reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1600 - Provider Agency Certification

Current through Register Vol. 48, No. 28, July 12, 2024
a) All
				services provided to CCP participants shall be delivered in accordance with
				Provider Agreements entered into between certified provider agencies and the
				Department.
b) For purposes of
				administrative efficiency, the Department may initiate the provider
				certification process for the CCP by a specific service, on a geographic basis,
				or in accordance with other criteria determined by the Department.
c) Initial Certification
Any willing and qualified provider agency (see the federal
				  Medicaid waiver, this Part and 42 CFR 431.51 (2008)) interested in the
				  opportunity to enter into a Provider Agreement with the Department for the
				  provision of CCP services shall comply with the following certification
				  procedures:
1) A provider agency
				requesting initial certification of qualifications shall submit, in a form and
				manner prescribed by the Department, material documenting the ability to comply
				with administrative requirements, service specifications and any other
				administrative or operational information required by the Department for the
				applicable service.
A) The Department or its
				designee will review the material submitted and, if necessary, will request
				additional information. The Department or its designee will conduct on-site
				reviews of a prospective provider agency for in-home service and adult day
				service under the CCP unless a performance review of the provider agency has
				already been completed by the Department or its designee within the prior 12
				months. The Department reserves the right to conduct on-site reviews of a
				prospective provider agency for emergency home response service and AMD service
				under the CCP.
B) If additional
				information is requested by the Department, the provider agency has 30 calendar
				days after the date of request to submit this information.
C) After 60 calendar days, the provider
				agency's request for certification of qualifications will be closed and all
				information must be resubmitted to the Department if the provider agency wants
				to continue to request certification.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1605 - Emergency Certification

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department shall obtain CCP services through any means of selection likely to
				result in provider certification and subsequent issuance of a Provider
				Agreement under the following circumstances:
1) service is immediately needed to prevent
				interruption of services to current participants;
2) service is immediately needed to protect a
				participant's health, safety or welfare;
3) service is of such a nature or the market
				place is such that only 1 provider is reasonably capable and willing to perform
				the requisite services; and/or
4)
				to establish new or additional services in an area in which the Department has
				determined an underserved population exists.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1607 - Standard CCP Provider Agreement

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				In order to enter into a CCP Provider Agreement, a provider must first be
				certified by the Department under Section
				240.1600 or
				240.1605.
b) A Provider Agreement shall be entered into
				between the Department and the certified provider agency as evidence of the
				terms and conditions of the agreement to provide CCP services within the
				geographic area specified within the Provider Agreement. Except during the
				transition period referred to in Section
				240.1600(b),
				Provider Agreements generally will be for a period of 3 years. A Provider
				Agreement does not guarantee that the provider will be the sole provider of CCP
				services within the described geographic area.
c) The terms and conditions of the Provider
				Agreement shall, at a minimum, include the following:
1) the Provider Agreement may be terminated
				without cause by either party upon 60 calendar days written notice;
2) the Provider Agreement may be amended,
				with the mutual consent of both parties, at any time during the term of the
				Agreement; and
3) all program and
				financial records, reports and related information and documentation, including
				participant files, that are generated as a result of the Provider Agreement
				shall be considered the property of the Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1615 - Provider Initiated Service Area Modifications

Current through Register Vol. 48, No. 28, July 12, 2024
a) To request approval to modify a service
				area, a certified provider agency must submit in writing to the Department a
				plan of the proposed expansion or reduction, reasons with supportive
				information for the modification, and the revised boundaries of the agency's
				original service area.
b) The
				Department may approve or deny requests for service area modification based
				upon 1 or more of the following reasons:
1)
				demonstrated ability or inability to comply with standards as illustrated by
				substantiated complaint history, review reports or prior contract
				actions;
2) evidence of ability or
				inability to manage and supervise services throughout the current service
				area;
3) continuity or disruption
				of participant care;
4) assurance
				of, or failure to assure, participant freedom of choice; or
5) action in, or failure to act in, the best
				interest of the participant or the CCP.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1645 - Objection to Certification Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) A provider may file an objection, in
				limited circumstances, if a certification request is denied by the
				Department.
b) Examples of
				circumstances that do not constitute an appealable basis for objection include:
1) timing of initiation of certification
				process by the Department;
2)
				termination of eligibility by closure of the file due to a provider's failure
				to comply with time frames for submitting a certification request under Section
				240.1600(b);
3) new supporting documentation to establish
				eligibility for certification or recertification as a service provider under
				the CCP following failure to comply with time frames for submitting material
				requested by the Department;
4)
				issues upon which the Department has already made a final administrative
				decision as a result of a previous objection or contract action involving the
				provider;
5) issues upon which an
				independent trier of fact has made a final determination or issued an
				order;
6) disputes as to service
				rates or the underlying methodology for calculating those rates;
7) duration of a service provider
				certification;
8) timing of the
				Provider Agreement process by the Department; or
9) other matters of general applicability
				that are not specifically adverse to the provider.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1650 - Classification, Identification and Receipt of Provider Service Violations

