK R AND N CTR 7 7 OAK PARK $15.92 $44.45 $88.21 $148.58 10/1/2017 7/1/20156004766 PARC AT JOLIET 9 9 JOLIET $12.87 $45.02 $100.11 $158.00 10/1/20176007090 PARIS HEALTH CARE CENTER 4 4 PARIS $11.07 $46.60 $88.04 $145.71 10/1/20176007140 PARK HOUSE NURSING REHAB 6 6 CHICAGO $11.51 $47.06 $77.50 $136.07 10/1/20176003073 PARK PLACE OF BELVIDERE 1 1 BELVIDERE $9.50 $45.80 $92.36 $147.66 10/1/20176003875 PARK POINTE HEALTHCARE AND REH 9 9 MORRIS $19.22 $53.08 $88.52 $160.82 10/1/20176007157 PARK RIDGE CARE CENTER 7 7 PARK RIDGE $16.48 $55.44 $96.24 $168.16 10/1/20176002315 PARK VIEW REHAB CENTER 6 6 CHICAGO $14.72 $41.72 $89.98 $146.42 10/1/20176007934 PARK VILLA NURSING REHAB CTR 7 7 PALOS HEIGHTS $20.01 $53.58 $105.36 $178.95 10/1/20176001374 PARKER NURSING AND REHAB CTR 2 2 STREATOR $11.16 $43.62 $95.84 $150.62 10/1/20176005003 PARKSHORE ESTATES NRSG REHAB 6 6 CHICAGO $13.59 $48.85 $98.91 $161.35 10/1/20176014385 PARKWAY MANOR 5 5 MARION $19.68 $42.39 $84.30 $146.37 10/1/20176009799 PAVILION OF WAUKEGAN 8 8 WAUKEGAN $12.63 $55.98 $108.01 $176.62 10/1/20176003206 PAXTON HEALTHCARE AND REHAB 4 4 PAXTON $15.55 $50.44 $75.45 $141.44 10/1/20176003339 PEARL PAVILION 1 1 FREEPORT $16.15 $45.38 $99.31 $160.84 10/1/2017 7/1/20166011712 PEKIN MANOR 2 2 PEKIN $18.02 $44.32 $73.61 $135.95 10/1/20176007355 PERSHING GARDENS HC CENTER 7 7 STICKNEY $16.38 $50.42 $109.22 $176.02 10/1/2017 7/1/20156007371 PETERSON PARK HEALTH CARE CTR 6 6 CHICAGO $18.58 $48.71 $125.97 $193.26 10/1/20176005441 PINCKNEYVILLE NURSING & REHABI 5 5 PINCKNEYVILLE $13.92 $37.09 $82.21 $133.22 10/1/2017 7/1/20156007413 PINE ACRES REHAB LIVING CENTER 1 1 DEKALB $17.96 $51.52 $94.79 $164.27 10/1/20176004741 PINE CREST HEALTH CARE 7 7 HAZEL CREST $17.78 $46.12 $87.81 $151.71 10/1/20176007447 PINECREST MANOR 1 1 MOUNT MORRIS $13.82 $50.58 $64.14 $128.54 10/1/20176003792 PIPER CITY REHAB LIVING CTR 4 4 PIPER CITY $10.96 $50.44 $76.04 $137.44 10/1/2017 7/1/20166012470 PITTSFIELD MANOR 3 3 PITTSFIELD $14.89 $40.30 $79.01 $134.20 10/1/20176007470 PLEASANT HILL HEALTHCARE 3 3 GIRARD $12.63 $38.68 $86.30 $137.61 10/1/20176007488 PLEASANT MEADOWS SENIOR LIVING 4 4 CHRISMAN $13.82 $48.02 $91.39 $153.23 10/1/20176007512 PLEASANT VIEW LUTHER HOME 2 2 OTTAWA $16.41 $50.44 $74.82 $141.67 10/1/20176007504 PLEASANT VIEW REHAB AND HCC 1 1 MORRISON $9.30 $45.95 $89.88 $145.13 10/1/20176007546 POLO REHABILITATION AND HCC 1 1 POLO $9.94 $49.51 $82.15 $141.60 10/1/20176004642 PONTIAC HEALTHCARE AND REHAB 4 4 PONTIAC $13.67 $48.27 $73.76 $135.70 10/1/20176007561 PRAIRIE CITY REHAB AND HC 2 2 