Section 240.350  Applicant/Client/Authorized Representative Cooperation

 

Applicant(s)/client(s)/authorized representative(s) shall cooperate with the representatives of the Department/Case Coordination Units (CCUs)/providers in determinations of eligibility or provision of Community Care Program (CCP) services.

 

a)         Failure to cooperate in the actions specified below shall be considered non-cooperative and shall be cause for suspension.

 

1)         A client/authorized representative shall notify the office of the provider at least one day in advance when the client will not be present in his/her home to receive scheduled services.

 

A)        If the client's absence from his/her home on a day services are scheduled is due to an emergency, the client/authorized representative shall advise the office of the provider as quickly as possible and it will not be considered non-cooperative.

 

B)        The provider shall document the absences of the client without prior notification thereof (except any absence caused by an emergency) and shall be reimbursed by the Department for 2 such absences (refer to Section 240.210).

 

C)        Two such documented absences within a State fiscal year shall be cause for suspension of the client's services pending termination.  The provider has the option of not reporting non-cooperative absences; however, if the second non-cooperative absence is reported with request for reimbursement, suspension procedures shall be implemented.

 

D)        The provider shall verbally advise the CCU on the same day, if possible, but not later than the next work day from the date of the second non-cooperative absence.  A written report including, at a minimum, the names of the client and the worker, and the dates of the first and second non-cooperative absence, shall be mailed by the provider to the CCU within 2 work days from the date of the second non-cooperative absence.

 

E)         Upon receipt of verbal notification of the second documented non-cooperative absence within a State fiscal year, the CCU shall suspend the client's services as required in Section 240.930.  The date of suspension shall be the date that the second non-cooperative absence occurred.

 

2)         A client/authorized representative shall notify the office of an adult day care provider at least 1 day in advance when the client will not be attending the adult day care site or will not be in need of transportation to or from the adult day care site, as scheduled and required by the plan of care.

 

A)        If the client's absence from the adult day care site or refusal to accept transportation to the adult day care site is due to an emergency, the client/authorized representative shall advise the office of the provider as quickly as possible and it will not be considered non-cooperative.

 

B)        The provider shall document the client's absence or refusal to accept transportation without prior notification thereof (except any absence caused by an emergency) and shall be reimbursed by the Department for 2 such absences or refusals (refer to Section 240.230).

 

C)        Two such documented absences or refusals within a State fiscal year shall be cause for suspension of the client's services pending termination.  The provider has the option of not reporting non-cooperative absences; however, if the second non-cooperative absence is reported with request for reimbusement, suspension procedures shall be implemented.

 

D)        The provider shall verbally advise the CCU on the same day, if possible, but not later than the next work day from the date of the second non-cooperative absence or refusal.  A written report including, at a minimum, the names of the client and the worker and the dates of the first and second non-cooperative absence or refusal, shall be mailed by the provider to the CCU within 2 work days from the date of the second non-cooperative absence or refusal.

 

E)         Upon receipt of verbal notification of the second documented non-cooperative absence or refusal within a State fiscal year, the CCU shall suspend the client's adult day care service (including transportation if specified in the plan of care) as required in Section 240.930.  The date of suspension shall be the date that the second non-cooperative absence or refusal occurred.

 

3)         A client/authorized representative shall not refuse to allow the provider into the client's home to provide services.

 

A)        The provider shall document the refusal to allow services to be provided and  shall be reimbursed by the Department for 2 such refusals (refer to Section 240.210).

 

B)        Two such documented refusals within a State fiscal year shall be cause for suspension of the client's services pending termination.  The provider shall verbally advise the CCU on the same day, if possible, but not later than the next work day from the date of the second refusal. A written report including, at a minimum, the names of the client and the worker and the dates of the first and second refusal, shall be mailed by the provider to the CCU within 2 work days from the date of the second refusal.

 

C)        Upon receipt of verbal notification of the second documented refusal within a State fiscal year, the CCU shall suspend the client's services as required in Section 240.930.  The date of suspension shall be the date that the second refusal to allow service occurred.

 

4)         A client/authorized representative shall not interfere with provision of the services specified in the plan of care, either in the client's home or in any adult day care site.

 

A)        The provider shall document the interference with provision of the services specified in the plan of care as stated above.

 

B)        Two such documented instances of interference within a State fiscal year shall be cause for suspension of the client's services pending termination.  The provider shall verbally advise the CCU on the same day, if possible, but not later than the next work day from the date of the second occurrence.  A written report including, at a minimum, the names of the client and the worker and the dates of the first and second occurrence, shall be mailed by the provider to the CCU within 2 work days from the date of the second occurrence.

 

C)        Upon receipt of verbal notification of the second documented occurrence of interference within a State fiscal year, the CCU shall suspend the client's services as required in Section 240.930.  The date of suspension shall be the date of the second occurrence of interference occurrence.

