Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 270 - ADULT PROTECTION AND ADVOCACY SERVICES › Subpart B - LONG TERM CARE OMBUDSMAN PROGRAM › Section 270.105 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Act" means the Illinois Act on the Aging [ 20 ILCS 105
				  ].
"AAA" or
"Area Agency on Aging" means any public or
				  non-profit private agency in a planning and service area designated by the
				  Department, which is eligible for funds available under the Older Americans
				  Act
(
				  42 USC
				  3001 et seq.)
and other funds made
				  available by the State of Illinois or the federal government.
(Section
				  3.07 of the Act)
"Assisted living establishment" or "assisted living" has the
				  same meaning given the term in Section 10 of the Assisted Living and Shared
				  Housing Act [
				  210 ILCS 9/10
				  ].
"Authorized representative" means a person properly delegated
				  or designated to exercise decision-making authority on behalf of another
				  person, including, but not limited to, guardians of the estate (whether
				  temporary or permanent), guardians of the person (whether temporary or
				  permanent), conservator, agents appointed under a power of attorney (whether
				  durable or not), health care surrogate decision-makers designated under the
				  Health Care Surrogate Act [ 775 ILCS 401 ], and representative payees,
				  including those appointed by the Social Security Administration or the Railroad
				  Retirement Board pursuant to federal law (see
				  45
				  CFR 1324.1 ).
"Certification" means the process by which an individual who
				  meets minimum qualifications is free of conflicts of interest and has
				  successfully completed training and other requirements of this Part.
				  Certification authorizes the individual to act as a representative of the
				  Office.
"Complaint" means a concern or allegation regarding action,
				  inaction or decisions that may adversely affect, or has adversely affected, the
				  health, safety, welfare or rights of one or more residents or participants that
				  is brought to the attention of, or initiated by, the Ombudsman for
				  action.
"Complainant" means anyone who contacts an Ombudsman for
				  assistance who has personal knowledge of an action, inaction or decision that
				  may affect the health, safety, welfare or rights of one or more residents or
				  participants.
"Community-based setting" means any place of abode
				  other than an individual's private home.
(Section 4.04(b)(2.8) of the
				  Act)
"Conflict of interest" means an individual or organizational
				  competing interest, obligation, or duty that compromises, influences or
				  interferes with (or gives the appearance of compromising, influencing or
				  interfering with) the integrity, activities or conduct of an Ombudsman, the
				  Office, the Department, Area Agencies on Aging, or provider agencies in
				  faithfully and effectively fulfilling their, his or her official duties.
"Department" means the Illinois Department on
				  Aging.
(Section 3.01 of the Act)
"Designation" means the authorization by the State Ombudsman
				  of an entity, such as a provider agency, to host a Regional Program in a
				  planning and service area or specified geographic area.
"Home Care Ombudsman Program" means either a subdivision of
				  the Office or an agency designated by the State Long-Term Care Ombudsman as a
				  subdivision of the Office and any Ombudsman housed within that agency that
				  provides advocacy services to participants. Home Care Ombudsmen are
				  representatives of the Office.
"Immediate family" means a member of the household or a
				  relative with whom there is a close personal or significant financial
				  relationship. (See
				  45
				  CFR 1324.1.)
"Long-term care facility" means any facility as
				  defined by Section 1-113 of the Nursing Home Care Act
[ 210 ILCS 45
				  ]
; any skilled nursing facility or a nursing facility that meets the
				  requirements of section 1819(a), (b), (c) and (d) or section 1919(a), (b), (c)
				  and (d) of the Social Security Act, as now or hereafter amended (
				  42
				  USC 1395i-3(a), (b), (c) and
				  (d) and
				  1396r(a), (b),
				  (c) and (d) )
; any facility as
				  defined by the ID/DD Community Care Act [
				  210 ILCS 47/1-113 ]; any
				  facility as defined by the MC/DD Act [
				  210 ILCS 46/1-113 ]; any
				  facility licensed under the Specialized Mental Health Rehabilitation Act of
				  2013 [
				  210 ILCS
				  49/4-105 or 4 -201]; any assisted living establishment
				  and shared housing establishment as defined by the Assisted Living and Shared
				  Housing Act [
				  210 ILCS 9/10 ]; and
				  any supportive living facility established under the Illinois Public Aid Code [
				  305 ILCS
				  5/5-5.01 ]. (Section 4.04(b)(2) of the Act)
"Managed care organization" or "MCO" means an organization
				  licensed and approved by the Illinois Department of Healthcare and Family
				  Services to provide care coordination and other services to older persons and
				  persons with disabilities in the State of Illinois.
