Section 676.30 Definitions
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.
(Source: Amended at 46 Ill.
Reg. 20840, effective December 19, 2022)
 |
TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.40 SERVICE DESCRIPTION
Section 676.40 Service
Description
The following is a listing of
the services available through HSP. The service level, combination of
services, and amount of services for which a customer is eligible is dependent
upon the needs of the customer as identified during the determination of eligibility
(see 89 Ill. Adm. Code 682).
a) Personal Assistant (PA) Services – services provided by an
individual employed by the customer.
b) Adult Day Care (ADC) Services – direct care and monitoring of
customers in a community-based setting for any portion of a 24-hour day for the
purpose of promoting social, physical, and emotional health and well-being and
offering an alternative to an institutional setting. ADC services are provided
only when the social, emotional, and physical needs of the customer cannot be
met in the home through other available services.
c) Homemaker Services – general support provided by trained and
professionally supervised individuals to maintain, strengthen, and safeguard
the functioning of an individual in his/her home when no responsible person is
available or capable of monitoring those services. Homemaker services include
the actual completion of, and the training in, completion of ADLs.
d) Maintenance Home Health Services – services provided for a
customer, in his/her home, that are prescribed or recommended by a physician or
other health care professional. These services include three basic categories
of care, which are:
1) direct health care provided by a registered nurse (RN) and/or
a licensed practical nurse (LPN);
2) direct health care provided by a Certified Nurse Aid (CNA) who
is supervised by an RN or LPN; and
3) in-home therapy, including the areas of physical, occupational
and speech therapy.
e) Home Delivered Meals – prepared food brought to the customer's
home. Usually, home delivered meals consist of a hot lunch and a smaller
dinner meal that may be refrigerated and eaten later. These services are
provided when available and when they are more cost effective than PA services
for an eligible individual who has a need for care in the area of meal
preparation but who can adequately feed him/herself.
f) Electronic Home Response Services (EHRS) – a 24-hour per day
emergency communication link to assistance outside the customer's home for
customers who have no other persons available for assistance should an
emergency arise.
g) Assistive Equipment – items necessary to accommodate the
customer's loss of function in the completion of his/her Activities of Daily
Living (ADLs). This does not include medical supplies, disposable personal
hygiene items, or items necessary for medical treatment. (See 89 Ill. Adm.
Code 686, Subpart H.)
h) Environmental Modification – services to physically modify the
customer's home to accommodate the customer's loss of function in the
completion of his/her ADLs. (See 89 Ill. Adm. Code 686, Subpart G.)
i) Respite Services – limited PA, Homemaker, and Maintenance
Home Health services provided to a customer to provide for the customer's ADLs
during periods of time it is necessary for the family/primary care giver to be
absent. Respite services are provided to a customer to allow the
family/primary care giver relief for vacations, rest, errands, family crises
and emergency situations. Respite services are provided in the maximum amount
of 240 hours per calendar year and are provided regardless of financial need.
During the COVID-19 Gubernatorial Disaster Proclamations, and subject to
federal approval, customers who exhaust 240 hours as a direct result of the
COVID-19 pandemic may have additional respite hours added to the Service Plan,
dependent upon the customer's needs and availability of customer's unpaid
caregiver, up to a maximum of 240 additional hours per calendar year. Any
additional Service Plan hours under this subsection are subject to the advance
approval of the Counselor or Managed Care Organization Care Coordinator.
j) Day Habilitation Services – assistance provided to a person
with a brain injury to assist with the acquisition, retention and improvement
in self-help, socialization and adaptive skills. These services are provided
in a setting separate from the residence in which the customer is residing.
k) Pre-Vocational Services – services provided to a person with a
brain injury that are aimed at preparing the individual for paid or unpaid
employment but are not job task oriented. Specific services include teaching
concepts such as compliance, attendance, task completion, problem solving and
safety.
l) Supported Employment Services – services provided to a
customer with a brain injury that consist of paid employment for persons for
whom competitive employment is unlikely, when the customer, because of his/her
disabilities, needs intensive, ongoing support to perform in a work setting.