Current through Register Vol. 48, No. 28, July 12, 2024
Failure to comply with the contract, proposal and Department
				  rules shall be identified and classified by the Department.
a) In determining the classification assigned
				to each provider service violation, the Department shall consider the
				following:
1) the severity of the
				violation;
2) the danger posed by
				the violation to the health, safety or welfare of the participant, based upon
				degree of participant impairment and availability of support sources;
3) the provider's efforts to correct
				violations;
4) the volume and scope
				of violations.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1660 - Provider Performance Reviews

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Providers under contract to the Department must comply with federal, State and
				local laws, regulations, Department rules and the contract requirements. When
				the provider signs the contract, this signature shall be the provider's
				certification that all applicable laws, rules and regulations, contract
				requirements, and statements included in the Provider Proposal shall be
				complied with. The Department shall have the authority to conduct performance
				reviews of a contracted provider agency at any time during the course of the
				provider's contract period. Any findings and/or contract actions resulting from
				a performance review may be appealed (see Section
				240.1661
				).
b) The Provider Performance
				Review consists of a sample of rules, of RFP requirements, and of cases that
				will be reviewed for performance.
c) If non-performance findings result from
				the Provider Performance Review, the provider shall receive a written report of
				the findings and have a specified period of time for adherence. The allowable
				time period shall be relevant to the classification of the violation and the
				applicable corrective action time frames specified in Section
				240.1650.
d) If non-performance findings result from
				the follow-up review, the Department may impose 1 or more of the contract
				actions specified in Section
				240.1665.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1661 - Provider and Care Coordination Unit Right to Appeal

Current through Register Vol. 48, No. 28, July 12, 2024
The provider and CCU have the right to appeal any finding
				  and/or contract action (see Section
				  240.1665
				  ) resulting from a performance review (see Sections
				  240.1660
				  and
				  240.1720
				  ).
a) Upon receipt of the Provider or
				CCU Performance Review report of non-performance findings and the written
				notification of contract actions to be taken, a provider or CCU wanting to
				appeal must do so in such a manner that the appeal is received at the
				Department's Springfield Office on or before the
				15th work day from the date of the notice. If the
				appeal is not received before the close of business on the
				15th work day, the appeal shall be
				disregarded.
b) Appeals shall be
				submitted in the manner and form specified by the Department and shall be
				addressed to the General Counsel and delivered or mailed to the Department's
				main office (see Section
				240.150
				):
c) General Counsel, with
				appropriate Department staff, will review the appeal and make a recommendation
				to the Director for final decision.
1) If the
				finding and/or contract action is determined by the Director to be valid, the
				finding/action shall be upheld/implemented.
2) If the finding and/or contract action is
				determined by the Director to be invalid, the appeal shall be upheld and the
				finding/action shall be modified or expunged, in whole or in part, with
				evidence placed in the provider or CCU file.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart P - PROVIDER PROCUREMENT › Section 240.1665 - Contract Actions for Failure to Comply with Community Care Program Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may impose 1 or more of the following contract
				  actions upon any CCP provider or contracted CCU that fails to comply with
				  Department rules or contract/Provider Agreement requirements, including any
				  statements made on the CCU Proposal or the provider's application for
				  certification. These actions include:
a) prohibition of specified staff from
				serving CCP participants (imposed when the Department finds that a worker, case
				manager, supervisor or other designated staff fails to comply;
b) purchase of a limited financial audit
				(imposed when the Department finds that a provider or CCU has failed to adhere
				to the fiscal requirements specified in this Part);
c) suspension of referrals for up to 90
				days;
d) transfer of a portion of
				the participants served under the contract or Provider Agreement;
e) training of staff;
f) termination of Provider Agreement or CCU
				contract and transfer of all participants;
g) requiring a review by the provider or CCU
				of all or a specified subset of files and provider or CCU certification of
				corrective action;
h) requiring the
				provider or CCU to contract with an outside management firm to evaluate program
				management and to implement recommendations for improvement as provided in the
				evaluation and negotiated with the Department;
i) suspending all or a portion of CCP
				payments until the action is corrected;
j) deducting overpayments to provider or CCU
				from future Provider or CCU Requests for Payment or requiring the provider or
				CCU to reimburse the Department;
k)
				refusing to accept a proposal from a CCU or to enter into a Provider Agreement
				with the provider in 1 or more specified areas open for procurement;
				and/or
l) taking any other action
				the Director determines to be appropriate to the non-performance
				circumstances.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart Q - CARE COORDINATION UNIT PROCUREMENT › Section 240.1710 - Procurement Cycle for Care Coordination Services

