TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.10 PERSONAL ASSISTANT (PA) REQUIREMENTS
Section 686.10 Personal
Assistant (PA) Requirements
In order to be employed by a
customer as a PA (89 Ill. Adm. Code 676.30), an individual must:
a) have a Social Security number and provide the Department of
Human Services (DHS) with documented verification of this number;
b) be a minor between 14 and 16 years of age who is not employed
during school hours, has an employment certificate and meets all other
requirements of the Child Labor Law [820 ILCS 205] and has an adult who is at
least 21 years of age and who is legally responsible for the customer who will
supervise the PA; be 16 years of age or older, enrolled in school and not
employed during school hours; or be 17 years of age or older and not enrolled
in school;
c) have provided to the customer at least two written or verbal
recommendations from present or former employers, the recommendation of a
Center for Independent Living (CIL), or, if never employed, references from at
least two non-relatives;
d) be able to communicate with the customer to the satisfaction
of the customer and counselor;
e) be able to follow directions to the satisfaction of the
customer and counselor;
f) have previous experience and/or training that is adequate and
consistent with the specific tasks required for safe and adequate care of the
customer;
g) if the customer has a contagious infectious disease, have a
physician, health care institution (i.e., hospital, nursing home, home health
agency), or CIL certify, in writing, that he/she has the knowledge of
precautionary procedures for the control of contagious infectious diseases, if
it is anticipated that he/she will come into contact with bodily fluids, or be evaluated
by a Registered Nurse licensed pursuant to the Nurse Practice Act [225 ILCS 65]
to determine that he/she has knowledge of those procedures;
h) complete an EMPLOYMENT AGREEMENT between the customer and PA
that certifies the PA:
1) shall provide services to the individual in accordance with
his/her SERVICE PLAN (IL 499-1049) (89 Ill. Adm. Code 676.30(u));
2) shall submit a bi-monthly calendar listing actual hours worked
each pay period (1-15; 16-last working day of the month), as verified by the
customer and in accordance with the number of hours authorized by DHS. The PA
shall not claim more hours than approved by DHS unless prior approval has been
granted by the counselor to address a temporary increased service need;
3) shall make available to DHS and other designated agencies
those records described in subsection (h)(2);
4) shall maintain all customer information as confidential and
not for release, either in writing or verbally, to anyone other than those
designated by DHS in writing;
5) shall not subcontract to any other person, any of the services
he/she has agreed to provide;
6) shall provide services only while the individual is in his/her
home or during the period covered by Section 684.60 (Provision of Services);
7) shall agree that the customer is responsible for locating,
choosing, employing, supervising, training, and disciplining as necessary the
PA. Further, that the State of Illinois does not provide paid vacation,
holiday, or sick leave; however, such absences shall be reported to the DHS
counselor per the HOME SERVICES TIME SHEET (IL 488-2251) only for the purposes
of processing payment;
8) understands that DHS reports all payments made to a PA to the
Illinois Department of Employment Security (DES) and that the PA may apply for
unemployment benefits, but DES, not DHS, makes the determination as to whether
the PA shall receive benefits;
9) understands that he/she may apply for Workers' Compensation
benefits through DHS and that some customers may carry such insurance coverage;
however, DHS maintains that the customer, not DHS, is the employer for these
purposes; and
10) understands that DHS will withhold Social Security tax (FICA)
from payments made to him/her. Federal and State income tax shall be withheld
if the PA completes and returns to DHS two separate W-4 forms;
i) complete an I-9 Immigration form, which must be retained by
the customer;
j) for PAs starting on or after April 13, 1992, complete a PA
STANDARDS (IL 488-2112) to be returned to DHS;
k) as of April 13, 1992, at the time of redetermination of
eligibility of the customer by which he/she is employed, have completed by the
customer, a PERSONAL ASSISTANT EVALUATION (IL 488-2089); and
l) if requested by the customer, give permission and the
necessary information for the customer to request a conviction background check
from the Illinois State Police. This permission will require the prospective
PA to sign the appropriate form provided by the customer.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.20 SERVICES THAT MAY BE PROVIDED BY A PA
Section 686.20 Services That
May Be Provided by a PA
A PA may perform or assist with:
a) household tasks, shopping, or personal care; and
b) incidental health care tasks that do not require independent
judgement, with the permission of the customer and/or family; and
c) monitoring to ensure the health and safety of the customer.