 

5)         An applicant/client/authorized representative or any family member/friend/acquaintance of the applicant/client/authorized representative shall not threaten or act abusively (e.g., physical, verbal, sexual, etc.) or display a weapon (e.g., gun, knife, etc.) against any representative of the Department, CCU or provider who is present in the applicant's/client's home or at an adult day care site.  The applicant/client/authorized representative shall be responsible for any animal present in the home of the applicant/client and shall prevent said animal from physically harming a representative of the Department/CCU/provider.

 

A)        If the threat or abuse takes place in a applicant's/client's home, the party who has been threatened or abused shall leave the premises immediately and verbally advise the CCU on the same day, if possible, but not later than the next work day.

 

B)        If the threat or abuse takes place in an adult day care site, the family/authorized representative shall be advised immediately and the CCU shall verbally be advised on the same day, if possible, but not later than the next work day.

 

C)        A written report including, at a minimum, the name of the client and the in-home worker/adult day care site worker, and the date and details of the threat or abuse, shall be mailed by the provider to the CCU within 2 work days from the date that the threat or abuse occurred.

 

D)        Upon receipt of verbal notification of threat or abuse, the CCU shall, on the same day, if possible, but not later than the next work day:

 

i)          suspend a client's services in the client's home and/or at an adult day care site, as required in Section 240.930; or

 

ii)         suspend an applicant's determination of eligibility process as required in Section 240.930.

 

E)         The date of suspension shall be the date that the threat or abuse occurred.

 

6)         The CCU shall notify the applicant/client/authorized representative and the provider of the suspension in accordance with Section 240.930(c) and (d).

 

7)         The CCU shall develop a memorandum of understanding between the applicant/client/authorized representative of the CCU and the provider, in accordance with Section 240.930(e).

 

8)         Upon the execution of the memorandum of understanding, the client's services or the applicant's determination of eligibility process, as appropriate, shall be reinstated in accordance with Section 240.930(f).

 

9)         Failure to sign a memorandum of understanding shall be grounds for termination or denial, as appropriate.

 

10)         If, following reinstatement, the requirements of the memorandum of understanding have not been adhered to by the applicant/client/authorized representative, the application shall be denied or services shall be terminated, as appropriate.

 

11)         Notification of denial or termination shall be in accordance with Sections 240.910 or 240.945, as appropriate.

 

b)         Failure to cooperate in the actions specified below shall be considered non-cooperation and shall be cause for denial of an application or termination of service, as appropriate.

 

1)         An applicant/client/authorized representative or any family member/friend/acquaintance of the applicant/client/authorized representative shall not inflict physical injury upon any representative of the Department, CCU or provider, either in the applicant's/client home or while the client is attending an adult day care site.

 

A)        If the infliction of physical injury takes place in the applicant's/client's home, the injured party shall leave the premises immediately and verbally advise the CCU on the same day, if possible, but not later than the next work day.

 

B)        If the infliction of physical injury takes place in an adult  day care site, the family/authorized representative shall be advised immediately and the client shall be removed immediately.  The CCU shall verbally be advised on the same day, if possible, but not later than the next work day.

 

C)        A written report including, at a minimum, the names of the client and the worker/adult day care site worker, and the date and details of the infliction of physical injury, shall be mailed by the provider to the CCU within 2 work days from the date that the physical injury was inflicted.

 

D)        Upon receipt of verbal notification of physical injury the CCU shall, on the same day, if possible, but not later than the next work day:

 

i)          institute immediate denial of application or termination of services.  The effective date of denial or termination shall be the date that the infliction of physical injury occurred;

 

ii)         verbally notify the applicant/client/authorized representative of the denial or termination.  Written notification shall be sent by certified mail to the applicant/client/authorized representative, and by regular mail to the provider within 5 calendar days from the date of the verbal notification; and

 

iii)         verbally notify the Department of the denial or termination followed by a written report within 5 calendar days from the date of the verbal notification.

 

2)         Applicant(s)/client(s)/authorized representative(s) shall provide assistance in securing documentation and/or factual information to be utilized in the determination of initial and continuing eligibility for Community Care Program (CCP) services, as well as the type, level and amount of services to be provided.  Refusal to provide the specified assistance needed shall be cause for denial of an application or termination of a client's services as appropriate.

 

3)         Applicant(s)/client(s)/authorized representative(s) shall provide a mailing address, including sufficient information to enable the Department/CCU/provider to locate the applicant/client/authorized representative (i.e., the name, address and telephone number of a contact through whom the applicant/client may be located, or it may be necessary to provide directions to the applicant's/client's home).  Refusal to provide the specified assistance needed shall be cause for denial of an application or termination of a client's services as appropriate.

 

4)         Notification of denial or termination shall be in accordance with Section 240.910 or 240.945 except as specified in subsection (b)(1)(D) above.

 

(Source:  Amended at 18 Ill. Reg. 609, effective February 1, 1994)