"Medical assistance waiver" means a waiver approved by the
				  U.S. Department of Health and Human Services, Centers for Medicaid and Medicare
				  Services, and administered by the State of Illinois pursuant to section 1915(c)
				  of the Social Security Act and other related authority.
"Monitoring tool" means a survey and questions developed by
				  the Office to provide review and oversight for a Regional Program.
"Office" means the Office of the State Long-Term Care
				  Ombudsman as established by the Department that is the distinct, separately
				  identifiable organizational unit headed by the State Long-Term Care Ombudsman
				  (see 45 CFR 1324.1
				  ).
"
Ombudsman
" or "representative of the
				  Office"
means any designated representative of the State Long-Term Care
				  Ombudsman Program; provided that the representative, whether he
or she
is paid for or volunteers his
or her
ombudsman
				  services, shall be qualified and
certified
by the Office to
				  perform the duties of an Ombudsman as specified by the Department in rules and
				  in accordance with the provisions of the Older Americans Act of 1965, as now or
				  hereafter amended
(Section 4.04(b)(3.1) of the Act). The term also
				  means the certified individuals who fulfill the duties of the Office, whether
				  the personnel supervision is provided by the State Ombudsman or by a provider
				  agency hosting a Regional Program or Home Care Ombudsman Program. (See
				  45
				  CFR 1324.1.)
"Participant" means an older person aged 60 or over
				  or an adult with a disability aged 18 through 59 who is eligible for services
				  under
a medical assistance waiver administered by the State of
				  Illinois or a person receiving care coordination and other services by a
				  managed care organization. (Section 4.04(b)(4) of the Act)
"Program" means the State Long-Term Care Ombudsman Program
				  through which the functions and duties of the Office are carried out,
				  consisting of the State Ombudsman, the Office headed by the State Ombudsman,
				  and the representatives of the Office. (See
				  45
				  CFR 1324.1.)
"Program records" means the confidential files and records
				  created by an Ombudsman while carrying out his or her official duties.
"Provider agency" means the Regional Program provider entity
				  designated by the State Long-Term Care Ombudsman to operate a Regional Program
				  in a planning and service area or a specified geographic area.
"Regional Long-Term Care Ombudsman Program" or "Regional
				  Program" means the entity designated by the State Long-Term Care Ombudsman as a
				  division of the Office.
"Regional Ombudsman" means a certified Ombudsman who works
				  full-time to perform Ombudsman functions exclusively and who shall have no
				  duties in the provider agency outside the scope of the Regional Program.
"Representative" means an authorized representative or any
				  person who is knowledgeable about a resident's or participant's circumstances
				  and has been designated by that resident or participant, in writing, or through
				  a documented verbal request or through the use of auxiliary aids, to represent
				  him or her.
"Resident" means
an older person aged 60 or over or
				  an adult with a disability aged 18 through 59 who is a current resident of a
				  long
-
term care facility
, a former resident, or a
				  deceased resident. (Section 4.04(b)(5) of the Act) Complaints concerning a
				  deceased resident are limited to systemic issues.
"Shared housing establishment"
has the same
				  meaning given that term in Section 10 of the Assisted Living and Shared Housing
				  Act [ 210 ILCS 9 ].
"State Long-Term Care Ombudsman" or "State Ombudsman"
means any person employed by the Department to fulfill the requirements
				  of the Office of State Long
-
Term Care Ombudsman as required
				  under the Older Americans Act of 1965, as now or hereafter amended, and
				  Departmental policy
(Section 4.04(b)(3) of the Act). The term also
				  means the individual who heads the Office and is responsible for personally, or
				  through representatives of the Office, fulfilling the functions,
				  responsibilities and duties set forth in federal regulations. (See
				  45
				  CFR 1324.1.)
"Willful interference" means actions or inactions taken by an
				  individual in an attempt to intentionally prevent, interfere with, or attempt
				  to impede the Ombudsman from performing any of the functions, responsibilities
				  or duties of the Ombudsman. (See
				  45
				  CFR 1324.1.)