Current through Register Vol. 48, No. 28, July 12, 2024
The Department will solicit proposals as specified in 89 Ill.
				  Adm. Code
				  220.610
				  through
				  220.645.
				  When conducting the solicitation as specified in 89 Ill. Adm. Code
				  220.655(e),
				  the Department shall assume all responsibilities specified for the Area Agency
				  on Aging in 89 Ill. Adm. Code
				  220.610
				  through 220.645.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart Q - CARE COORDINATION UNIT PROCUREMENT › Section 240.1720 - Care Coordination Unit Performance Review

Current through Register Vol. 48, No. 28, July 12, 2024
a) Each CCU under contract to the Department
				must comply with the Request for Proposal, federal, State and local laws,
				regulations and Department rules, policies and procedures. When the CCU signs
				the contract, this signature shall be the CCU's certification that all
				applicable laws, rules and regulations will be complied with, as well as all
				statements included in the CCU Proposal except those contradicting applicable
				laws, rules and regulations.
b) The
				Department shall have the authority to conduct a review of a contracted CCU
				agency at any time during the course of the CCU's contract period for the
				purpose of protecting the health, safety and welfare of CCP
				participants.
c) The Department
				shall conduct a review in accordance with Department procedures.
d) Review Reports shall be maintained by the
				Department and findings shall be acted upon as specified in 89 Ill. Adm. Code
				220.670
				and/or
				240.1665.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart R - ADVISORY COMMITTEE › Section 240.1800 - Community Care Program Advisory Committee

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Director shall appoint individuals to
				serve on the Community Care Program Advisory Committee (CCPAC) that shall
				advise the Department on rates of reimbursement for the CCP service delivery
				network and issues affecting the CCP service delivery network and recommend
				solution strategies. The CCPAC shall meet on a bi-monthly basis.
b) Persons appointed to the CCPAC shall be
				appointed based upon their experience with the CCP, geographic representation,
				and willingness to serve. Representatives shall serve at their own expense and
				must abide by all applicable ethics laws. Representatives will be appointed to
				represent older adults and provider, advocacy, policy research and other
				constituencies committed to the delivery of high quality in-home and
				community-based services to older adults. Representatives shall be appointed to
				assure representation from:
1) adult day
				service providers;
2) in-home
				service providers;
3)
				CCUs;
4) emergency home response
				providers;
5) statewide trade or
				labor unions that represent homecare aides and direct care staff;
6) Area Agencies on Aging;
7) adults over age 60;
8) membership organizations representing
				older adults; and
9) other
				organizational entities, providers of care, and/or individuals determined by
				the Director to have demonstrated interest and expertise in the fields of
				in-home and community-based care.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1910 - Establishment of Fixed Unit Rates

Current through Register Vol. 48, No. 28, July 12, 2024
Rate methodologies and rates of payment for the Elderly
				  Medicaid HCBS Waiver program are developed by the Department with consultation,
				  oversight, and final approval by HFS, the State Medicaid agency. During the
				  Waiver's 5-year renewal process, the federal Centers for Medicare and Medicaid
				  Services review the State's Elderly Waiver compliance, including rate
				  sufficiency.
a) The fixed unit rates
				will be reviewed annually, at a minimum, and adjustments will be made to
				conform to CCP's appropriation and to program service requirements and federal
				and State changes in statutes and rules affecting CCP.
b) In establishing fixed unit rates of
				reimbursement, the Department will take into consideration the following:
1) cost information provided by service
				providers;
2) current market
				conditions and trend analyses; and
3) CCP appropriation levels.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1920 - Contract Specific Variations

