Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 676 - PROGRAM DESCRIPTION › Subpart A - GENERAL PROGRAM PROVISIONS › Section 676.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purposes of this Subchapter, unless otherwise stated,
				  the following terms shall have the following meanings.
Activities of Daily Living or ADLs - those tasks an
				  individual must do, or that an individual must have provided for them, in order
				  to prevent institutionalization (i.e., bathing, dressing, shopping, cooking,
				  housekeeping, etc.).
Brain Injury - conditions including traumatic brain injury,
				  infection (encephalitis, meningitis), anoxia, stroke, aneurysm, electrical
				  injury, malignant neoplasm, and toxic encephalopathy. Congenital disabilities
				  such as cerebral palsy or epilepsy are not eligible diagnoses, nor are
				  degenerative or neurological disorders due to aging, such as dementia or
				  Parkinson's or Alzheimer's Disease.
Brain Injury Habilitation Assessment - assessment that
				  incorporates the results of neuropsychological, occupational therapy, and/or
				  other appropriate clinical evaluations; this assessment reviews a brain injury
				  Customer's ability to independently and safely complete activities for daily
				  living. This does not replace or duplicate the current HSP eligibility
				  assessment tool (DON).
CMMS - the federal Centers for Medicare & Medicaid
				  Services (formerly HCFA, the federal Health Care Financing
				  Administration).
Customer
A Customer is anyone who:
has been referred to HSP for a determination of eligibility
				  for services;
has applied for services through HSP;
is receiving services through HSP; or
has received services through HSP.
If the Customer is unable to satisfy some or all of their
				  obligations under the HSP, including, without limitation, the obligation to
				  serve as the employer of the IP or PA, the Customer's parent, family member,
				  guardian, or duly authorized representative may act on behalf of the Customer
				  and is included within the definition of "Customer," as used throughout this
				  Part.
For purposes of the IP or PA services performed pursuant to
				  the HSP, the Customer shall serve as the employer of the IP or PA. In this
				  capacity, the Customer is responsible for aspects of the employment
				  relationship between the Customer and the IP or PA, including, without
				  limitation, locating and hiring the IP or PA, training the IP or PA, directing,
				  evaluating and otherwise supervising the work performed by the IP or PA,
				  imposing (when, in the opinion of the Customer, it is appropriate or necessary)
				  disciplinary action against the IP or PA, and terminating the employment
				  relationship between the Customer and the IP or PA.
Collective Bargaining Agreement (CBA) - A signed agreement
				  between the union representing Individual Providers and the State of Illinois
				  as a result of a negotiation regarding topics such as wages, hours, and terms
				  and conditions of employment by the Customer. The current CBA is published on
				  the Illinois Department of Central Management Services' Website.
Counselor - the DHS-DRS staff person or contractual Case
				  Manager who helps to ensure that the funds available under the HSP are properly
				  distributed in accordance with the Service Plan, any applicable waiver
				  programs, and all applicable laws.
Determination of Need or DON - the assessment tool used to
				  determine an individual's non-financial eligibility for HSP services based on
				  the individual's impairment and need for care. This form measures the level of
				  risk of institutionalization for the individual.
DHS - Illinois Department of Human Services.
Electronic Visit Verification (EVV) System - an electronic
				  system that records authorized HSP services were performed, the Customer
				  received the services, the location of the service delivery, the worker
				  performing the service, and the precise time the service begins and
				  ends.
Electronic Visit Verification Identification Number or EVV ID
				  - a unique identification number that is assigned to each Service Provider for
				  use with the HSP EVV system. Service Providers enter their unique EVV ID each
				  time they record their time in or out of the EVV system.
Family - anyone related by blood, marriage, or adoption to
				  the individual seeking services through HSP or anyone with whom the individual
				  has a close inter-personal relationship and who resides with the
				  individual.
Family Unit - for the purposes of determining financial
				  eligibility, the number of persons derived when counting the individual seeking
				  services through HSP and the number of persons in the household who are legally
				  responsible for the individual seeking services and for whom the individual
				  seeking services is legally responsible.
HFS - Illinois Department of Healthcare and Family
				  Services.
Home Services Program or HSP - a State and federally funded
				  program designed to allow Illinois residents, who are at risk of unnecessary or
				  premature institutionalization, to receive necessary care and services in their
				  homes, as opposed to being placed in an institution.
Home - a private residence where the Customer lives that is
				  not an intermediate care or skilled nursing facility as defined at 77 Ill. Adm.
				  Code 300, or a residential program operated by, or for which funding is
				  provided by, the Illinois Department of Human Services, Division of Mental
				  Health and Division of Developmental Disabilities as defined at 59 Ill. Adm.
				  Code 120. For the purposes of this Subchapter, the term "home" shall include
				  domestic violence shelters as defined in Section 1(c) of the Domestic Violence
				  Shelter Act [20 ILCS
				  2210/1(c)] and publicly or privately
				  administered shelters designed to provide temporary living accommodations for
				  persons who are homeless.
Individual Provider or IP - an individual selected, employed,
				  and supervised by the Customer to provide varied services that are identified
				  on the Customer's approved HSP Service Plan. An Individual Provider may be a
				  Personal Assistant, Registered Nurse, Licensed Practical Nurse, Certified
				  Nursing Assistant, Occupational Therapist, Physical Therapist or Speech
				  Therapist.
