ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …page 1 illinois department of healthcare and family...

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Page 1 ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES BUREAU OF RATE DEVELOPMENT AND ANALYSIS MEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016 Building Facility Rate Capital Support Nursing Total Effective Capital Rate ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date 6000012 A MERKLE C KNIPPRATH N H 4 4 CLIFTON $9.07 $46.85 $69.68 $125.60 10/1/2016 6000020 ABBINGTON REHAB NURSING CENTER 7 7 ROSELLE $14.60 $49.47 $90.38 $154.45 10/1/2016 7/1/2014 6000038 ABBOTT HOUSE 8 8 HIGHLAND PARK $11.47 $49.04 $55.09 $115.60 7/1/2014 Eligible for Provisional License as SMHRF 6000046 ADDOLORATA VILLA 7 7 WHEELING $13.92 $55.98 $99.70 $169.60 10/1/2016 6007959 ALBANY CARE 7 7 EVANSTON $15.70 $33.26 $55.95 $104.91 7/1/2014 Eligible for Provisional License as SMHRF 6000103 ALDEN DEBES REHABILITATION AND 1 1 ROCKFORD $14.99 $49.65 $85.79 $150.43 10/1/2016 6014757 ALDEN DES PLAINES REHAB HHC 7 7 DES PLAINES $22.20 $55.98 $113.34 $191.52 10/1/2016 6003735 ALDEN ESTATES OF BARRINGTON 7 7 BARRINGTON $23.27 $55.98 $151.62 $230.87 10/1/2016 6013429 ALDEN ESTATES OF EVANSTON 7 7 EVANSTON $19.32 $55.98 $133.08 $208.38 10/1/2016 6007033 ALDEN ESTATES OF NAPERVILLE 7 7 NAPERVILLE $16.88 $53.32 $118.44 $188.64 10/1/2016 6014500 ALDEN ESTATES OF NORTHMOOR 6 6 CHICAGO $22.43 $51.87 $109.97 $184.27 10/1/2016 6014922 ALDEN ESTATES OF ORLAND PARK 7 7 ORLAND PARK $18.80 $55.98 $112.77 $187.55 10/1/2016 6016695 ALDEN ESTATES OF SHOREWOOD 9 9 SHOREWOOD $19.22 $45.68 $94.39 $159.29 10/1/2016 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 $14.19 $48.50 $145.04 $207.73 10/1/2016 6009849 ALDEN LINCOLN PARK REHAB 6 6 CHICAGO $11.23 $52.87 $100.33 $164.43 10/1/2016 6005714 ALDEN LONG GROVE REHAB 8 8 LONG GROVE $14.63 $50.21 $102.12 $166.96 10/1/2016 6014765 ALDEN NORTH SHORE REHAB AND HC 7 7 SKOKIE $21.70 $55.98 $92.34 $170.02 10/1/2016 6014773 ALDEN OF WATERFORD 8 8 AURORA $19.48 $55.98 $108.81 $184.27 10/1/2016 6007165 ALDEN PARK STRATHMOOR 1 1 ROCKFORD $12.80 $49.65 $99.78 $162.23 10/1/2016 7/1/2014 6001366 ALDEN POPLAR CR REHAB AND HCC 7 7 HOFFMAN ESTATE $18.21 $52.08 $106.67 $176.96 10/1/2016 6008304 ALDEN TERRACE OF MCHENRY REHAB 8 8 MCHENRY $10.10 $43.65 $105.26 $159.01 10/1/2016 6013353 ALDEN TOWN MANOR REHAB AND HCC 7 7 CICERO $20.74 $49.73 $103.73 $174.20 10/1/2016 6000459 ALDEN VALLEY RIDGE REHAB HCC 7 7 BLOOMINGDALE $12.68 $51.37 $101.49 $165.54 10/1/2016 6003529 ALEDO REHAB HEALTH CARE CTR 10 10 ALEDO $9.14 $38.14 $72.42 $119.70 10/1/2016 6004014 ALHAMBRA CARE CENTER 11 11 ALHAMBRA $10.44 $28.46 $73.44 $112.34 10/1/2016 7/1/2014 6000087 ALL AMERICAN NURSING HOME 6 6 CHICAGO $11.97 $45.18 $74.67 $131.82 10/1/2016 7/1/2014 6000129 ALPINE FIRESIDE HEALTH CENTER 1 1 ROCKFORD $15.30 $47.68 $79.54 $142.52 10/1/2016 6000152 ALTON MEM HOSP HATCH SNF UNIT 11 11 ALTON $5.44 $46.71 $78.51 $130.66 7/1/2014 6002778 ALTON REHAB AND NURSING CENTER 11 11 ALTON $11.52 $43.69 $94.86 $150.07 10/1/2016 7/1/2014 6000186 AMBASSADOR NURSING REHAB CTR 6 6 CHICAGO $14.37 $50.93 $128.67 $193.97 10/1/2016 7/1/2015 6001267 AMBERWOOD CARE CENTRE 1 1 ROCKFORD $14.19 $40.82 $104.19 $159.20 10/1/2016 7/1/2015 6001788 ANNA REHAB AND NURSING CENTER 5 5 ANNA $10.12 $40.67 $85.22 $136.01 10/1/2016 6005730 APERION CARE AMBOY 1 1 AMBOY $11.60 $40.92 $96.62 $149.14 10/1/2016 7/1/2014 6001010 APERION CARE BLOOMINGTON 4 4 BLOOMINGTON $9.88 $49.89 $87.35 $147.12 10/1/2016 6001150 APERION CARE BRIDGEPORT 5 5 BRIDGEPORT $9.39 $43.93 $93.04 $146.36 10/1/2016 6007207 APERION CARE BURBANK 7 7 BURBANK $18.32 $55.98 $128.91 $203.21 10/1/2016 6008064 APERION CARE CHICAGO HEIGHTS 7 7 CHICAGO HEIGHT $14.05 $43.24 $91.25 $148.54 10/1/2016 6006852 APERION CARE COLFAX 4 4 COLFAX $11.16 $50.44 $98.20 $159.80 10/1/2016 6005508 APERION CARE DECATUR 4 4 DECATUR $12.92 $39.00 $81.53 $133.45 10/1/2016 6002547 APERION CARE DOLTON 7 7 DOLTON $18.79 $49.25 $119.52 $187.56 10/1/2016

Transcript of ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY …page 1 illinois department of healthcare and family...

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

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6000012 A MERKLE C KNIPPRATH N H 4 4 CLIFTON $9.07 $46.85 $69.68 $125.60 10/1/20166000020 ABBINGTON REHAB NURSING CENTER 7 7 ROSELLE $14.60 $49.47 $90.38 $154.45 10/1/2016 7/1/20146000038 ABBOTT HOUSE 8 8 HIGHLAND PARK $11.47 $49.04 $55.09 $115.60 7/1/2014 Eligible for Provisional License as SMHRF6000046 ADDOLORATA VILLA 7 7 WHEELING $13.92 $55.98 $99.70 $169.60 10/1/20166007959 ALBANY CARE 7 7 EVANSTON $15.70 $33.26 $55.95 $104.91 7/1/2014 Eligible for Provisional License as SMHRF6000103 ALDEN DEBES REHABILITATION AND 1 1 ROCKFORD $14.99 $49.65 $85.79 $150.43 10/1/20166014757 ALDEN DES PLAINES REHAB HHC 7 7 DES PLAINES $22.20 $55.98 $113.34 $191.52 10/1/20166003735 ALDEN ESTATES OF BARRINGTON 7 7 BARRINGTON $23.27 $55.98 $151.62 $230.87 10/1/20166013429 ALDEN ESTATES OF EVANSTON 7 7 EVANSTON $19.32 $55.98 $133.08 $208.38 10/1/20166007033 ALDEN ESTATES OF NAPERVILLE 7 7 NAPERVILLE $16.88 $53.32 $118.44 $188.64 10/1/20166014500 ALDEN ESTATES OF NORTHMOOR 6 6 CHICAGO $22.43 $51.87 $109.97 $184.27 10/1/20166014922 ALDEN ESTATES OF ORLAND PARK 7 7 ORLAND PARK $18.80 $55.98 $112.77 $187.55 10/1/20166016695 ALDEN ESTATES OF SHOREWOOD 9 9 SHOREWOOD $19.22 $45.68 $94.39 $159.29 10/1/20166006886 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 $14.19 $48.50 $145.04 $207.73 10/1/20166009849 ALDEN LINCOLN PARK REHAB 6 6 CHICAGO $11.23 $52.87 $100.33 $164.43 10/1/20166005714 ALDEN LONG GROVE REHAB 8 8 LONG GROVE $14.63 $50.21 $102.12 $166.96 10/1/20166014765 ALDEN NORTH SHORE REHAB AND HC 7 7 SKOKIE $21.70 $55.98 $92.34 $170.02 10/1/20166014773 ALDEN OF WATERFORD 8 8 AURORA $19.48 $55.98 $108.81 $184.27 10/1/20166007165 ALDEN PARK STRATHMOOR 1 1 ROCKFORD $12.80 $49.65 $99.78 $162.23 10/1/2016 7/1/20146001366 ALDEN POPLAR CR REHAB AND HCC 7 7 HOFFMAN ESTATE $18.21 $52.08 $106.67 $176.96 10/1/20166008304 ALDEN TERRACE OF MCHENRY REHAB 8 8 MCHENRY $10.10 $43.65 $105.26 $159.01 10/1/20166013353 ALDEN TOWN MANOR REHAB AND HCC 7 7 CICERO $20.74 $49.73 $103.73 $174.20 10/1/20166000459 ALDEN VALLEY RIDGE REHAB HCC 7 7 BLOOMINGDALE $12.68 $51.37 $101.49 $165.54 10/1/20166003529 ALEDO REHAB HEALTH CARE CTR 10 10 ALEDO $9.14 $38.14 $72.42 $119.70 10/1/20166004014 ALHAMBRA CARE CENTER 11 11 ALHAMBRA $10.44 $28.46 $73.44 $112.34 10/1/2016 7/1/20146000087 ALL AMERICAN NURSING HOME 6 6 CHICAGO $11.97 $45.18 $74.67 $131.82 10/1/2016 7/1/20146000129 ALPINE FIRESIDE HEALTH CENTER 1 1 ROCKFORD $15.30 $47.68 $79.54 $142.52 10/1/20166000152 ALTON MEM HOSP HATCH SNF UNIT 11 11 ALTON $5.44 $46.71 $78.51 $130.66 7/1/20146002778 ALTON REHAB AND NURSING CENTER 11 11 ALTON $11.52 $43.69 $94.86 $150.07 10/1/2016 7/1/20146000186 AMBASSADOR NURSING REHAB CTR 6 6 CHICAGO $14.37 $50.93 $128.67 $193.97 10/1/2016 7/1/20156001267 AMBERWOOD CARE CENTRE 1 1 ROCKFORD $14.19 $40.82 $104.19 $159.20 10/1/2016 7/1/20156001788 ANNA REHAB AND NURSING CENTER 5 5 ANNA $10.12 $40.67 $85.22 $136.01 10/1/20166005730 APERION CARE AMBOY 1 1 AMBOY $11.60 $40.92 $96.62 $149.14 10/1/2016 7/1/20146001010 APERION CARE BLOOMINGTON 4 4 BLOOMINGTON $9.88 $49.89 $87.35 $147.12 10/1/20166001150 APERION CARE BRIDGEPORT 5 5 BRIDGEPORT $9.39 $43.93 $93.04 $146.36 10/1/20166007207 APERION CARE BURBANK 7 7 BURBANK $18.32 $55.98 $128.91 $203.21 10/1/20166008064 APERION CARE CHICAGO HEIGHTS 7 7 CHICAGO HEIGHT $14.05 $43.24 $91.25 $148.54 10/1/20166006852 APERION CARE COLFAX 4 4 COLFAX $11.16 $50.44 $98.20 $159.80 10/1/20166005508 APERION CARE DECATUR 4 4 DECATUR $12.92 $39.00 $81.53 $133.45 10/1/20166002547 APERION CARE DOLTON 7 7 DOLTON $18.79 $49.25 $119.52 $187.56 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6005847 APERION CARE ELGIN 8 8 ELGIN $11.47 $54.20 $95.16 $160.83 10/1/20166006845 APERION CARE EVANSTON 7 7 EVANSTON $20.53 $48.47 $123.03 $192.03 10/1/20166015333 APERION CARE FOREST PARK 7 7 FOREST PARK $21.70 $48.88 $121.59 $192.17 10/1/2016 7/1/20156000434 APERION CARE GALESBURG 2 2 GALESBURG $13.09 $40.51 $94.28 $147.88 10/1/2016 7/1/20156007280 APERION CARE HIGHWOOD 8 8 HIGHWOOD $19.52 $44.78 $109.16 $173.46 10/1/20166014617 APERION CARE INTERNATIONAL 6 6 CHICAGO $22.20 $48.75 $115.09 $186.04 10/1/20166008650 APERION CARE JACKSONVILLE 3 3 JACKSONVILLE $13.28 $39.56 $86.83 $139.67 10/1/2016 7/1/20156000095 APERION CARE LITCHFIELD 3 3 LITCHFIELD $9.67 $40.08 $89.38 $139.13 10/1/2016 7/1/20146001077 APERION CARE MIDLOTHIAN 7 7 MIDLOTHIAN $14.70 $45.18 $105.80 $165.68 10/1/20166002646 APERION CARE MOLINE 10 10 EAST MOLINE $12.88 $44.26 $94.54 $151.68 10/1/2016 7/1/20146002059 APERION CARE OAK LAWN 7 7 OAK LAWN $16.48 $50.10 $124.33 $190.91 10/1/20166007520 APERION CARE PLUM GROVE 7 7 PALATINE $20.49 $46.83 $114.98 $182.30 10/1/20166008783 APERION CARE SPRING VALLEY 2 2 SPRING VALLEY $7.72 $48.96 $76.79 $133.47 10/1/20166002661 APERION CARE SPRINGFIELD 3 3 SPRINGFIELD $8.12 $42.00 $91.53 $141.65 10/1/20166004204 APERION CARE ST ELMO 5 5 SAINT ELMO $13.10 $42.14 $105.43 $160.67 10/1/2016 7/1/20156006308 APERION CARE TOLUCA 2 2 TOLUCA $8.57 $48.85 $92.45 $149.87 10/1/20166008312 APERION CARE WILMINGTON 9 9 WILMINGTON $14.50 $44.03 $97.66 $156.19 10/1/2016 7/1/20156000384 APOSTOLIC CHRISTIAN HOME 2 2 ROANOKE $14.69 $50.44 $77.89 $143.02 10/1/20166002885 APOSTOLIC CHRISTIAN HOME 2 2 EUREKA $16.41 $49.92 $73.32 $139.65 10/1/2016 7/1/20156000400 APOSTOLIC CHRISTIAN RESTMOR 2 2 MORTON $16.85 $50.44 $68.20 $135.49 10/1/20166000426 APOSTOLIC CHRISTIAN SKYLINES 2 2 PEORIA $13.82 $49.59 $79.40 $142.81 10/1/20166008155 ARBOUR HEALTH CARE CENTER 6 6 CHICAGO $13.16 $44.39 $82.68 $140.23 10/1/20166009823 ARCOLA HEALTH CARE CENTER 4 4 ARCOLA $9.63 $36.01 $79.55 $125.19 10/1/20166000517 ARTHUR HOME 4 4 ARTHUR $9.51 $47.66 $65.18 $122.35 10/1/20166016729 ASBURY GARDENS NSG AND REHAB 8 8 NORTH AURORA $19.48 $51.75 $107.27 $178.50 10/1/20166008205 ASPEN REHAB AND HEALTH CARE 10 10 SILVIS $12.20 $50.96 $73.23 $136.39 10/1/2016 7/1/20156016273 ASSISI HCC AT CLARE OAKS 7 7 BARTLETT $18.18 $55.98 $92.30 $166.46 10/1/20166006662 ASTORIA PLACE LIVING & REHAB 6 6 CHICAGO $17.76 $56.24 $118.48 $192.48 10/1/20166003834 ATRIUM HEALTH CARE CENTER 6 6 CHICAGO $13.80 $45.27 $91.68 $150.75 10/1/2016 7/1/20156007181 AUBURN REHAB AND HCC 3 3 AUBURN $8.78 $35.60 $79.26 $123.64 10/1/20166014344 AVANTARA LONG GROVE 8 8 LONG GROVE $17.46 $47.61 $126.39 $191.46 10/1/20166009096 AVANTARA PARK RIDGE 7 7 PARK RIDGE $18.89 $55.98 $115.88 $190.75 10/1/20166003214 AVANTI WELLNESS AND REHAB 7 7 NILES $16.75 $49.29 $116.19 $182.23 10/1/20166011340 AVISTON COUNTRYSIDE MANOR 11 11 AVISTON $13.24 $42.38 $76.48 $132.10 10/1/20166000640 BALLARD RESPIRATORY AND REHAB 7 7 DES PLAINES $17.48 $55.82 $158.87 $232.17 10/1/20166000657 BALMORAL NURSING HOME 6 6 CHICAGO $11.01 $32.49 $71.65 $115.15 10/1/20166000731 BARRY COMMUNITY CARE 3 3 BARRY $9.06 $40.29 $67.86 $117.21 10/1/20166008171 BATAVIA REHAB HEALTH CARE CTR 8 8 BATAVIA $12.57 $55.98 $91.66 $160.21 10/1/20166000764 BAYSIDE TERRACE 8 8 WAUKEGAN $10.85 $38.53 $54.39 $103.77 7/1/2014 Eligible for Provisional License as SMHRF6000806 BEECHER MANOR NURSG AND RHB CT 9 9 BEECHER $19.71 $53.08 $105.85 $178.64 10/1/20166000822 BELHAVEN NURSING REHAB CTR 6 6 CHICAGO $18.25 $55.98 $135.65 $209.88 10/1/2016 7/1/2015

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6000889 BELLA TERRA MORTON GROVE 7 7 MORTON GROVE $19.84 $49.44 $113.44 $182.72 10/1/20166000848 BELMONT NURSING HOME 6 6 CHICAGO $12.65 $49.57 $56.10 $118.32 7/1/2014 Eligible for Provisional License as SMHRF6000855 BEMENT HEALTH CARE CENTER 4 4 BEMENT $11.34 $41.46 $75.68 $128.48 10/1/2016 7/1/20146005391 BENTON REHAB HEALTH CARE CTR 5 5 BENTON $9.26 $43.31 $67.03 $119.60 10/1/2016 7/1/20146010110 BERKELEY NURSING REHAB CENTER 7 7 OAK PARK $18.15 $55.98 $96.32 $170.45 10/1/2016 7/1/20146000863 BETHALTO CARE 11 11 BETHALTO $9.57 $44.50 $86.04 $140.11 10/1/20166014872 BETHANY REHAB AND HCC 1 1 DEKALB $18.85 $51.52 $84.53 $154.90 10/1/2016 7/1/20146006688 BETHESDA REHAB AND SENIOR CARE 6 6 CHICAGO $13.46 $55.98 $85.14 $154.58 10/1/20166000962 BIG MEADOWS INC 1 1 SAVANNA $13.91 $48.57 $72.03 $134.51 10/1/2016 7/1/20146000988 BIRCHWOOD PLAZA 6 6 CHICAGO $12.71 $39.49 $91.99 $144.19 10/1/20166000996 BLOOMINGTON REHAB AND HCC 4 4 BLOOMINGTON $9.66 $50.44 $103.15 $163.25 10/1/20166001069 BOURBONNAIS TERRACE NH 9 9 BOURBONNAIS $10.27 $34.73 $52.94 $97.94 7/1/2014 Eligible for Provisional License as SMHRF6001101 BREESE NURSING HOME 11 11 BREESE $10.21 $41.54 $73.75 $125.50 10/1/20166001119 BRENTWOOD NORTH HC REHAB CTR 8 8 RIVERWOODS $13.90 $55.98 $131.31 $201.19 10/1/20166001127 BRENTWOOD SUB ACUTE HEALTHCARE 7 7 BURBANK $19.23 $51.75 $146.70 $217.68 10/1/20166005474 BRIA OF BELLEVILLE 11 11 BELLEVILLE $14.56 $41.92 $91.15 $147.63 10/1/2016 7/1/20156007983 BRIA OF CAHOKIA 11 11 EAST SAINT LOUI $10.50 $38.76 $86.38 $135.64 10/1/20166007991 BRIA OF CHICAGO HEIGHTS 7 7 SOUTH CHICAGO $17.19 $40.26 $99.92 $157.37 10/1/2016 7/1/20146000954 BRIA OF FOREST EDGE 6 6 CHICAGO $11.79 $36.89 $102.86 $151.54 10/1/20166003503 BRIA OF GENEVA 8 8 GENEVA $11.25 $55.98 $108.41 $175.64 10/1/20166010086 BRIA OF PALOS HILLS 7 7 PALOS HILLS $14.88 $45.78 $97.70 $158.36 10/1/2016 7/1/20146001283 BRIA OF RIVER OAKS 7 7 BURNHAM $16.05 $36.83 $120.15 $173.03 10/1/2016 7/1/20146009930 BRIA OF WESTMONT 7 7 WESTMONT $12.58 $44.26 $111.22 $168.06 10/1/20166001143 BRIAR PLACE 7 7 INDIAN HEAD PAR $13.86 $44.40 $71.43 $129.69 10/1/20166001168 BRIDGEVIEW HEALTH CARE CENTER 7 7 BRIDGEVIEW $15.05 $45.78 $121.24 $182.07 10/1/20166000353 BRIDGEWAY SENIOR LIVING 7 7 BENSENVILLE $16.52 $55.98 $105.66 $178.16 10/1/2016 7/1/20156001176 BRIGHTVIEW HEALTHCARE REHAB 6 6 CHICAGO $14.61 $52.58 $104.20 $171.39 10/1/2016 7/1/20156002018 BRYN MAWR CARE 6 6 CHICAGO $15.01 $32.48 $55.85 $103.34 7/1/2014 Eligible for Provisional License as SMHRF6001242 BUCKINGHAM PAVILION INC 6 6 CHICAGO $14.49 $41.32 $76.36 $132.17 10/1/20166001259 BURGESS SQUARE HEALTHCARE CTR 7 7 WESTMONT $11.90 $51.15 $89.05 $152.10 10/1/20166001275 BURGIN MANOR 5 5 OLNEY $11.71 $38.61 $97.63 $147.95 10/1/20166001291 BURNSIDE COMMUNITY HEALTH CTR 4 4 MARSHALL $11.67 $46.84 $77.54 $136.05 10/1/20166001317 CAHOKIA NURSING AND REHAB CTR 11 11 EAST SAINT LOUI $14.07 $42.39 $79.51 $135.97 10/1/20166014674 CALHOUN NURSING AND REHAB CTR 3 3 HARDIN $14.40 $39.41 $70.00 $123.81 10/1/20166001333 CALIFORNIA GDNS NUR REHAB CTR 6 6 CHICAGO $15.24 $44.14 $78.05 $137.43 10/1/2016 7/1/20156008635 CAMBRIDGE NURSING REHAB CENTER 7 7 SKOKIE $16.85 $50.53 $120.53 $187.91 10/1/20166002489 CAPITOL HLTHCARE AND REHAB CTR 3 3 SPRINGFIELD $9.91 $40.88 $82.01 $132.80 10/1/20166009203 CARBONDALE REHABILITATION AND 5 5 CARBONDALE $9.04 $42.88 $90.81 $142.73 10/1/20166001424 CARE CENTER OF ABINGDON 2 2 ABINGDON $12.34 $43.92 $65.91 $122.17 10/1/2016 7/1/20146009336 CARLINVILLE REHAB AND HLTC 3 3 CARLINVILLE $11.97 $43.24 $81.46 $136.67 10/1/20166001473 CARLYLE HEALTHCARE CENTER INC 11 11 CARLYLE $14.18 $44.61 $87.24 $146.03 10/1/2016 7/1/2014

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6016539 CARMI MANOR 5 5 CARMI $8.87 $43.35 $77.07 $129.29 10/1/20166001507 CARRIER MILLS NURSING REHAB CT 5 5 CARRIER MILLS $12.50 $40.09 $83.20 $135.79 10/1/20166000970 CASEY HEALTH CARE CENTER 4 4 CASEY $10.20 $48.94 $72.75 $131.89 10/1/20166010227 CASEYVILLE NRSG AND REHAB CTR 11 11 CASEYVILLE $13.23 $40.07 $80.47 $133.77 10/1/20166002869 CEDAR RIDGE HEALTH REHAB CTR 11 11 LEBANON $12.66 $46.71 $94.85 $154.22 10/1/20166001523 CENTER HOME HISPANIC ELDERLY 6 6 CHICAGO $15.60 $54.41 $115.64 $185.65 10/1/20166001564 CENTRAL BAPTIST VILLAGE 7 7 NORRIDGE $16.29 $55.98 $84.21 $156.48 10/1/20166001580 CENTRAL NURSING HOME 6 6 CHICAGO $9.44 $27.73 $91.82 $128.99 10/1/20166001598 CENTRAL PLAZA 6 6 CHICAGO $13.51 $44.74 $66.60 $124.85 7/1/2014 Eligible for Provisional License as SMHRF 7/1/20146012355 CENTRALIA MANOR 5 5 CENTRALIA $16.97 $41.30 $83.41 $141.68 10/1/20166008601 CHALET LIVING & REHAB 6 6 CHICAGO $15.94 $55.98 $104.85 $176.77 10/1/20166001457 CHAMPAIGN URBANA NURSING REHAB 4 4 SAVOY $14.96 $50.44 $85.88 $151.28 10/1/20166001358 CHARLESTON REHAB HEALTH CARE 4 4 CHARLESTON $10.19 $42.27 $83.58 $136.04 10/1/2016 7/1/20156010367 CHATEAU NURSING AND REHAB 7 7 WILLOWBROOK $16.27 $51.15 $115.26 $182.68 10/1/2016 7/1/20146008841 CHESTER REHAB AND NURSING CTR 5 5 CHESTER $10.69 $43.38 $69.03 $123.10 10/1/2016 7/1/20146001697 CHICAGO RIDGE NURSING CENTER 7 7 CHICAGO RIDGE $13.89 $36.49 $76.92 $127.30 10/1/20166001739 CHRISTIAN NURSING HOME 3 3 LINCOLN $16.84 $44.38 $82.96 $144.18 10/1/2016 7/1/20156001770 CISNE REHAB AND HEALTH CENTER 5 5 CISNE $7.72 $43.93 $107.56 $159.21 10/1/20166000277 CITADEL CARE CENTER-ELGIN 8 8 ELGIN $16.04 $55.98 $90.24 $162.26 10/1/20166000269 CITADEL CARE CENTER-KANKAKEE 9 9 KANKAKEE $14.72 $48.06 $95.46 $158.24 10/1/20166006563 CITADEL CARE CENTER-WILMETTE 7 7 WILMETTE $18.26 $55.98 $97.72 $171.96 10/1/20166009948 CITY VIEW MULTICARE CENTER LLC 7 7 CICERO $14.84 $39.14 $92.62 $146.60 10/1/20166005144 CLARIDGE HEALTHCARE CENTER 8 8 LAKE BLUFF $10.83 $40.10 $109.37 $160.30 10/1/20166001796 CLARK MANOR CONVALESCENT CTR 6 6 CHICAGO $16.68 $40.10 $104.96 $161.74 10/1/20166001846 CLAYTON RESIDENTAL HOME 6 6 CHICAGO $14.12 $42.80 $66.18 $123.10 7/1/2014 Eligible for Provisional License as SMHRF6001887 CLINTON MANOR LIVING CENTER 11 11 NEW BADEN $11.34 $45.93 $72.01 $129.28 10/1/20166004469 COBDEN REHAB AND NRSG CENTER 5 5 COBDEN $9.87 $39.73 $65.90 $115.50 10/1/20166007496 COLLINSVILLE REHAB HEALTH CARE 11 11 COLLINSVILLE $11.15 $38.29 $77.32 $126.76 10/1/20166001945 COLONIAL HLTHCARE AND REHAB CT 2 2 PRINCETON $11.17 $46.28 $91.86 $149.31 10/1/20166001952 COLONIAL MANOR 4 4 DANVILLE $16.24 $50.44 $80.18 $146.86 10/1/20166013106 COLUMBIA REHAB AND NURSING CTR 11 11 COLUMBIA $16.05 $46.24 $95.07 $157.36 10/1/20166001994 COLUMBUS MANOR RES CARE HOME 6 6 CHICAGO $9.11 $31.41 $44.46 $84.98 7/1/2014 Eligible for Provisional License as SMHRF6002026 COMMUNITY CARE CENTER 6 6 CHICAGO $11.77 $39.06 $90.58 $141.41 10/1/20166006175 COMMUNITY NRSG AND REHAB CTR 7 7 NAPERVILLE $15.71 $50.90 $120.97 $187.58 10/1/20166016711 CONCORDIA VILLAGE CARE CENTER 3 3 SPRINGFIELD $16.85 $40.28 $71.25 $128.38 10/1/20166002075 CONTINENTAL NURSING REHAB CTR 6 6 CHICAGO $14.90 $50.31 $107.84 $173.05 10/1/2016 7/1/20156003420 CORNERSTONE REHAB AND HC 2 2 PEORIA HEIGHTS $11.84 $50.44 $86.26 $148.54 10/1/20166015200 COULTERVILLE REHAB AND HCC 5 5 COULTERVILLE $18.18 $43.93 $67.95 $130.06 10/1/20166002141 COUNTRY HEALTH 4 4 GIFFORD $26.69 $50.44 $75.97 $153.10 10/1/20166002174 COUNTRYSIDE CARE CENTRE 8 8 AURORA $15.60 $46.13 $107.25 $168.98 10/1/2016 7/1/20146002190 COUNTRYSIDE NURSING AND REHAB 7 7 DOLTON $16.11 $41.83 $103.82 $161.76 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6005631 COUNTRYVIEW CARE CTR OF MACOMB 2 2 MACOMB $9.68 $47.66 $59.62 $116.96 10/1/2016 7/1/20146003008 COURTYARD HEALTHCARE CENTER 7 7 BERWYN $17.93 $50.15 $99.29 $167.37 10/1/2016 7/1/20146001093 COVENANT HEALTH CARE CENTER 7 7 NORTHBROOK $14.88 $55.98 $100.58 $171.44 10/1/20166002208 COVENANT HEALTH CARE CENTER 8 8 BATAVIA $17.23 $55.98 $90.40 $163.61 10/1/20166002273 CRESTWOOD TERRACE NURSING CTR 7 7 CRESTWOOD $13.11 $35.07 $56.96 $105.14 10/1/20166010136 CROSSROADS CARE CTR WOODSTOCK 8 8 WOODSTOCK $11.80 $48.90 $109.70 $170.40 10/1/20166002299 CRYSTAL PINES REHAB AND HCC 8 8 CRYSTAL LAKE $15.09 $53.62 $94.54 $163.25 10/1/20166002307 CUMBERLAND REHAB HEALTH CARE 4 4 GREENUP $9.41 $44.13 $78.14 $131.68 10/1/20166002364 DANVILLE CARE CENTER LTD 4 4 DANVILLE $10.98 $46.64 $78.44 $136.06 10/1/20166010342 DAYSTAR NURSING AND REHAB CTR 5 5 CAIRO $11.91 $42.46 $78.83 $133.20 10/1/20166007363 DECATUR MANOR HEALTHCARE 4 4 DECATUR $11.85 $33.69 $55.99 $101.53 7/1/2014 Eligible for Provisional License as SMHRF6003081 DECATUR REHAB HEALTH CARE CTR 4 4 DECATUR $10.04 $50.44 $74.80 $135.28 10/1/2016 7/1/20146005276 DIXON REHAB AND HCC 1 1 DIXON $10.26 $45.42 $80.18 $135.86 10/1/20166002521 DOBSON PLAZA NURSING & REHAB 7 7 EVANSTON $15.87 $48.15 $109.00 $173.02 10/1/20166002539 DOCTORS NURSING AND REHAB CTR 5 5 SALEM $13.36 $38.22 $104.50 $156.08 10/1/20166002570 DOUGLAS NURSING AND REHAB CTR 4 4 MATTOON $15.09 $44.20 $86.87 $146.16 10/1/20166002943 DUQUOIN NURSING AND REHAB 5 5 DU QUOIN $12.62 $37.19 $85.23 $135.04 10/1/2016 7/1/20156003222 EAST BANK CENTER 1 1 LOVES PARK $5.37 $48.05 $112.34 $165.76 10/1/20166007025 EASTSIDE HEALTH CARE CENTER 3 3 PITTSFIELD $10.49 $43.90 $88.25 $142.64 10/1/20166009237 EASTVIEW TERRACE 4 4 SULLIVAN $10.96 $44.46 $93.48 $148.90 10/1/2016 7/1/20156002679 EDEN VILLAGE 11 11 GLEN CARBON $12.09 $44.73 $71.25 $128.07 10/1/20166002729 EDWARDSVILLE NRSNG REHAB CTR 11 11 EDWARDSVILLE $12.27 $42.28 $91.40 $145.95 10/1/20166009559 EFFINGHAM REHAB HEALTH CARE CT 5 5 EFFINGHAM $10.27 $41.70 $73.96 $125.93 10/1/2016 7/1/20156002745 EL PASO HEALTH CARE CENTER 2 2 EL PASO $12.05 $45.14 $90.34 $147.53 10/1/20166003248 ELDORADO REHAB AND HEALTHCARE 5 5 ELDORADO $11.85 $30.18 $59.80 $101.83 10/1/20166002810 ELIZABETH NURSING HOME 1 1 ELIZABETH $7.07 $44.08 $70.13 $121.28 10/1/20166010144 ELM BROOK HEALTHCARE AND REHAB 7 7 ELMHURST $12.90 $50.63 $109.68 $173.21 10/1/20166002828 ELMHURST EXTENDED CARE CENTER 7 7 ELMHURST $11.94 $54.24 $80.77 $146.95 10/1/20166005961 ELMWOOD NURSING AND REHAB CTR 11 11 MARYVILLE $13.40 $41.32 $80.01 $134.73 10/1/20166002844 ELMWOOD TERRACE HEALTHCARE CTR 8 8 AURORA $11.11 $51.77 $99.36 $162.24 10/1/20166002851 ELSTON NURSING AND REHAB CENTR 6 6 CHICAGO $14.24 $50.36 $91.55 $156.15 10/1/20166005425 ENFIELD REHAB HEALTH CARE 5 5 PEORIA $8.70 $43.93 $81.68 $134.31 10/1/2016 7/1/20146004667 ESTATES OF HYDE PARK 6 6 CHICAGO $13.72 $43.56 $92.69 $149.97 10/1/20166002877 EUNICE C SMITH HOME 11 11 ALTON $5.44 $46.71 $90.46 $142.61 10/1/20166002901 EVENGLOW LODGE 4 4 PONTIAC $13.82 $48.31 $76.49 $138.62 10/1/2016 7/1/20156002133 EVERGREEN NURSING AND REHAB CT 5 5 EFFINGHAM $10.62 $38.12 $79.54 $128.28 10/1/20166002950 FAIR HAVENS CHRISTIAN HOME 4 4 DECATUR $12.09 $50.22 $86.71 $149.02 10/1/20166002976 FAIR OAKS HEALTH CARE CENTER 8 8 CRYSTAL LAKE $15.55 $55.98 $105.44 $176.97 10/1/20166002984 FAIR OAKS REHAB AND HCC 1 1 SOUTH BELOIT $13.77 $50.75 $87.84 $152.36 10/1/20166003024 FAIRHAVEN CHRISTIAN RET HOME 1 1 ROCKFORD $16.41 $51.52 $82.63 $150.56 10/1/20166001051 FAIRMONT CARE CENTRE 6 6 CHICAGO $21.39 $49.59 $115.48 $186.46 10/1/2016 7/1/2015

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6003040 FAIRVIEW HAVEN NURSING HOME 4 4 FAIRBURY $13.93 $50.44 $59.90 $124.27 10/1/20166003099 FAIRVIEW NURSING CENTER 5 5 DU QUOIN $10.58 $36.15 $65.00 $111.73 10/1/2016 7/1/20156003107 FAITH CARE CENTER 11 11 HIGHLAND $16.84 $46.44 $74.91 $138.19 10/1/20166004824 FARMER CITY REHAB AND HC 4 4 FARMER CITY $10.73 $47.43 $100.88 $159.04 10/1/20166003115 FARMINGTON COUNTRY MANOR 2 2 FARMINGTON $12.37 $49.24 $73.35 $134.96 10/1/2016 7/1/20146003123 FAYETTE COUNTY HOSPITAL NH 5 5 VANDALIA $6.15 $43.93 $65.74 $115.82 10/1/20166001614 FIRESIDE HOUSE OF CENTRALIA 5 5 CENTRALIA $10.38 $40.52 $76.21 $127.11 10/1/20166000939 FLANAGAN REHAB HEALTH CARE 4 4 FLANAGAN $10.95 $50.44 $92.08 $153.47 10/1/20166003172 FLORA GARDENS CARE CENTER 5 5 FLORA $10.68 $41.19 $83.80 $135.67 10/1/2016 7/1/20146003156 FLORA REHAB HEALTH CARE CTR 5 5 FLORA $11.82 $43.93 $80.53 $136.28 10/1/2016 7/1/20146003180 FLORENCE NURSING HOME 8 8 MARENGO $12.61 $49.25 $91.05 $152.91 10/1/2016 7/1/20146003198 FONDULAC REHAB HEALTH CARE CTR 2 2 EAST PEORIA $12.22 $50.44 $77.18 $139.84 10/1/20166001135 FOREST CITY REHAB AND NRSG CTR 1 1 ROCKFORD $12.58 $35.60 $72.33 $120.51 10/1/20166000483 FOREST VIEW REHAB NURSING CTR 7 7 ITASCA $14.27 $47.27 $126.79 $188.33 10/1/20166000137 FOSTER HEALTH AND REHAB CENTER 6 6 CHICAGO $14.85 $47.14 $111.83 $173.82 10/1/2016 7/1/20146012413 FRANCISCAN VILLAGE 7 7 LEMONT $13.46 $55.98 $92.50 $161.94 10/1/20166003289 FRANKFORT HEALTHCARE REHAB CTR 5 5 WEST FRANKFOR $8.80 $40.24 $80.80 $129.84 10/1/20166003297 FRANKFORT TERRACE NURSING CTR 9 9 FRANKFORT $10.80 $38.53 $70.17 $119.50 10/1/20166003305 FRANKLIN GROVE LIVING REHAB 1 1 FRANKLIN GROVE $11.11 $46.91 $73.25 $131.27 10/1/20166003321 FREEBURG CARE CENTER 11 11 FREEBURG $11.93 $36.01 $79.23 $127.17 10/1/2016 7/1/20156003388 FRIENDSHIP MANOR 10 10 ROCK ISLAND $13.83 $50.35 $66.95 $131.13 10/1/2016 7/1/20146015895 FRIENDSHIP MANOR HEALTH CARE 5 5 NASHVILLE $10.06 $38.41 $83.18 $131.65 10/1/20166005979 FRIENDSHIP SKILLED NSG REHAB 3 3 CARLINVILLE $10.32 $44.49 $74.13 $128.94 10/1/20166003404 FRIENDSHIP VILLAGE OF SCHAUMBU 7 7 SCHAUMBURG $16.97 $55.98 $111.67 $184.62 10/1/2016 7/1/20146003438 GALENA STAUSS NURSING HOME 1 1 GALENA $7.78 $51.11 $75.62 $134.51 10/1/20166009567 GARDENVIEW MANOR 4 4 DANVILLE $11.95 $37.42 $81.34 $130.71 10/1/2016 12/1/20156000467 GENERATIONS AT APPLEWOOD 7 7 MATTESON $16.08 $49.08 $106.65 $171.81 10/1/20166002067 GENERATIONS AT COLUMBUS PARK 6 6 CHICAGO $17.30 $40.15 $81.30 $138.75 10/1/20166008270 GENERATIONS AT ELMWOOD PARK 7 7 ELMWOOD PARK $18.63 $41.81 $135.17 $195.61 10/1/20166006514 GENERATIONS AT NEIGHBORS 1 1 BYRON $12.40 $48.47 $92.29 $153.16 10/1/2016 7/1/20146006837 GENERATIONS AT OAKTON PAVILLIO 7 7 DES PLAINES $16.40 $39.50 $110.93 $166.83 10/1/20166007793 GENERATIONS AT REGENCY 7 7 NILES $21.04 $48.46 $108.06 $177.56 10/1/20166008130 GENERATIONS AT ROCK ISLAND 10 10 ROCK ISLAND $13.59 $40.61 $88.44 $142.64 10/1/2016 7/1/20146006076 GENESIS SENIOR LIVING ALEDO 10 10 ALEDO $12.09 $47.02 $68.06 $127.17 10/1/20166003552 GIBSON COMMUNITY HOSPITAL ANNE 4 4 GIBSON CITY $15.97 $50.44 $64.21 $130.62 10/1/20166003578 GILMAN HEALTHCARE CENTER 4 4 GILMAN $13.97 $44.51 $81.88 $140.36 10/1/20166006191 GLEN BRIDGE NURSING AND REHAB 7 7 NILES $17.36 $45.95 $118.87 $182.18 10/1/2016 7/1/20156003586 GLEN OAKS NURSING REHAB CENTER 7 7 NORTHBROOK $14.22 $44.61 $93.33 $152.16 10/1/20166008833 GLEN SAINT ANDREW LIVING COMM 7 7 NILES $8.74 $55.98 $109.35 $174.07 10/1/20166003610 GLEN VIEW TERRACE NURSING CTR 7 7 GLENVIEW $18.90 $53.28 $106.87 $179.05 10/1/20166003594 GLENCREST HLTHCR AND REHAB CTR 6 6 CHICAGO $16.29 $49.38 $123.67 $189.34 10/1/2016 7/1/2015