Current through Register Vol. 48, No. 28, July 12, 2024
The Department will consider reimbursing a provider at a rate
				  other than the established fixed unit rate to compensate for contract specific
				  variations in cost. This consideration will be made under the following
				  circumstances:
a) Evidence suggests
				that a contract area currently served by a provider will become "unserved" due
				to inadequate reimbursement by the State to cover costs. An adjusted rate will
				be used only after the "emergency contracting process", as defined in Section
				240.1605,
				has shown that no provider offered an emergency contract is willing to provide
				service in the contract area at the established fixed unit rate. The adjusted
				rate will then be determined through the competitive procurement process as
				defined in Section 240.1605.
b)
				Once a contract area has established an adjusted rate, that rate shall be
				effective until a new procurement process has been initiated.
c) The adjusted rate contractor must still
				meet the requirements for an in-home service provider as stated in Sections
				240.2020
				and
				240.2040.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1930 - Fixed Unit Rate of Reimbursement for In-home Homemaker Service

Current through Register Vol. 48, No. 28, July 12, 2024
The Department will establish a fixed unit rate of
				  reimbursement for in-home service exclusive of those services defined in
				  Section
				  240.270.
				  Current providers will be notified in writing of any change in the fixed unit
				  rate. The fixed unit rate of reimbursement will be published in the official
				  State newspaper.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1940 - Fixed Unit Rates of Reimbursement for Adult Day Service and Transportation

Current through Register Vol. 48, No. 28, July 12, 2024
The Department will establish fixed unit rates of
				  reimbursement for adult day service and transportation as defined in Section
				  240.230.
				  Current providers will be notified in writing of any change in the fixed unit
				  rate. The fixed unit rates of reimbursement will be published in the official
				  State newspaper.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1950 - Adult Day Service Fixed Unit Reimbursement Rates

Current through Register Vol. 48, No. 28, July 12, 2024
Adult day service providers under contract with the
				  Department shall be uniformly reimbursed for the provision of adult day service
				  at the rates established by the Department. The reimbursable units of adult day
				  services shall be as follows:
a) One
				unit of adult day service is defined in Section
				240.230(c)(1)
				as 1 direct participant contact hour (excluding transportation time) provided
				to a participant.
b) One unit of
				documented adult day transportation provided by the adult day service provider
				is defined in Section
				240.230(c)(2)
				as a 1-way trip per participant to or from the adult day site and the client's
				home.
1) No more than 2 units of
				transportation shall be provided per participant in a 24 hour period.
2) A unit of transportation shall not include
				transportation on outings, trips to physicians, shopping or other miscellaneous
				trips.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1955 - Fixed Unit Rates of Reimbursement for Emergency Home Response Service

Current through Register Vol. 48, No. 28, July 12, 2024
EHRS providers executing a contractual agreement with the
				  Department pursuant to Section
				  240.1600 shall be
				  uniformly reimbursed for the provision of EHRS at fixed unit rates of
				  reimbursement established by the Department. The reimbursable units of EHRS
				  shall be as follows:
a) Installation
				and Removal
The Department shall pay a 1-time installation fee at a fixed
				  unit reimbursement rate established by the Department for the installation of
				  the base unit in the participant's home. The Department shall not pay any fee
				  for expenses incurred by the EHRS provider if service could not be provided due
				  to either the participant's absence or the participant's refusal to admit the
				  EHRS provider's employee into the home. The Department shall not pay any fee
				  for removal of the base unit.
b) Monthly Service
The Department shall pay a monthly service fee per
				  participant at a fixed unit reimbursement rate established by the Department
				  for providing EHRS to participants. The Department shall not pay for the cost
				  of maintaining telephone service for the participants or any associated charges
				  or fees.
c) The rates will
				be reviewed annually, at a minimum. Adjustments may be made to conform to the
				appropriation, service requirements and/or changes in federal and State laws,
				regulations and/or rules affecting the service.
d) In establishing the rates of
				reimbursement, the Department will comply with federal requirements for
				Medicaid waivers, which are described in the State Medicaid Plan maintained by
				HFS and posted on the HFS website. The Department will use a Request for
				Information process to obtain rate information from providers and then consider
				whether the resulting average is supported by the appropriation level for the
				program in light of trend analyses on use of the service and current market
				conditions. The goal is to ensure adequate provider participation and
				participant choice. The specific amount that the service provider will be
				reimbursed for a unit of service is reflected in the provider contract and is
				listed on the Department's website.
e) Upon written notification from the
				Department of a change in the rates of reimbursement, an AMD provider may
				exercise its 60 calendar day termination rights if the EHRS provider no longer
				wishes to provide services thereafter at the new rates of
				reimbursement.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1957 - Fixed Unit Rates of Reimbursement for Automated Medication Dispenser Service