(Source: Amended at 38 Ill.
Reg. 16978, effective July 25, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.25 CRIMINAL BACKGROUND CHECK
Section 686.25 Criminal
Background Check
a) A Home Services Customer may require any PA candidate to
submit to a criminal background investigation and to successfully complete a
criminal background investigation as a condition of being selected as the PA to
that Customer.
b) In the event that a customer elects to require a PA candidate
to submit to a criminal background investigation, the customer shall be
obligated only to inform DHS-Division of Rehabilitation Services (DRS) of
his/her decision and DHS-DRS will provide the Customer an appropriate form that
the Customer may file with the Illinois State Police to initiate the criminal
background investigation. The results of the criminal background investigation
will be sent directly to the customer, and the customer shall have no
obligation to share the results of the investigation with DHS-DRS. Nothing
contained in this Section shall restrict a customer from extending a
conditional offer of employment to any PA candidate pending the results of the
background investigation.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.30 ANNUAL REVIEW OF PA PERFORMANCE
Section 686.30 Annual Review
of PA Performance
a) Pursuant to 686.10(k), annually, at the time of
redetermination of the individual's eligibility, a Personal Assistant
Evaluation (IL 488-2089) shall be completed, by the customer with assistance of
the counselor, for each PA providing services through the Home Services Program
(HSP).
b) PAs shall be evaluated based upon:
1) accuracy of work (e.g., ranging from making many errors to few
errors);
2) cleanliness of working area (e.g., ranging from very untidy to
exceptionally clean);
3) use of work time (e.g., ranging from very wasteful to very
efficient);
4) responsibility (e.g., ranging from irresponsible to
responsible);
5) attendance (e.g., ranging from frequently absent or late to
always prompt); and
6) attitude towards the customer (e.g., ranging from
disrespectful to respectful).
c) The outcome of the evaluation shall be mediated by the
counselor between the PA and the customer regarding any unresolved issues, up
to and including replacement of the PA by the customer, if necessary.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.40 PAYMENT FOR PA SERVICES
Section 686.40 Payment for
PA Services
a) PAs shall be paid at the hourly rate set by law, but never
less than the current federal minimum wage.
b) PAs shall be paid twice each month for services rendered. The
first payment shall be for any services rendered by the PA, pursuant to the
customer's Service Plan, from the first day of the month through the fifteenth
day of the month. The second payment shall be for any services rendered by the
PA, pursuant to the customer's Service Plan, from the sixteenth day of the
month through the last day of the month.
c) No PA shall be reimbursed by DHS-DRS for services rendered to
one or more HSP customers for more than 16 hours in a 24-hour period. The
counselor may grant an exception should an emergency occur that results in the
loss of a paid or unpaid primary caregiver who resides with the customer, and
there is imminent danger to the health, safety and well being of the customer.
When this occurs, the additional hours may not exceed the annual service cost
maximum (SCM). The 16-hour limitation does not apply to PAs providing respite
services.
(Source: Amended at 29 Ill.
Reg. 16508, effective October 17, 2005)
SUBPART B: ADULT DAY CARE PROVIDERS
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.100 ADULT DAY CARE (ADC) PROVIDER REQUIREMENTS
Section 686.100 Adult Day
Care (ADC) Provider Requirements
a) Adult Day Care (ADC) Providers (see 89 Ill. Adm. Code 676.40) must
either be approved by DHS or by the Illinois Department on Aging (DoA) pursuant
to DoA's rules found at 89 Ill. Adm. Code 240, with the exception that the term
"the elderly" in 89 Ill. Adm. Code 240.1560(a)(1)(A)(ii) and (a)(2)(A)(iii)
should be replaced with the term "individuals with disabilities".
b) In order to be approved as an ADC Provider by DHS, the ADC
Provider must meet all of the conditions specified by DoA, as cited above, and:
1) employ a full-time program director;
2) employ the equivalent of a full-time program
coordinator/director;
3) employ a program nurse who is on duty at least a portion of
every standard business day;
4) employ a nutrition staff;
5) comply with the provisions of:
A) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 701),
as amended;
B) the Illinois Human Rights Act [775 ILCS 5];
C) the Illinois Accessibility Code (71 Ill. Adm. Code 400);
D) the Americans with Disabilities Act (42 U.S.C. 12101); and
E) the Health Insurance Portability and Accountability Act (42 U.S.C.
