reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 679 - DETERMINATION OF NEED (DON) AND RESULTING SERVICE COST MAXIMUMS (SCMs) › Section 679.40 - Scoring the DON for Respite Cases

Current through Register Vol. 48, No. 28, July 12, 2024
In order to be eligible for respite services, the individual
				must receive 29 points in Part A of the DON, which includes the 10 points from
				the Mini-Mental Status Examination, as appropriate. No points are necessary in
				Part B as respite services are to provide relief to a caregiver who normally
				provides all care for an individual which is at no cost to
				DHS.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 679 - DETERMINATION OF NEED (DON) AND RESULTING SERVICE COST MAXIMUMS (SCMs) › Section 679.50 - Service Cost Maximums (SCMs)

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 For each individual meeting the minimum required DON scores for eligibility
			 (see 89 Ill. Adm. Code 682), there is a corresponding Service Cost Maximum
			 (SCM) for his/her DON score which is the maximum amount that may be expended
			 for services through HSP for an individual who chooses HSP services over
			 institutionalization. This amount directly corresponds to the amount the State
			 would expect to pay for the nursing care component of institutionalization if
			 the individual chose institutionalization.
b) The monthly SCMs for individuals served
			 under the HSP Disabled Individual Medicaid Waiver are:
DON Range
11/1/03 SCM
8/1/04 SCM
8/1/05 SCM
8/1/06 SCM
8/1/07 SCM
29-32
$1,154
$1,194
$1,249
$1,329
$1,488
33-40
$1,326
$1,371
$1,435
$1,527
$1,710
41-49
$1,475
$1,526
$1,597
$1,699
$1,902
50-59
$1,766
$1,827
$1,912
$2,034
$2,277
60-69
$2,076
$2,147
$2,247
$2,390
$2,677
70-79
$2,244
$2,322
$2,430
$2,585
$2,894
80-100
$2,412
$2,495
$2,612
$2,778
$3,111
c) The
			 monthly SCMs for individuals served under the HSP AIDS Medicaid Waiver are:
DON Range
11/1/03 SCM
8/1/04 SCM
8/1/05 SCM
8/1/06 SCM
8/1/07 SCM
29-32
$1,486
$1,538
$1,609
$1,712
$1,917
33-40
$2,228
$2,305
$2,412
$2,566
$2,873
41-49
$2,970
$3,073
$3,216
$3,421
$3,831
50-59
$3,714
$3,842
$4,021
$4,278
$4,790
60-69
$4,458
$4,611
$4,827
$5,134
$5,749
70-79
$5,198
$5,378
$5,628
$5,987
$6,704
80-100
$5,943
$6,148
$6,435
$6,845
$7,664
d) The
			 monthly SCMs for individuals served under the HSP Brain Injury Medicaid Waiver
			 are:
DON Range
11/1/03 SCM
8/1/04 SCM
8/1/05 SCM
8/1/06 SCM
8/1/07 SCM
29-32
$1,286
$1,331
$1,393
$1,482
$1,659
33-40
$1,427
$1,476
$1,545
$1,644
$1,841
41-49
$1,586
$1,640
$1,717
$1,826
$2,045
50-59
$1,901
$1,966
$2,058
$2,189
$2,451
60-69
$2,234
$2,311
$2,419
$2,573
$2,881
70-79
$2,415
$2,499
$2,615
$2,782
$3,115
80-100
$2,597
$2,686
$2,811
$2,990
$3,349
e) The
			 SCM for an individual may be exceeded on a monthly basis to meet a temporary
			 increase in need for services as long as the average monthly cost for services
			 during the twelve month period does not exceed the SCM. Such an increase in
			 services shall not last more than 3 months.
f) The exceptional care rate (ECR) for
			 individuals who cannot be served under an HSP waiver's SCM is established by
			 the Department of Healthcare and Family Services (HFS) under 89 Ill. Adm. Code
			 140.569(i).
			 This rate is comparable to the assessed cost for institutionalization and shall
			 not be exceeded. To determine the exceptional care rate for an individual
			 served under an HSP waiver program:
1) the
			 nearest approved exceptional care nursing facility to the individual's
home is identified;
2) the exceptional care rate for that
			 facility is requested from HFS; and
3) the daily exceptional care rate is
			 multiplied by 30.3 to establish a monthly
average.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.10 - Who Must be Prescreened

