Section 677.10  Assurance of Customer Rights

 

The Department shall assure that Customers receive an explanation of their rights.  A copy of the HSP Customer Bill of Rights shall be provided to all Customers during the initial determination of eligibility, at the annual redetermination of eligibility, change in services, case closure, and upon request by the Customer.

 

(Source:  Amended at 46 Ill. Reg. 20850, effective December 19, 2022)

 

Section 677.20  Nondiscrimination

 

DHS shall not discriminate against any customer seeking or receiving services through HSP on the basis of his/her race, religion, sex, marital status, national origin or ancestry, age, handicap, disability, military status or any other status protected by law.

 

(Source:  Amended at 23 Ill. Reg. 5072, effective April 12, 1999)

 

Section 677.30  Confidentiality of Information

 

All customer information maintained by DHS-ORS for the purposes of administering  the funds available under the HSP is confidential and shall only be used for the purpose of the administration of HSP, pursuant to the Health Insurance Portability and Accountability Act (42 USC 1320(d) et seq.) and the regulations promulgated thereunder, and DHS' rules found at 89 Ill. Adm. Code 505 − Confidentiality and 89 Ill. Adm. Code 676.110.

 

(Source:  Amended at 28 Ill. Reg. 6449, effective April 8, 2004)

 

Section 677.40  Freedom of Choice

 

Under the HSP, a Customer has the following rights; however, the choices made by the Customer may affect the services available through HSP for which the Customer is eligible or which might otherwise be available.

 

a)         A Customer shall have the right to apply for and, if eligible, receive services under the program of the Customer's choice. Therefore, a Customer eligible for both institutional care and HSP services has the right to choose one or the other but may not receive both at the same time. Institutional care is not available through HSP and, if the Customer chooses HSP services, DHS-ORS shall have the right to determine the waiver under which the Customer will be served and the level of the provider of services.

 

b)         At any time, a Customer has the right not to accept those HSP services that the Customer has been determined eligible to receive. However, if the Customer chooses to terminate services, the Customer may have to reapply for services and undergo another determination of eligibility if the Customer later desires services through HSP.

 

c)         A Customer has the right to choose their living arrangement, including the physical dwelling and persons residing in the dwelling.  However, such choices may impact the amount or scope of the services received by the Customer.  HSP will not impose a living arrangement on any Customer.

 

d)         A Customer applying for, or receiving, services through HSP shall have the right to choose medical and non-medical service providers.  However, payment may only be made to those service providers which meet the standards established by DHS as found at 89 Ill. Adm. Code 686 and who will accept DHS' fees for a specific service approved by DHS, if DHS is to issue payment for the service.

 

e)         A Customer has the right to participate in the service planning process during initial determination of eligibility, subsequent redetermination of eligibility, and when updates to the service plan are requested by the Customer.

 

f)         A Customer has the right to select their setting from among setting options, including non-disability specific settings and an option for a private unit in a residential setting.  The setting options are identified and documented in the person-centered service plan and are based on the individual’s needs, preferences, and, for residential settings, resources available for room and board.

 

(Source:  Amended at 46 Ill. Reg. 20850, effective December 19, 2022)

 

Section 677.50  Referral

 

a)         A Customer has the right to receive information regarding all DHS programs, including HSP.

 

b)         A Customer has the right to be referred by HSP for other appropriate services, within and outside DHS.  The Customer's permission must be received in writing prior to HSP making any such referral, pursuant to DHS rules at 89 Ill. Adm. Code 505 − Confidentiality.

 

c)         All communications given or sent to a Customer shall be in a language, medium, and at a level which the Customer can understand.

 

(Source:  Amended at 46 Ill. Reg. 20850, effective December 19, 2022)

 

Section 677.60  Application

 

An individual has the right to apply for services through any DHS programs and to have the application processed in an appropriate and expedient manner.

 

Section 677.70  Notice of Action

 

Every customer has the right to a written notice of the disposition of any referral, application, or any denial, termination, or change in services.  Such a notice shall be mailed at least 15 working days prior to the effective date of the action and shall include:

 

a)         a clear statement of the action taken;

 

b)         a clear statement of the reason for the action;

 

c)         a clear and complete statement of the customer's right of appeal;

 

d)         a statement indicating that, if an appeal is filed, services will continue at the level at the time the appeal is filed during the period of the appeal under the conditions and limitations stated at 89 Ill. Adm. Code 510.60.

 

Section 677.80  Appeal of an Action Taken by HSP

 

The customer has the right to appeal an action or inaction on the part of HSP, with certain limitations, as set forth at 89 Ill. Adm. Code 510 − Appeals and Hearings.

 

(Source:  Amended at 23 Ill. Reg. 5072, effective April 12, 1999)

 

Section 677.90  Repayment of Assistance

 

a)         If the customer's financial status changes, DHS shall not seek repayment for the HSP services provided prior to the date DHS-ORS was knowledgeable of the change.  At any time, a customer may voluntarily repay all or part of the costs associated with services provided to him/her.

 

b)         DHS shall seek repayment for any and all services determined to have been inappropriately provided to a customer due to false disclosure, omission or misrepresentation of a customer's financial status.  Reimbursement shall be sought pursuant to DHS' rules found at 89 Ill. Adm. Code 527 − Recovery of Misspent Funds.

 

(Source:  Amended at 23 Ill. Reg. 5072, effective April 12, 1999)

 

Section 677.100  Customer Bill of Rights

 

Customers of the Home Services Program have the right to basic safety; information; choice, participation and self-determination; dignity and individuality; redress grievances; and fiduciary assistance in securing their rights.

