TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 679
DETERMINATION OF NEED (DON) AND
RESULTING SERVICE COST MAXIMUMS (SCMs)
SECTION 679.10 GENERAL PROVISIONS
Section 679.10 General
Provisions
a) The DON, pursuant to 89 Ill. Adm. Code 676.30(d), is the
assessment tool used to determine an individual's non-financial eligibility for
HSP services based on the individual's impairment in the completion of the activities
of daily living (ADLs) (Part A) and the individual's need for care that is not
met by existing family and other resources (Part B). This assessment is made to
determine whether or not the individual is at imminent risk of
institutionalization, and therefore eligible for placement in a
hospital/nursing facility and/or services through HSP.
b) If the individual receives at least the minimum DON score to
be considered eligible for institutional placement or HSP services (see 89 Ill.
Adm. Code 682), the DON score relates to a specific Service Cost Maximum (SCM)
that may be expended on services for an individual who chooses HSP services as
an option to institutionalization (see Section 679.50).
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 679
DETERMINATION OF NEED (DON) AND
RESULTING SERVICE COST MAXIMUMS (SCMs)
SECTION 679.20 COMPOSITION OF THE DON
Section 679.20 Composition
of the DON
The DON is comprised of three
sections which are:
a) the Mini-Mental Status Examination section, as developed by
the University of Illinois-Chicago, School of Public Health, which is used to
determine the individual's cognitive functioning, and therefore the ability of
the individual to adequately respond to the DON questions about his or her
functioning capacity in the completion of the DON. Home Service Program staff
may choose to not administer the MMSE if interaction with the customer, during
the interview to gather demographic information, reveals no cognitive problems.
The Mini-Mental Status Examination section shall not be administered to
individuals who:
1) are 12 years of age or younger;
2) manifest, or have been diagnosed with, mental retardation or a
related condition that results in impairment of a person's general intellectual
functioning; or
3) manifest adaptive behavior and require services similar to an
individual with mental retardation.
b) Part A which measures the individual's need for care in the
completion of ADLs; and
c) Part B which measures the individual's unmet need for care in
the completion of ADLs.
(Source: Amended at 24 Ill. Reg. 6563, effective May 1, 2000)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 679
DETERMINATION OF NEED (DON) AND
RESULTING SERVICE COST MAXIMUMS (SCMs)
SECTION 679.30 SCORING OF THE DON EXCEPT FOR RESPITE CASES
Section 679.30 Scoring of
the DON Except for Respite Cases
a) An individual receiving a 14 or more on the Mini-Mental Status
Examination shall receive "zero" points towards his/her column A
score. An individual receiving less than 14 points shall receive an additional
"10" points added to his/her column A score for the determination of
eligibility and a SCM.
b) The remaining two sections of the DON measure the individual's
ability to complete the ADLs. The ADLs are specifically: eating, bathing,
grooming, dressing, transferring, incontinence care, preparing meals, being
alone, telephoning, managing money, routine health care tasks (or those health
care tasks not requiring specialized training), specialized health care tasks
(or those requiring assistance from trained medical practitioners), necessary
travel outside the home, laundry, and housework.
1) Part A of the DON measures the individual's need for
assistance in the completion of each of the ADLs on the following rating scale.
A) None ("0" points) – the individual can perform all
essential components of the ADL with or without an existing assistive device;
B) Minimal ("1" point) – the individual can perform most
of the ADL, with or without an existing assistive device, but requires some
supervision and/or assistance to ensure the task is fully completed;
C) Moderate ("2" points) – the individual requires a
great deal of supervision and/or assistance, with or without existing assistive
devices, in the completion of the essential components of the task; and
D) Severe ("3" points) – the individual cannot perform
any of the essential components of the task, with or without existing assistive
devices and requires constant supervision and/or assistance.
2) Part B of the DON measures the individual's unmet need for
care in the completion of the ADLs on the following scale.
A) None ("0" points) – the individual has no unmet need
for care in that the individual needs no assistance in completion of the
essential components of the task, or family and/or other resources already
provide for this task;
B) Minimal ("1" point) – the individual's need for
assistance in the completion of the task is met at least 50% of the time, and,
without periodic assistance, there is a risk to the individual's health and
safety;
C) Frequent ("2" points) – the individual's need for
assistance in the completion of the task is met less than 50% of the time and,
without assistance, there is moderate risk to the individual's health and
safety; and
D) Constant ("3" points) – the individual's need for
assistance in the completion of the task is seldom (less than 10% of the time)
or never met and, without assistance, there is extreme risk to the individual's
health and safety.
c) In administering the DON for children, the assessor should
ensure the ratings given reflect limitations due to the individual's disability
and not the individual's age and/or the additional burden placed on the
caregiver.
1) On Part A, determine if a child of the individual's age should
be able to complete all or part of the task. If the inability to perform the
task relates only to the individual's age, a score of "zero" should
be given. Otherwise, score "1", "2", or "3"
according to the individual's impairment level.
2) On Part B, determine the additional burden placed on a
caregiver providing the service. If, because of the individual's age, there is
no increased burden, a score of "0" should be given. If there is an
increased burden on the caregiver due to the individual's disability, score
"1", "2", or "3" according to the increased level
of burden in providing the task.
(Source: Amended at 43 Ill.