Current through Register Vol. 48, No. 28, July 12, 2024
Per Department of Public Aid (DPA) rules found at 89 Ill. Adm.
				Code
				140.642,
				certain individuals ages 18 through 59 who are not determined to be
				developmentally disabled or classified with severe mental illness as determined
				through completion of the Level I ID Screen (OBRA:
1), who seek nursing facility placement, must
			 be prescreened. For the purpose of this Part, "nursing facility" means a
			 location licensed under the Nursing Home Care Act [210 ILCS 45 ] as a skilled
			 or intermediate nursing facility, or a location certified to participate in the
			 Medicare program under Title XVIII of the Social Security Act (
			 42 U.S.C.
			 301, et seq.), or the Medicaid program under
			 Title XIX of the Social Security Act.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.20 - DHS Prescreening Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) Pursuant to Section 2-201.5 of the Nursing
			 Home Care Act [210 ILCS 45 ], DHS must prescreen any individual, as described
			 in Section
			 681.10,
			 who seeks admission to a nursing facility.
b) DHS Home Services Program does not
			 prescreen individuals who:
1) are less than
			 18 years of age, or 60 years of age or older;
2) are transferred from one nursing facility
			 to another nursing facility;
3)
			 resided in a nursing facility for a period of at least 60 calendar days who are
			 returning to a nursing facility after an absence of not more than 60 calendar
			 days;
4) are returning to a nursing
			 facility after an absence for medical care, regardless of the duration of the
			 absence;
5) have a diagnosis of
			 developmental disability or severe mental illness, regardless of age;
6) are admitted to a facility that is part of
			 a Life Care Contract;
7) are
			 admitted to a hospice;
8) are
			 admitted to a nursing facility for respite care from the community for a period
			 of no more than 15 calendar days;
9) are admitted to a sheltered care
			 facility;
10) are admitted to a
			 facility operated under the Hospital Licensing Act [210 ILCS 85 ] whose actual
			 length of stay in such a facility is less than 21 calendar days. If an
			 individual's stay extends to 21 days or beyond, he/she must be
			 prescreened;
11) are admitted to a
			 facility operated by a provider licensed under the Alternative Care Delivery
			 Act [210 ILCS
			 3/35 ] whose actual length of stay in such a facility
			 is less than 21 calendar days. If an individual's stay extends to 21 days or
			 beyond, he/she must be prescreened; or
12) were residents of a nursing facility on
			 June 30, 1996.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.30 - Prescreening Process

Current through Register Vol. 48, No. 28, July 12, 2024
The Prescreening process is the completion of the DON and
				reporting of the results. The DON, completed by the counselor or appropriate
				representative of a cooperating social service agency/hospital who has been
				trained by DHS or DoA, measures the level of impairment of an individual and
				the individual's unmet need for care. Determination of eligibility for
				institutional care and eligibility for HSP services is based on the points
				earned in both of these categories and their totals. The results of the
				Prescreening are reported via the Inter-Agency Certification of Screening
				Results For Long Term Care (DPA:2536).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.35 - Assessment Validity Period and Customer Rights

Current through Register Vol. 48, No. 28, July 12, 2024
A prescreening shall be valid for a period of 90 calendar days
				from the date of completion. The individual who is prescreened shall be
				informed of:
a) the availability of
			 services through the Home Services Program, if such services are appropriate;
			 and
b) his/her right to refuse
			 nursing facility placement, Home Services, or both.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.40 - Time Frames

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a request
			 for a prescreening is received by DHS from a social service agency/hospital
			 which is providing DHS with customer information including a DON score, the
			 counselor must act on the request within 2 working days.
b) If a request for prescreening is received
			 by DHS from a social services agency/hospital or the community which includes
			 only basic customer information (i.e., name, address, etc.), the counselor must
			 act on the request within 5 working days.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.50 - Outcome of Prescreening Process

Current through Register Vol. 48, No. 28, July 12, 2024
As a result of the Prescreening, the individual will be
				determined as:
a) eligible for nursing
			 facility placement and therefore eligible to consider HSP as an alternative to
			 institutional care; or
b)
			 ineligible for nursing facility placement or to receive HSP services.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.60 - Certification of Prescreening Results

Current through Register Vol. 48, No. 28, July 12, 2024
a) After the prescreening is completed, if
			 the customer has chosen institutional placement, the counselor must complete an
			 Inter-Agency Certification of Screening Results For Long Term Care (DPA:2536)
			 form and an OBRA 1 ID Screen form and forward the results to the nursing
			 facility. A partial HSP Eligibility Summary (IL 488-0325) is required from the
			 case file.
b) Further, if the
			 individual is eligible and has chosen institutional placement over HSP
			 services, the customer must sign and date the appropriate form, indicating
			 nursing home preference and that the customer has been informed of the
			 availability of HSP services as an alternative to institutionalization and has
			 chosen the institutional care.
c)
			 Results must be certified, as per subsection (a) above, regardless of whether
			 the individual is eligible.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 681 - PRESCREENING › Section 681.70 - Necessity of Prescreening