1320d);
6) record the administration of all prescribed medications for
those Customers served through HSP who are unable to self-administer medication
as documented by a physician licensed pursuant to the Medical Practice Act [225
ILCS 60], a registered nurse licensed pursuant to the Nursing Practice Act [225
ILCS 65], or as documented in the individual's Service Plan (IL 488-1049) (89
Ill. Adm. Code 676.30);
7) provide DHS with a record of the amount of pre-service
training each employee has;
8) require, and provide DHS documentation of, at least 12 hours
of in-service training for each staff person each fiscal year;
9) successfully complete an Adult Day Care Provider Review (IL
488-2129) pursuant to Section 686.120;
10) accept reimbursement at or below the federally-approved
Medicaid rates pursuant to the currently active 1915(c) Home and Community
Based Services Waiver;
11) maintain adequate records for planning, budgeting,
administration and program evaluation and planning. These records shall be
available to DHS and the United States Department of Health and Human Services
(HHS), or any entity designated by DHS or HHS, and shall be maintained for a period
of at least 5 years or until advised that all State and federal audits are
completed. These records must include, but not be limited to:
A) records of all referrals, including the disposition of each
referral;
B) all Customer records;
C) administrative records, including:
i) service statistics; and
ii) billing and payment records;
D) personnel records, including:
i) schedules and attendance records for staff and volunteers;
ii) training records for staff and volunteers;
iii) annual performance evaluations for all staff and, as
appropriate, all volunteers; and
12) have an Affirmative Action Plan in place which is approved by
its governing body.
c) a
facility that houses an adult day care program (including satellite sites)
shall meet the criteria for the Centers for Medicare and Medicaid Services
definition of a home and community-based setting pursuant to 42 CFR
441.301(c)(4) and 42 CFR 441.301(c)(5).
d) if a
provider meets the criteria listed in this Section, application to HSP should
be made to:
Illinois Department of Human
Services
Division of Rehabilitation
Services
Home Services Program, Program
Compliance
100 S. Grand Ave. East
Springfield IL 62794
(Source: Amended at 46 Ill.
Reg. 20865, effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.110 SERVICES WHICH MUST BE PROVIDED BY ADC PROVIDERS
Section 686.110 Services
Which Must Be Provided by ADC Providers
In order for an Adult Day Care
Provider to be recognized by DHS and used to provide services to individuals
receiving services through HSP, each Adult Day Care Center must agree to
provide the following services:
a) written and individualized care planning;
b) assistance and arrangement of personal care, hygiene, and
self-care training, as appropriate, based on each individual's needs;
c) leisure time and recreation activities;
d) assistance of a medical nature (e.g., medication, assessment,
exercise);
e) meals and snacks; and
f) maintenance of a complete record for each individual served
through the Adult Day Care Center, including full recording of all required
services provided to the customer as listed in subsections (a) through (e),
above.
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.120 COMPLIANCE REVIEW OF ADC PROVIDERS
Section 686.120 Compliance
Review of ADC Providers
a) DHS-DRS shall complete a review of each ADC Provider, at least
every two years, to ensure compliance with the criteria set forth in this
Subpart.
b) The review shall consist of an on-site review conducted by HSP
staff using the Adult Day Care Review form (IL 488-2129). Written notification
shall be provided to the ADC Provider prior to the review.
c) Within 15 days after the completion of the review, a copy of
the completed IL 488-2129, along with a letter stating the results of the
review, shall be mailed to the ADC.
1) If the ADC Provider is approved, included with the letter
shall be an ADC Provider Rate Agreement for execution by the appropriate
provider staff and return to DHS-DRS.
