Section 240.1020  Interim Services

Interim services are Community Care Program (CCP) services provided to individuals age 60 and over on an interim basis, dependent upon the applicant's presumptive eligibility and following prescreening of the applicant.

a)         Presumptive eligibility shall be based upon the following criteria:

1)         an application has been completed by an individual age 60 or over, or by the individual's authorized representative, following prescreening.

2)         Notification has been received by the Case Coordination Unit (CCU) from a hospital or from an individual or agency in the community that the applicant is at imminent risk of nursing facility placement within 3 work days.

3)         A Physician, Nurse Practitioner, Registered Nurse, or Christian Science Practitioner has certified in writing that the applicant is unable to remain safely in his/her home without the provision of in-home or community-based services and is, therefore, at imminent risk of nursing facility placement within 3 work days.  The Physician, Nurse Practitioner, Registered Nurse, or Christian Science Practitioner further certifies that the proposed CCP plan of care will enable the applicant to remain at home safely.

4)         The Determination of Need (DON) has been administered and the applicant has received the minimum required score of 15 points on Part A and a total score of at least 29 points on the DON.

5)         The applicant has provided declared information on all other CCP eligibility requirements.

6)         The Interim Client Agreement has been fully executed, the applicant has completed a Client's Vendor Selection form in accordance with Section 240.330, and the vendor has been notified.

7)         The determination of presumptive eligibility shall be completed and the vendor notified within 3 work days from the date of receipt of the completed application (or notice of the completion of the application) by the CCU.

b)         When presumptive eligibility has been determined and interim services are approved in accordance with the plan of care, services shall be initiated by the vendor to the applicant within 2 work days from the date of notification to the vendor of the applicant's presumptive eligibility.

c)         A DON shall be administered in the home of the applicant by the CCU within 15 calendar days from the date of discharge of the applicant from a hospital, or notification by an individual or agency in the community that the applicant is at imminent risk of institutionalization.  The formal determination of eligibility for CCP services shall be completed within 90 calendar days from the date of receipt of the completed application (or notice of the completion of the application) by the CCU.

d)         Interim services may continue up to a maximum of 90 calendar days from the date of application pending finalization of the formal determination of eligibility by the CCU. Services shall be denied at any time during the 90 calendar day interim service period:

1)         if evidence of ineligibility, based upon any eligibility requirement, is determined; or

2)         if the applicant fails to cooperate in the determination of eligibility process; or

3)         as specified in Section 240.660, in the event that an applicant's eligibility cannot be determined due to the applicant's failure to provide reasonable documentation (factual information to substantiate provided information when provided information is contradictory or not specific) within 90 calendar days from the date of receipt of the completed application (or notice of the completion of the application) by the CCU; or

4)         if a plan of care cannot be developed which adequately meets the applicant's determined needs (see Section 240.920(n)).

e)         Notification of eligibility or ineligibility shall be provided in writing.  If eligibility is denied, provision of interim services shall cease on the date of receipt by the vendor of the Case Action Notice.

(Source:  Amended at 19 Ill. Reg. 16031, effective November 20, 1995)