Current through Register Vol. 48, No. 28, July 12, 2024
It is not required that an individual undergo prescreening to
				apply for HSP services. Prescreening is only required when institutionalization
				is being considered as a placement for the individual.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart A - GENERAL APPLICABILITY › Section 682.10 - General Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
In order to receive services through HSP, an individual must
				  meet all non-financial eligibility criteria and financial eligibility criteria
				  as listed in this Part.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart B - NON-FINANCIAL ELIGIBILITY CRITERIA › Section 682.100 - General Eligibility Criteria

Current through Register Vol. 48, No. 28, July 12, 2024
In order to receive services through HSP a customer
				  must:
a) be a citizen of the United
				States, or be an individual who is living permanently in the United States
				after having been legally admitted;
b) have applied for, be a recipient of, or be
				found eligible for Medicaid benefits through HFS and within 60 days after the
				date of application for HSP, the HSP staff must have verification of the
				aforementioned. HSP staff shall seek to obtain this verification through the
				Integrated Eligibility System (IES) or another HFS system that provides
				verification of Medicaid Status. Customers may need to provide this
				verification, if HSP staff is unable to verify through other means. Customers
				may be found eligible for Medicaid and be placed on Spend Down. However, a
				customer is not required to meet the eligibility criteria for Medicaid to
				receive benefits, nor is Medicaid eligibility or verification of application
				required to receive Interim Services (see 89 Ill. Adm. Code 682). The customer
				must agree to apply for Medicaid, and cooperate with HFS, to receive Interim
				Services. Customers having applied for HSP services prior to October 1, 1991
				may choose to apply for Medicaid;
c) be a resident of the State of
				Illinois;
d) be under the age of 60
				at the time of application for HSP services, unless the individual is applying
				for services under the HSP AIDS Medicaid Waiver or under the HSP Brain Injury
				Medicaid Waiver, in which case there is no age criteria for
				application;
e) have a severe
				disability that is expected to last for at least 12 months or for the duration
				of life;
f) be an individual with a
				disability who is in need of long-term care, as determined by the DON score
				completed as a result of a prescreening (89 Ill. Adm. Code 679) or application
				for HSP services. In order to be determined to have met this criteria, the
				individual must receive a DON score of at least 15 points on part A, which
				includes, if applicable, the 10 points from the Mini-Mental Examination, with a
				total DON score of at least 29 points; and
g) not require in-home services that are
				expected to cost more than the cost the State would pay for institutional care
				for an individual with a similar DON score.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart C - FINANCIAL ELIGIBILITY CRITERIA › Section 682.200 - Assets Limitation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Adult
				Customers, age 18 years or above, may have no more than $17,500 in
				Customer-only non-exempt assets in order to receive services through
				HSP.
b) Minor Customers, those
				under 18 years, may have no more than $35,000 in total family non-exempt
				assets. In order to determine total family assets, the Customer and all other
				individuals who contribute to the family unit, or rely on the family unit for
				support, shall be counted.
c) A
				married Customer, whose spouse does not receive HSP services and is not
				institutionalized, shall not own interest in non-exempt assets having a total
				value in excess of $17,500. Non-exempt assets having a value over this figure
				and up to the amount allowed by the Community Spouse Asset Allowance, as
				adopted by the Illinois Department of Healthcare and Family Services (HFS) at
				89 Ill. Adm. Code
				120.379(d),
				must be transferred to, or for the sole benefit of, the community spouse. If
				the Customer's assets exceed the asset disregard and prevention of spousal
				impoverishment amount, but the excess is less than $17,500, the Customer is
				eligible for HSP services. If the excess is greater than $17,500, the
				individual is ineligible for services. Customers who may be qualified for the
				spousal impoverishment exception may receive Interim Services while HFS
				determines the eligibility factor.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart C - FINANCIAL ELIGIBILITY CRITERIA › Section 682.210 - Transfer of Assets

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any transfer
				or sale of non-exempt assets which occur within the time periods specified in
				this Section shall be used in determining the individual's assets for the
				purpose of Section
				682.200.
b) Transfers involving a trust shall be
				considered as an asset unless the transfer occurred 60 months prior to the
				individual's application for services.
c) If an individual applying for services has
				transferred or sold non-exempt assets within the last 36 months prior to
				application for services, he/she must verify that he/she received fair market
				value for the assets. Fair market value is the worth on the open market of the
				asset, at the time it was transferred or sold. If less than fair market value
				was received, the difference between the amount received for the asset and the
				fair market value of the asset will be used in determining the individual's
				assets for the purpose of Section 682.200.
d) The transfer or selling of non-exempt
				assets at the time of application or while an individual's Home Services
				Program case file is open will result in the fair market value of the asset
				being used in determining the individual's assets for the purposes of Section
				682.200.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart C - FINANCIAL ELIGIBILITY CRITERIA › Section 682.220 - Exempt Assets

