reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.630 - Determination of Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
				determination of eligibility is an examination of each participant's
				circumstances to determine the functional need for receipt of CCP, nursing
				facility, or supported living program provider services. This determination
				shall consist of analyzing, evaluating and documenting, when necessary,
				current, full and complete information obtained from the face-to-face
				comprehensive assessment of the participant in his/her place of
				residence.
b) The assessment shall
				include the comprehensive assessment tool and all required CCP forms authorized
				by the Department, or any successor assessment tool and forms used to determine
				the need for long-term services and supports.
c) A participant's request/services may be
				denied or terminated when eligibility criteria are not met, as required by
				Sections
				240.710
				through
				240.875.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.640 - Eligibility Decision

Current through Register Vol. 48, No. 28, July 12, 2024
A decision regarding the participant's initial eligibility or
				  ineligibility to receive CCP services shall be made within 30 calendar days
				  after the date of receipt by the Department or its CCU of a completed referral
				  form for CCP services, unless delayed by the participant/authorized
				  representative. (See Section
				  240.660.)
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.650 - Continuous Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
Eligibility shall be continuous throughout the participant's
				  participation in CCP. Continuous eligibility is validated through the
				  redetermination process specified in Section
				  240.655,
				  except for instances involving an automatic, non-discretionary change in
				  eligibility, rates or benefits by federal or State statute or regulation. A
				  redetermination of eligibility shall be conducted at least once annually or as
				  requested, and as required by Section 240.655.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.655 - Redeterminations Process

Current through Register Vol. 48, No. 28, July 12, 2024
Redetermination of CCP shall be conducted by the CCU at least
				  annually; whenever requested by the participant/authorized representative; or
				  whenever the participant may have experienced a change in his/her needs that
				  indicates the need for a redetermination to assure continued eligibility (see
				  Section
				  240.630
				  ).
a) A decision on the redetermination
				shall be made within 30 calendar days after the date the redetermination
				process begins, except as extended by the Department.
b) Redeterminations conducted at the request
				of the participant/authorized representative or whenever the participant may
				have experienced a change in needs shall be accomplished and a decision
				rendered within 30 calendar days after the date of the request for
				redetermination, except as extended by the Department.
c) The 30 calendar day time limit for
				completion of a redetermination of a participant's eligibility shall be
				extended by any delay caused by the participant/authorized representative.
1) Participant delay is defined as the number
				of calendar days a redetermination of eligibility is delayed because of the
				participant's/authorized representative's failure to provide documentation
				supporting his/her eligibility or otherwise cooperate as set out in Section
				240.350.
2) In the event that a participant's
				eligibility cannot be determined due to the participant's/authorized
				representative's failure to provide documentation within 30 calendar days after
				the date it is verbally requested by the CCU, the CCU shall extend the time
				limit for an additional 60 calendar days, after which services shall be
				terminated if documentation is not provided.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.660 - Extension of Time Limit

Current through Register Vol. 48, No. 28, July 12, 2024
The 30 calendar day time limit for completion of a
				  determination of a participant's eligibility may be extended by any delay
				  caused by the participant.
a)
				Participant delay is defined as the number of calendar days a determination of
				eligibility is delayed because of the participant's/authorized representative's
				failure to provide documentation supporting his/her eligibility.
b) In the event that a participant's
				eligibility cannot be determined due to the participant's/authorized
				representative's failure to provide documentation within 90 calendar days after
				the date of receipt of the completed referral form, the request for services
				shall be denied.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.710 - Age

Current through Register Vol. 48, No. 28, July 12, 2024
To be eligible to receive CCP services, a participant shall
				  be at least 60 years of age. A participant's/authorized representative's
				  statement regarding age shall be accepted unless the information is
				  contradictory, not specific, or otherwise questionable. In these cases, the
				  participant/authorized representative is responsible for providing
				  documentation of age to supplement the statement.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.715 - Determination of Need