Supported employment includes, but is not limited to, activities needed to
sustain the customer in supported employment (i.e., supervision and training).
m) Behavioral Services – remedial therapies provided to a person
with a brain injury to decrease the individual's severe maladaptive behaviors.
These services are intended to enable the customer to better manage his or her
behavior and to make the customer more capable of living independently.
(Source: Amended at 45 Ill.
Reg. 10034, effective July 22, 2021)
SUBPART B: CASE MANAGEMENT
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.100 CASE FILES (REPEALED)
Section 676.100 Case Files
(Repealed)
(Source: Repealed at 23 Ill. Reg. 6445, effective May 17, 1999)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.110 SHARING OF CUSTOMER INFORMATION BETWEEN HSP AND OTHER DHS PROGRAMS
Section 676.110 Sharing of
Customer Information Between HSP and Other DHS Programs
a) All information received by DHS-ORS for the purpose of
providing HSP services to a customer shall only be used for such purposes and
may not be shared with any other program of DHS unless the individual consents
to the release of such information and a release of information is signed by
the customer authorizing the release.
b) No information may be obtained from a case file of another
program of DHS by HSP for the purposes of providing services to a customer
unless the customer consents to the release of such information and a release
of information is signed by the customer authorizing the release. DHS-ORS
shall only release information pursuant to the Health Insurance Portability and
Accountability Act (42 USC 1320(d) et seq.) and the regulations promulgated
thereunder.
(Source: Amended at 28 Ill.
Reg. 6445, effective April 8, 2004)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.120 DOCUMENTATION OF INFORMATION
Section 676.120
Documentation of Information
All records and information
which may effect the determination of eligibility, services, or future services
must be maintained in the customer's case file.
(Source: Amended at 23 Ill. Reg. 6445, effective May 17, 1999)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.130 CUSTOMER SIGNATURES AND INFORMATION REQUIRED TO RECEIVE SERVICES UNDER THE HSP
Section 676.130 Customer
Signatures and Information Required to Receive Services Under the HSP
a) In order to receive services, or continue to receive HSP
services, for which DHS-DRS would pay on behalf of the customer, a customer is
required to sign all forms, and supply any information required to complete
those forms, which are necessary to comply with all applicable State and
federal laws or the provisions of the Medicaid Waiver or are necessary to
process payments through the Comptroller's Office. During the duration of
Executive Order 2020-20 and any subsequent re-issuance and extension, and
subject to federal approval, with respect to any DHS-DRS forms, where a
signature cannot be expeditiously obtained due to the COVID-19 pandemic and
associated social distancing, customers may take the following actions which
will constitute a signature for immediate purposes:
1) Provide electronic approval or digital signature in writing
via fax, email, or similar method of program-approved submission; or
2) Provide
verbal assent by telephone, constituting a telephonic signature.
b) Consistent with its obligation to ensure that the HSP funds
are properly distributed, the Department shall have the authority to develop
sample forms that may be used as guidance to the customer in the exercise of
his/her obligations under the HSP. Except as required by law or specific
provisions of the HSP, the customer is not obligated to use such sample forms
and may deviate from or alter such sample forms.
c) A customer employing a personal assistant is required to enter
into an Employment Agreement with his/her personal assistant to confirm their
understanding of the nature of the employment relationship involved and the
extent of control that the customer retains over the services performed by the
personal assistant, as prescribed by 89 Ill. Adm. Code 686.10.
(Source: Amended at 45 Ill. Reg. 10034,
effective July 22, 2021)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.140 APPLICATION BY DHS-ORS EMPLOYEES, INDIVIDUALS HOLDING CONTRACTS WITH DHS-ORS, DHS-ORS ADVISORY COUNCIL MEMBERS, FAMILY MEMBERS OF DHS-ORS EMPLOYEES, OR CLOSE FRIENDS OF DHS-ORS EMPLOYEES
Section 676.140 Application
by DHS-ORS Employees, Individuals Holding Contracts with DHS-ORS, DHS-ORS
Advisory Council Members, Family Members of DHS-ORS Employees, or Close Friends
of DHS-ORS Employees
a) At any time a DHS-ORS employee, an individual holding a
contract with DHS-ORS, a DHS-ORS Advisory Council member, a family member of a
DHS-ORS employee, or a close friend of a DHS-ORS employee applies for services
from DHS-ORS, and it is brought to the attention of the counselor, the
counselor must notify his/her supervisor who shall notify the Home Services
Administration in writing.