2) If the ADC Provider is not approved, the letter shall contain
specific information regarding:
A) deficiencies
found as a result of the review;
B) the action necessary for the ADC Provider to come into
compliance;
C) the time frames within which the ADC Provider must come into
compliance; and
D) the information necessary for the ADC Provider to request
re-evaluation after the compliance issues are addressed.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.130 APPEAL OF COMPLIANCE REVIEW FOR ADC PROVIDERS
Section 686.130 Appeal of
Compliance Review for ADC Providers
a) ADC Providers determined not to be in compliance with DHS-DRS
requirements as a result of the review may appeal the decision to the Bureau Chief
of the Bureau of Home Services Program. The Bureau Chief shall conduct a
review of the facts related to the rating and shall, within 15 working days,
provide a written decision to the ADC Provider.
b) If the ADC Provider is not satisfied with the decision of the
Bureau Chief, the ADC Provider may request review of the Chief's decision by
the DHS-DRS Director. The request must be in writing from the ADC provider and
received by the DHS-DRS Director within 10 working days after the date the
decision was rendered by the Bureau Chief. The decision of the DHS-DRS
Director shall be final.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.140 PAYMENT FOR ADC SERVICES
Section 686.140 Payment for
ADC Services
a) DHS shall pay no more than the rate approved by DoA for Adult
Day Care Services. The rate established by DoA shall include meals, snacks,
and, in some instances, transportation provided by the ADC Center.
b) Adult Day Care Providers shall submit monthly billings for
approved services provided the previous month and progress reports for each
customer served by the provider for the month being billed. Billings may be
submitted less frequently at the discretion of the Adult Day Care Provider.
SUBPART C: HOMEMAKER SERVICES
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.200 HOMEMAKER SERVICE PROVIDER REQUIREMENTS
Section 686.200 Homemaker
Service Provider Requirements
In order to provide Homemaker Services
under HSP (see 89 Ill. Adm. Code 676.40), a Homemaker Service Provider must be
in compliance with all Medicaid provider requirements for the Illinois
Department of Healthcare and Family Services (HFS) and DHS.
a) Only Homemaker Service Providers with an approved Homemaker Agreement
may be used to provide Homemaker Services to individuals being served through
HSP.
b) In order to be approved by HSP, the Homemaker Service Provider
must comply with the following, to the satisfaction of HSP:
1) provide a comprehensive array of services that include, but
are not limited to, those services described in Section 686.210;
2) assure HSP that all referrals will be responded to within 48
hours after receipt from HSP;
3) have written billing procedures and provide a copy to HSP as
part of the compliance review;
4) have documented procedures to cover unexpected absences and
emergencies to ensure services will be provided in an adequate and safe manner
to all individuals served by the Homemaker Service Provider;
5) have written procedures to respond to customer and counselor
complaints regarding services;
6) maintain comprehensive written job descriptions for, at a
minimum, the positions of Executive Director or Administrator, supervisory
staff, and Homemakers;
7) have established a local presence to ensure regular and
on-going contact with HSP and other appropriate community groups;
8) have procedures for regular and on-going recruitment of Homemakers
through local resources;
9) be incorporated or provide HSP with a copy of a written
statement of purpose and function;
10) maintain adequate records for planning, budgeting,
administration and program evaluation and planning. These records shall be
available at all times to HSP and the United States Department of Health and
Human Services (HHS), or any entity designated by HSP or HHS, and shall be
maintained for a period of at least 5 years, or until advised that all State
and federal audits are completed. These records must include, but not be
limited to:
A) records of all referrals, including the disposition of each
referral;
B) customer records, which include:
i) dates and times services were provided to each individual;
ii) dates and times of supervisor-Homemaker weekly conferences;
iii) semi-annual reports of supervisory visits with each customer
served;
iv) monthly service reports for each customer served that document
a summary of services, actual or anticipated changes in the customer's
condition, recommended changes in the current HSP Service Plan, and all
customer contacts;
v) records of all staffings held pertaining to the customer;
vi) records of all financial transactions between the customer and
any Homemaker Service Provider employee;
C) administrative records, which include:
i) cumulative service statistics pertaining to any agreement
with HSP;
ii) billing and payment records that pertain to HSP;
D) personnel records, which include:
i) attendance records;
ii) schedules for all direct service staff;
iii) documentation regarding each individual's qualification for
the position held;
iv) wage rate and effective date for each staff member;
v) job performance evaluations for each staff person that include
annual evaluations and at least one probationary evaluation completed within
the first six months of employment;
vi) orientation and training attendance information for each staff
member, which must include the name of each instructor, the date, the time and
the title of each training program attended; and
vii) verification of liability insurance in the amounts of at least
$15,000 per person bodily injury, $30,000 minimum per occurrence, and $10,000
in property damage, per occurrence, if the employee will or could be expected
to transport customers in the course of his/her work;
11) maintain insurance coverage against any and all liability,
loss, damage and/or expense from wrongful or negligent acts of the Homemaker
Service Provider or any of its employees and provide HSP with written
verification of that coverage;
12) maintain written procedures on reporting loss and damage
arising from the wrongful or negligent acts of the Homemaker Service Provider
or any of its employees;
13) agree to hold harmless DHS and HSP against any and all
liability, loss, damage, cost, or expense arising from wrongful or negligent
acts of the Homemaker Service Provider or any of its employees;
14) assist HSP in monitoring and evaluating the Homemaker Service
Provider's performance under any agreement with HSP;
15) maintain any and all information regarding individuals
referred to the Homemaker Service Provider by HSP as confidential and not for
public release without the written consent of HSP and the customer;
16) maintain and have available for review by customers and
purchasers of services policies governing:
A) the nature and scope of each service provided by the Homemaker
Service Provider;
B) a two-way receipt system for any time an employee of the Homemaker
Service Provider handles an individual's money, food stamps or other negotiable
items or tender;
C) personnel policies governing salary, leave time, hours of work,
employee grievance procedures, and attendance at in and out-service trainings;
and
17) have in place an Affirmative Action Plan that is approved by
its governing body.
c) At a minimum, each Homemaker Service Provider must employ
qualified staff in the positions of:
1) Executive Director or Administrator for each local unit
providing services, who is responsible for the administration of the Homemaker
Services program and who, at a minimum, has or is making continued progress
towards:
A) a Bachelor's degree in health, human services, or a related
field;
B) licensure as a Registered Nurse pursuant to the Nurse Practice
Act;
C) certification as a home health care administrator, medical
clinic administrator, or other health services administrator; or
D) one year of related job experience in social services or in a
health agency to replace each year of education required in subsections
(c)(1)(A) through (C), provided that at least one year of experience was in a
program that provides services to individuals with disabilities.
2) For the purposes of subsections (c)(1)(A) through (C)
"continued progress" shall mean current registration and evidence of
successful completion of course work in an accredited junior college, college,
or university for a minimum of 2 semesters or 3 quarters of each academic
year. Successful completion shall mean a grade of at least "C" in undergraduate
course work or a grade of "B" in graduate course work;
3) Supervisors, in a ratio of no less than the equivalent of one
full-time supervisor to the equivalent of every 20 full-time Homemakers, who are
responsible for the supervision of Homemaker staff and who, at a minimum, have:
A) a Bachelor's degree with course work in social science, home
economics, or nursing;
B) knowledge and skill equivalent to completion of a Bachelor's
degree, as described in subsection (c)(1)(A); or
C) a high school diploma or its equivalent plus health service
experience including at least 2 years supervisory experience;
4) Homemakers who have:
A) been determined to be in good health;
B) knowledge and skill equivalent to a high school diploma;
C) experience as a homemaker, either in his or her own home or
through employment; and
D) knowledge of:
i) nursing care;
ii) first aid;
iii) personal and environmental hygiene;
iv) household budgeting;
v) housekeeping;
vi) nutrition;
vii) food preparation; and
viii) clothing care.
d) Each supervisor and Homemaker must, at a minimum, participate
in the following training programs:
1) Orientation, which shall include:
A) the philosophy and purpose of Homemaker Services; and
B) the functions of Homemaker Services;
2) In-service training, directed at increasing the Homemaker
Service Provider's knowledge and skills, of not less than 12 hours each year in
areas including:
A) disability awareness; and
B) Acquired Immunodeficiency Syndrome (AIDS).