Current through Register Vol. 48, No. 28, July 12, 2024
a) To be eligible
				to receive CCP services, a participant shall exhibit a need for nursing
				facility, supportive living program, or home and community-based services. The
				Determination of Need assessment tool or any successor assessment tool
				authorized by the Department specifies the factors that together, determine the
				participant's need for long term care or home and community-based
				services.
b) The need for long term
				care is based upon the determined need for a continuum of in-home and
				community-based services to prevent inappropriate or premature placement in a
				nursing facility.
c) The extent and
				degree of a participant's need for long term care shall be determined on the
				basis of impaired cognitive and functional status as well as the available
				physical/environmental supports provided to the participant by family, friends
				or others in the community.
d) The
				Determination of Need assessment tool consists of 2 parts:
1) The Mini-Mental State Examination
				(Folstein, Folstein and McHugh, 1975, no later editions or amendments included)
				measures cognitive functioning of the participant.
A) The participant who receives a score of 21
				or higher shall be considered cognitively intact and zero points shall be added
				to the Part A, Level of Impairment, score on the Determination of Need
				assessment tool.
B) The participant
				who receives a score of 20 or less or who has been diagnosed by a physician or
				psychiatrist as having dementia, Alzheimer's disease, or organic brain syndrome
				shall be considered cognitively impaired and 10 points shall be added to the
				Part A, Level of Impairment, score on the Determination of Need assessment
				tool.
C) Ten additional points
				shall be added to the Part A, Level of Impairment, score on the Determination
				of Need assessment tool for the participant who meets the following 3 criteria:
i) Participant has been adjudicated disabled
				or incompetent by a Probate Court judge or judge assigned to render a decision
				on such matters in a court of competent jurisdiction;
ii) a physician or psychiatrist licensed by
				the State of Illinois has certified that, in his/her professional judgement,
				the participant suffers from Alzheimer's disease, organic brain syndrome, or
				dementia; and
iii) a physician or
				psychiatrist licensed by the State of Illinois has certified that, in his/her
				professional judgement, the participant requires 24-hour home and
				community-based services to remain in the home.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.727 - Minimum Score Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
Participants determined eligible to receive CCP services
				  shall have their need for nursing facility care or home and community-based
				  services established by receipt of a minimum score of 29 points on the DON, 15
				  of which must be scored on Total Impairment, which includes Part A and the MMSE
				  (see Section
				  240.715
				  ).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.728 - Maximum Payment Levels for Person-Centered Plans of Care Including In-home Service

Current through Register Vol. 48, No. 28, July 12, 2024
Maximum monthly service dollars are calculated according to
				  the participant's total DON score and approved person-centered plan of care for
				  in-home service or other combination of options, excluding adult day service.
				  These maximum monthly service dollars will be adjusted by the Department to be
				  consistent with any future unit rate adjustments for CCP providers.
DON SCORE
SERVICE MAXIMUM LEVEL
(Effective on and after January 1, 2022)
29
$ 627
30
701
31
777
32
852
33
926
34
1,002
35
1,077
36
1,150
37
1,226
38
1,301
39
1,375
40
1,451
41
1,526
42
1,599
43
1,676
44
1,750
45
1,827
46
1,899
47
1,975
48
2,051
49
2,123
50
2,200
51
2,275
52
2,350
53
2,424
54
2,496
55
2,573
56
2,648
57
2,725
58
2,797
59
2,874
60
2,949
61
3,022
62
3,098
63
3,174
64
3,247
65
3,322
66
3,399
67
3,471
68
3,547
69
3,622
70
3,696
71
3,772
72
3,847
73
3,920
74
3,997
75
4,071
76
4,147
77
4,221
78
4,296
79
4,372
80
4,444
81
4,521
82
4,596
83
4,671
84
4,745
85
4,822
86
4,895
87
4,969
88
5,046
89
5,118
90
5,195
91
5,270
92
5,343
93
5,419
94
5,495
95
5,568
96
5,643
97
5,720
98
5,792
99
5,868
100
5,944
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.729 - Maximum Payment Levels for Person-Centered Plans of Care Including Adult Day Service

Current through Register Vol. 48, No. 28, July 12, 2024
Maximum monthly service dollars are calculated according to
				  the participant's total DON score and approved person-centered plan of care for
				  adult day service or other combination of options including adult day service.
				  These maximum monthly service dollars will be adjusted by the Department to be
				  consistent with any future unit rate adjustments for CCP providers.
DON SCORE
SERVICE MAXIMUM LEVEL
(Effective on and after January 1, 2022)
29
$ 1,284
30
1,493
31
1,717
32
1,937
33
2,161
34
2,382
35
2,518
36
2,652
37
2,786
38
2,920
39
3,055
40
3,191
41
3,325
42
3,460
43
3,595
44
3,729
45
3,865
46
4,000
47
4,135
48
4,268
49
4,403
50
4,538
51
4,673
52
4,809
53
4,941
54
5,076
55
5,212
56
5,344
57
5,481
58
5,615
59
5,750
60
5,884
61
6,019
62
6,154
63
6,287
64
6,424
65
6,557
66
6,693
67
6,830
68
6,961
69
7,098
70
7,233
71
7,367
72
7,502
73
7,637
74
7,771
75
7,905
76
8,041
77
8,175
78
8,311
79
8,445
80
8,578
81
8,714
82
8,849
83
8,983
84
9,118
85
9,254
86
9,386
87
9,522
88
9,656
89
9,789
90
9,926
91
10,059
92
10,196
93
10,332
94
10,463
95
10,600
96
10,735
97
10,870
98
11,004
99
11,138
100
11,273
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.730 - Person-Centered Plan of Care