Current through Register Vol. 48, No. 28, July 12, 2024
For the purpose of determining the amount of the individual's
				  assets, as described in Section
				  682.200,
				  the following assets shall be considered to be exempt and not counted:
a) the individual's primary residence,
				including its furnishings and contents and all contiguous property on which it
				is situated;
b) vehicles, except
				those used primarily for recreation;
c) personal property;
d) resources, including, but not limited to,
				land, buildings and equipment, supplies, or tools used in business or
				agricultural income-producing operations;
e) life insurance including:
1) group life insurance held as a condition
				of employment or provided by an employer;
2) a prepaid burial plan with a value of up
				to $1,500; or
3) any life insurance
				policy with cash value, or redeemable face value of $2000, or less;
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart C - FINANCIAL ELIGIBILITY CRITERIA › Section 682.230 - Assets Held in Joint Ownership

Current through Register Vol. 48, No. 28, July 12, 2024
a) If
				an asset is held in joint ownership with a non-spouse, the percentage of the
				asset owned by the individual shall be used to determine the value of the
				customer's share.
b) All assets of
				spouses will be considered joint assets and the value divided equally unless a
				written legal agreement exists which designates the asset(s) to the other
				partner. In the case where a legal agreement exists, only the assets shared in
				common shall be considered.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart D - EFFECT OF OTHER SERVICES ON HSP › Section 682.300 - Effect of Other Services on HSP

Current through Register Vol. 48, No. 28, July 12, 2024
a) A customer cannot receive services through
				the HSP if he/she is receiving services through any other agency's home care
				program if that agency will seek reimbursement for those services through a
				Medicaid Waiver.
b) A customer
				receiving services through a program described in subsection (a) above must
				terminate those services prior to the time any services may be provided through
				the HSP, pursuant to Medicaid regulations.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart E - REDETERMINATION OF ELIGIBILITY › Section 682.400 - Redetermination Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
All Customers who want to continue receiving services through
				  the HSP must have their eligibility redetermined and must continue to meet all
				  eligibility criteria stated in Subparts B and C of this Part.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart E - REDETERMINATION OF ELIGIBILITY › Section 682.410 - Redetermination Time Frames

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any
				Customer served under the Medicaid Waiver for Persons with Physical
				Disabilities shall have his/her eligibility redetermined whenever there is a
				change in his/her condition or situation that may affect his/her continued
				eligibility, but if no such change, at least every 12 months.
b) Any Customer served under the Medicaid
				Waiver for Persons with HIV/AIDS shall have his/her eligibility redetermined
				whenever there is a change in his/her condition or situation that may affect
				his/her continued eligibility, but if no such change, at least every 12
				months.
c) Any Customer served
				under the Medicaid Waiver for Persons with a Brain Injury shall have his/her
				eligibility redetermined whenever there is a change in his/her condition or
				situation that may affect his/her continued eligibility, but if no such change
				occurs, at least once every 12 months.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart F - GRANDFATHERING PROVISIONS › Section 682.500 - Exceptions to Eligibility Standards

Current through Register Vol. 48, No. 28, July 12, 2024
A Customer who was receiving planned services through HSP
				  prior to July 17, 1983, and has remained in a continuous active status since
				  that time, and meets the current minimum DON point requirements may:
a) have a planned service cost above the SCM
				established for that Customer's DON score as established July 17, 1983;
				and
b) have more than $17,500 in
				non-exempt, Customer-only assets.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 682 - ELIGIBILITY › Subpart F - GRANDFATHERING PROVISIONS › Section 682.520 - Exceptions to Service Cost Maximums

Current through Register Vol. 48, No. 28, July 12, 2024
a) If the established SCM for a case is
				exceeded due to a DHS-ORS approved provider rate increase, the customer may
				continue to receive the same amount of services even though the SCM will be
				exceeded.
b) If an increase in
				services is indicated, services must stay within the established SCM for the
				case, regardless of the impact of provider rates.
c) Cases involving ventilator dependent
				customers and other customers with exceptional care needs whose need for care
				cannot be met by the SCM may have a rate established by Department of Public
				Aid (DPA) per 89 Ill. Adm. Code
				684.70(c).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.10 - Service Plan

Current through Register Vol. 48, No. 28, July 12, 2024
a) All services
			 provided to a Customer through HSP must be necessary to meet an unmet care need
			 of the individual or to provide relief to the caregiver for Customers eligible
			 for respite care services and listed on an HSP Service Plan that is developed
			 for the Customer and agreed to and signed by the counselor and the Customer in
			 accordance with 89 Ill. Adm. Code
			 676.130(a).
b) Services shall be developed with Customer
			 participation, provided in a manner that reflects the individual's choices,
			 when applicable, and address his/her strengths, needs, and desired
			 goals.
c) Services provided through
			 HSP to a Customer must be:
1) safe and
			 adequate;
2) cost
			 effective;
3) the most economical
			 in terms of the Customer's needs, unless a service is not available at the most
			 economical level. In these instances, the next higher service level may be used
			 as long as services remain within the Service Cost Maximum (SCM) established
			 for the Customer. Documentation of an ongoing effort to locate services at the
			 appropriate level must be in the Customer's case file; and
4) in compliance with all HSP requirements
			 and regulations.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.20 - Procuring an Appropriate Service Provider