Current through Register Vol. 48, No. 28, July 12, 2024
AMD service providers executing a contractual agreement with
				  the Department pursuant to Section
				  240.1600 shall be
				  uniformly reimbursed for the provision of AMD units at fixed unit rates of
				  reimbursement established by the Department. The reimbursable units of AMD
				  service shall be as follows:
a)
				Installation, Initial Training and Removal
The Department shall pay a 1-time installation fee at a fixed
				  unit reimbursement rate established by the Department for the installation and
				  initial training of the participant/authorized representative/responsible party
				  of the AMD unit in the participant's residence. The Department shall not pay
				  any fee for expenses incurred by the AMD provider if service could not be
				  provided due to either the participant's absence or the participant's refusal
				  to admit the AMD provider's employee into the residence. The Department shall
				  not pay any fee for removal of the AMD unit.
b) Monthly Service
The Department shall pay a monthly service fee per
				  participant at a fixed unit reimbursement rate established by the Department
				  for providing AMD service that includes maintaining administrative and
				  technical support to program machines; providing 24 hour technical assistance
				  and additional training; signal monitoring, troubleshooting, machine
				  maintenance, repair and replacement; notifications to the responsible party on
				  missed medication doses and power outage; tracking and analyzing data; and
				  providing reports as requested by the Department. The Department will not pay
				  for the cost of maintaining telephone service for the participant or any
				  associated charges or fees.
c) The rates will be reviewed annually, at a
				minimum, and adjustments may be made to conform to the appropriation, service
				requirements and/or changes in federal and State laws, regulations and/or rules
				affecting the service.
d) In
				establishing the rates of reimbursement, the Department may consider any of the
				following factors:
1) appropriation
				levels;
2) cost information
				provided by the providers; and/or
3) current market conditions and trend
				analyses.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1960 - Care Coordination Fixed Unit Reimbursement Rates

Current through Register Vol. 48, No. 28, July 12, 2024
Care Coordination Units under contract with the Department
				  shall be uniformly reimbursed for the provision of CCPcare coordination
				  services at the rates established by the Department. The reimbursable CCP care
				  coordination service activities subsequent to a procurement conducted under 89
				  Ill. Adm. Code
				  220.610
				  through
				  220.675
				  as follows:
a) completion of each
				initial eligibility determination for CCP services;
b) completion of each redetermination of CCP
				eligibility not to exceed 1 redetermination per month per
				participant;
c) completion of each
				face-to-face screening of a participant;
d) completion of each HFS Interagency
				Certification of Results - Determination of Imminent Risk form, following
				prescreening by Choices for Care screeners;
e) completion of each HFS OBRA-1 (Level I ID
				Screen);
f) availability to receive
				participant inquiries and requests, by telephone or in person, and to respond
				to those requests and inquiries for each active participant per
				month;
g) completion of each
				Deinstitutionalization assessment;
h) completion of one face-to-face visit
				between initial assessment and annual reassessment that is to occur between 4
				and 8 months after the last determination or redetermination of
				eligibility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart S - PROVIDER RATES › Section 240.1970 - Enhanced Rate for Health Insurance Costs

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may be appropriated funds to pay an enhanced
				  rate under CCP to those in-home service provider agencies that offer health
				  insurance coverage as a benefit to their direct service worker
				  employees.
a) Definitions
For purposes of this Section:
"Direct service worker" means an employee who provides
				  homecare aide services for an in-home service provider agency under CCP.
"Health insurance" means a Type 1 plan or a Type 2
				  plan.
1) Type 1 Plan
A Type 1 plan must comply with, be comparable to, or exceed
				  required mandated benefits, coverages, and co-payment levels for individual and
				  group insurance policies under the Illinois Insurance Code [ 215 ILCS 5 ] and
				  50 Ill. Adm. Code, Subchapter ww and individual and group contracts for health
				  maintenance organizations under the Health Maintenance Organization Act [ 215
				  ILCS 125 ] and 50 Ill. Adm. Code 4521.
2) Type 2 Plan
A Type 2 plan is employer-paid health insurance as part of
				  collective bargaining with unionized direct service workers through a
				  Taft-Hartley Multi-employer Health and Welfare Plan that defines the
				  eligibility requirements and coverage under section 302(c)(5) of the Labor
				  Management Relations Act of 1947 (
				  29 USC
				  141 ).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart T - FINANCIAL REPORTING › Section 240.2020 - Financial Reporting of In-home Service