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
				person-centered plan of care will be developed using the person-centered
				planning process in accordance with Section
				240.550.
b) The person-centered plan of care, and any
				subsequent revisions, shall be written in plain language and shall reflect the
				participant's goals, preferences and desired outcomes, indicating services and
				supports important to the participant, based upon the functional needs
				identified by the comprehensive assessment, including:
1) a description of the conditions that
				directly correspond to the assessed functional needs, including:
A) the strengths and preferences of the
				individual, and resources available to him/her;
B) the clinical and support needs as
				identified through a comprehensive assessment of functional needs;
C) paid and unpaid services and supports that
				will assist the participant to achieve identified goals, and natural supports
				and vendors available to meet those needs;
D) risk factors and measures in place to
				minimize harm, including possible interventions that may be used if aid is
				necessary for adherence to program requirements, and the customized strategies
				and back-up plans to minimize any risk factors for the individual;
E) identification of the Care Coordinator and
				other individuals/vendors responsible for monitoring the person-centered plan
				of care;
F) any measures that will
				be used to support how to evaluate the effectiveness of the services and
				supports; and
G) the time limits
				for periodic reviews to determine if services and supports are still
				appropriate, need to be modified, or can be terminated.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.735 - Supplemental Information

Current through Register Vol. 48, No. 28, July 12, 2024
The CCP determination of eligibility shall be supplemented by
				  any collateral casework information (e.g., medical statement from attending
				  Physician, Nurse Practitioner, Registered Nurse or Christian Science
				  Practitioner, and documentation of family support) deemed necessary by the
				  Department. Supplemental casework information will be included in the case
				  notes.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.740 - Assessment of Need

Current through Register Vol. 48, No. 28, July 12, 2024
a) The CCP
				comprehensive assessment tool and determination of need for CCP services shall
				be administered by CCU care coordinators or Department personnel who are
				technically competent persons certified by the Department to conduct the
				comprehensive assessment and determinations of need.
b) The certification shall result from the
				successful completion of training, which includes, but is not limited to, the
				following topics.
1) financial eligibility
				determination (see Sections
				240.800
				through
				240.875
				);
2) administration of the DON
				(see Section
				240.715
				);
3) person-centered plan of care
				development and implementation;
4)
				performance of Choices for Care screenings (see Section
				240.1010
				); and
5) form utilization and
				flow.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.741 - Prerequisites for Automated Medication Dispenser Service

Current through Register Vol. 48, No. 28, July 12, 2024
a) Authorization for the AMD service is
				determined based on a participant's need for the service, including the
				participant's medication, medical, cognitive and physical needs that indicate
				the potential to benefit from the AMD service.
b) To be authorized for the service, the
				participant must:
1) meet all of the following
				criteria:
A) eligibility for CCP
				services;
B) take 1 or more
				medications that necessitate the medications be taken at a set schedule to
				avoid complications;
C) have the
				potential to benefit from the service, understand the need to take medications,
				respond to alerts to take medication and is physically able to take medication
				independently from the AMD unit;
D)
				designate an assisting party to assist with the AMD unit and medications;
				and
E) commit to using the AMD unit
				appropriately; and
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.750 - Citizenship

Current through Register Vol. 48, No. 28, July 12, 2024
To be eligible for CCP a participant must be either a U.S.
				  citizen or a noncitizen within the specific categories and subject to the
				  restrictions set forth at 89 Ill. Adm. Code
				  120.310.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.755 - Residence