Current through Register Vol. 48, No. 28, July 12, 2024
a) The counselor is responsible for
			 identifying the appropriate level of service provider based on the Customer's
			 level of service need, the Customer's ability to manage service delivery and
			 the Customer's approval of the initial Service Plan.
b) When a Customer seeks to hire an
			 Individual Provider, the following requirements must be met:
1) The Customer must have the ability to
			 manage the Individual Provider in all aspects of the employment relationship.
A) If the Customer is determined to be able
			 to manage an Individual Provider, the Customer is responsible for identifying,
			 interviewing, hiring, managing, disciplining and ending the employment
			 relationship with the Individual Provider.
B) The Customer must meet all HSP
			 requirements, including those outlined in 89 Ill. Adm. Code 686, Subpart P
			 (Individual Provider Overtime and Travel Time) and Subpart Q (Electronic Visit
			 Verification).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.30 - Family Members as Service Providers

Current through Register Vol. 48, No. 28, July 12, 2024
a) The following individuals shall not be
			 paid through HSP to be a Customer's service provider.
1) The Customer's legally responsible family
			 members (89 Ill. Adm. Code
			 676.30), including
			 the Customer's spouse, a parent of a child who is under age 18 or a legal
			 guardian of an individual who is under age 18;
2) The Customer's minor child (under age
			 18);
3) The Customer's foster
			 parents if the Customer is under age 18; or
4) The Customer's stepparents, if the
			 Customer is a minor child (under age 18).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.50 - Service Plan Content

Current through Register Vol. 48, No. 28, July 12, 2024
The HSP Service Plan shall include:
a) the type of services to be provided to the
			 Customer;
b) the specific tasks
			 involved;
c) the frequency with
			 which the specific tasks are to be provided;
d) the number of hours each task is to be
			 provided per month;
e) the rate of
			 payment for the services;
f) the
			 goals, including any personal goals, of the Customer and desired
			 outcomes;
g) for a Customer
			 receiving Individual Provider services, the number of Individual Providers that
			 are necessary to cover the weekly hours on the Service Plan as required by 89
			 Ill. Adm. Code
			 686.1520
			 and sufficient backup Individual Providers to cover those events when a
			 regularly-scheduled Individual Provider is unavailable or unable to provide
			 services required under 89 Ill. Adm. Code 686.1520;
h) the next planned date for redetermination
			 of eligibility; and
i) signatures
			 of the HSP counselor, the Customer, and each Individual Provider and/or agency
			 provider who is to deliver the services identified in the Service Plan. During
			 the COVID-19 Gubernatorial Disaster Proclamations, and subject to federal
			 approval, signatures may be obtained consistent with 89 Ill. Admin. Code
			 676.130(a).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.60 - Provision of Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Except
			 as provided in subsection (b) services shall not be provided to an eligible
			 individual when he/she is:
1)
			 hospitalized;
2) in a skilled
			 nursing facility or intermediate care facility;
3) not residing in his/her home or
			 non-institutional residence; or
4)
			 outside the State of Illinois.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.70 - Service Planning Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
a) For customers served under a Medicaid
			 Waiver program administered by DHS-DRS, all services listed on the Service Plan
			 must be necessary to meet an unmet care need of the individual or, for respite
			 cases, to provide relief to the caregiver, and must be within the SCM for the
			 DON score attained by the customer as a result of the determination or
			 redetermination of eligibility.
b)
			 Customers who cannot be served under the HSP waiver programs' SCM and who meet
			 the criteria established by HFS, may be eligible for an exceptional care rate
			 (89 Ill. Adm. Code
			 140.569(a)(2)
			 ). The monthly cost of these services provided through the Home Services
			 Program shall not exceed the exceptional care rate.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.80 - Interim Services