Current through Register Vol. 48, No. 28, July 12, 2024
a) Provider agencies will be required to
				submit a cost report as described in this Section( Direct Service Worker Cost
				Certification). The report must be based upon actual, documented expenditures.
1) The report must be submitted annually,
				within 6 months after the end of the reporting period, and may be prepared as a
				part of the provider's annual audit.
2) The report may be on either a calendar
				year basis or the provider's fiscal year (once a provider has elected to base
				the reports on a calendar or fiscal year, this election can be changed only
				upon written approval of the Department).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart T - FINANCIAL REPORTING › Section 240.2023 - Financial Reporting of Rate-Based Wage Increases for Direct Service Workers

Current through Register Vol. 48, No. 28, July 12, 2024
a) In-home
				service provider agencies will be required to submit a cost report to the
				Department to document compliance with any rate increase authorized for the
				purpose of increasing wages paid by a provider agency to direct service workers
				who provide homecare aide services under the Community Care Program.
b) The cost report must be submitted within
				60 calendar days after issuance of written notification of such a rate increase
				by the Department.
c) The accuracy
				of the cost report must be attested to by an authorized representative of the
				in-home service provider agency.
d)
				The Department reserves the right to require the in-home service provider
				agency to engage an independent certified public accounting firm to verify the
				information and data submitted by the provider if the Department is in
				possession of evidence to suggest the information and data submitted is
				inaccurate, incomplete or fraudulent. This audit will be performed at the
				provider agency's expense.
e) The
				Department may take appropriate contract enforcement action in the following
				instances:
1) an in-home service provider
				agency did not submit a cost report;
2) a cost report is inaccurate, incomplete,
				or fraudulent; or
3) an in-home
				service provider agency did not increase the wages paid to its direct service
				workers in the amount required by a rate increase under the Community Care
				Program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart T - FINANCIAL REPORTING › Section 240.2030 - Unallowable Costs for In-home Service

Current through Register Vol. 48, No. 28, July 12, 2024
Certain costs shall not be considered by the Department in
				  establishing a fixed rate of reimbursement for in-home service:
a) expenses resulting from transactions with
				related parties/parent organizations that are greater than the going market
				cost of the transactions to the provider;
b) non-straightline depreciation;
c) bad debts;
d) special benefits to owners, including
				owner and key-man life insurance;
e) compensation to non-working owners and
				officers;
f) discounts, rebates,
				allowances, and charity grants offered by the agency;
g) entertainment expenses;
h) fundraising;
i) legal fees for litigation with
				governmental agencies;
j) awards,
				grants and gifts to individuals;
k)
				fines and penalties;
l) contingency
				funds;
m) losses on other grants
				and contracts; and
n) health
				coverage costs incurred for direct service workers by any qualifying provider
				for which an enhanced rate is paid for that purpose by the Department under
				Section
				240.1970.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart T - FINANCIAL REPORTING › Section 240.2040 - Minimum Direct Service Worker Costs for In-home Service

Current through Register Vol. 48, No. 28, July 12, 2024
a) Providers are required to expend a minimum
				of 77% of the total revenues due from the Department (see Section
				240.2020(b)
				) to include the participant incurred expense that may have been applicable for
				direct service worker costs prior to July 1, 2010, as enumerated in Section
				240.2050,
				during a reporting year.
1) This percentage is
				to be adhered to on a statewide basis.
2) The remaining 23% of the total revenues
				may be spent by the provider agencies, at their discretion, on administrative
				or program support costs, also delineated in Section 240.2050.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart T - FINANCIAL REPORTING › Section 240.2050 - Cost Categories for In-home Service

Current through Register Vol. 48, No. 28, July 12, 2024
Providers of in-home service for which a fixed rate is
				  established will provide for cost reporting based on the following
				  categories:
a) Direct service worker
				costs (costs paid to or on behalf of direct service workers), which may
				include:
1) wages, time paid on behalf of the
				worker (i.e., vacation, sick leave, holiday and personal leave);
2) health coverage for any provider that does
				not qualify for an enhanced rate under Public Act 95-713 on or after July 1,
				2008, or the amount of cost incurred in excess of the enhanced rate paid to the
				provider during a reporting period; life insurance; and disability
				insurance;
3) retirement
				coverage;
4) FICA;
5) uniforms;
6) workers' compensation;
7) FUTA;
8) travel time and travel
				reimbursement;
9) unemployment
				insurance; and
10) other costs
				approved, in advance, as direct service costs by the Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart A - INTRODUCTION › Section 270.10 - Summary and Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
This Part describes the organization, standards and
				  responsibilities of the programs that comprise the Department's Adult
				  Protection and Advocacy Services.
a)
				Services
These services include the Long Term Care Ombudsman Program,
				  the Adult Protective Services Program and the Senior Legal Assistance
				  Program.
b) Purpose
1) The Long Term Care Ombudsman Program is
				designed to ensure that adults age 60 and over and persons with disabilities
				age 18 through 59 receive quality services in long term care facilities or
				in-home and community-based settings.
2) The Adult Protective Services Program is
				designed to prevent abuse, neglect, financial exploitation, or self-neglect of
				adults with disabilities age 18 through 59 and persons age 60 or older who
				reside in a domestic living situation.
3) The Senior Legal Assistance Program is
				designed to provide legal assistance to persons age 60 or older.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart A - INTRODUCTION › Section 270.15 - Communications or Service by Verifiable Electronic Methods