Current through Register Vol. 48, No. 28, July 12, 2024
a) To be eligible
				for CCP, a participant must be a resident of the State of Illinois as defined
				in Section 2-10 of the Public Aid Code [ 305 ILCS 5 ].
b) Only those persons who are legally
				admitted to the U.S. can be found to be residents of the State of Illinois. The
				residency of a participant is based on 1 of the following factors:
1) A participant whose residence is located
				in Illinois, but whose U.S. Post Office address indicates a state other than
				Illinois (i.e., a participant residing near the State line), is a resident of
				Illinois;
2) An individual
				currently living in Illinois and receiving a State Supplementary Payment (as
				defined in 42 CFR 435.4 ), Mandatory State Supplement or Optional State
				Supplement from a different state, is not a resident of Illinois for purposes
				of CCP eligibility;
3) A
				participant who is incapable of stating his/her intent to remain in Illinois is
				a resident of Illinois if he/she currently lives in Illinois.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart G - NON-FINANCIAL REQUIREMENTS › Section 240.760 - Social Security Number

Current through Register Vol. 48, No. 28, July 12, 2024
a) To be
				eligible for CCP, each participant must furnish a Social Security Number (SSN).
				If more than 1 SSN has been used by a participant, then all SSNs are to be
				furnished.
b) If any CCP
				participant does not have an SSN, the Department or CCU shall assist him/her in
				making the application.
c) CCP
				services will not be denied, delayed or discontinued pending the issuance or
				validation of an SSN if the participant has applied for the SSN.
d) Participants who refuse to furnish an SSN,
				and/or apply for an SSN when requested, are ineligible for CCP.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.800 - Financial Factors

Current through Register Vol. 48, No. 28, July 12, 2024
a) All CCP
				participants/authorized representatives are required to provide information,
				relative to the value and types of assets owned, requested to determine
				eligibility for services under CCP based on enrollment in a medical assistance
				program administered by HFS.
b) All
				participants/authorized representatives are required to provide information,
				relative to the amount and source of all income, requested to determine
				eligibility for services under CCP based on enrollment in a medical assistance
				program administered by HFS.
c)To
				determine whether a participant is presumptively eligible for enrollment to
				receive interim services under Sections
				240.865
				and
				240.1020,
				CCUs will determine assets and income in accordance with the requirements set
				forth by HFS at 89 Ill. Adm. Code 120 (Medical Assistance Programs).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.810 - Assets

Current through Register Vol. 48, No. 28, July 12, 2024
a) To be eligible
				to receive CCP services, a participant shall not own interest in non-exempt
				assets having a combined value in excess of $17,500, if:
1) unmarried; or
2) married and:
A) spouse is receiving CCP
				services;
B) spouse is in a nursing
				facility;
C) spouse does not reside
				on a permanent basis with, and does not receive support from or give support
				to, the participant;
D) spouse is
				abandoned; or
E) spouse is
				potentially abusing the participant.
EXCEPTION: A participant, who is married and the spouse does
				  not receive CCP services, shall not own interest in non-exempt assets having a
				  total value in excess of the asset disregard amount allowed by HFS for Medicaid
				  in a pre-paid burial plan or life insurance policy + burial merchandise.
				  Non-exempt assets having value over the asset disregard amount up to the amount
				  allowed by the Community Spouse Asset Allowance, as adopted by HFS at 89 Ill.
				  Adm. Code
				  120.379(d),
				  must be transferred to or for the sole benefit of the community spouse. If the
				  couple owns assets that exceed the asset disregard and prevention of spousal
				  impoverishment amounts allowed by statute, the excess (up to the amount of
				  non-exempt assets allowed after transfer, and/or up to the amount of countable
				  monthly income allowed after diversion) shall be designated as a spend down, to
				  be spent before Medicaid enrollment is established.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.815 - Exempt Assets