PRAIRIE CITY $9.17 $43.60 $66.00 $118.77 10/1/20176008502 PRAIRIE CROSSING LVG AND REHAB 1 1 SHABBONA $12.10 $47.64 $107.48 $167.22 10/1/2017 7/1/20166011746 PRAIRIE MANOR NURSING REHAB 7 7 CHICAGO HEIGHTS $23.91 $49.26 $119.92 $193.09 10/1/20176007082 PRAIRIE ROSE HEALTH CARE CTR 3 3 PANA $10.40 $41.42 $79.69 $131.51 10/1/2017 7/1/20166001812 PRAIRIE VIEW CARE OF LEWISTOWN 2 2 LEWISTOWN $9.87 $42.03 $94.48 $146.38 10/1/2017 7/1/20156006027 PRAIRIE VLG HEALTHCARE CTR INC 3 3 JACKSONVILLE $12.12 $38.31 $85.46 $135.89 10/1/2017 7/1/20156007595 PRAIRIEVIEW LUTHERAN HOME 4 4 DANFORTH $12.95 $50.44 $77.78 $141.17 10/1/20176005771 PRESENCE COR MARIAE CENTER 1 1 ROCKFORD $12.52 $51.52 $76.55 $140.59 10/1/2017

Page 13: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 13

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6005854 PRESENCE MARYHAVEN NSG REHAB 7 7 GLENVIEW $14.39 $55.98 $97.52 $167.89 10/1/20176005912 PRESENCE MCAULEY MANOR 8 8 AURORA $12.98 $55.98 $81.38 $150.34 10/1/20176007009 PRESENCE OUR LADY OF VICTORY 9 9 BOURBONNAIS $14.39 $53.08 $90.98 $158.45 10/1/20176007439 PRESENCE PINE VIEW CARE CENTER 8 8 SAINT CHARLES $10.96 $55.98 $89.08 $156.02 10/1/20176014575 PRESENCE RESURRECTION LIFE CTR 6 6 CHICAGO $17.23 $54.57 $83.55 $155.35 10/1/20176007892 PRESENCE RESURRECTION NRC 7 7 PARK RIDGE $10.64 $54.29 $104.88 $169.81 10/1/20176008874 PRESENCE SAINT BENEDICT NRC 7 7 NILES $13.92 $55.98 $106.35 $176.25 10/1/20176008817 PRESENCE ST ANNE CENTER 1 1 ROCKFORD $12.09 $51.52 $85.83 $149.44 10/1/20176008973 PRESENCE ST JOSEPH CENTER 1 1 FREEPORT $14.24 $51.52 $78.09 $143.85 10/1/20176012678 PRESENCE VILLA FRANCISCAN 9 9 JOLIET $14.39 $53.08 $94.78 $162.25 10/1/20176009591 PRESENCE VILLA SCALABRINI NC 7 7 NORTHLAKE $12.05 $55.95 $108.43 $176.43 10/1/20176012645 PRINCETON REHABILITATION AND H 6 6 CHICAGO $17.33 $51.00 $88.43 $156.76 10/1/20176007876 PROVIDENCE DOWNERS GROVE 7 7 DOWNERS GROVE $14.88 $55.98 $89.32 $160.18 10/1/20176007843 PROVIDENCE PALOS HEIGHTS 7 7 PALOS HEIGHTS $14.39 $55.98 $92.47 $162.84 10/1/20176016356 RADFORD GREEN 8 8 LINCOLNSHIRE $18.90 $55.98 $89.77 $164.65 10/1/20176007751 RED BUD REGIONAL CARE 5 5 RED BUD $14.47 $43.93 $74.77 $133.17 10/1/20176008239 REGENCY CARE 3 3 SPRINGFIELD $15.16 $44.49 $79.22 $138.87 10/1/20176011381 REGENCY CARE OF MORRIS 9 9 MORRIS $17.11 $53.01 $99.94 $170.06 10/1/2017 7/1/20166011373 REGENCY CARE OF STERLING 1 1 STERLING $15.00 $51.52 $93.21 $159.73 10/1/2017 7/1/20166006712 RENAISSANCE CARE CENTER 2 2 CANTON $10.70 $37.41 $88.87 $136.98 10/1/20176007850 REST HAVEN