Reg. 2117, effective January 24, 2019)
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 679
DETERMINATION OF NEED (DON) AND
RESULTING SERVICE COST MAXIMUMS (SCMs)
SECTION 679.40 SCORING THE DON FOR RESPITE CASES
Section 679.40 Scoring the
DON for Respite Cases
In order to be eligible for
respite services, the individual must receive 29 points in Part A of the DON,
which includes the 10 points from the Mini-Mental Status Examination, as
appropriate. No points are necessary in Part B as respite services are to provide
relief to a caregiver who normally provides all care for an individual which is
at no cost to DHS.
| TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER d: HOME SERVICES PROGRAM
PART 679
DETERMINATION OF NEED (DON) AND
RESULTING SERVICE COST MAXIMUMS (SCMs)
SECTION 679.50 SERVICE COST MAXIMUMS (SCMS)
Section 679.50 Service Cost
Maximums (SCMs)
a) For each individual meeting the minimum required DON scores
for eligibility (see 89 Ill. Adm. Code 682), there is a corresponding Service
Cost Maximum (SCM) for his/her DON score which is the maximum amount that may
be expended for services through HSP for an individual who chooses HSP services
over institutionalization. This amount directly corresponds to the amount the
State would expect to pay for the nursing care component of
institutionalization if the individual chose institutionalization.
b) The monthly SCMs for individuals served under the HSP Disabled
Individual Medicaid Waiver are:
|
DON Range
|
11/1/03 SCM
|
8/1/04 SCM
|
8/1/05 SCM
|
8/1/06 SCM
|
8/1/07 SCM
|
|
29-32
|
$1,154
|
$1,194
|
$1,249
|
$1,329
|
$1,488
|
|
33-40
|
$1,326
|
$1,371
|
$1,435
|
$1,527
|
$1,710
|
|
41-49
|
$1,475
|
$1,526
|
$1,597
|
$1,699
|
$1,902
|
|
50-59
|
$1,766
|
$1,827
|
$1,912
|
$2,034
|
$2,277
|
|
60-69
|
$2,076
|
$2,147
|
$2,247
|
$2,390
|
$2,677
|
|
70-79
|
$2,244
|
$2,322
|
$2,430
|
$2,585
|
$2,894
|
|
80-100
|
$2,412
|
$2,495
|
$2,612
|
$2,778
|
$3,111
|
c) The monthly SCMs for individuals served under the HSP AIDS
Medicaid Waiver are:
|
DON Range
|
11/1/03 SCM
|
8/1/04 SCM
|
8/1/05 SCM
|
8/1/06 SCM
|
8/1/07 SCM
|
|
29-32
|
$1,486
|
$1,538
|
$1,609
|
$1,712
|
$1,917
|
|
33-40
|
$2,228
|
$2,305
|
$2,412
|
$2,566
|
$2,873
|
|
41-49
|
$2,970
|
$3,073
|
$3,216
|
$3,421
|
$3,831
|
|
50-59
|
$3,714
|
$3,842
|
$4,021
|
$4,278
|
$4,790
|
|
60-69
|
$4,458
|
$4,611
|
$4,827
|
$5,134
|
$5,749
|
|
70-79
|
$5,198
|
$5,378
|
$5,628
|
$5,987
|
$6,704
|
|
80-100
|
$5,943
|
$6,148
|
$6,435
|
$6,845
|
$7,664
|
d) The monthly SCMs for individuals served under the HSP Brain
Injury Medicaid Waiver are:
|
DON Range
|
11/1/03 SCM
|
8/1/04 SCM
|
8/1/05 SCM
|
8/1/06 SCM
|
8/1/07 SCM
|
|
29-32
|
$1,286
|
$1,331
|
$1,393
|
$1,482
|
$1,659
|
|
33-40
|
$1,427
|
$1,476
|
$1,545
|
$1,644
|
$1,841
|
|
41-49
|
$1,586
|
$1,640
|
$1,717
|
$1,826
|
$2,045
|
|
50-59
|
$1,901
|
$1,966
|
$2,058
|
$2,189
|
$2,451
|
|
60-69
|
$2,234
|
$2,311
|
$2,419
|
$2,573
|
$2,881
|
|
70-79
|
$2,415
|
$2,499
|
$2,615
|
$2,782
|
$3,115
|
|
80-100
|
$2,597
|
$2,686
|
$2,811
|
$2,990
|
$3,349
|
e) The SCM for an individual may be exceeded on a monthly basis
to meet a temporary increase in need for services as long as the average
monthly cost for services during the twelve month period does not exceed the
SCM. Such an increase in services shall not last more than 3 months.
f) The exceptional care rate (ECR) for individuals who cannot be
served under an HSP waiver's SCM is established by the Department of Healthcare
and Family Services (HFS) under 89 Ill. Adm. Code 140.569(i). This rate is
comparable to the assessed cost for institutionalization and shall not be
exceeded. To determine the exceptional care rate for an individual served
under an HSP waiver program:
1) the
nearest approved exceptional care nursing facility to the individual's
home is identified;
2) the
exceptional care rate for that facility is requested from HFS; and
3) the daily exceptional care rate is multiplied by 30.3 to
establish a monthly
average.
(Source: Amended at 31 Ill.
Reg. 422, effective December 29, 2006)
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