Current through Register Vol. 48, No. 28, July 12, 2024
a) Exempt Assets
1) Homestead property.
2) Clothing and personal effects.
3) Household furnishings.
4) Business or farming equipment used for the
				production of income.
5) Motor
				vehicles except those primarily used for recreational purposes.
6) Group life insurance held as a condition
				of employment or provided by employer.
7) The principal of a trust fund only when
				the instrument establishing the trust specifically states the principal cannot
				be impaired.
8) One of the
				following:
A) a prepaid burial plan with a
				total value of up to the amounts specified in 89 Ill. Adm. Code
				120.381(c) and
				(d) if burial merchandise is not specified.
				If burial merchandise is specified in the burial plan, that merchandise shall
				be exempt. Any excess of the allowed amounts in value for burial services shall
				be considered non-exempt; or
B)
				life insurance policy with a total face or cash value of the amount specified
				in 89 Ill. Adm. Code
				120.381(a)(5)
				or less. When both cash and face value exceed this amount, apply the excess
				cash value over this amount toward the non-exempt assets.
C) Burial spaces intended for use of the
				participant and grave markers shall be exempt (see 89 Ill. Adm. Code
				120.381(b)
				).
9) The value of the
				allotment under the Supplemental Nutrition Assistance Program (SNAP) Act of
				2008 (
				7 USC
				2017(b) ).
10) The value of the U.S. Department of
				Agriculture donated foods (surplus commodities).
11) The value of supplemental food assistance
				received under the Child Nutrition Act of 1966 as amended (
				42
				USC 1780(b) ) and the
				special food service program for children under the National School Lunch Act,
				as amended (
				42 USC
				1760 ).
12) Assets protected by purchase of a
				certified long-term care insurance policy that meets State standards [
				320 ILCS
				35/25(a)(1) through (5) ].
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.820 - Asset Transfers

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				following transactions are considered transfers of assets:
1) when a participant buys, sells or gives
				away real or personal property; or
2) if the participant changes the way real or
				personal property is held.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.825 - Income

Current through Register Vol. 48, No. 28, July 12, 2024
a) Documentation of
				all currently available income that is not specified as exempt shall be
				provided during the participant's determination/redetermination of eligibility
				for CCP.
b) In accordance with
				provisions of 89 Ill. Adm. Code
				120.379,
				a participant whose spouse (i.e., community spouse) is not receiving CCP
				services may divert income to his/her spouse so that the spouse may have exempt
				income up to the amount exempted by HFS (see 89 Ill. Adm. Code
				120.379(e)
				) for a community spouse.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.835 - Earned Income

Current through Register Vol. 48, No. 28, July 12, 2024
Earned income is remuneration acquired through the receipt of
				  salaries or wages for services performed as an employee or profits from an
				  activity in which the participant is self-employed. Income received as payment
				  for jury duty or serving as an election judge is considered earned income. This
				  includes any payments for mileage, meals, etc.
a) Exempt Earned Income
The first $20.00 of gross monthly earned income plus one-half
				  of the next $60.00 shall be exempt. Additionally, the following recognized
				  expenses of employment shall be exempt:
1) Withholding taxes (federal and
				state)
2) Social Security
				tax
3) Transportation costs. If the
				participant's own car is the means of transportation, the mileage reimbursement
				rate paid by the State of Illinois per mile shall be allowed as transportation
				expense.
4) Lunch supplementation
A) If carried from home, 15 cents per working
				day to a maximum of $3.00 per month.
B) If purchased at work, 45 cents per working
				day to a maximum of $9.00 per month.
5) Special tools and uniforms required by
				employment
6) The following
				expenses ONLY if mandatory as a condition of employment:
A) Union dues
B) Group life insurance premiums
C) Group health insurance premiums
D) Retirement plan withholding
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.840 - Potential Retirement, Disability and Other Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
a) Participants are required to apply for all
				financial benefits for which they may qualify and to avail themselves of those
				benefits at the earliest possible date.
b) The CCU is responsible for making
				participant referrals to the appropriate agency or resources when it appears
				that financial benefits may be available.
c) Potential benefits may include, but are
				not limited to the following:
1) Social
				Security Benefits
2) Railroad
				Retirement Benefits
3) Veterans'
				Benefits
4) Servicemen's Dependents
				Allowances
5) Unemployment
				Compensation Benefits, Supplementary Unemployment Assistance
6) Worker's Compensation Benefits
7) Black Lung Disease Benefits
8) Benefits from private industry,
				professional groups, labor unions and other organizations.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.845 - Family

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of this Subpart, family means the participant,
				  his/her spouse or partner in a civil union if residing in the same household,
				  and any persons declared by the participant and spouse or civil union partner,
				  if applicable, as dependents for federal income tax purposes. Any income
				  received by any family member shall be considered family
				  income.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.850 - Monthly Average Income

Current through Register Vol. 48, No. 28, July 12, 2024
Income to be received on a monthly basis during the twelve
				  (12) month period is to be added to the total amount of income received during
				  the previous twelve (12) months from irregular (other than monthly) sources:
				  e.g., farm, interest and/or dividend income. The total amount of income thus
				  determined is to be divided by twelve (12) to arrive at the monthly
				  average.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.860 - Change in Income