Current through Register Vol. 48, No. 28, July 12, 2024
Prior to determination of eligibility (see 89 Ill. Adm. Code
				682), the customer may receive interim services while an official determination
				of eligibility (see 89 Ill. Adm. Code 682) is being completed if enough
				information exists to presumptively establish eligibility based on:
a) DON score;
b) evidence of a disability as described at
			 89 Ill. Adm. Code
			 682.100(e)
			  based on medical documentation, counselor
			 observation, or oral information received from a knowledgeable medical
			 professional;
c) the customer's
			 financial eligibility, per 89 Ill. Adm. Code 682: Subpart C; and
d) the customer meeting all eligibility
			 criteria as listed in 89 Ill. Adm. Code 682.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.90 - Coordination of HSP and Other Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) No HSP services may be provided to an
			 individual who is a student under the age of 21 during the hours covered by the
			 individual's Individualized Education Plan (IEP). Services for which the
			 customer is determined eligible through HSP may be provided during the period
			 the customer is not receiving services through his/her IEP.
b) Customers receiving services through HSP
			 must, at the earliest possible date, apply for and accept, if eligible, all
			 other benefits which may affect HSP eligibility or services.
c) All individuals applying for HSP services
			 must apply for, and have an eligibility determination made for, Medicaid
			 benefits through DPA. Customers in an active service status prior to October 1,
			 1991, may choose to apply for Medicaid.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 684 - SERVICE PLANNING AND PROVISION › Section 684.100 - Denial or Termination of HSP Services

Current through Register Vol. 48, No. 28, July 12, 2024
HSP services shall be denied or terminated and case closure
				initiated at any time the Customer:
a)
			 moves from the State of Illinois or cannot be located or contacted;
b) is determined to have a projected service
			 cost above that of the projected cost of institutionalization, with the
			 exceptions found at 89 Ill. Adm. Code
			 682.520;
c) refuses services or further
			 services;
d) dies;
e) is institutionalized and not expected to
			 be released for a period to exceed 60 calendar days;
f) has been referred to another agency for
			 the same or similar services and no longer requires or is eligible for HSP
			 services;
g) fails to conduct
			 himself or herself in an appropriate manner (e.g., commits physical, sexual or
			 repeated verbal abuse against a DHS employee, provider or agent providing
			 services through HSP; knowingly provides false information; or performs illegal
			 activity that would have a direct and negative effect on the Home Services
			 Program);
h) is not, or is no
			 longer, at risk of institutionalization due to improvement of his or her
			 condition;
i) fails to meet other
			 eligibility criteria found at 89 Ill. Adm. Code 682 as a result of an initial
			 determination of eligibility or redetermination of eligibility;
j) fails to cooperate (e.g., refuses to
			 complete and sign necessary forms, fails to keep appointments, fails to
			 maintain adequate providers);
k)
			 cannot have a safe and adequate Service Plan developed for him or her as a
			 result of the original determination of eligibility or redetermination of
			 eligibility; or
l) fails to comply
			 with HSP requirements.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart A - PERSONAL ASSISTANTS › Section 686.20 - Services That May Be Provided by a PA

Current through Register Vol. 48, No. 28, July 12, 2024
A PA may perform or assist with:
a) household tasks, shopping, or personal
				care; and
b) incidental health care
				tasks that do not require independent judgement, with the permission of the
				customer and/or family; and
c)
				monitoring to ensure the health and safety of the customer.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart A - PERSONAL ASSISTANTS › Section 686.25 - Criminal Background Check

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
				Home Services Customer may require any PA candidate to submit to a criminal
				background investigation and to successfully complete a criminal background
				investigation as a condition of being selected as the PA to that
				Customer.
b) In the event that a
				customer elects to require a PA candidate to submit to a criminal background
				investigation, the customer shall be obligated only to inform DHS-Division of
				Rehabilitation Services (DRS) of his/her decision and DHS-DRS will provide the
				Customer an appropriate form that the Customer may file with the Illinois State
				Police to initiate the criminal background investigation. The results of the
				criminal background investigation will be sent directly to the customer, and
				the customer shall have no obligation to share the results of the investigation
				with DHS-DRS. Nothing contained in this Section shall restrict a customer from
				extending a conditional offer of employment to any PA candidate pending the
				results of the background investigation.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart A - PERSONAL ASSISTANTS › Section 686.30 - Annual Review of PA Performance