Current through Register Vol. 48, No. 28, July 12, 2024
Unless otherwise specified, the following procedures for
				  communications and service of documents and other information by verifiable
				  electronic methods (collectively referred to as "service") shall be followed
				  for this Part:
a) The Department may
				provide service upon an individual (with the individual's consent) and its
				authorized or legal representative at designated email addresses. An
				individual's authorized or legal representative shall designate at least one
				email address and may designate up to 2 additional email addresses (for up to a
				total of 3 email addresses) at which service is accepted. The individual and
				the authorized or legal representatives must immediately notify the Department
				of a change of email address and provide an annual verification of the relevant
				email addresses. Service by email is effective at the time of the transmission
				and will be deemed confirmed if a failure to deliver message is not
				received.
b) If the Department
				receives notification that service to all designated email addresses fails, the
				Department will accomplish service by some other means such as First Class Mail
				to the last mailing address provided by the individual and the authorized or
				legal representative.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart B - LONG TERM CARE OMBUDSMAN PROGRAM › Section 270.100 - Long-Term Care Ombudsman Program: Purpose and Program Model

Current through Register Vol. 48, No. 28, July 12, 2024
This Subpart describes the organization, standards and
				  responsibilities of the State Long-Term Care Ombudsman Program administered by
				  the Office of the State Long-Term Care Ombudsman and through the Illinois
				  Department on Aging.
a) The Long-Term
				Care Ombudsman Program is authorized in accordance with the federal Older
				Americans Act (
				42 USC
				3001 et seq.), implementing regulations under
				45 CFR 1324, and the Illinois Act on Aging [
				20 ILCS
				105/4.04 ].
b) The Long-Term Care Ombudsman Program is
				modeled on the following principles:
1)
				Resident directed advocacy intervention by Ombudsmen through provider agencies
				to ensure
that older persons and persons with disabilities receive
				quality services. This is accomplished by providing advocacy services
				for:
A)
Residents of
				long-term care facilities; and
B)
Participants receiving home care
				and community-based care.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart B - LONG TERM CARE OMBUDSMAN PROGRAM › Section 270.115 - Display of the Ombudsman Poster

Current through Register Vol. 48, No. 28, July 12, 2024
Each long-term care facility shall display posters supplied
				  by the Office in the following manner:
a) Each poster shall be prominently displayed
				in the facility in a place accessible to residents and the public.
b) The poster shall not be obscured in any
				manner by any other material. Each poster shall be placed with the bottom of
				the poster approximately 42 inches from the level of the floor.
c) If a majority of residents speak a
				language other than English, then a majority of the posters shall be in that
				language if they are available from the Department.
d) A poster shall be placed:
1) in each wing on each floor of the
				facility,
2) in each of the
				facility's activity rooms, and
3)
				at the main entrance/exit of the facility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart B - LONG TERM CARE OMBUDSMAN PROGRAM › Section 270.130 - Conflict of Interest

Current through Register Vol. 48, No. 28, July 12, 2024
The Department and the State Ombudsman will ensure that no
				  individual, or member of the immediate family, directing, employed by,
				  participating in, or with responsibilities for the selection or designation of
				  the Regional Programs shall be subject to a conflict of interest, as defined by
				  section 712(f) of the Older Americans Act (
				  42 USC
				  3058g(f) ). Accordingly,
				  organizational and individual conflicts of interest that may impact the
				  effectiveness and credibility of the work of the Office shall be identified and
				  the Department and the State Ombudsman will direct action to remove or remedy
				  the conflict in accordance with federal regulations (
				  45 CFR
				  1324.21 (2016)) and Ombudsman policies and
				  procedures.
a) Organizations involved
				in the establishment of the Program and individuals who carry out the duties of
				the Program, Office, Department, Area Agencies on Aging and provider agencies
				shall be free from conflicts of interest.
b) When a potential conflict of interest is
				identified, the Office shall review the circumstances of the conflict to
				determine whether:
1) An actual conflict
				exists;
2) Whether the conflict was
				knowing or accidental; and
3)
				Whether the conflict could be remedied by appropriate action by the individual
				or agency involved.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart B - LONG TERM CARE OMBUDSMAN PROGRAM › Section 270.132 - Organizational Standards and Responsibilities: Department on Aging