Current through Register Vol. 48, No. 28, July 12, 2024
It is the responsibility of a participant/authorized
				  representative to inform the CCU/Department of any change in the participant's
				  income. Change in income shall be reported at the time of determination or
				  redetermination of eligibility or within 30 calendar days after the date of the
				  change, whichever is sooner. The participant/authorized representative shall
				  provide written documentation when available. (See Section
				  240.360.) Failure
				  to notify the CCU/Department of a change in income may result in reimbursement
				  to the Department or termination.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.865 - Application For Medical Assistance (Medicaid)

Current through Register Vol. 48, No. 28, July 12, 2024
Participants/authorized representatives will be required to
				  apply for and, if financially eligible, enroll in medical assistance under
				  Article V of the Illinois Public Aid Code as a condition of eligibility for
				  (CCP).
a) The Care Coordinator shall,
				when needed:
1) provide the
				participant/authorized representative with a copy of the mail-in medical
				assistance application and/or the web portal address for the online
				application, as appropriate;
2)
				assist the participant/authorized representative with completing the
				application; and
3) submit the
				application at the web portal address or to the participant's local Department
				of Human Services (DHS) office.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart H - FINANCIAL REQUIREMENTS › Section 240.875 - Participant Responsibility

Current through Register Vol. 48, No. 28, July 12, 2024
If a participant desires services in addition to those
				  authorized by CCP, the participant shall be responsible for full payment for
				  those additional services.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.905 - Prohibition of Institutionalized Individuals From Receiving Community Care Program Services

Current through Register Vol. 48, No. 28, July 12, 2024
a)CCP
				services shall not be provided to:
1) any
				participant who is eligible for those services while an in-patient of any
				institution that is subject to licensure as required by the Illinois Nursing
				Home Care Act [ 210 ILCS 45 ].
2)any individual residing in a public
				institution (see 42 CFR 435.1009 ).
3)any individual confined or detained in any
				local or State penal or correctional institution or by a federal law
				enforcement agency.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.910 - Written Notification

Current through Register Vol. 48, No. 28, July 12, 2024
Each participant requesting CCP services shall receive
				  written notification of eligibility or ineligibility to receive CCP
				  services.
a) Written notification
				shall be sent to the participant/authorized representative within 15 calendar
				days after the date of the completed determination of eligibility.
b) The written notification shall contain the
				following statement:
NOTICE
If you have been found eligible for Community Care services,
				  you should begin receiving services within 15 calendar days after the date of
				  this Notice. If a homecare aide has not come to help you within 15 calendar
				  days, you can hire your own homecare aide (including a friend or relative) to
				  provide the amount and type of Community Care services specified in this
				  Notice. The Department on Aging will pay the homecare aide you have hired to
				  the extent authorized by the CCP Participant Agreement. Payment shall continue
				  until the Department's approved provider initiates provision of Community Care
				  services to you.
c) If it is
				necessary for the participant/authorized representative to hire his/her own
				homecare aide due to the failure of the authorized provider to provide CCP
				services within 15 calendar days, the temporary services and payment for those
				services shall terminate immediately upon initiation of service provided by a
				CCP approved provider. (See Section
				240.1580(c).)
d) If a participant is determined ineligible
				and request for CCP services is denied, the written notification shall be sent
				to the participant/authorized representative by certified mail, return receipt
				requested, or given to the participant/authorized representative personally, in
				which case the participant/authorized representative shall provide a signed and
				dated receipt for the notice. The notice shall clearly state the reason for the
				denial and shall advise the participant/authorized representative of his/her
				right to appeal the decision. (See Section
				240.400.)
e) If a participant is denied because of
				death, the notice may be sent by regular mail.
f) The date of the written notice of
				eligibility or ineligibility shall be the same date as the date of mailing. The
				provider shall be notified on the same date of mailing as the
				participant.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.915 - Service Provision