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6006647 GLENLAKE TERRACE NURSING REHAB 8 8 WAUKEGAN $11.79 $42.52 $116.95 $171.26 10/1/20166007918 GLENSHIRE NURSING REHAB CENTRE 7 7 RICHTON PARK $18.34 $51.25 $127.63 $197.22 10/1/20166003628 GLENWOOD HEALTHCARE AND REHAB 7 7 GLENWOOD $16.72 $48.77 $117.82 $183.31 10/1/20166003636 GOLDEN GOOD SHEPHERD HOME 3 3 GOLDEN $10.43 $43.06 $59.80 $113.29 10/1/20166007637 GOOD SAM PROPHETS RIVERVIEW 1 1 PROPHETSTOWN $12.52 $51.52 $81.50 $145.54 10/1/20166003495 GOOD SAM SOC GENESEO VILLAGE 10 10 GENESEO $14.24 $48.44 $66.18 $128.86 10/1/20166001515 GOOD SAM SOCIETY MT CARROLL 1 1 MOUNT CARROLL $14.24 $48.25 $78.47 $140.96 10/1/20166003677 GOOD SAMARITAN FLANAGAN 4 4 FLANAGAN $12.09 $50.44 $70.90 $133.43 10/1/20166003685 GOOD SAMARITAN HOME OF QUINCY 3 3 QUINCY $16.84 $44.49 $64.68 $126.01 10/1/20166005573 GOOD SAMARITAN PONTIAC 4 4 PONTIAC $10.80 $49.55 $59.16 $119.51 10/1/20166003727 GOTTLIEB MEMORIAL HOSPITAL 7 7 MELROSE PARK $7.85 $55.98 $99.40 $163.23 7/1/20166060524 GRAHAM HOSP EXT CARE FACILITY 2 2 CANTON $8.22 $50.44 $79.61 $138.27 10/1/20166001986 GRANITE NURSING AND REHAB CTR 11 11 GRANITE CITY $17.95 $38.49 $84.12 $140.56 10/1/20166003776 GRASMERE PLACE 6 6 CHICAGO $12.38 $37.00 $53.51 $102.89 7/1/2014 Eligible for Provisional License as SMHRF 7/1/20146015499 GREEK AMERICAN REHAB CARE CTR 7 7 WHEELING $17.26 $53.43 $114.01 $184.70 10/1/20166016570 GREENFIELDS OF GENEVA 8 8 GENEVA $18.18 $55.98 $122.62 $196.78 10/1/20166000202 GREENWOOD CARE 7 7 EVANSTON $15.65 $39.53 $55.16 $110.34 7/1/2014 Eligible for Provisional License as SMHRF6003511 GROSSE POINTE MANOR 7 7 NILES $19.37 $51.62 $94.56 $165.55 10/1/20166000574 GROVE OF FOX VALLEY 8 8 AURORA $15.74 $44.74 $109.40 $169.88 10/1/20166003933 HALLMARK HOUSE NURSING CENTER 2 2 PEKIN $13.16 $49.37 $72.97 $135.50 10/1/20166003974 HAMILTON MEM REHAB AND HCC 5 5 MC LEANSBORO $13.26 $43.93 $69.97 $127.16 10/1/20166004006 HAMMOND HENRY DISTRICT HOSPITA 10 10 GENESEO $16.84 $53.08 $79.06 $148.98 7/1/20166004048 HARBOR CREST HOME 1 1 FULTON $5.80 $47.43 $57.64 $110.87 10/1/20166013684 HARMONY NURSING AND REHAB CTR 6 6 CHICAGO $20.50 $51.74 $116.59 $188.83 10/1/20166004089 HAVANA HEALTH CARE CENTER 3 3 HAVANA $13.24 $41.19 $79.02 $133.45 10/1/2016 7/1/20156015317 HAWTHORNE INN OF DANVILLE 4 4 DANVILLE $15.75 $41.96 $79.51 $137.22 10/1/20166009310 HEARTHSTONE MANOR 8 8 WOODSTOCK $14.54 $55.98 $65.16 $135.68 10/1/2016 7/1/20146013437 HEARTLAND CHRISTIAN VILLAGE 4 4 NEOGA $14.24 $46.85 $76.39 $137.48 10/1/20166004121 HEARTLAND MANOR INC 4 4 CASEY $10.83 $49.76 $55.87 $116.46 10/1/20166011597 HEARTLAND OF CANTON 2 2 CANTON $14.56 $49.02 $76.78 $140.36 10/1/20166000301 HEARTLAND OF CHAMPAIGN 4 4 CHAMPAIGN $11.11 $50.44 $72.95 $134.50 10/1/20166000285 HEARTLAND OF DECATUR 4 4 DECATUR $15.59 $47.67 $88.05 $151.31 10/1/20166003446 HEARTLAND OF GALESBURG 2 2 GALESBURG $17.02 $50.44 $69.33 $136.79 10/1/20166011613 HEARTLAND OF HENRY 2 2 HENRY $14.85 $48.47 $68.83 $132.15 10/1/20166005649 HEARTLAND OF MACOMB 2 2 MACOMB $15.73 $50.44 $79.65 $145.82 10/1/20166006233 HEARTLAND OF MOLINE 10 10 MOLINE $14.50 $48.19 $95.60 $158.29 10/1/20166000244 HEARTLAND OF NORMAL 4 4 NORMAL $14.04 $50.44 $65.99 $130.47 10/1/20166011571 HEARTLAND OF PAXTON 4 4 PAXTON $16.13 $49.50 $77.31 $142.94 10/1/20166000293 HEARTLAND OF PEORIA 2 2 PEORIA $14.35 $49.03 $72.81 $136.19 10/1/20166008056 HEARTLAND OF RIVERVIEW 2 2 EAST PEORIA $16.76 $50.44 $103.35 $170.55 10/1/20166004139 HEATHER HEALTH CARE CENTER 7 7 HARVEY $18.28 $49.69 $82.29 $150.26 10/1/2016 7/1/2014

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6004147 HEIGHTS HLTHCARE AND REHAB CTR 2 2 PEORIA HEIGHTS $12.45 $48.20 $76.07 $136.72 10/1/2016 7/1/20156006704 HELIA HEALTHCARE OF BELLEVILLE 11 11 BELLEVILLE $9.81 $46.71 $109.38 $165.90 10/1/20166016091 HELIA HEALTHCARE OF BENTON 5 5 BENTON $3.66 $43.93 $72.79 $120.38 10/1/20166003800 HELIA HEALTHCARE OF CHAMPAIGN 4 4 CHAMPAIGN $9.27 $44.00 $64.76 $118.03 10/1/20166005870 HELIA HEALTHCARE OF ENERGY 5 5 ENERGY $7.78 $36.52 $74.16 $118.46 10/1/20166004493 HELIA HEALTHCARE OF GREENVILLE 5 11 GREENVILLE $5.08 $44.33 $72.18 $121.59 10/1/20166006910 HELIA HEALTHCARE OF OLNEY 5 5 OLNEY $9.36 $26.23 $77.13 $112.72 10/1/20166003255 HELIA SOUTHBELT HEALTHCARE 11 11 BELLEVILLE $11.59 $43.65 $84.47 $139.71 10/1/20166012066 HENDERSON CO RETIREMENT CENTER 2 2 STRONGHURST $12.85 $45.59 $78.12 $136.56 10/1/20166003917 HENRY AND JANE VONDERLIETH CTR 3 3 MOUNT PULASKI $11.67 $44.49 $71.33 $127.49 10/1/20166000756 HERITAGE HEALTH 3 3 JACKSONVILLE $13.79 $44.49 $87.42 $145.70 10/1/20166000780 HERITAGE HEALTH BEARDSTOWN 3 3 BEARDSTOWN $11.88 $44.49 $77.08 $133.45 10/1/20166004261 HERITAGE HEALTH BLOOMINGTON 4 4 BLOOMINGTON $18.46 $50.44 $77.67 $146.57 10/1/20166000723 HERITAGE HEALTH CARLINVILLE 3 3 CARLINVILLE $12.89 $43.01 $77.51 $133.41 10/1/20166007199 HERITAGE HEALTH CHILLICOTHE 2 2 CHILLICOTHE $13.90 $50.41 $93.63 $157.94 10/1/2016 7/1/20146002083 HERITAGE HEALTH DWIGHT 4 4 DWIGHT $15.32 $50.32 $88.88 $154.52 10/1/20166005920 HERITAGE HEALTH EL PASO 2 2 EL PASO $16.72 $50.44 $91.52 $158.68 10/1/20166006902 HERITAGE HEALTH ELGIN 8 8 ELGIN $14.27 $55.33 $123.50 $193.10 10/1/2016 7/1/20146003560 HERITAGE HEALTH GIBSON CITY 4 4 GIBSON CITY $13.82 $50.40 $80.30 $144.52 10/1/2016 7/1/20156000681 HERITAGE HEALTH GILLESPIE 3 3 GILLESPIE $12.41 $43.33 $79.33 $135.07 10/1/20166004592 HERITAGE HEALTH HOOPESTON 4 4 HOOPESTON $17.99 $47.75 $68.87 $134.61 10/1/20166000699 HERITAGE HEALTH LITCHFIELD 3 3 LITCHFIELD $13.64 $44.41 $91.23 $149.28 10/1/20166004253 HERITAGE HEALTH MENDOTA 2 2 MENDOTA $11.94 $50.01 $94.79 $156.74 10/1/20166005367 HERITAGE HEALTH MINONK 2 2 MINONK $15.84 $50.44 $94.55 $160.83 10/1/2016 7/1/20156010128 HERITAGE HEALTH MOUNT ZION 4 4 MOUNT ZION $16.56 $49.83 $75.16 $141.55 10/1/20166004287 HERITAGE HEALTH MT STERLING 3 3 MOUNT STERLING $13.68 $44.49 $69.94 $128.11 10/1/2016 7/1/20156008510 HERITAGE HEALTH NORMAL 4 4 NORMAL $16.29 $49.94 $85.23 $151.46 10/1/20166000707 HERITAGE HEALTH PANA 3 3 PANA $13.23 $41.85 $91.17 $146.25 10/1/20166004303 HERITAGE HEALTH PERU 2 2 PERU $15.13 $48.38 $95.13 $158.64 10/1/20166002125 HERITAGE HEALTH ROBINSON 5 5 ROBINSON $13.41 $43.93 $75.52 $132.86 10/1/20166004279 HERITAGE HEALTH SPRINGFIELD 3 3 SPRINGFIELD $15.52 $44.49 $90.36 $150.37 10/1/2016 7/1/20156000715 HERITAGE HEALTH STAUNTON 3 3 STAUNTON $12.01 $44.49 $75.19 $131.69 10/1/2016 7/1/20146004311 HERITAGE HEALTH STREATOR 2 2 STREATOR $16.57 $49.16 $85.58 $151.31 10/1/2016 7/1/20156004337 HERITAGE SQUARE 1 1 DIXON $9.07 $50.53 $83.02 $142.62 10/1/20166003362 HERRIN REHAB AND NRSG CENTER 5 5 HERRIN $9.00 $37.53 $80.78 $127.31 10/1/2016 7/1/20156004352 HICKORY NURSING PAVILION 7 7 HICKORY HILLS $15.52 $49.25 $80.42 $145.19 10/1/20166016687 HICKORY POINT CHRISTIAN VILL 4 4 FORSYTH $16.85 $46.11 $120.55 $183.51 10/1/20166001663 HIGHLAND HEALTH CARE CENTER 11 11 HIGHLAND $9.69 $46.52 $89.80 $146.01 10/1/20166000392 HIGHLAND OAKS 8 8 ELGIN $14.39 $55.98 $81.61 $151.98 10/1/20166004410 HILLCREST RETIREMENT VILLAGE 8 8 ROUND LAKE BEA $12.53 $46.74 $99.89 $159.16 10/1/2016 7/1/20146004428 HILLSBORO REHAB AND HLTC 3 3 HILLSBORO $11.14 $42.63 $74.32 $128.09 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6004451 HILLSIDE REHAB AND CARE CENTER 9 9 YORKVILLE $6.68 $47.72 $81.32 $135.72 10/1/20166004477 HILLTOP SKILLED NURSING REHAB 4 4 CHARLESTON $11.49 $35.29 $74.22 $121.00 10/1/20166004485 HILLVIEW HEALTH CARE CENTER 5 5 VIENNA $8.72 $37.65 $58.75 $105.12 10/1/20166004501 HITZ MEMORIAL HOME 11 11 ALHAMBRA $11.23 $46.71 $74.57 $132.51 10/1/20166004550 HOLY FAMILY VILLA 7 7 PALOS PARK $18.18 $55.98 $70.75 $144.91 10/1/20166004212 ILLINI HERITAGE REHAB AND HC 4 4 CHAMPAIGN $9.69 $41.99 $94.69 $146.37 10/1/20166013023 ILLINI RESTORATIVE CARE 10 10 SILVIS $15.55 $51.52 $66.66 $133.73 10/1/20166004675 ILLINOIS KNIGHTS TEMPLAR HOME 4 4 PAXTON $11.67 $50.44 $90.89 $153.00 10/1/20166012579 IMBODEN CREEK LIVING CENTER 4 4 DECATUR $15.52 $50.44 $73.64 $139.60 10/1/20166001028 INTEGRITY HC OF GODFREY 11 11 GODFREY $12.12 $46.71 $115.80 $174.63 10/1/20166007116 INTEGRITY HC OF SMITHTON 11 11 SMITHTON $10.57 $46.71 $59.75 $117.03 10/1/20166009534 INTEGRITY HC OF WOOD RIVER 11 11 WOOD RIVER $14.15 $46.71 $74.90 $135.76 10/1/2016 7/1/20146004790 IROQUOIS RESIDENT HOME 4 4 WATSEKA $11.67 $50.44 $51.55 $113.66 10/1/20166004840 JACKSONVILLE SKILLED NRSG REH 3 3 JACKSONVILLE $11.62 $38.22 $97.79 $147.63 10/1/2016 7/1/20156004899 JENNINGS TERRACE 8 8 AURORA $9.69 $45.20 $68.74 $123.63 10/1/20166013312 JERSEYVILLE MANOR 3 3 JERSEYVILLE $16.12 $40.75 $81.60 $138.47 10/1/20166004907 JERSEYVILLE NSG AND REHAB CTR 3 3 JERSEYVILLE $16.22 $43.79 $83.90 $143.91 10/1/20166004964 JOLIET TERRACE NURSING CTR 9 9 JOLIET $10.57 $37.90 $55.20 $103.67 10/1/20166005433 JONESBORO REHAB HEALTH CARE 5 5 JONESBORO $9.58 $43.92 $83.50 $137.00 10/1/20166004972 KANKAKEE TERRACE NURSING CTR 9 9 BOURBONNAIS $12.04 $38.02 $57.85 $107.91 7/1/2014 Eligible for Provisional License as SMHRF6006126 KENSINGTON PLACE NRSG REHAB 6 6 CHICAGO $14.06 $45.30 $106.21 $165.57 10/1/20166005011 KEWANEE CARE HOME 10 10 KEWANEE $12.85 $44.88 $89.68 $147.41 10/1/20166005128 LAHARPE DAVIER HEALTH CARE 3 3 LA HARPE $9.69 $44.23 $89.96 $143.88 10/1/20166009807 LAKE PARK CENTER 8 8 WAUKEGAN $9.38 $32.88 $56.94 $99.20 7/1/2014 Eligible for Provisional License as SMHRF6005177 LAKE SHORE HEALTHCARE REHAB 6 6 CHICAGO $14.60 $49.20 $115.05 $178.85 10/1/2016 7/1/20146005169 LAKEFRONT NURSING & REHAB CENT 6 6 CHICAGO $13.50 $47.53 $87.08 $148.11 10/1/20166005185 LAKELAND REHAB AND HCC 5 5 EFFINGHAM $11.81 $42.62 $78.38 $132.81 10/1/20166005227 LAKEVIEW REHAB NURSING CENTER 6 6 CHICAGO $13.51 $54.89 $126.60 $195.00 10/1/20166005235 LAKEWOOD NURSING AND REHAB CTR 9 9 PLAINFIELD $18.85 $49.99 $115.42 $184.26 10/1/20166001044 LEBANON CARE CENTER 11 11 LEBANON $11.01 $37.58 $88.06 $136.65 10/1/20166005284 LEE MANOR NURSING HM 7 7 DES PLAINES $16.88 $44.33 $117.15 $178.36 10/1/20166014492 LEMONT NURSING AND REHAB CTR 7 7 LEMONT $21.17 $50.59 $110.76 $182.52 10/1/20166005292 LENA LIVING CENTER 1 1 LENA $9.76 $47.56 $79.78 $137.10 10/1/2016 7/1/20146012157 LEROY MANOR 4 4 LE ROY $15.43 $45.75 $77.74 $138.92 10/1/20166005300 LEWIS MEMORIAL 3 3 SPRINGFIELD $16.84 $44.49 $87.31 $148.64 10/1/2016 7/1/20156011993 LEXINGTON HEALTH CARE CENTER O 7 7 BLOOMINGDALE $18.25 $51.26 $107.37 $176.88 10/1/20166005318 LEXINGTON HEALTH CARE CTR INC 7 7 LOMBARD $15.73 $49.10 $112.46 $177.29 10/1/20166012967 LEXINGTON HEALTH CARE OF CHICA 7 7 CHICAGO RIDGE $21.14 $48.71 $107.56 $177.41 10/1/20166013098 LEXINGTON OF ELMHURST 7 7 ELMHURST $17.03 $51.93 $114.92 $183.88 10/1/20166013361 LEXINGTON OF LAGRANGE 7 7 LA GRANGE $23.21 $53.46 $109.90 $186.57 10/1/20166014138 LEXINGTON OF LAKE ZURICH 8 8 LAKE ZURICH $17.94 $50.32 $96.10 $164.36 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6014682 LEXINGTON OF ORLAND PARK 7 7 ORLAND PARK $21.06 $47.43 $112.70 $181.19 10/1/20166012553 LEXINGTON OF SCHAUMBURG 7 7 SCHAUMBURG $21.18 $49.62 $100.29 $171.09 10/1/20166012975 LEXINGTON OF STREAMWOOD 7 7 STREAMWOOD $21.20 $50.66 $107.89 $179.75 10/1/20166014369 LEXINGTON OF WHEELING 7 7 OTHER $20.99 $50.62 $109.10 $180.71 10/1/20166005359 LIBERTYVILLE MANOR EXT CARE 8 8 LIBERTYVILLE $12.08 $55.55 $80.37 $148.00 10/1/20166005375 LIEBERMAN CENTER FOR HEALTH 7 7 SKOKIE $14.88 $56.24 $105.32 $176.44 10/1/2016 7/1/20146005563 LITTLE SISTERS OF THE POOR 6 6 CHICAGO $10.11 $55.98 $74.38 $140.47 10/1/20166005599 LUTHERAN CARE CTR 5 5 ALTAMONT $12.16 $43.93 $65.72 $121.81 10/1/20166005607 LUTHERAN HOME FOR THE AGED 7 7 ARLINGTON HGTS $18.18 $55.98 $78.48 $152.64 10/1/2016 7/1/20146005615 LUTHERAN HOME INC 2 2 PEORIA $12.52 $50.44 $71.07 $134.03 10/1/20166005623 LYDIA HEALTHCARE 7 7 ROBBINS $15.40 $38.27 $57.09 $110.76 7/1/2014 Eligible for Provisional License as SMHRF6016885 MANOR COURT OF CARBONDALE 5 5 CARBONDALE $16.84 $38.89 $77.33 $133.06 10/1/20166015879 MANOR COURT OF CLINTON 4 4 CLINTON $17.98 $46.11 $86.26 $150.35 10/1/20166016133 MANOR COURT OF FREEPORT 1 1 FREEPORT $17.96 $51.52 $78.01 $147.49 10/1/20166013189 MANOR COURT OF MARYVILLE 11 11 MARYVILLE $13.47 $44.96 $76.28 $134.71 10/1/20166016190 MANOR COURT OF PEORIA 2 2 PEORIA $20.79 $46.11 $78.17 $145.07 10/1/20166015887 MANOR COURT OF PERU 2 2 PERU $17.87 $46.11 $69.96 $133.94 10/1/20166015861 MANOR COURT OF PRINCETON 2 2 PRINCETON $17.87 $46.11 $79.49 $143.47 10/1/2016 7/1/20146000228 MANORCARE OF ARLINGTON HEIGHTS 7 7 ARLINGTON HEIGH $18.32 $55.98 $93.67 $167.97 10/1/20166012686 MANORCARE OF ELK GROVE VILLAGE 7 7 ELK GROVE VLG $21.58 $53.57 $104.88 $180.03 10/1/20166006332 MANORCARE OF HINSDALE 7 7 HINSDALE $11.08 $55.98 $95.55 $162.61 10/1/20166012611 MANORCARE OF HOMEWOOD 7 7 HOMEWOOD $21.11 $53.81 $106.35 $181.27 10/1/20166010482 MANORCARE OF LIBERTYVILLE 8 8 LIBERTYVILLE $16.43 $55.40 $100.59 $172.42 10/1/20166000251 MANORCARE OF NAPERVILLE 7 7 NAPERVILLE $14.95 $55.98 $115.93 $186.86 10/1/20166015168 MANORCARE OF NORTHBROOK 7 7 NORTHBROOK $21.70 $53.30 $101.14 $176.14 10/1/20166000236 MANORCARE OF OAK LAWN EAST 7 7 OAK LAWN $19.76 $54.32 $110.83 $184.91 10/1/20166000343 MANORCARE OF OAK LAWN WEST 7 7 OAK LAWN $17.75 $55.08 $113.56 $186.39 10/1/20166010912 MANORCARE OF PALOS HTS EAST 7 7 PALOS HEIGHTS $21.54 $53.48 $104.26 $179.28 10/1/20166014534 MANORCARE OF PALOS HTS WEST 7 7 PALOS HEIGHTS $23.37 $55.98 $110.43 $189.78 10/1/20166000327 MANORCARE OF ROLLING MEADOWS 7 7 ROLLING MEADOW $19.67 $52.27 $95.75 $167.69 10/1/20166011589 MANORCARE OF SOUTH HOLLAND 7 7 SOUTH HOLLAND $21.20 $54.26 $107.61 $183.07 10/1/20166000335 MANORCARE OF WESTMONT 7 7 WESTMONT $17.31 $55.98 $96.68 $169.97 10/1/20166005706 MAPLE CREST CARE CENTRE 1 1 BELVIDERE $13.70 $46.96 $104.52 $165.18 10/1/2016 7/1/20146005748 MAR KA NURSING HOME 11 11 MASCOUTAH $10.11 $43.42 $77.51 $131.04 10/1/20166005755 MARGARET MANOR 6 6 CHICAGO $13.00 $49.03 $45.45 $107.48 7/1/2015 Eligible for Provisional License as SMHRF 7/1/20156005763 MARGARET MANOR NORTH 6 6 CHICAGO $11.51 $42.94 $54.24 $108.69 7/1/2015 Eligible for Provisional License as SMHRF 7/1/20156005797 MARIGOLD REHABILITATION HCC 2 2 GALESBURG $11.91 $46.74 $71.29 $129.94 10/1/20166003230 MARION REHAB AND NRSG CENTER 5 5 MARION $15.03 $41.60 $82.14 $138.77 10/1/20166011688 MASON CITY AREA NURSING HOME 3 3 MASON CITY $12.52 $44.49 $71.95 $128.96 10/1/20166004691 MASON POINT 4 4 SULLIVAN $9.37 $50.44 $83.40 $143.21 10/1/20166005888 MATTOON REHAB AND HCC 4 4 MATTOON $10.99 $48.76 $70.62 $130.37 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6005896 MAYFIELD CARE CENTER 6 6 CHICAGO $12.93 $49.50 $123.29 $185.72 10/1/2016 7/1/20156005938 MCKINLEY COURT 4 4 DECATUR $14.32 $47.72 $94.70 $156.74 10/1/2016 7/1/20146005417 MCLEANSBORO REHAB HEALTH CARE 5 5 MC LEANSBORO $9.24 $43.93 $92.06 $145.23 10/1/20166005953 MEADOW MANOR SKILLED NRSG REH 3 3 TAYLORVILLE $10.26 $39.30 $83.48 $133.04 10/1/20166013120 MEADOWBROOK MANOR 9 9 BOLINGBROOK $17.07 $46.15 $118.30 $181.52 10/1/20166014518 MEADOWBROOK MANOR NAPERVILLE 7 7 NAPERVILLE $18.61 $48.91 $108.55 $176.07 10/1/20166016281 MEADOWBROOK MANOR OF LAGRANGE 7 7 LA GRANGE $16.22 $44.69 $116.22 $177.13 10/1/20166005987 MEADOWOOD 5 5 GRAYVILLE $9.03 $28.31 $59.50 $96.84 10/1/20166006001 MEADOWS MENNONITE 4 4 CHENOA $14.69 $49.26 $81.86 $145.81 10/1/2016 7/1/20156006019 MEDINA NURSING CENTER 1 1 DURAND $14.27 $48.91 $84.17 $147.35 10/1/20166006035 MEMORIAL CARE CENTER 