Intermediate Care Facility or ICF - a nursing facility that
				  provides regular health related care to its residents, as well as those
				  services necessary for safe and adequate living.
Legally Responsible Family Member - a spouse, parent of a
				  child who is under age 18 or a legal guardian of an individual who is under age
				  18.
Medicaid - the Medicaid program administered by HFS under the
				  Public Aid Code [305 ILCS 5/11].
Medicaid Waiver - the waiver allowing HSP to claim federal
				  reimbursement for approved levels of in-home care for individuals who would
				  otherwise be placed in institutions for that care. The Medicaid Waiver is
				  overseen at the federal level by CMMS.
Non-Waivable Conviction - Criminal convictions listed within
				  the current Collective Bargaining Agreement Provider Screening Policy for which
				  the Customer may not consent to working with an Individual Provider with a
				  criminal history.
Overtime - the time worked by an Individual Provider for an
				  HSP Customer or Customers that exceeds 40 hours in a work week.
Pay Period - a semi-monthly period that runs from either the
				  first day of the month through the 15th day of the
				  month or from the 16th day of the month through the
				  last day of the month.
Personal Assistant or PA - an individual employed by the
				  Customer to provide varied HSP services as described in 89 Ill. Adm.
				  686.20. A personal assistant may
				  also be referred to as an Individual Provider.
Personal Assistant or Individual Provider Backup Plan - the
				  plan developed by the Customer and designed to ensure that the Customer
				  receives the necessary care and services under the HSP in the event that the
				  Customer's regular PA or IP is unavailable or unwilling to perform their
				  obligations under the HSP. The Customer is responsible for designating the
				  backup personal assistant or backup Individual Provider.
Person-Centered Planning ( PCP) - a service planning process
				  directed by the Customer or their representative that is intended to identify
				  the Customer's strengths, capacities, preferences, needs, and desired outcomes.
				  PCP includes participants freely chosen by the Customer who assist in
				  identifying and accessing a personalized mix of services and supports in an
				  inclusive community setting.
Physician - a Doctor of Medicine (M.D.) or Doctor of
				  Osteopathy (D.O.) licensed pursuant to the Medical Practice Act [225 ILCS
				  60].
Prescreening - an assessment to determine an individual's
				  need for institutional care at the ICF or SNF level and to ensure Medicaid
				  payment for such a placement is appropriate, and the assessment of whether HSP
				  services are an appropriate alternative to institutional care for the
				  individual.
Revalidation - The process whereby a person or entity
				  currently enrolled in the Illinois Medicaid Program Advanced Cloud Technology
				  (IMPACT) verifies and updates their enrollment information on file in
				  accordance with 89 Ill. Adm. Code
				  140.11 and
				  42 CFR
				  455.414.
Service Cost Maximum or SCM - the maximum monthly amount that
				  may be expended for HSP services for an eligible individual. This amount is
				  determined based on the individual's DON score and the specific programmatic
				  component of HSP through which the individual is being served.
Service Plan - specifically, the Home Services Program
				  Service Plan (IL 488-1049), Home Services Program Service Plan Addendum (IL
				  488-1050) or the Interim Agreement (IL 488-2344) forms, on which all services
				  to be provided to an individual through HSP are listed. The Service Plan is
				  developed with the individual's consent and participation.
Service Provider - an individual or agency, defined within 89
				  Ill. Adm. Code 676.40, approved to provide
				  services that are identified on the Customer's approved HSP Service Plan. A
				  Service Provider may be a Maintenance Home Health Agency, Homemaker Agency,
				  Personal Assistant/Individual Provider, Registered Nurse, Licensed Practical
				  Nurse, Certified Nursing Assistant, Occupational Therapist, Physical Therapist,
				  or Speech Therapist.
Services - the necessary tasks provided to an individual, in
				  one or more of the areas listed in Section
				  676.40 and listed on the
				  individual's Service Plan, through HSP with the intent of preventing the
				  unnecessary institutionalization of the individual.
Skilled Nursing Facility or SNF - a facility that provides
				  regular and on-going nursing level care to its residents due to the residents'
				  medical conditions, as well as those services necessary for safe and adequate
				  living.
Task Identification Number or Task ID - a number which
				  identifies an HSP service. A Task ID is entered by a Service Provider when the
				  Service Provider calls out of the EVV system.
Travel Time - the time an Individual Provider spends
				  traveling between two or more different HSP Customers addresses on the same
				  workday.
An IP will not be paid travel time for any trip to or from
				  their home; if an IP lives with an HSP Customer, the IP cannot be paid for
				  travel time to another Customer's home if the trip begins or ends at the IP's
				  home.
Travel time does not include the time an IP spends traveling
				  on personal business between Customer work visits (e.g., lunch, breaks,
				  errands, etc.).
Waivable Conviction - Criminal convictions listed within the
				  current Collective Bargaining Agreement Provider Screening Policy where the
				  Customer may consent to working with an Individual Provider with a criminal
				  history.
Work Week - a work week begins each Sunday at 12:00 a.m.
				  (midnight) and ends each Saturday at 11:59 p.m.