Current through Register Vol. 48, No. 28, July 12, 2024
If a participant is determined eligible for CCP, services
				  shall be provided in accordance with the person-centered plan of care within 15
				  calendar days after the date of the notification of eligibility, as required by
				  Section
				  240.910,
				  unless delayed by the participant/authorized representative.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.930 - Suspension of Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) CCP
				services may be suspended by a CCU when a participant has not cooperated with
				the vendor in the provision of services as set forth in Section
				240.350.
				Services shall be reinstated when the participant has met and continues to meet
				the requirements in the memorandum of understanding (MOU) (see Section
				240.350).
b) The vendor shall
				notify the CCU of the need for suspension in accordance with Section
				240.350.
c) Upon receipt of the
				vendor's verbal request for suspension, the CCU shall immediately, but not
				later than the next work day, verbally advise the participant of the suspension
				and the date of the suspension of services. This date shall be the date the
				vendor left or was unable to render service.
d) Notification of the suspension of services
				shall be sent to the participant/authorized representative and the vendors by
				the CCU by regular mail within 5 calendar days after the verbal notification by
				the CCU to the participant.
e) The
				CCU, in accordance with Section 240.350, shall obtain the signature of all
				parties to the MOU within 30 calendar days after the effective date of
				suspension.
f) Upon execution of
				the MOU (see Section
				240.160 ),
				reinstatement of service shall be authorized in writing by the CCU, to be
				effective on or before 15 calendar days after the date of the last signature on
				the MOU. The written notice shall be provided to the participant and vendors by
				regular mail.
g) Suspension of
				services may not be appealed because a suspension is not a final
				decision.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.940 - Penalty Payments

Current through Register Vol. 48, No. 28, July 12, 2024
The Department shall pay $100 to each eligible participant to
				  whom a Notice of Eligibility is not mailed within 45 calendar days after the
				  date on which eligibility is determined, as defined in Section
				  240.510,
				  by the Department or a CCU. It shall be the responsibility of the
				  participant/authorized representative to notify the Department in writing when
				  this occurs.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.945 - Notification

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any participant
				whose CCP services are being changed in the following manner shall be advised
				of the change by written notice: change of service type; reduced amount of
				service; or termination.
1) The written
				notice shall be sent to a participant/authorized representative by certified
				mail, return receipt requested, or given personally, in which case the
				participant/authorized representative is to provide a signed and dated receipt
				for the notice, except for instances involving automatic, non-discretionary
				changes in eligibility, rates or benefits required by federal or State statute
				or regulation. In these instances, regular mail is acceptable. Also, in the
				event of the death of a participant, regular mail is acceptable for
				notification purposes.
2) The
				notice shall clearly state the reason for the action being taken.
3) The participant/authorized representative
				shall be notified of the action being taken no later than 15 calendar days
				after the date of assessment or redetermination and the action shall be
				effective no sooner than 15 calendar days after the date of the notice if the
				action is adverse to the participant (see Section
				240.160 for a
				definition of adverse action). This time frame does not apply to termination as
				a result of the non-cooperative act specified in Section
				240.350(b)(1).
4) In instances involving an automatic,
				non-discretionary change in eligibility, rates or benefits required by federal
				or State statute or regulation, the participant/authorized representative will
				be notified of the action being taken at least 15 calendar days prior to the
				implementation by the CCU of the change affecting the participant. The action
				will be effective no sooner than 15 calendar days after the date of notice if
				the action is adverse to the participant.
5) In the event of a death, the termination
				shall be effective the date of the participant's death. The form shall be dated
				and mailed/hand-delivered upon the Department or the CCU being informed of the
				death.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.950 - Reasons for Termination

Current through Register Vol. 48, No. 28, July 12, 2024
A participant shall be terminated from CCP for 1 or more of
				  the reasons identified in this Section:
a) participant is deceased;
b) participant has been institutionalized or
				is otherwise not available for services for more than 60 calendar
				days;
c) participant's condition
				has improved and there is no longer a need for CCP services as measured by the
				CCP DON to determine need for long-term services and supports;
d) participant cannot be located;
e) participant/authorized representative has
				requested termination of services;
f) participant/authorized representative
				refuses transfer to a different vendor/CCU and the current vendor/CCU cannot
				provide services needed by the participant;
g) participant/authorized representative has
				failed to cooperate with the Department/CCU/vendor as required and as specified
				in Section
				240.350;
h) participant no longer meets citizenship
				requirements;
i) participant no
				longer meets residency requirements;
j) the CCU determines that an adequate
				person-centered plan of care cannot be developed that meets the participant's
				determined needs under Section
				240.715.
k) the total value of a participant's
				non-exempt assets has increased and exceeds $17,500;
l) participant/authorized representative
				failed to report the transfer of non-exempt assets within the past 60 months
				for the purpose of obtaining CCP services;
m) participant/authorized representative has
				failed to report or refused to provide documentation of changes in
				circumstances, as required by Section
				240.360;
n) participant/authorized representative
				refuses to sign a Participant Agreement - Person-centered Plan of
				Care;
o) participant refuses to
				sign the Participant Agreement and Consent Form in accordance with Section
				240.330;
				or
p)Participant/authorized
				representative refuses to apply for and, if eligible, enroll in medical
				assistance under Article V of the Public Aid Code, as required by Section
				240.865.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.955 - Reasons for Reduction or Change