e) The Homemaker Service Provider shall have a written policy and
procedures governing a self-evaluation process to evaluate services and case
management with an outcome of written recommendations to the governing body of
the Homemaker Service Provider to improve the services provided.
f) The Homemaker Service Provider shall abide by provisions of
the following federal and State laws and regulations regarding employment
practices and compliance:
1) Laws and Regulations
A) Title VI of the Civil Rights Act of
1964 (42 USC 2000d);
B) Section
504 of the Rehabilitation Act of 1973 (29 USC 701);
C) the
Americans With Disabilities Act (42 USC 12101);
D) the
Illinois Human Rights Act [775 ILCS 5];
E) the Health Care Worker Background Check Act [225 ILCS 46]; and
F) the Health Insurance Portability and Accountability Act (42
USC 1320(d) et seq.).
2) Further, the Homemaker Service Provider shall provide HSP with
a letter certifying compliance with the provisions of the laws listed in
subsection (f)(1) and a copy of the Affirmative Action Plan for the Homemaker
Service Provider.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.210 SERVICES THAT MUST BE PROVIDED BY HOMEMAKER SERVICE PROVIDERS
Section 686.210 Services That
Must Be Provided by Homemaker Service Providers
An approved Homemaker Service
Provider must provide professionally directed home management and personal care
services through trained Homemaker employees to HSP customers when the customer
does not have a responsible person or entity to assist him or her, and the
customer requires teaching, performance and/or assistance with:
a) household, financial and time management;
b) nutrition, meal planning and food preparation, which includes
specially prescribed diets and snacks;
c) personal care and hygiene that is nonmedical in nature;
d) observation and reporting of a customer's behavior and
activities to HSP for the purpose of assessment and service planning; and
e) emergency services to meet an unforeseen need in the areas
listed in subsections (a) through (d) when required by the customer and
preapproved by HSP.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.220 COMPLIANCE REVIEW OF HOMEMAKER SERVICE PROVIDERS
Section 686.220 Compliance
Review of Homemaker Service Providers
HSP shall conduct a compliance review on all Homemaker
Service Providers as a condition of determining compliance, or continued
compliance, with the criteria established under this Subpart.
a) A
Homemaker Service Provider seeking an HSP rate agreement shall undergo a
compliance review as a condition of approval by HSP.
b) A
Homemaker Service Provider with a current HSP rate agreement shall undergo a
compliance review at least every two years as a condition of determining
continued compliance under the program.
c) All Homemaker Service Providers with current HSP rate
agreements shall be notified in writing by HSP, at least 10 working days prior
to the date of the compliance review.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.230 APPEAL RIGHTS OF HOMEMAKER SERVICE PROVIDERS
Section 686.230 Appeal Rights
of Homemaker Service Providers
a) Homemaker Service Providers not satisfied with a DHS program
decision or an HSP compliance review, may submit an appeal request in writing to
the Bureau Chief of the Home Services Program. Appeal requests must be filed
within 30 days after the program decision or compliance review. The Bureau
Chief shall conduct a review of the facts and shall, within 15 working days,
provide a written decision to the Homemaker Service Provider.
b) If the Homemaker Service Provider is not satisfied with the
decision of the Bureau Chief, the Homemaker Service Provider may request review
of the Bureau Chief's decision by the Director of DHS-DRS. The request must be
in writing and received by the DHS-DRS Director within 10 working days after
the date the decision was rendered by the Bureau Chief. The decision of the DHS-DRS
Director shall be final.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.235 ENHANCED RATE FOR HEALTH INSURANCE COSTS
Section 686.235 Enhanced Rate for Health Insurance Costs
An enhanced rate shall be paid to Homemaker Service
Providers that offer health insurance coverage as a benefit to their Homemaker
employees who provide services to customers under HSP.
a) For
purposes of this Section, "health insurance" means a Type 1 plan or a
Type 2 plan as described in subsections (a)(1) and (2).