MANOR 5 5 ALBION $3.97 $37.18 $50.74 $91.89 10/1/20176007884 RESTHAVE HOME OF WHITESIDE CO 1 1 MORRISON $16.84 $47.87 $68.55 $133.26 10/1/2017 7/1/20156007942 RIDGEVIEW CARE CENTER 5 5 OBLONG $10.90 $35.23 $75.42 $121.55 10/1/20176003453 RIDGEVIEW REHAB NURSING CENTER 6 6 CHICAGO $15.67 $48.06 $91.68 $155.41 10/1/20176001085 RIVER NORTH BRADLEY H AND R 9 9 BRADLEY $13.41 $42.10 $92.26 $147.77 10/1/2017 7/1/20156004758 RIVER VIEW REHAB CENTER 8 8 ELGIN $12.62 $42.33 $82.91 $137.86 10/1/20176008015 RIVERSHORES HLTH AND REHAB CTR 2 2 MARSEILLES $11.07 $46.72 $87.31 $145.10 10/1/20176008072 ROBINGS MANOR REHAB HLTH CR 3 3 BRIGHTON $12.11 $36.39 $78.32 $126.82 10/1/20176008098 ROCHELLE GARDENS CARE CENTER 1 1 ROCHELLE $10.47 $44.99 $59.91 $115.37 10/1/2017 7/1/20166008106 ROCHELLE REHAB HEALTH CARE 1 1 ROCHELLE $11.79 $51.52 $74.61 $137.92 10/1/2017 7/1/20166008114 ROCK FALLS REHAB HLTH CARE CTR 1 1 ROCK FALLS $9.89 $51.42 $76.63 $137.94 10/1/20176002695 ROCK RIVER GARDENS 1 1 STERLING $8.55 $39.13 $49.08 $96.76 10/1/20176008049 ROCK RIVER HEALTH CARE 1 1 ROCKFORD $12.71 $43.47 $103.43 $159.61 10/1/2017 7/1/20166008163 ROLLING HILLS MANOR 8 8 ZION $14.88 $55.98 $92.80 $163.66 10/1/20176005136 ROSEVILLE REHAB HEALTH CARE 2 2 ROSEVILLE $9.62 $46.49 $74.20 $130.31 10/1/20176012074 ROSEWOOD CARE CENTER ALTON 11 11 ALTON $14.95 $42.51 $74.95 $132.41 10/1/20176014237 ROSEWOOD CARE CENTER ELGIN 8 8 ELGIN $16.42 $51.18 $84.84 $152.44 10/1/20176010466 ROSEWOOD CARE CENTER GALESBURG 2 2 GALESBURG $14.23 $41.85 $72.40 $128.48 10/1/20176014633 ROSEWOOD CARE CENTER INVERNESS 7 7 INVERNESS $22.20 $52.72 $92.09 $167.01 10/1/20176012835 ROSEWOOD CARE CENTER JOLIET 9 9 JOLIET $15.52 $50.13 $95.53 $161.18 10/1/20176012587 ROSEWOOD CARE CENTER OF MOLINE 10 10 MOLINE $14.73 $48.06 $80.00 $142.79 10/1/2017

Page 14: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 14

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6012165 ROSEWOOD CARE CENTER PEORIA 2 2 PEORIA $13.50 $49.68 $71.34 $134.52 10/1/20176014658 ROSEWOOD CARE CENTER ROCKFORD 1 1 ROCKFORD $17.46 $49.15 $56.82 $123.43 10/1/20176012017 ROSEWOOD CARE CTR EAST PEORIA 2 2 EAST PEORIA $13.84 $48.51 $71.79 $134.14 10/1/20176014401 ROSEWOOD CARE CTR EDWARDSVILLE 11 11 EDWARDSVILLE $16.83 $46.71 $74.40 $137.94 10/1/20176019723 ROSEWOOD CARE CTR NORTHBROOK 7 7 NORTHBROOK $21.11 $53.85 $111.95 $186.91 10/1/20176014666 ROSEWOOD CARE CTR ST CHARLES 8 8 ST CHARLES $19.01 $55.06 $80.62 $154.69 10/1/20176003065 ROSICLARE REHAB HEALTH CR 5 5 ROSICLARE $9.85 $43.93 $86.06 $139.84 10/1/2017 7/1/20156005029 