11 11 BELLEVILLE $6.15 $46.71 $97.57 $150.43 10/1/20166006050 MENDOTA LUTHERAN HOME 2 2 MENDOTA $12.09 $49.20 $76.08 $137.37 10/1/20166016737 MERCY CIRCLE 6 6 CHICAGO $18.18 $45.20 $91.39 $154.77 10/1/20166015697 MERCY HARVARD HOSPITAL CR CTR 8 8 HARVARD $10.15 $55.98 $88.61 $154.74 10/1/20166015812 MERIDIAN VILLAGE CARE CENTER 11 11 GLEN CARBON $16.85 $46.71 $76.52 $140.08 10/1/20166006118 METROPOLIS REHAB AND HCC 5 5 METROPOLIS $16.62 $43.74 $69.46 $129.82 10/1/20166006134 MID AMERICA CARE CENTER 6 6 CHICAGO $15.40 $47.51 $91.66 $154.57 10/1/20166003826 MIDWAY NEUROLOGICAL REHAB CTR 7 7 BRIDGEVIEW $14.24 $40.03 $108.00 $162.27 10/1/20166001341 MIDWEST REHAB AND RESPIRATORY 11 11 BELLEVILLE $11.34 $44.45 $82.50 $138.29 10/1/2016 7/1/20146014294 MILLER HEALTHCARE CENTER 9 9 KANKAKEE $18.18 $49.74 $86.27 $154.19 10/1/20166006258 MOMENCE MEADOWS NURSING AND RE 9 9 MOMENCE $13.57 $50.62 $113.56 $177.75 10/1/2016 7/1/20156006266 MONMOUTH NURSING HOME 2 2 MONMOUTH $12.84 $46.60 $60.86 $120.30 10/1/2016 7/1/20156006290 MONROE PAV HEALTH TREATMENT CT 6 6 CHICAGO $12.63 $41.79 $52.34 $106.76 7/1/2014 Eligible for Provisional License as SMHRF6006316 MONTEBELLO HEALTH CARE CENTER 3 3 HAMILTON $9.52 $38.57 $63.68 $111.77 10/1/2016 7/1/20146004444 MONTGOMERY NURSING AND REHAB 3 3 HILLSBORO $11.19 $42.47 $90.31 $143.97 10/1/20166013171 MONTGOMERY PLACE 6 6 CHICAGO $14.39 $55.98 $59.37 $129.74 10/1/20166005698 MOORINGS HEALTH CENTER 7 7 ARLINGTON HGTS $14.39 $54.40 $94.38 $163.17 10/1/20146006407 MORTON TERRACE H AND R CENTRE 2 2 MORTON $11.73 $40.00 $85.66 $137.39 10/1/20166006399 MORTON VILLA HLTH AND REH CTR 2 2 MORTON $11.23 $38.85 $86.14 $136.22 10/1/20166012322 MOWEAQUA REHAB AND HEALTH CR 4 4 MOWEAQUA $12.66 $38.65 $82.92 $134.23 10/1/20166012512 MT VERNON COUNTRYSIDE MANOR 5 5 MOUNT VERNON $14.89 $41.16 $72.16 $128.21 10/1/20166001531 MT VERNON HEALTH CARE CENTER 5 5 MOUNT VERNON $8.92 $36.80 $82.20 $127.92 10/1/20166006498 NATURE TRAIL HEALTH CARE CTR 5 5 MOUNT VERNON $10.03 $43.93 $80.39 $134.35 10/1/2016 7/1/20146006506 NAZARETHVILLE RETIREMENT HOME 7 7 DES PLAINES $11.10 $55.98 $86.06 $153.14 10/1/20166006522 NEW ATHENS HOME FOR THE AGED 11 11 NEW ATHENS $12.09 $44.26 $81.53 $137.88 10/1/2016 7/1/20156002091 NEWMAN REHAB HEALTH CARE CTR 4 4 NEWMAN $10.75 $49.18 $114.20 $174.13 10/1/2016 7/1/20146006548 NEWTON CARE CENTER 5 5 NEWTON $6.40 $41.39 $57.62 $105.41 10/1/20166003644 NILES NURSING AND REHAB CTR 7 7 NILES $17.51 $47.23 $110.89 $175.63 10/1/2016 7/1/20156006555 NOKOMIS REHAB HEALTH CARE CTR 3 3 NOKOMIS $11.41 $37.88 $77.46 $126.75 10/1/20166006571 NORRIDGE GARDENS 7 7 NORRIDGE $16.53 $47.35 $109.42 $173.30 10/1/20166006589 NORTH ADAMS HOME 3 3 MENDON $12.95 $40.30 $61.45 $114.70 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6006605 NORTH AURORA CARE CENTER 8 8 NORTH AURORA $11.24 $49.29 $71.90 $132.43 10/1/2016 7/1/20146000210 NORTH LOGAN HEALTHCARE CENTER 4 4 DANVILLE $9.40 $40.03 $87.51 $136.94 10/1/20166006670 NORTHWOODS CARE CENTRE 1 1 BELVIDERE $14.74 $46.05 $101.61 $162.40 10/1/2016 7/1/20146006696 NORWOOD CROSSING 6 6 CHICAGO $13.92 $55.98 $91.48 $161.38 10/1/2016 7/1/20146006779 OAK LAWN RESPIRATORY AND REHAB 7 7 OAK LAWN $11.58 $47.75 $167.89 $227.22 10/1/20166006811 OAK TERRACE HEALTHCARE CENTER 3 3 SPRINGFIELD $7.49 $40.28 $33.57 $81.34 10/1/20166006720 OAKBROOK HEALTHCARE CENTER LTD 7 7 OAK BROOK $14.07 $51.25 $108.14 $173.46 10/1/20166006829 OAKRIDGE HEALTHCARE CENTER 7 1 HILLSIDE $11.01 $53.21 $103.92 $168.14 10/1/20166003487 OAKVIEW HTS CONT CARE REHAB 5 5 MOUNT CARMEL $15.97 $43.47 $69.60 $129.04 10/1/20166006860 ODD FELLOWS REBEKAH HOME 4 4 MATTOON $12.52 $48.70 $63.30 $124.52 10/1/20166006878 ODIN HEALTH CARE CENTER 5 5 ODIN $11.42 $42.84 $86.01 $140.27 10/1/2016 7/1/20146009989 OREGON LIVING AND REHAB CENTER 1 1 OREGON $12.83 $47.39 $76.91 $137.13 10/1/2016 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 $86.12 $150.84 10/1/20166006993 OUR LADY OF ANGELS RETIREMENT 9 9 JOLIET $14.88 $50.50 $76.92 $142.30 10/1/20166002109 PALM TERRACE OF MATTOON 4 4 MATTOON $11.09 $38.77 $92.34 $142.20 10/1/20166006795 PARAMOUNT OAK PARK R AND N CTR 7 7 OAK PARK $15.92 $44.45 $87.33 $147.70 10/1/2016 7/1/20156004766 PARC AT JOLIET 9 9 JOLIET $12.87 $45.02 $93.94 $151.83 10/1/20166007090 PARIS HEALTH CARE CENTER 4 4 PARIS $11.07 $46.60 $90.47 $148.14 10/1/20166007140 PARK HOUSE NURSING REHAB 6 6 CHICAGO $11.51 $47.06 $66.15 $124.72 10/1/20166003073 PARK PLACE OF BELVIDERE 1 1 BELVIDERE $9.50 $45.80 $97.72 $153.02 10/1/20166003875 PARK POINTE HEALTHCARE AND REH 9 9 MORRIS $19.22 $53.08 $87.09 $159.39 10/1/20166007157 PARK RIDGE CARE CENTER 7 7 PARK RIDGE $16.48 $55.44 $92.40 $164.32 10/1/2016 7/1/20146002315 PARK VIEW REHAB CENTER 6 6 CHICAGO $14.72 $41.72 $88.63 $145.07 10/1/2016 7/1/20146007934 PARK VILLA NURSING REHAB CTR 7 7 PALOS HEIGHTS $20.01 $53.58 $102.42 $176.01 10/1/20166001374 PARKER NURSING AND REHAB CTR 2 2 STREATOR $11.16 $43.62 $103.89 $158.67 10/1/20166005003 PARKSHORE ESTATES NRSG REHAB 6 6 CHICAGO $13.59 $48.85 $96.25 $158.69 10/1/20166014385 PARKWAY MANOR 5 5 MARION $19.68 $42.39 $83.44 $145.51 10/1/2016 7/1/20146009799 PAVILION OF WAUKEGAN 8 8 WAUKEGAN $12.63 $55.98 $111.56 $180.17 10/1/20166003206 PAXTON HEALTHCARE AND REHAB 4 4 PAXTON $15.55 $50.44 $83.12 $149.11 10/1/20166003339 PEARL PAVILION 1 1 FREEPORT $13.40 $45.38 $72.44 $131.22 10/1/20166011712 PEKIN MANOR 2 2 PEKIN $18.02 $44.32 $75.12 $137.46 10/1/20166007355 PERSHING GARDENS HC CENTER 7 7 STICKNEY $16.38 $50.42 $94.25 $161.05 10/1/2016 7/1/20156007371 PETERSON PARK HEALTH CARE CTR 6 6 CHICAGO $18.58 $48.71 $119.80 $187.09 10/1/20166005441 PINCKNEYVILLE NURSING REHAB 5 5 PINCKNEYVILLE $13.92 $37.09 $71.94 $122.95 10/1/2016 7/1/20156007413 PINE ACRES REHAB LIVING CENTER 1 1 DEKALB $17.96 $51.52 $93.48 $162.96 10/1/2016 7/1/20146004741 PINE CREST HEALTH CARE 7 7 HAZEL CREST $17.78 $46.12 $86.37 $150.27 10/1/20166007447 PINECREST MANOR 1 1 MOUNT MORRIS $13.82 $50.58 $66.90 $131.30 10/1/20166003792 PIPER CITY REHAB LIVING CTR 4 4 PIPER CITY $9.67 $50.44 $83.54 $143.65 10/1/20166012470 PITTSFIELD MANOR 3 3 PITTSFIELD $14.89 $40.30 $73.30 $128.49 10/1/20166007470 PLEASANT HILL HEALTHCARE 3 3 GIRARD $12.63 $38.68 $67.97 $119.28 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6007488 PLEASANT MEADOWS SENIOR LIVING 4 4 CHRISMAN $13.82 $48.02 $76.85 $138.69 10/1/20166007512 PLEASANT VIEW LUTHER HOME 2 2 OTTAWA $16.41 $50.44 $74.98 $141.83 10/1/2016 7/1/20146007504 PLEASANT VIEW REHAB AND HCC 1 1 MORRISON $9.30 $45.95 $93.58 $148.83 10/1/20166007546 POLO REHABILITATION AND HCC 1 1 POLO $9.94 $49.51 $88.51 $147.96 10/1/20166004642 PONTIAC HEALTHCARE AND REHAB 4 4 PONTIAC $13.67 $48.27 $82.62 $144.56 10/1/20166007561 PRAIRIE CITY REHAB AND HC 2 2 PRAIRIE CITY $9.17 $43.60 $74.11 $126.88 10/1/20166008502 PRAIRIE CROSSING LVG AND REHAB 1 1 SHABBONA $10.85 $47.64 $86.69 $145.18 10/1/20166011746 PRAIRIE MANOR NURSING REHAB 7 7 CHICAGO HEIGHT $23.91 $49.26 $120.55 $193.72 10/1/2016 7/1/20146007082 PRAIRIE ROSE HEALTH CARE CTR 3 3 PANA $9.13 $41.42 $85.05 $135.60 10/1/20166001812 PRAIRIE VIEW CARE OF LEWISTOWN 2 2 LEWISTOWN $9.87 $42.03 $90.71 $142.61 10/1/2016 7/1/20156006027 PRAIRIE VLG HEALTHCARE CTR INC 3 3 JACKSONVILLE $12.12 $38.31 $85.13 $135.56 10/1/2016 7/1/20156007595 PRAIRIEVIEW LUTHERAN HOME 4 4 DANFORTH $12.95 $50.44 $85.54 $148.93 10/1/20166005771 PRESENCE COR MARIAE CENTER 1 1 ROCKFORD $12.52 $51.52 $73.59 $137.63 10/1/20166005854 PRESENCE MARYHAVEN NSG REHAB 7 7 GLENVIEW $14.39 $55.98 $98.53 $168.90 10/1/20166005912 PRESENCE MCAULEY MANOR 8 8 AURORA $12.98 $55.98 $80.78 $149.74 10/1/20166007009 PRESENCE OUR LADY OF VICTORY 9 9 BOURBONNAIS $14.39 $53.08 $86.42 $153.89 10/1/20166007439 PRESENCE PINE VIEW CARE CENTER 8 8 SAINT CHARLES $10.96 $55.98 $79.17 $146.11 10/1/20166014575 PRESENCE RESURRECTION LIFE CTR 6 6 CHICAGO $17.23 $54.57 $81.62 $153.42 10/1/20166007892 PRESENCE RESURRECTION NRC 7 7 PARK RIDGE $10.64 $54.29 $94.58 $159.51 10/1/20166008874 PRESENCE SAINT BENEDICT NRC 7 7 NILES $13.92 $55.98 $108.49 $178.39 10/1/20166008817 PRESENCE ST ANNE CENTER 1 1 ROCKFORD $12.09 $51.52 $88.59 $152.20 10/1/20166008973 PRESENCE ST JOSEPH CENTER 1 1 FREEPORT $14.24 $51.52 $81.89 $147.65 10/1/20166012678 PRESENCE VILLA FRANCISCAN 9 9 JOLIET $14.39 $53.08 $88.08 $155.55 10/1/20166009591 PRESENCE VILLA SCALABRINI NC 7 7 NORTHLAKE $12.05 $55.95 $107.44 $175.44 10/1/20166012645 PRINCETON REHABILITATION AND H 6 6 CHICAGO $17.33 $51.00 $87.05 $155.38 10/1/20166007876 PROVIDENCE DOWNERS GROVE 7 7 DOWNERS GROVE $14.88 $55.98 $85.78 $156.64 10/1/20166007843 PROVIDENCE PALOS HEIGHTS 7 7 PALOS HEIGHTS $14.39 $55.98 $96.48 $166.85 10/1/20166016356 RADFORD GREEN 8 8 LINCOLNSHIRE $18.90 $55.98 $86.42 $161.30 10/1/20166008734 RAINBOW BEACH CARE CENTER 6 6 CHICAGO $17.66 $55.19 $57.64 $130.49 7/1/2014 Eligible for Provisional License as SMHRF6007751 RED BUD REGIONAL CARE 5 5 RED BUD $14.47 $43.93 $78.56 $136.96 10/1/2016 7/1/20146008239 REGENCY CARE 3 3 SPRINGFIELD $15.16 $44.49 $80.44 $140.09 10/1/20166011381 REGENCY CARE OF MORRIS 9 9 MORRIS $15.77 $53.01 $94.51 $163.29 10/1/20166011373 REGENCY CARE OF STERLING 1 1 STERLING $14.15 $51.52 $80.55 $146.22 10/1/20166006712 RENAISSANCE CARE CENTER 2 2 CANTON $10.70 $37.41 $89.37 $137.48 10/1/20166007850 REST HAVEN MANOR 5 5 ALBION $3.97 $37.18 $50.23 $91.38 10/1/20166007884 RESTHAVE HOME OF WHITESIDE CO 1 1 MORRISON $16.84 $47.87 $73.74 $138.45 10/1/2016 7/1/20156007942 RIDGEVIEW CARE CENTER 5 5 OBLONG $10.90 $35.23 $72.13 $118.26 10/1/2016 7/1/20146003453 RIDGEVIEW REHAB NURSING CENTER 6 6 CHICAGO $15.67 $48.06 $88.41 $152.14 10/1/20166007975 RIDGWAY REHAB AND NRSG CENTER 5 5 RIDGWAY $9.27 $34.50 $87.87 $131.64 10/1/2016 7/1/20146001085 RIVER NORTH BRADLEY H AND R 9 9 BRADLEY $13.41 $42.10 $99.33 $154.84 10/1/2016 7/1/20156004758 RIVER VIEW REHAB CENTER 8 8 ELGIN $12.62 $42.33 $85.59 $140.54 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6008015 RIVERSHORES HLTH AND REHAB CTR 2 2 MARSEILLES $11.07 $46.72 $92.00 $149.79 10/1/20166008072 ROBINGS MANOR REHAB HLTH CR 3 3 BRIGHTON $12.11 $36.39 $80.37 $128.87 10/1/20166008098 ROCHELLE GARDENS CARE CENTER 1 1 ROCHELLE $8.80 $44.99 $64.60 $118.39 10/1/20166008106 ROCHELLE REHAB HEALTH CARE 1 1 ROCHELLE $10.07 $51.52 $82.34 $143.93 10/1/20166008114 ROCK FALLS REHAB HLTH CARE CTR 1 1 ROCK FALLS $9.89 $51.42 $105.05 $166.36 10/1/20166002695 ROCK RIVER GARDENS 1 1 STERLING $8.55 $39.13 $50.23 $97.91 10/1/20166008049 ROCK RIVER HEALTH CARE 1 1 ROCKFORD $10.89 $43.47 $103.44 $157.80 10/1/20166008163 ROLLING HILLS MANOR 8 8 ZION $14.88 $55.98 $90.51 $161.37 10/1/20166005136 ROSEVILLE REHAB HEALTH CARE 2 2 ROSEVILLE $9.62 $46.49 $69.16 $125.27 10/1/20166012074 ROSEWOOD CARE CENTER ALTON 11 11 ALTON $14.95 $42.51 $71.91 $129.37 10/1/20166014237 ROSEWOOD CARE CENTER ELGIN 8 8 ELGIN $16.42 $51.18 $82.66 $150.26 10/1/20166010466 ROSEWOOD CARE CENTER GALESBURG 2 2 GALESBURG $14.23 $41.85 $76.53 $132.61 10/1/20166014633 ROSEWOOD CARE CENTER INVERNESS 7 7 INVERNESS $22.20 $52.72 $94.64 $169.56 10/1/20166012835 ROSEWOOD CARE CENTER JOLIET 9 9 JOLIET $15.52 $50.13 $92.46 $158.11 10/1/20166012587 ROSEWOOD CARE CENTER MOLINE 10 10 MOLINE $14.73 $48.06 $68.75 $131.54 10/1/20166012165 ROSEWOOD CARE CENTER PEORIA 2 2 PEORIA $13.50 $49.68 $76.13 $139.31 10/1/20166014658 ROSEWOOD CARE CENTER ROCKFORD 1 1 ROCKFORD $17.46 $49.15 $77.66 $144.27 10/1/20166010391 ROSEWOOD CARE CENTER SWANSEA 11 11 SWANSEA $13.37 $46.71 $80.94 $141.02 10/1/20166012017 ROSEWOOD CARE CTR EAST PEORIA 2 2 EAST PEORIA $13.84 $48.51 $78.70 $141.05 10/1/20166014401 ROSEWOOD CARE CTR EDWARDSVILLE 11 11 EDWARDSVILLE $16.83 $46.71 $77.88 $141.42 10/1/20166019723 ROSEWOOD CARE CTR NORTHBROOK 7 7 NORTHBROOK $21.11 $53.85 $111.94 $186.90 10/1/20166014666 ROSEWOOD CARE CTR ST CHARLES 8 8 ST CHARLES $19.01 $55.06 $89.86 $163.93 10/1/20166003065 ROSICLARE REHAB HEALTH CR 5 5 ROSICLARE $9.85 $43.93 $84.89 $138.67 10/1/2016 7/1/20156005029 ROYAL OAKS CARE CENTER 10 10 KEWANEE $10.12 $37.71 $84.32 $132.15 10/1/20166008684 RUSHVILLE NURSING & REHABILITA 3 3 RUSHVILLE $9.48 $43.30 $69.36 $122.14 10/1/20166008320 SACRED HEART HOME 6 6 CHICAGO $12.07 $48.91 $55.59 $116.57 7/1/2014 Eligible for Provisional License as SMHRF6008338 SALEM VILLAGE NURSING AND REHA 9 9 JOLIET $13.08 $49.38 $116.10 $178.56 10/1/20166008346 SALINE CARE CENTER 5 5 HARRISBURG $9.86 $34.43 $74.92 $119.21 10/1/20166008213 SANDWICH REHAB HEALTH CARE 1 1 SANDWICH $11.63 $51.52 $81.33 $144.48 10/1/2016 7/1/20156001929 SAUK VALLEY SENIOR LIVING 1 1 ROCK FALLS $10.42 $47.83 $90.43 $148.68 10/1/20166005722 SELECT POST ACUTE CARE 2 2 EUREKA $12.09 $50.44 $60.06 $122.59 10/1/20166008460 SELFHELP HOME OF CHICAGO 6 6 CHICAGO $18.18 $55.98 $83.53 $157.69 10/1/2016 7/14/20156010250 SEMINARY MANOR 2 2 GALESBURG $13.22 $46.44 $82.63 $142.29 10/1/20166007272 SHARON HEALTH CARE WILLOWS 2 2 PEORIA $9.22 $41.48 $91.58 $142.28 10/1/20166007926 SHARON HEALTH CARE WOODS 2 2 PEORIA $9.97 $41.01 $51.08 $102.06 7/1/2014 Eligible for Provisional License as SMHRF6007306 SHARON HEALTHCARE ELMS 2 2 PEORIA $10.53 $44.72 $106.61 $161.86 10/1/20166007298 SHARON HEALTHCARE PINES 2 2 PEORIA $10.56 $42.36 $68.98 $121.90 10/1/2016 7/1/20156008528 SHAWNEE CHRISTIAN NURSING CTR 5 5 HERRIN $11.23 $40.09 $80.62 $131.94 10/1/20166004055 SHAWNEE ROSE CARE CENTER 5 5 HARRISBURG $9.06 $32.62 $76.05 $117.73 10/1/20166008544 SHELBYVILLE MANOR 4 4 SHELBYVILLE $16.06 $41.91 $83.25 $141.22 10/1/20166008536 SHELBYVILLE REHAB HEALTH CARE 4 4 SHELBYVILLE $8.58 $49.62 $98.38 $156.58 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6008569 SHELDON HEALTH CARE CENTER 4 4 SHELDON $9.89 $50.44 $62.35 $122.68 10/1/20166002687 SHERIDAN SHORES REHAB CENTER 6 6 CHICAGO $18.03 $42.94 $82.31 $143.28 10/1/2016 7/1/20146012827 SHERMAN WEST COURT 8 8 ELGIN $14.88 $55.98 $89.38 $160.24 10/1/20166008643 SKOKIE MEADOWS NURSING CTR II 7 7 SKOKIE $16.07 $37.38 $57.09 $110.54 7/1/2014 Eligible for Provisional License as SMHRF6016059 SMITH CROSSING 9 9 ORLAND PARK $18.18 $45.68 $85.91 $149.77 10/1/20166009732 SMITH VILLAGE 6 6 CHICAGO $11.56 $55.98 $84.44 $151.98 10/1/20166011464 SNYDER VILLAGE 2 2 METAMORA $15.11 $48.71 $67.88 $131.70 10/1/20166008718 SOUTH ELGIN REHAB HEALTH CARE 8 8 SOUTH ELGIN $10.80 $52.66 $105.28 $168.74 10/1/2016 7/1/20146016497 SOUTH SUBURBAN REHAB CENTER 7 7 HOMEWOOD $17.30 $49.95 $103.45 $170.70 10/1/2016 7/1/20156008759 SOUTHGATE HEALTH CARE CENTER 5 5 METROPOLIS $14.28 $41.44 $66.89 $122.61 10/1/20166014781 SOUTHPOINT NURSING REHAB CTR 6 6 CHICAGO $21.00 $48.97 $127.44 $197.41 10/1/20166001895 SOUTHVIEW MANOR NURSING CENTER 6 6 CHICAGO $14.26 $38.92 $70.29 $123.47 10/1/20166016786 SPRING CREEK NRSG REHAB CTR 9 9 JOLIET $10.71 $46.84 $97.41 $154.96 10/1/20166011803 SPRINGS AT CRYSTAL LAKE 8 8 CRYSTAL LAKE $15.71 $45.20 $95.27 $156.18 10/1/20166016877 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 $74.04 $142.93 10/1/20166008890 ST CLARAS MANOR 3 3 LINCOLN $9.51 $44.24 $81.17 $134.92 10/1/20166010664 ST JAMES WELLNESS REHAB VILLAS 9 9 CRETE $15.16 $53.08 $99.81 $168.05 10/1/20166008940 ST JOHNS HOSPITAL LTC UNIT 3 3 SPRINGFIELD $7.26 $44.49 $74.36 $126.11 10/1/20166011407 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 $94.34 $161.88 10/1/20166009005 ST JOSEPHS HOME FOR THE ELDERL 7 7 PALATINE $9.22 $55.98 $67.27 $132.47 10/1/20166008999 ST JOSEPHS NURSING HOME 2 2 LACON $4.19 $50.44 $75.69 $130.32 10/1/20166011910 ST PATRICKS RES 7 7 NAPERVILLE $14.88 $53.80 $96.28 $164.96 10/1/20166009120 ST PAULS HOME 11 11 BELLEVILLE $9.51 $46.02 $65.27 $120.80 10/1/20166009112 ST PAULS HOUSE AND HEALTH CARE 6 6 CHICAGO $15.34 $55.98 $94.89 $166.21 10/1/2016 7/1/20146005466 ST VINCENTS HOME INC 3 3 QUINCY $14.48 $40.51 $67.01 $122.00 10/1/2016 7/1/20156009013 ST. MARTHA MANOR 6 6 CHICAGO $13.38 $50.55 $61.46 $125.39 10/1/20166010441 STEARNS NURSING AND REHAB CTR 11 11 GRANITE CITY $13.68 $41.65 $73.33 $128.66 10/1/20166009179 STERLING PAVILION 1 1 STERLING $11.67 $41.99 $90.02 $143.68 10/1/20166008494 STONEBRIDGE SENIOR LIVING 5 5 BENTON $9.13 $37.02 $74.00 $120.15 10/1/2016 7/1/20146009211 SULLIVAN REHAB HEALTH CARE CTR 4 4 SULLIVAN $9.76 $41.01 $82.13 $132.90 10/1/20166009294 SUNRISE SKILLED NURSING REHAB 3 3 VIRDEN $10.10 $38.30 $79.92 $128.32 10/1/20166009302 SUNSET HOME 3 3 QUINCY $13.40 $44.49 $77.30 $135.19 10/1/20166009328 SUNSET REHAB HEALTH CARE 2 2 CANTON $13.20 $36.90 $71.23 $121.33 10/1/20166009831 SWANSEA REHAB HEALTH CARE CENT 11 11 SWANSEA $9.17 $39.29 $100.79 $149.25 10/1/2016 7/1/20146007678 SYCAMORE HEALTHCARE CENTER 3 3 QUINCY $9.02 $32.65 $71.24 $112.91 10/1/2016 7/1/20146014831 SYMPHONY AT 87TH STREET 6 6 CHICAGO $22.15 $51.34 $112.14 $185.63 10/1/20166014906 SYMPHONY AT ARIA 7 