Current through Register Vol. 48, No. 28, July 12, 2024
a) Pursuant to
				686.10(k),
				annually, at the time of redetermination of the individual's eligibility, a
				Personal Assistant Evaluation (IL 488-2089) shall be completed, by the customer
				with assistance of the counselor, for each PA providing services through the
				Home Services Program (HSP).
b) PAs
				shall be evaluated based upon:
1) accuracy of
				work (e.g., ranging from making many errors to few errors);
2) cleanliness of working area (e.g., ranging
				from very untidy to exceptionally clean);
3) use of work time (e.g., ranging from very
				wasteful to very efficient);
4)
				responsibility (e.g., ranging from irresponsible to responsible);
5) attendance (e.g., ranging from frequently
				absent or late to always prompt); and
6) attitude towards the customer (e.g.,
				ranging from disrespectful to respectful).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart A - PERSONAL ASSISTANTS › Section 686.40 - Payment for PA Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) PAs
				shall be paid at the hourly rate set by law, but never less than the current
				federal minimum wage.
b) PAs shall
				be paid twice each month for services rendered. The first payment shall be for
				any services rendered by the PA, pursuant to the customer's Service Plan, from
				the first day of the month through the fifteenth day of the month. The second
				payment shall be for any services rendered by the PA, pursuant to the
				customer's Service Plan, from the sixteenth day of the month through the last
				day of the month.
c) No PA shall be
				reimbursed by DHS-DRS for services rendered to one or more HSP customers for
				more than 16 hours in a 24-hour period. The counselor may grant an exception
				should an emergency occur that results in the loss of a paid or unpaid primary
				caregiver who resides with the customer, and there is imminent danger to the
				health, safety and well being of the customer. When this occurs, the additional
				hours may not exceed the annual service cost maximum (SCM). The 16-hour
				limitation does not apply to PAs providing respite services.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart B - ADULT DAY CARE PROVIDERS › Section 686.110 - Services Which Must Be Provided by ADC Providers

Current through Register Vol. 48, No. 28, July 12, 2024
In order for an Adult Day Care Provider to be recognized by
				  DHS and used to provide services to individuals receiving services through HSP,
				  each Adult Day Care Center must agree to provide the following services:
a) written and individualized care
				planning;
b) assistance and
				arrangement of personal care, hygiene, and self-care training, as appropriate,
				based on each individual's needs;
c) leisure time and recreation
				activities;
d) assistance of a
				medical nature (e.g., medication, assessment, exercise);
e) meals and snacks; and
f) maintenance of a complete record for each
				individual served through the Adult Day Care Center, including full recording
				of all required services provided to the customer as listed in subsections (a)
				through (e), above.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart B - ADULT DAY CARE PROVIDERS › Section 686.120 - Compliance Review of ADC Providers

Current through Register Vol. 48, No. 28, July 12, 2024
a) DHS-DRS shall complete a review of each
				ADC Provider, at least every two years, to ensure compliance with the criteria
				set forth in this Subpart.
b) The
				review shall consist of an on-site review conducted by HSP staff using the
				Adult Day Care Review form (IL 488-2129). Written notification shall be
				provided to the ADC Provider prior to the review.
c) Within 15 days after the completion of the
				review, a copy of the completed IL 488-2129, along with a letter stating the
				results of the review, shall be mailed to the ADC.
1) If the ADC Provider is approved, included
				with the letter shall be an ADC Provider Rate Agreement for execution by the
				appropriate provider staff and return to DHS-DRS.
2) If the ADC Provider is not approved, the
				letter shall contain specific information regarding:
A) deficiencies found as a result of the
				review;
B) the action necessary for
				the ADC Provider to come into compliance;
C) the time frames within which the ADC
				Provider must come into compliance; and
D) the information necessary for the ADC
				Provider to request re-evaluation after the compliance issues are
				addressed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart B - ADULT DAY CARE PROVIDERS › Section 686.130 - Appeal of Compliance Review for ADC Providers

Current through Register Vol. 48, No. 28, July 12, 2024
a) ADC Providers determined not to be in
				compliance with DHS-DRS requirements as a result of the review may appeal the
				decision to the Bureau Chief of the Bureau of Home Services Program. The Bureau
				Chief shall conduct a review of the facts related to the rating and shall,
				within 15 working days, provide a written decision to the ADC
				Provider.
b) If the ADC Provider is
				not satisfied with the decision of the Bureau Chief, the ADC Provider may
				request review of the Chief's decision by the DHS-DRS Director. The request
				must be in writing from the ADC provider and received by the DHS-DRS Director
				within 10 working days after the date the decision was rendered by the Bureau
				Chief. The decision of the DHS-DRS Director shall be final.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart B - ADULT DAY CARE PROVIDERS › Section 686.140 - Payment for ADC Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) DHS
				shall pay no more than the rate approved by DoA for Adult Day Care Services.
				The rate established by DoA shall include meals, snacks, and, in some
				instances, transportation provided by the ADC Center.
b) Adult Day Care Providers shall submit
				monthly billings for approved services provided the previous month and progress
				reports for each customer served by the provider for the month being billed.
				Billings may be submitted less frequently at the discretion of the Adult Day
				Care Provider.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart C - HOMEMAKER SERVICES › Section 686.210 - Services That Must Be Provided by Homemaker Service Providers