ROYAL OAKS CARE CENTER 10 10 KEWANEE $10.12 $37.71 $77.97 $125.80 10/1/20176008684 RUSHVILLE NURSING & REHABILITA 3 3 RUSHVILLE $9.48 $43.30 $87.77 $140.55 10/1/20176008338 SALEM VILLAGE NURSING AND REHA 9 9 JOLIET $13.08 $49.38 $104.69 $167.15 10/1/20176008346 SALINE CARE NURSING AND REHAB 5 5 HARRISBURG $10.65 $34.43 $77.69 $122.77 10/1/2017 7/1/20166008213 SANDWICH REHAB HEALTH CARE 1 1 SANDWICH $11.63 $51.52 $75.49 $138.64 10/1/2017 7/1/20156001929 SAUK VALLEY SENIOR LIVING 1 1 ROCK FALLS $10.42 $47.83 $90.42 $148.67 10/1/20176005722 SELECT POST ACUTE CARE 2 2 EUREKA $12.09 $50.44 $71.45 $133.98 10/1/20176008460 SELFHELP HOME OF CHICAGO 6 6 CHICAGO $18.18 $55.98 $76.75 $150.91 10/1/2017 7/14/20156010250 SEMINARY MANOR 2 2 GALESBURG $16.38 $46.44 $80.56 $143.38 10/1/2017 7/1/20156007272 SHARON HEALTH CARE WILLOWS 2 2 PEORIA $10.74 $41.48 $89.22 $141.44 10/1/2017 7/1/20166007306 SHARON HEALTHCARE ELMS 2 2 PEORIA $10.53 $44.72 $105.39 $160.64 10/1/20176007298 SHARON HEALTHCARE PINES 2 2 PEORIA $10.56 $42.36 $70.33 $123.25 10/1/2017 7/1/20156008528 SHAWNEE CHRISTIAN NURSING CTR 5 5 HERRIN $11.23 $40.09 $84.98 $136.30 10/1/20176004055 SHAWNEE ROSE CARE CENTER 5 5 HARRISBURG $9.06 $32.62 $82.23 $123.91 10/1/20176008544 SHELBYVILLE MANOR 4 4 SHELBYVILLE $16.06 $41.91 $87.75 $145.72 10/1/20176008536 SHELBYVILLE REHAB HEALTH CARE 4 4 SHELBYVILLE $8.58 $49.62 $80.34 $138.54 10/1/20176008569 SHELDON HEALTH CARE CENTER 4 4 SHELDON $9.89 $50.44 $74.05 $134.38 10/1/20176002687 SHERIDAN SHORES REHAB CENTER 6 6 CHICAGO $18.03 $42.94 $90.34 $151.31 10/1/20176012827 SHERMAN WEST COURT 8 8 ELGIN $14.88 $55.98 $81.46 $152.32 10/1/20176016059 SMITH CROSSING 9 9 ORLAND PARK $18.18 $45.68 $90.88 $154.74 10/1/20176009732 SMITH VILLAGE 6 6 CHICAGO $11.56 $55.98 $77.44 $144.98 4/1/20176011464 SNYDER VILLAGE 2 2 METAMORA $15.97 $48.71 $64.07 $128.75 10/1/2017 7/1/20166008718 SOUTH ELGIN REHAB HEALTH CARE 8 8 SOUTH ELGIN $10.80 $52.66 $106.47 $169.93 10/1/20176016497 SOUTH SUBURBAN REHAB CENTER 7 7 HOMEWOOD $17.30 $49.95 $101.94 $169.19 10/1/2017 7/1/20156008759 SOUTHGATE HEALTH CARE CENTER 5 5 METROPOLIS $14.28 $41.44 $71.23 $126.95 10/1/20176014781 SOUTHPOINT NURSING REHAB CTR 6 6 CHICAGO $21.00 $48.97 $128.17 $198.14 10/1/20176001895 SOUTHVIEW MANOR NURSING CENTER 6 6 CHICAGO $14.26 $38.92 $70.67 $123.85 10/1/20176016786 SPRING CREEK NRSG REHAB CTR 9 9 JOLIET $13.45 $46.84 $93.26 $153.55 10/1/2017 7/1/20166011803 SPRINGS AT CRYSTAL LAKE 8 8 CRYSTAL LAKE $20.77 $55.98 $91.36 $168.11 10/1/20176016877 SPRINGS AT MONARCH LANDING 7 7 NAPERVILLE $22.19 $45.20 $96.66 $164.05 4/29/20166008866 ST ANTHONYS NURSING AND REHAB 10 10 ROCK ISLAND $17.37 $51.52 $73.74 $142.63 10/1/20176008890 ST CLARAS MANOR 3 3 LINCOLN $9.51 $44.24 $88.00 $141.75 10/1/20176010664 ST JAMES WELLNESS REHAB VILLAS 9 9 CRETE $15.16 $53.08 $102.05 $170.29 10/1/20176008940 ST JOHNS HOSPITAL LTC UNIT 3 3 SPRINGFIELD $7.26 $44.49 $33.57 $85.32 7/1/2017