Current through Register Vol. 48, No. 28, July 12, 2024
Reasons for reduction in level or amount of services provided
				  to a participant or change in type of services or any other change in service
				  shall be based on current determination of eligibility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart J - SPECIAL SERVICES › Section 240.1010 - Choices for Care Nursing Facility, Supportive Living Program, and Community-Based Screening

Current through Register Vol. 48, No. 28, July 12, 2024
a) Choices
				for Care nursing facility, supportive living program, and community-based
				prescreening is the assessment of the need of all participants age 60 and over,
				regardless of the payment source, prior to placement in a nursing facility
				(licensed under the Nursing Home Care Act; certified to participate in the
				Medicare program under Title XVIII of the Social Security Act (
				42 USC
				301 et seq.), or certified to participate in
				the Medicaid program under Title XIX of the Social Security Act; placement in a
				supportive living program (Medicaid waiver)); or to determine if the
				participant/authorized representative chooses community-based services and
				supports.
b) Except as indicated in
				subsections (j) and (l), any participant seeking admission to a nursing
				facility or supportive living program must be screened to determine his/her
				need for nursing facility or supportive living program services pursuant to
				this Section.
c) Prescreening shall
				be accomplished by completion of the DON, completion of the HFS Interagency
				Certification of Screening Results form, and completion of an HFS OBRA Level I
				Screen if the participant is determined appropriate for nursing facility or
				supportive living program placement. In addition, the participant will receive
				a copy of:
1)
Notice of Privacy
				Practices
brochure; and
2)
Your need to know about Adult
				Protective Services
brochure.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart J - SPECIAL SERVICES › Section 240.1020 - Interim Services

Current through Register Vol. 48, No. 28, July 12, 2024
Interim services are CCP services provided to participants
				  age 60 and over on an interim basis, dependent upon the participant's
				  presumptive eligibility and following prescreening of the participant.
a) Presumptive eligibility shall be based
				upon the following criteria:
1) A referral
				has been received from a participant age 60 or over, or from the participant's
				authorized representative, following prescreening.
2) Notification has been received by the CCU
				from a hospital or from a participant/authorized representative or agency in
				the community that the participant is at imminent risk of nursing facility
				placement within 3 calendar days.
3) The DON to determine need for long-term
				services and supports has been administered.
4) The participant/authorized representative
				has provided declared information on all other CCP eligibility
				requirements.
5) The
				participant/authorized representative has signed a Participant Agreement and
				Consent Form.
6) After presumptive
				eligibility has been determined, the CCU shall notify the vendor within the
				next business day and services will start within 2 business days.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart J - SPECIAL SERVICES › Section 240.1040 - Intense Service Provision

Current through Register Vol. 48, No. 28, July 12, 2024
Several CCP workers' services (not to exceed 4) may be
				  utilized, on a 1-time basis only, to clean a new participant's home, thereby
				  making it possible to maintain the health and safety of the participant.
				  However, the total monthly service costs may not exceed the maximum monthly
				  cost allowable as indicated on the participant agreement.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart J - SPECIAL SERVICES › Section 240.1050 - Temporary Service Increase

Current through Register Vol. 48, No. 28, July 12, 2024
A participant who is currently receiving services under CCP
				  may request a temporary service increase when he/she is at imminent risk of
				  nursing facility care or has been hospitalized for not more than 60 calendar
				  days.
a) The CCU will conduct the DON
				to determine need for long-term services and supports within 2 calendar days
				after notification.
b) The CCU will
				assist the participant/authorized representative with the completion of the
				Participant Agreement and Consent Form. The CCU shall verbally authorize a
				temporary increase in services if the need is indicated by the determination.
				The CCU shall notify the vendor by telephone to reinstate services, giving the
				date of discharge and the temporary increase.
c) Notification shall be given to the
				participant/authorized representative and the vendor immediately following
				completion of the required forms. The notification shall be confirmed in
				writing. Both the verbal and written notification shall indicate the increase
				and the temporary nature of the increase.
d) The CCU shall make a home visit to the
				participant for the purpose of redetermination of need to determine if the
				temporary increase should be continued or reduced. (See Section
				240.620(c).)