b) After review of the situation, the Home Services
Administration shall make assignment of the case to an appropriate staff member
to ensure propriety of services.
c) For the purposes of this Section, "family member"
shall mean spouse, sibling, child, parent, parent-in-law, sibling-in-law, or
any other blood relative who resides in the household of the employee or
employee's spouse.
d) For the purpose of this Section, "close friend"
shall mean any individual who has such a relationship with the employee that
would cause a conflict of interest or the appearance of impropriety.
e) Any employee who knows of or suspects that services to another
DHS-ORS employee, individual who holds a contract with DHS-ORS, DHS-ORS
Advisory Council member, family member of a DHS-ORS employee, or close friend
of a DHS-ORS employee have not been reported as required in subsection (a),
above, shall report the situation to his/her immediate supervisor. The
immediate supervisor must investigate the situation and take appropriate
action. Appropriate action may include reassignment of the case and discipline
of the employee violating these requirements if there is evidence the employee
knew the individual to be an individual described in subsection (a), above, and
failed to report the situation.
(Source: Amended at 23 Ill. Reg. 6445, effective May 17, 1999)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.150 GEOGRAPHIC CASE ASSIGNMENT
Section 676.150 Geographic
Case Assignment
A customer will be served by the
office which is assigned the geographic area of the customer's residence.
Exceptions to such assignment may be made only with the written approval of the
Home Services Program, Chief of the Bureau of Field Operations.
(Source: Amended at 23 Ill. Reg. 6445, effective May 17, 1999)
SUBPART C: VENDOR PAYMENT
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.200 VENDOR PAYMENT
Section 676.200 Vendor
Payment
Because HCFA regulations (42 CFR
447.10(d)) prohibit re-assignment of provider claims, no payment will be made
directly to any customer of the HSP. In order to ensure that HSP funds are
administered properly, no payment, on behalf of any customer, will be made to
any vendor unless the services for which the payment is to be made were
approved by DHS-HSP. No payment, on behalf of any customer, shall be made
until after service has been rendered and verified.
(Source: Amended at 23 Ill. Reg. 6445, effective May 17, 1999)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.210 REPORTING AND COLLECTION OF MISSPENT FUNDS
Section 676.210 Reporting
and Collection of Misspent Funds
Any funds authorized through HSP
thought to have been misspent shall be reported and collected, as appropriate
pursuant to DHS rules found at 89 Ill. Adm. Code 527 - Misspent Funds.
SUBPART D: REFERRAL TO DEPARTMENT ON AGING DoA
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.300 CRITERIA FOR REFERRAL TO DOA
Section 676.300 Criteria for
Referral to DoA
In accordance with the
provisions of the interagency agreement between DHS and DoA, individuals
meeting the following criteria shall be referred to DoA to receive services
through DoA's Community Care Program (CCP) and their HSP cases closed after the
initiation of CCP services. These individuals are those who:
a) are at least 60 years of age at the time of the referral to
DoA;
b) are receiving only homemaker services, adult day care
services, home delivered meals, or any combination of these services;
c) have a DON score of at least 15 points on Part A, which
includes the 10 points from the Mini-Mental Status Examination (89 Ill. Adm.
Code 679.20(a)), if applicable, with a total score of not less than 29 points;
and
d) have agreed to being referred to DoA to receive services.
(Source: Amended at 21 Ill. Reg. 2678, effective February 7, 1997)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 676
PROGRAM DESCRIPTION
SECTION 676.310 DISPOSITION OF CASES NOT APPROPRIATE FOR REFERRAL TO DOA
Section 676.310 Disposition
of Cases not Appropriate for Referral to DoA
Any customer not meeting the
criteria for referral to DoA stated in Section 676.300 shall have his/her case
maintained by DHS and shall continue to receive services through HSP as long as
he/she continues to meet the eligibility criteria established by DHS.
(Source: Amended at 23 Ill. Reg. 6445, effective May 17, 1999)
|
|
|
|
|
|
|
|
|
|
|