Page 15: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 15

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6011407 ST JOSEPH MED CTR NURSING UNIT 4 4 BLOOMINGTON $3.66 $50.44 $29.21 $83.31 7/1/20146008957 ST JOSEPH VILLAGE OF CHICAGO 6 6 CHICAGO $11.56 $55.98 $105.14 $172.68 10/1/20176009005 ST JOSEPHS HOME FOR THE ELDERL 7 7 PALATINE $9.22 $55.98 $63.79 $128.99 10/1/20176008999 ST JOSEPHS NURSING HOME 2 2 LACON $4.19 $50.44 $66.01 $120.64 10/1/20176011910 ST PATRICKS RES 7 7 NAPERVILLE $14.88 $53.80 $96.92 $165.60 10/1/20176009120 ST PAULS HOME 11 11 BELLEVILLE $16.84 $46.02 $60.10 $122.96 10/1/2017 7/1/20166009112 ST PAULS HOUSE AND HEALTH CARE 6 6 CHICAGO $15.34 $55.98 $82.93 $154.25 10/1/20176005466 ST VINCENTS HOME INC 3 3 QUINCY $14.48 $40.51 $74.12 $129.11 10/1/2017 7/1/20156010441 STEARNS NURSING AND REHAB CTR 11 11 GRANITE CITY $13.68 $41.65 $78.76 $134.09 10/1/20176009179 STERLING PAVILION 1 1 STERLING $11.67 $41.99 $88.12 $141.78 10/1/20176008494 STONEBRIDGE NURSING AND REHAB 5 5 BENTON $10.15 $37.02 $84.63 $131.80 10/1/2017 7/1/20166009211 SULLIVAN REHAB HEALTH CARE CTR 4 4 SULLIVAN $10.43 $41.01 $74.98 $126.42 10/1/2017 7/1/20166009294 SUNRISE SKILLED NURSING REHAB 3 3 VIRDEN $10.10 $38.30 $73.31 $121.71 10/1/20176009302 SUNSET HOME 3 3 QUINCY $14.69 $44.49 $74.48 $133.66 10/1/2017 7/1/20166009328 SUNSET REHAB HEALTH CARE 2 2 CANTON $13.92 $36.90 $69.11 $119.93 10/1/2017 7/1/20166009831 SWANSEA REHAB HEALTH CARE CENT 11 11 SWANSEA $9.17 $39.29 $93.29 $141.75 10/1/20176014831 SYMPHONY AT 87TH STREET 6 6 CHICAGO $22.15 $51.34 $114.15 $187.64 10/1/20176014906 SYMPHONY AT ARIA 7 7 HILLSIDE $21.46 $49.62 $112.54 $183.62 10/1/20176014641 SYMPHONY AT MIDWAY 6 6 CHICAGO $20.12 $49.75 $109.48 $179.35 10/1/20176009401 SYMPHONY AT THE TILLERS 9 9 OSWEGO $16.29 $53.08 $128.72 $198.09 10/1/20176007967 SYMPHONY EVANSTON HEALTHCARE 7 7 EVANSTON $19.93 $55.98 $108.53 $184.44 10/1/20176001689 SYMPHONY OF BRONZEVILLE 6 6 CHICAGO $16.09 $45.18 $104.07 $165.34 10/1/20176014195 SYMPHONY OF BUFFALO GROVE 8 8 BUFFALO GROVE $18.10 $50.88 $112.79 $181.77 10/1/20176004832 SYMPHONY OF CHICAGO WEST 6 6 CHICAGO $16.82 $48.78 $106.93 $172.53 10/1/20176002265 