 

a)         Basic safety includes:

 

1)         the right to protection from physical, sexual, mental and verbal abuse, neglect and exploitation, including financial exploitation;

 

2)         the right to be served by providers who are properly trained and are providing services within their scope of practice and the scope of their certification or licensure by the State;

 

3)         the right to have all personal, financial and medical information kept confidential;

 

4)         the right to have the provider of home care services respect the personal property of the Customer to whom it provides services and, if the Customer reports a theft or loss of personal property, the provider shall investigate and shall report back to the Customer the results of the investigation; and

 

5)         the right to freedom from coercion and restraint.

 

b)         Information includes:

 

1)         the right to be informed of the following by a provider within two weeks after starting to receive home care services:

 

A)        the Customer's rights under Section 17.1 of the Disabled Persons Rehabilitation Act [20 ILCS 2405] (Act); and

 

B)        the entities the Customer may contact if their rights are violated, including the name and contact information for DHS and the Department on Aging and other State and local agencies responsible for enforcing the Home Care Consumer Bill of Rights (Section 17.1 of the Act).

 

2)         the right to be informed about:

 

A)        the cost of home care services prior to receiving those services;

 

B)        whether the cost of services is covered under health insurance, long-term care insurance, or other private or public programs; and

 

C)        any charges the Customer will be expected to pay;

 

3)         the right to access information about the availability of the home care services provided in their community and has the right to choose among home care services and providers of home care services available in that community.

 

c)         Choice, participation, and self-determination includes:

 

1)         the right to participate in the planning of their services;

 

2)         the right to make choices about aspects of their services;

 

3)         the right to choose providers and schedules to the extent practicable and consistent with HSP rules and procedures, including, but not limited to, overtime and the number of hours a provider may work in a given day or week;

 

4)         the right to receiving reasonable accommodation of their needs and preferences;

 

5)         the right to include anyone they choose to participate with them in the service planning process;

 

6)         the right to be provided with sufficient information to make informed decisions;

 

7)         the right to be fully informed in advance about any proposed changes in care and services, and to be involved in the decision-making process regarding those changes to the extent practicable; and

 

8)         the right to refuse services and to receive an explanation of the consequences of doing so.

 

d)         Dignity and individuality includes:

 

1)         the right to receive home services in a way that promotes their dignity and individuality; and

 

2)         the right to be treated with respect at all times.

 

e)         Redress grievances includes:

 

1)         the right to express grievances about the quality of their home services, the number of hours of service, and any violations of their rights; and

 

2)         the right to receive prompt responses to those concerns and to be informed about who they may contact to have the grievances addressed in an appropriate and timely manner and without retaliation.

 

f)         Fiduciary assistance in securing a Customer's rights may be provided by the Illinois Department on Aging's Home and Community Ombudsman Program.  [20 ILCS 2405/17.1]

 

(Source:  Amended at 46 Ill. Reg. 20850, effective December 19, 2022)

 

Section 677.200  Customer Responsibilities

 

It is the responsibility of each Customer to:

 

a)         provide information that is necessary for HSP to process the Customer's referral for HSP services;

 

b)         provide a current valid street address;

 

c)         provide contact information, including, but not limited to, a current telephone number and, if available, a current email address and inform the local HSP office and service providers of any updated contact information;

 

d)         sign all required forms for a determination of eligibility to be made for HSP services;

 

e)         assist HSP staff with gathering information that is necessary to determine eligibility, including, but not limited to, medical and financial records;

 

f)         during the COVID-19 Gubernatorial Disaster Proclamations, subject to federal approval, and in accordance with 89 Ill. Adm. Code 676.130(a), sign all required forms that are necessary to comply with HSP requirements, applicable federal law or the provisions of the Medicaid Waiver, or that are necessary to process payment through the Comptroller's Office;

 

g)         comply with all HSP requirements related to enrollment, employment and management of an Individual Provider.  If a Customer utilizes an Individual Provider for services, the Customer must comply with all HSP requirements pertaining to Individual Provider compliance policies, all HSP requirements pertaining to Electronic Visit Verification (EVV) (see 89 Ill. Adm.Code 686, Subpart Q), and ensure all Individual Providers who are providing services to the Customer comply with HSP requirements in 89 Ill. Adm. Code 686;

 

h)         sign the Individual Provider Payment Policies form (IL 488-2252), which is available at HSP local offices.  Signing the form acknowledges the Customer's understanding of the nature of the employment relationship with the Individual Provider.  The Customer, as the employer, is responsible for certain aspects of the employment relationship with the Individual Provider, such as locating, hiring and disciplining, and may, as necessary, terminate the Individual Provider;

 

i)          report all changes in circumstances that may affect eligibility or continued eligibility for HSP services, as soon as they are known.  These include changes in:

 

1)         address;

 

2)         living arrangement;

 

3)         income or assets;

 

4)         services provided to the individual at no cost to HSP;

 

5)         service needs;

 

6)         medical and/or psychological condition;

 

7)         service providers;

 

8)         absence of the individual from their home that affects service provision; and

 

9)         residency or citizenship status;

 

j)          apply for any and all other financial and service benefits that the Customer may be eligible to receive, including any benefits that may affect HSP, level of services required by the individual and cost of services to HSP;

 

k)         cooperate with HSP projects conducted for the purpose of obtaining or validating general program information or operations when those projects are not related to Customer-specific eligibility;

 

l)          cooperate with service providers, HSP staff, and representatives in complying with HSP service plans, reassessments of eligibility and other administrative rules related to HSP; and

 

m)        cooperate with the Department of Human Services in applying for, receiving, maintaining and recertifying eligibility for Medicaid.

 

(Source:  Amended at 46 Ill. Reg. 20850, effective December 19, 2022)