Current through Register Vol. 48, No. 28, July 12, 2024
a)
The
				Department shall establish
a Long
-
Term Care
				Ombudsman Program, through the Office of State Long
-
Term Care
				Ombudsman, in accordance with the provisions of the Older Americans Act of
				1965, as now or hereafter amended.
b) Federal regulations are incorporated by
				reference for the establishment of the Office of the State Long-Term Care
				Ombudsman at
				45
				CFR 1324.11 (2016) and Department
				responsibilities related to the Ombudsman Program at
				45
				CFR 1324.15 (2016). These incorporations do
				not include any later amendments or editions. The Department will collaborate
				with the Ombudsman in accordance with this Part and the federal regulations for
				the State's implementation of the Program. (See 81 Fed. Reg. 35645 (June 3,
				2016).)
c)
The Department,
				in consultation with the Office, shall cooperate with the Department of Human
				Services and other State agencies in providing information and training to
				designated Regional Long
-
Term Care Ombudsman Programs about
				the appropriate assessment and treatment (including information about
				appropriate supportive services, treatment options, and assessment of
				rehabilitation potential) of the
residents and the
participants they serve.
(Section 4.04(c) of the
				Act)
d) Based on the Older
				Americans Act, the Department makes grants to AAAs in a planning and service
				area to build comprehensive systems for older people throughout the State and
				develop policies governing all aspects of applicable programs, including the
				Ombudsman Program. (See 45 CFR 1321.)
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart B - LONG TERM CARE OMBUDSMAN PROGRAM › Section 270.134 - Organizational Standards and Responsibilities: Office of the State Long-Term Care Ombudsman

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Office will be established in accordance with federal requirements under
				45
				CFR 1324.11 (2016) and this Subpart. The
				Office shall collaborate with the Department in accordance this Part and with
				the federal regulations for the State's implementation of the
				Program.
b)
The Office
				shall be composed of at least one full-time Ombudsman and shall include a
				system of designated Regional Long-Term Care Ombudsman
				Programs.
c)
Each
				Regional Program shall be designated by the State Long-Term Care Ombudsman as a
				subdivision of the Office and any representative of a Regional Program shall be
				treated as a representative of the Office.
(Section 4.04(c) of the
				Act)
d) The State Long-Term Care
				Ombudsman certifies individuals as Ombudsmen. In order to be recommended for
				certification, an Ombudsman must complete the training set forth in the
				policies and procedures and satisfy the requirements of this Section. The State
				Long-Term Care Ombudsman may also remove certification of an
				Ombudsman.
e)
The State
				Long-Term Care Ombudsman and all other Ombudsmen must submit to background
				checks under the Health Care Worker Background Check Act
[ 225 ILCS 46
				]
and receive training, as prescribed by the Department, before
				visiting facilities, private homes, or community-based settings. Training must
				include information specific to:
1)
Assisted living establishments, supportive living facilities, shared
				housing establishments, and private homes; and
2)
The rights of residents and
				participants.
(Section 4.04(c) of the Act)
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart B - LONG TERM CARE OMBUDSMAN PROGRAM › Section 270.136 - Organizational Standards and Responsibilities: Area Agencies on Aging

Current through Register Vol. 48, No. 28, July 12, 2024
a) AAAs receive
				grants of Older Americans Act funds designated for the Ombudsman Program that,
				along with any other available funds, support Ombudsman services in the
				applicable planning and service areas. Pursuant to receipt of these funds, the
				responsibilities of the AAA include (see
				45 CFR
				1321.63 ):
1)
The development of an area plan
				that provides for the development of a comprehensive and coordinated service
				delivery system for social services needed by older persons.
2) Entering
into cooperative
				arrangements with other service planners and providers,
including
				provider agencies,
to:
A)
Facilitate access to and utilization of all existing
				services;
B)
Develop social services effectively and efficiently to meet the needs
				of older persons; and
C)
Coordinate existing services to meet the special needs and
				circumstances of minority senior citizens.
(Section 3.07 of the
				Act)