SYMPHONY OF CRESTWOOD 7 7 CRESTWOOD $17.53 $49.50 $109.58 $176.61 10/1/20176006282 SYMPHONY OF DECATUR 4 4 DECATUR $13.70 $44.44 $100.68 $158.82 10/1/20176016554 SYMPHONY OF HANOVER PARK 7 7 HANOVER PARK $26.15 $55.98 $119.31 $201.44 10/1/20176002463 SYMPHONY OF JOLIET 9 9 JOLIET $16.31 $47.40 $113.28 $176.99 10/1/20176005490 SYMPHONY OF LINCOLN 3 3 LINCOLN $15.05 $42.60 $103.09 $160.74 10/1/20176004733 SYMPHONY OF LINCOLN PARK 6 6 CHICAGO $17.73 $53.60 $107.93 $179.26 10/1/20176003958 SYMPHONY OF MORGAN PARK 6 6 CHICAGO $14.80 $48.00 $103.67 $166.47 10/1/20176002174 SYMPHONY OF ORCHARD VALLEY 8 8 AURORA $15.60 $46.13 $118.65 $180.38 10/1/20176014823 SYMPHONY OF SOUTH SHORE 6 6 CHICAGO $21.75 $52.59 $112.06 $186.40 10/1/2017 7/1/20156014252 TABOR HILLS HEALTHCARE FACILIT 7 7 NAPERVILLE $17.23 $55.98 $85.63 $158.84 10/1/20176009369 TAYLORVILLE CARE CENTER 3 3 TAYLORVILLE $10.83 $39.24 $77.75 $127.82 10/1/20176009377 TERRACE NURSING HOME 8 8 WAUKEGAN $12.15 $44.89 $106.55 $163.59 10/1/20176003768 TERRACE ON THE PARK 11 11 MASCOUTAH $10.87 $45.62 $81.94 $138.43 10/1/2017 7/1/20166001465 THE CARLTON AT THE LAKE 6 6 CHICAGO $19.28 $50.66 $113.47 $183.41 10/1/20176008593 THE GROVE AT THE LAKE 8 8 ZION $17.26 $49.89 $112.05 $179.20 10/1/20176010144 THE GROVE OF ELMHURST 7 7 ELMHURST $12.90 $50.63 $111.13 $174.66 10/1/20176008916 THE GROVE OF EVANSTON LIVING & 7 7 EVANSTON $17.94 $55.98 $126.68 $200.60 10/1/2017

Page 16: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 16

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6003057 THE GROVE OF LAGRANGE PARK LIV 7 7 LA GRANGE PARK $18.50 $52.81 $109.73 $181.04 10/1/20176003412 THE GROVE OF NORTHBROOK 7 7 NORTHBROOK $16.72 $50.77 $109.86 $177.35 10/1/20176009625 THE GROVE OF SKOKIE 7 7 SKOKIE $17.04 $47.36 $110.18 $174.58 10/1/20176009393 THREE SPRINGS LODGE NRSG HOME 5 5 CHESTER $11.23 $40.10 $57.79 $109.12 10/1/2017 7/1/20156007330 TIMBERCREEK REHAB AND HEALTH C 2 2 PEKIN $11.32 $45.39 $72.10 $128.81 10/1/20176003750 TIMBERPOINT HEALTHCARE CENTER 3 3 CAMP POINT $10.17 $44.15 $95.48 $149.80 10/1/2017 7/1/20166009427 TOULON REHAB HEALTH CARE CTR 2 2 TOULON $12.29 $45.01 $80.37 $137.67 10/1/20176003263 TOWER HILL HEALTHCARE CENTER 8 8 SOUTH ELGIN $13.01 $45.97 $92.56 $151.54 10/1/20176016901 TRANSITIONAL CARE OF ARLINGTON 7 7 ARLINGTON HEIGH $23.30 $55.98 $122.17 $201.45 10/1/20176009443 TRI STATE NURSING REHAB CENTER 7 7 LANSING $17.37 $50.93 $116.56 $184.86 10/1/20176002588 TUSCOLA HEALTH CARE CENTER 4 4 TUSCOLA $9.01 $38.53 $97.72 $145.26 10/1/2017 7/1/20156004188 TWIN LAKES