7 HILLSIDE $21.46 $49.62 $105.13 $176.21 10/1/20166014641 SYMPHONY AT MIDWAY 6 6 CHICAGO $20.12 $49.75 $109.32 $179.19 10/1/20166009401 SYMPHONY AT THE TILLERS 9 9 OSWEGO $16.29 $53.08 $108.75 $178.12 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6007967 SYMPHONY EVANSTON HEALTHCARE 7 7 EVANSTON $19.93 $51.75 $124.60 $196.28 10/1/20166016554 SYMPHONY OF HANOVER PARK 7 7 HANOVER PARK $26.15 $55.98 $119.04 $201.17 10/1/20166001689 SYMPHONY OF BRONZEVILLE 6 6 CHICAGO $16.09 $45.18 $91.34 $152.61 10/1/2016 7/1/20146014195 SYMPHONY OF BUFFALO GROVE 8 8 BUFFALO GROVE $18.10 $50.88 $113.97 $182.95 10/1/20166004832 SYMPHONY OF CHICAGO WEST 6 6 CHICAGO $16.82 $48.78 $104.97 $170.57 10/1/2016 7/1/20146002265 SYMPHONY OF CRESTWOOD 7 7 CRESTWOOD $17.53 $49.50 $106.83 $173.86 10/1/2016 7/1/20146006282 SYMPHONY OF DECATUR 4 4 DECATUR $13.70 $44.44 $100.74 $158.88 10/1/2016 7/1/20146002463 SYMPHONY OF JOLIET 9 9 JOLIET $16.31 $47.40 $111.76 $175.47 10/1/2016 7/1/20146005490 SYMPHONY OF LINCOLN 3 3 LINCOLN $15.05 $42.60 $110.60 $168.25 10/1/2016 7/1/20146004733 SYMPHONY OF LINCOLN PARK 6 6 CHICAGO $17.73 $53.60 $107.75 $179.08 10/1/20166003958 SYMPHONY OF MORGAN PARK 6 6 CHICAGO $14.80 $48.00 $96.88 $159.68 10/1/20166014823 SYMPHONY OF SOUTH SHORE 6 6 CHICAGO $21.75 $52.59 $108.99 $183.33 10/1/2016 7/1/20156014252 TABOR HILLS HEALTHCARE FACILIT 7 7 NAPERVILLE $17.23 $55.98 $93.25 $166.46 10/1/2016 7/1/20146009369 TAYLORVILLE CARE CENTER 3 3 TAYLORVILLE $10.83 $39.24 $74.66 $124.73 10/1/20166009377 TERRACE NURSING HOME 8 8 WAUKEGAN $12.15 $44.89 $106.92 $163.96 10/1/20166003768 TERRACE ON THE PARK 11 11 MASCOUTAH $10.11 $45.62 $75.95 $131.68 10/1/20166001465 THE CARLTON AT THE LAKE 6 6 CHICAGO $19.28 $50.66 $100.78 $170.72 10/1/20166005516 THE GROVE AT LINCOLN PARK 6 6 CHICAGO $16.12 $44.99 $117.49 $178.60 10/1/2016 7/1/20156008593 THE GROVE AT THE LAKE 8 8 ZION $17.26 $49.89 $112.47 $179.62 10/1/2016 7/1/20146008916 THE GROVE OF EVANSTON LIVING & 7 7 EVANSTON $17.94 $55.98 $115.67 $189.59 10/1/20166003057 THE GROVE OF LAGRANGE PARK LIV 7 7 LA GRANGE PARK $18.50 $52.81 $110.81 $182.12 10/1/2016 7/1/20146003412 THE GROVE OF NORTHBROOK 7 7 NORTHBROOK $16.72 $50.77 $108.83 $176.32 10/1/20166009625 THE GROVE OF SKOKIE 7 7 SKOKIE $17.04 $47.36 $113.00 $177.40 10/1/2016 7/1/20146009385 THORNTON HEIGHTS TERRACE 7 7 CHICAGO HEIGHT $14.68 $40.07 $62.27 $117.02 7/1/2014 Eligible for Provisional License as SMHRF6009393 THREE SPRINGS LODGE NRSG HOME 5 5 CHESTER $11.23 $40.10 $58.61 $109.94 10/1/2016 7/1/20156007330 TIMBERCREEK REHAB AND HEALTH C 2 2 PEKIN $11.32 $45.39 $92.54 $149.25 10/1/20166003750 TIMBERPOINT HEALTHCARE CENTER 3 3 CAMP POINT $9.76 $44.15 $81.51 $135.42 10/1/20166009427 TOULON REHAB HEALTH CARE CTR 2 2 TOULON $12.29 $45.01 $81.29 $138.59 10/1/20166003263 TOWER HILL HEALTHCARE CENTER 8 8 SOUTH ELGIN $13.01 $45.97 $98.73 $157.71 10/1/20166016901 TRANSITIONAL CARE OF ARLINGTON 7 7 ARLINGTON HEIGH $22.19 $45.20 $96.66 $164.05 12/18/20156009443 TRI STATE NURSING REHAB CENTER 7 7 LANSING $17.37 $50.93 $104.52 $172.82 10/1/20166002588 TUSCOLA HEALTH CARE CENTER 4 4 TUSCOLA $9.01 $38.53 $108.29 $155.83 10/1/2016 7/1/20156004188 TWIN LAKES REHAB HEALTH CARE 4 4 PARIS $10.37 $41.32 $116.42 $168.11 10/1/2016 7/1/20156009484 TWIN WILLOWS NURSING CENTER 5 5 SALEM $8.66 $35.35 $72.44 $116.45 10/1/2016 7/1/20156009492 UNION COUNTY HOSPITAL LTC 5 5 ANNA $4.73 $43.93 $82.60 $131.26 10/1/20166009500 UNITED METHODIST VILLAGE 5 5 LAWRENCEVILLE $8.65 $41.56 $63.57 $113.78 10/1/20166013072 UNITED METHODIST VILLAGE N CAM 5 5 LAWRENCEVILLE $14.27 $40.24 $62.97 $117.48 10/1/20166002711 UNIVERSITY NURSING AND RHB CTR 11 11 EDWARDSVILLE $10.82 $41.10 $94.49 $146.41 10/1/20166009260 VANDALIA REHAB HEALTH CARE 5 5 VANDALIA $8.76 $43.47 $81.07 $133.30 10/1/2016 7/1/20156007322 VILLA AT EVERGREEN PARK 7 7 EVERGREEN PAR $16.99 $55.98 $101.34 $174.31 10/1/20166007041 VILLA AT PA PETERSON 1 1 ROCKFORD $15.73 $51.52 $85.18 $152.43 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6007868 VILLA AT SOUTH HOLLAND 7 7 SOUTH HOLLAND $26.32 $55.98 $108.54 $190.84 10/1/20166014856 VILLA AT WINDSOR PARK 6 7 CHICAGO $21.08 $47.06 $110.93 $179.07 10/1/20166012991 VILLA HEALTH CARE INC EAST 3 3 SHERMAN $14.69 $44.49 $81.17 $140.35 10/1/20166011332 VILLAGE AT VICTORY LAKES 8 8 LINDENHURST $12.51 $55.98 $98.23 $166.72 10/1/20166009674 WABASH CHRISTIAN RETIREMENT CR 5 5 CARMI $13.10 $43.79 $86.66 $143.55 10/1/2016 7/1/20156009682 WALKER NURSING HOME 3 3 VIRGINIA $12.07 $43.65 $54.77 $110.49 10/1/20166009690 WALNUT MANOR 2 2 WALNUT $11.90 $49.56 $72.62 $134.08 10/1/20166014377 WARREN BARR LINCOLNSHIRE 8 8 LINCOLNSHIRE $17.97 $55.98 $105.87 $179.82 10/1/20166004725 WARREN BARR LIVING & REHAB CTR 6 6 CHICAGO $18.36 $55.98 $123.54 $197.88 10/1/20166014963 WARREN BARR NORTH SHORE 8 8 HIGHLAND PARK $19.27 $54.23 $119.19 $192.69 10/1/20166008825 WARREN BARR SOUTH LOOP 6 6 CHICAGO $15.29 $54.02 $158.50 $227.81 10/1/20166008262 WARREN PARK HEALTH LIVING CTR 6 6 CHICAGO $13.56 $50.85 $70.09 $134.50 10/1/2016 7/1/20146009740 WASHINGTON CHRISTIAN VILLAGE 2 2 WASHINGTON $11.83 $45.83 $70.57 $128.23 10/1/2016 7/1/20156002430 WATERFORD NURSING AND REHAB 6 6 CHICAGO $17.06 $38.10 $83.70 $138.86 10/1/2016 7/1/20156009757 WATERFRONT TERRACE 6 6 CHICAGO $16.34 $48.69 $94.16 $159.19 10/1/20166009765 WATSEKA REHAB HEALTH CARE CTR 4 4 WATSEKA $10.37 $46.59 $91.83 $148.79 10/1/20166009435 WAUCONDA HEALTHCARE AND REHAB 8 8 WAUCONDA $15.67 $50.55 $106.99 $173.21 10/1/20166006365 WAVERLY PLACE OF STOCKTON 1 1 STOCKTON $12.04 $43.60 $112.32 $167.96 10/1/2016 7/1/20146009815 WAY FAIR NURSING AND REHAB CTR 5 5 FAIRFIELD $10.73 $39.67 $75.35 $125.75 10/1/20166009856 WENTWORTH REHAB AND HCC 6 6 CHICAGO $17.55 $44.13 $92.87 $154.55 10/1/20166006100 WESLEY PLACE 6 6 CHICAGO $16.29 $55.98 $100.26 $172.53 10/1/20166009864 WESLEY VILLAGE 2 2 MACOMB $14.79 $45.95 $66.37 $127.11 10/1/20166009872 WEST CHICAGO TERRACE NH 7 7 WEST CHICAGO $11.40 $39.35 $63.60 $114.35 10/1/20166013478 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 10/1/2016 7/1/20156012173 WESTCHESTER HEALTH AND REHAB C 7 7 WESTCHESTER $20.38 $55.98 $91.41 $167.77 10/1/2016 7/1/20156007603 WESTMINSTER PLACE 7 7 EVANSTON $9.22 $55.98 $103.65 $168.85 10/1/20166000194 WESTSIDE REHAB CARE CENTER 5 5 WEST FRANKFOR $7.90 $35.39 $91.71 $135.00 10/1/20166009955 WESTWOOD MANOR 6 6 CHICAGO $14.15 $37.86 $71.45 $123.46 10/1/2016 7/1/20146009963 WHEATON CARE CENTER 7 7 WHEATON $13.40 $47.85 $89.22 $150.47 10/1/2016 7/1/20156006597 WHITE HALL NURSING AND REHAB 3 3 WHITE HALL $17.79 $30.87 $79.71 $128.37 10/1/2016 7/1/20156004881 WHITE OAK REHABILITATION HCC 5 5 MOUNT VERNON $11.10 $43.93 $82.11 $137.14 10/1/2016 7/1/20146008379 WILLOW CREST NURS PAVILION LTD 1 1 SANDWICH $12.03 $43.09 $86.92 $142.04 10/1/20166003842 WILLOW ROSE REHAB HEALTH CARE 3 3 JERSEYVILLE $9.01 $40.48 $85.87 $135.36 10/1/20166010037 WILLOWS HEALTH CENTER 1 1 ROCKFORD $12.04 $51.52 $74.58 $138.14 10/1/20166010045 WILSON CARE 6 6 CHICAGO $13.63 $37.19 $56.87 $107.69 7/1/2014 Eligible for Provisional License as SMHRF6010052 WINCHESTER HOUSE 8 8 LIBERTYVILLE $7.27 $66.61 $101.40 $175.28 10/1/20166010078 WINDMILL NURSING PAVILION 7 7 SOUTH HOLLAND $17.87 $44.27 $96.40 $158.54 10/1/2016 7/1/20156005904 WINDSOR ESTATES NURSING AND RE 7 7 COUNTRY CLUB H $18.03 $54.05 $106.25 $178.33 10/1/20166011753 WINDSOR PARK MANOR 7 7 CAROL STREAM $16.76 $45.20 $96.66 $158.62 11/1/20156005334 WINFIELD WOODS HEALTHCARE CTR 7 7 WINFIELD $14.12 $44.76 $91.74 $150.62 10/1/2016

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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICESBUREAU OF RATE DEVELOPMENT AND ANALYSISMEDICAID RATE LIST FOR NURSING FACILITIES as of 10-01-2016Building Facility Rate Capital Support Nursing Total Effective Capital Rate

ID Name HSA Area City Rate Rate Rate Rate Date Notes Change Eff Date6010094 WINNING WHEELS 1 1 PROPHETSTOWN $15.97 $51.52 $92.00 $159.49 10/1/20166010102 WINSTON MANOR CONVALESCENT N H 6 6 CHICAGO $10.01 $36.42 $60.11 $106.54 10/1/20166001713 WOOD GLEN NURSING AND REHAB CE 7 7 WEST CHICAGO $16.31 $45.46 $56.56 $118.33 10/1/20166007074 WOODBRIDGE NURSING PAVILION 6 6 CHICAGO $15.17 $40.95 $100.29 $156.41 10/1/20166008361 WYNSCAPE HEALTH AND REHAB 7 7 WHEATON $14.82 $55.98 $69.61 $140.41 10/1/2016

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