Current through Register Vol. 48, No. 28, July 12, 2024
An approved Homemaker Service Provider must provide
				  professionally directed home management and personal care services through
				  trained Homemaker employees to HSP customers when the customer does not have a
				  responsible person or entity to assist him or her, and the customer requires
				  teaching, performance and/or assistance with:
a) household, financial and time
				management;
b) nutrition, meal
				planning and food preparation, which includes specially prescribed diets and
				snacks;
c) personal care and
				hygiene that is nonmedical in nature;
d) observation and reporting of a customer's
				behavior and activities to HSP for the purpose of assessment and service
				planning; and
e) emergency services
				to meet an unforeseen need in the areas listed in subsections (a) through (d)
				when required by the customer and preapproved by HSP.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart C - HOMEMAKER SERVICES › Section 686.220 - Compliance Review of Homemaker Service Providers

Current through Register Vol. 48, No. 28, July 12, 2024
HSP shall conduct a compliance review on all Homemaker
				  Service Providers as a condition of determining compliance, or continued
				  compliance, with the criteria established under this Subpart.
a) A Homemaker Service Provider seeking an
				HSP rate agreement shall undergo a compliance review as a condition of approval
				by HSP.
b) A Homemaker Service
				Provider with a current HSP rate agreement shall undergo a compliance review at
				least every two years as a condition of determining continued compliance under
				the program.
c) All Homemaker
				Service Providers with current HSP rate agreements shall be notified in writing
				by HSP, at least 10 working days prior to the date of the compliance
				review.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart C - HOMEMAKER SERVICES › Section 686.230 - Appeal Rights of Homemaker Service Providers

Current through Register Vol. 48, No. 28, July 12, 2024
a) Homemaker Service Providers not satisfied
				with a DHS program decision or an HSP compliance review, may submit an appeal
				request in writing to the Bureau Chief of the Home Services Program. Appeal
				requests must be filed within 30 days after the program decision or compliance
				review. The Bureau Chief shall conduct a review of the facts and shall, within
				15 working days, provide a written decision to the Homemaker Service
				Provider.
b) If the Homemaker
				Service Provider is not satisfied with the decision of the Bureau Chief, the
				Homemaker Service Provider may request review of the Bureau Chief's decision by
				the Director of DHS-DRS. The request must be in writing and received by the
				DHS-DRS Director within 10 working days after the date the decision was
				rendered by the Bureau Chief. The decision of the DHS-DRS Director shall be
				final.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart C - HOMEMAKER SERVICES › Section 686.235 - Enhanced Rate for Health Insurance Costs

Current through Register Vol. 48, No. 28, July 12, 2024
An enhanced rate shall be paid to Homemaker Service Providers
				  that offer health insurance coverage as a benefit to their Homemaker employees
				  who provide services to customers under HSP.
a) For purposes of this Section, "health
				insurance" means a Type 1 plan or a Type 2 plan as described in subsections
				(a)(1) and (2).
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 individuals
				  and group insurance policies and individual and group contracts for health
				  maintenance organizations under the Illinois Insurance Code [215 ILCS 5 ], the
				  Health Maintenance Organization Act [215 ILCS 125 ], and 50 Ill. Adm. Code
				  2001.
2) Type 2 Plan
A Type 2 plan is employer-paid health insurance as part of
				  collective bargaining with unionized Homemaker employees through a Taft-Hartley
				  Multi-employer Health and Welfare Plan. The Labor Management Relations Act of
				  1947 (
				  29 USC
				  141 et seq.) describes the requirements and
				  coverage at
				  29 USC
				  186(c)(5).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 686 - PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT › Subpart C - HOMEMAKER SERVICES › Section 686.240 - Payment Information for Homemaker Service Providers

Current through Register Vol. 48, No. 28, July 12, 2024
a) Payment information for all Homemaker
				Service Providers
1) Payment for Homemaker
				Services shall be at the rate specified in the rate agreement signed by HSP and
				the approved Homemaker Service Provider.
2) Services shall be paid in accordance with
				the time recorded by the Homemaker employee pursuant to the Service Plan (see
				89 Ill. Adm. Code
				676.30 ) developed
				for the customer.
3) Homemaker
				Service Providers shall submit monthly billings for approved services provided
				the previous month and monthly progress reports for each customer served by the
				Homemaker Service Provider for the month being billed.
4) Payment for Homemaker Services shall be
				allowed only for those hours services are being provided to the HSP customer.
				No payment shall be claimed for those periods that the Homemaker employee
				spends traveling, in conferences, etc., or for expenses incurred by the
				Homemaker employee.
5) By accepting
				any payment under HSP, a Homemaker Service Provider agrees to repay the State
				of Illinois if:
A) the total revenue from the
				monthly billings exceeds the actual, approved documented services under this
				Section for the reporting period;
B) an error occurred in the calculation of
				the monthly billing submitted to HSP and the provider was overpaid;
C) the Homemaker Service Provider received
				payment for services during a time the provider was determined ineligible to
				provide services under HSP; or
D)
				the Homemaker Service Provider misspent HSP funds or received funding from HSP
				while participating in fraudulent activity.