REHAB HEALTH CARE 4 4 PARIS $10.37 $41.32 $87.47 $139.16 10/1/2017 7/1/20156009484 TWIN WILLOWS NURSING CENTER 5 5 SALEM $8.66 $35.35 $71.76 $115.77 10/1/2017 7/1/20156009492 UNION COUNTY HOSPITAL LTC 5 5 ANNA $4.73 $43.93 $88.41 $137.07 10/1/20176009500 UNITED METHODIST VILLAGE 5 5 LAWRENCEVILLE $8.65 $41.56 $72.10 $122.31 10/1/20176013072 UNITED METHODIST VILLAGE NORTH 5 5 LAWRENCEVILLE $14.27 $40.24 $65.44 $119.95 10/1/20176002711 UNIVERSITY NURSING AND RHB CTR 11 11 EDWARDSVILLE $10.82 $41.10 $101.57 $153.49 10/1/20176009260 VANDALIA REHAB HEALTH CARE 5 5 VANDALIA $8.76 $43.47 $80.12 $132.35 10/1/2017 7/1/20156001127 VERACARE BURBANK 7 7 BURBANK $19.23 $55.98 $126.00 $201.21 10/1/20176007322 VILLA AT EVERGREEN PARK 7 7 EVERGREEN PARK $16.99 $55.98 $99.96 $172.93 10/1/20176007868 VILLA AT SOUTH HOLLAND 7 7 SOUTH HOLLAND $23.16 $55.98 $106.03 $185.17 10/1/20176014856 VILLA AT WINDSOR PARK 6 7 CHICAGO $21.08 $47.06 $105.53 $173.67 10/1/20176012991 VILLA HEALTH CARE INC EAST 3 3 SHERMAN $14.69 $44.49 $77.76 $136.94 10/1/20176011332 VILLAGE AT VICTORY LAKES 8 8 LINDENHURST $12.51 $55.98 $101.89 $170.38 10/1/20176009674 WABASH CHRISTIAN RETIREMENT CR 5 5 CARMI $13.10 $43.79 $86.56 $143.45 10/1/2017 7/1/20156009682 WALKER NURSING HOME 3 3 VIRGINIA $12.07 $43.65 $58.85 $114.57 10/1/20176005516 WARREN BARR LINCOLN PARK 6 6 CHICAGO $17.48 $44.99 $115.88 $178.35 10/1/2017 7/1/20166014377 WARREN BARR LINCOLNSHIRE 8 8 LINCOLNSHIRE $17.97 $55.98 $113.23 $187.18 10/1/20176004725 WARREN BARR LIVING & REHAB CTR 6 6 CHICAGO $18.36 $55.98 $114.83 $189.17 10/1/20176014963 WARREN BARR NORTH SHORE 8 8 HIGHLAND PARK $20.70 $54.23 $112.59 $187.52 10/1/2017 7/1/20166008825 WARREN BARR SOUTH LOOP 6 6 CHICAGO $15.29 $54.02 $174.45 $243.76 10/1/20176008262 WARREN PARK HEALTH LIVING CTR 6 6 CHICAGO $13.56 $50.85 $82.03 $146.44 10/1/20176009740 WASHINGTON CHRISTIAN VILLAGE 2 2 WASHINGTON $11.83 $45.83 $82.19 $139.85 10/1/2017 7/1/20156002430 WATERFORD CARE CENTER, THE 6 6 CHICAGO $17.06 $38.10 $103.76 $158.92 10/1/2017 7/1/20156009757 WATERFRONT TERRACE 6 6 CHICAGO $16.40 $48.69 $95.89 $160.98 10/1/2017 7/1/20166009765 WATSEKA REHAB HEALTH CARE CTR 4 4 WATSEKA $10.37 $46.59 $82.25 $139.21 10/1/20176009435 WAUCONDA HEALTHCARE AND REHAB 8 8 WAUCONDA $15.67 $50.55 $107.11 $173.33 10/1/20176006365 WAVERLY PLACE OF STOCKTON 1 1 STOCKTON $12.04 $43.60 $92.17 $147.81 10/1/20176009815 WAY FAIR NURSING AND REHAB CTR 5 5 FAIRFIELD $10.73 $39.67 $83.77 $134.17 10/1/20176009856 WENTWORTH REHAB AND HCC 6 6 CHICAGO $17.55 $44.13 $97.79 $159.47 10/1/20176006100 WESLEY PLACE 6 6 CHICAGO $16.29 $55.98 $103.94 $176.21 10/1/2017

Page 17: ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …...page 2 illinois department of healthcare and family services bureau of rate development and analysis medicaid rate list for nursing

Page 17

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2017 (no SMHRFs)

Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Change Eff Date

6009864 WESLEY VILLAGE 2 2 MACOMB $15.97 $45.95 $68.31 $130.23 10/1/2017 7/1/20166009872 WEST CHICAGO TERRACE NH 7 7 WEST CHICAGO $11.40 $39.35 $57.85 $108.60 10/1/20176013478 WEST SUBURBAN HOSP MED CTR SNF 7 7 OAK PARK $13.46 $45.20 $49.78 $108.44 7/1/20146001002 WEST SUBURBAN NURSING REHAB 7 7 BLOOMINGDALE $13.59 $45.64 $124.25 $183.48 10/1/2017 7/1/20156012173 WESTCHESTER HEALTH AND REHAB C 7 7 WESTCHESTER $20.38 $55.98 $95.23 $171.59 10/1/2017 7/1/20156007603 WESTMINSTER PLACE 7 7 EVANSTON $9.22 $55.98 $114.49 $179.69 10/1/20176000194 WESTSIDE REHAB CARE CENTER 5 5 WEST FRANKFORT $7.90 $35.39 $85.88 $129.17 10/1/20176009955 WESTWOOD MANOR 6 6 CHICAGO $14.15 $37.86 $72.69 $124.70 10/1/20176009963 WHEATON CARE CENTER 7 7 WHEATON $13.40 $47.85 $88.17 $149.42 10/1/2017 7/1/20156006597 WHITE HALL NURSING AND REHAB 3 3 WHITE HALL $17.79 $30.87 $78.05 $126.71 10/1/2017 7/1/20156004881 WHITE OAK REHABILITATION HCC 5 5 MOUNT VERNON $11.10 $43.93 $73.18 $128.21 10/1/20176008379 WILLOW CREST NURS PAVILION LTD 1 1 SANDWICH $13.88 $43.09 $105.71 $162.68 10/1/2017 7/1/20166003842 WILLOW ROSE REHAB HEALTH CARE 3 3 JERSEYVILLE $10.40 $40.48 $83.38 $134.26 10/1/2017 7/1/20166010037 WILLOWS HEALTH CENTER 1 1 ROCKFORD $12.04 $51.52 $74.07 $137.63 10/1/20176010052 WINCHESTER HOUSE 8 8 LIBERTYVILLE $7.27 $66.61 $92.39 $166.27 10/1/20176010078 WINDMILL NURSING PAVILION 7 7 SOUTH HOLLAND $17.87 $44.27 $93.98 $156.12 10/1/2017 7/1/20156005904 WINDSOR ESTATES NURSING AND RE 7 7 COUNTRY CLUB HI $18.03 $54.05 $96.23 $168.31 10/1/20176011753 WINDSOR PARK MANOR 7 7 CAROL STREAM $16.76 $55.98 $85.99 $158.73 10/1/20176005334 WINFIELD WOODS HEALTHCARE CTR 7 7 WINFIELD $14.12 $44.76 $89.87 $148.75 10/1/20176010094 WINNING WHEELS 1 1 PROPHETSTOWN $15.97 $51.52 $96.35 $163.84 10/1/20176010102 WINSTON MANOR CONVALESCENT N H 6 6 CHICAGO $10.75 $36.42 $61.95 $109.12 10/1/2017 7/1/20166001713 WOOD GLEN NURSING AND REHAB CE 7 7 WEST CHICAGO $16.31 $45.46 $58.07 $119.84 10/1/20176007074 WOODBRIDGE NURSING PAVILION 6 6 CHICAGO $16.18 $40.95 $118.32 $175.45 10/1/2017 7/1/20166008361 WYNSCAPE HEALTH AND REHAB 7 7 WHEATON $14.82 $55.98 $69.61 $140.41 10/1/2017