1) Type 1 Plan
A Type 1 plan must comply with, be
comparable to, or exceed required mandated benefits, coverages, and co-payment
levels for individuals and group insurance policies and individual and group
contracts for health maintenance organizations under the Illinois Insurance
Code [215 ILCS 5], the Health Maintenance Organization Act [215 ILCS 125], and 50
Ill. Adm. Code 2001.
2) Type 2 Plan
A Type 2 plan is employer-paid
health insurance as part of collective bargaining with unionized Homemaker
employees through a Taft-Hartley Multi-employer Health and Welfare Plan. The
Labor Management Relations Act of 1947 (29 USC 141 et seq.) describes the
requirements and coverage at 29 USC 186(c)(5).
b) Initial Application
1) An
interested Homemaker Service Provider must submit an initial application at
least 120 days prior to the end of each State fiscal year. The application may
be obtained from and must be submitted to the Home Services Liaison for Health
Insurance, Department of Human Services, 100 South Grand Avenue East, P.O. Box
19429, Springfield, Illinois 62794-9429.
2) Homemaker
Service Providers that are found by HSP to have deficiencies may not apply for
the enhanced rate until deficiencies are corrected to the satisfaction of HSP.
c) Eligibility
Eligibility
requirements include:
1) Verification
of a current rate agreement as a Homemaker Service Provider under the HSP.
2) A
copy of a health insurance plan or a certification of insurance and the
effective date of that document, to establish that:
A) the
Homemaker Service Provider provides health insurance at its own expense for its
Homemaker employees, which may include coverage for those employees'
dependents; or
B) the
Homemaker Service Provider will provide for health insurance as part of
collective bargaining with unionized Homemaker employees, which may include
coverage for those employees' dependents through a Taft-Hartley Multi-employer
Health and Welfare Plan.
3) Specification
of the total number of employees and the total number of Homemaker employees,
together with a certification from a responsible party for the Homemaker
Service Provider to the effect that:
A) under a
Type 1 health insurance plan:
i) health
insurance coverage is offered to all Homemaker employees who have worked at
least an average of 20 hours per week for three consecutive months under HSP;
and
ii) at
least one quarter of the total number of Homemaker employees accept the offer
of health insurance.
B) under a
Type 2 health insurance plan:
i) health
insurance coverage is offered to all of the Homemaker employees subject to the
collective bargaining agreement who have worked at least an average of 20 hours
per week for three consecutive months under HSP; and
ii) at
least one quarter of the total number of Homemaker employees, or any higher
percentage required under federal law, accept the offer of health insurance.
4) Submission
of any other relevant information requested by HSP for administrative or audit
purposes.
d) Notification
It is the responsibility of a
Homemaker Service Provider to notify HSP within 7 days of any change in its
eligibility status, including, but not limited to, cancellation or termination
of the health insurance plan or purchase of a new plan. A Homemaker Service
Provider is only required to monitor participation by Homemaker employees in
order to submit the initial application, the Annual Insurance Review required
by subsection (e), and required financial reporting.
e) Annual Insurance Review
1) Once
a Homemaker Service Provider is determined eligible by HSP and is paid an
enhanced rate for health insurance costs, the Homemaker Service Provider must
thereafter substantiate its continued eligibility under subsection (c) by
submitting appropriate supporting documentation at the same time as its annual
financial report under Section 686.250.
2) As
part of the Annual Insurance Review, an independent certified public accounting
firm for the Homemaker Service Provider must verify the actual, documented
expense for health insurance provided for the period listed as part of the
required financial reporting under Section 686.250.
3) HSP
reserves the right to require a Homemaker Service Provider to engage an
independent certified public accounting firm, approved by HSP, to verify the
information and data submitted by the Homemaker Service Provider if HSP is in
possession of evidence to suggest the information and data submitted is
inaccurate, incomplete or fraudulent. This audit will be performed at the
Homemaker Service Provider's expense.
4) HSP
shall notify a Homemaker Service Provider in the event of a determination
during the Annual Insurance Review that:
A) the
Homemaker Service Provider is no longer eligible for continued payment of the
enhanced rate for health insurance costs;
B) the
total revenue from the enhanced rate for health insurance costs exceeds the
actual, documented expenses for health insurance costs for the reporting
period;
C) there
was an error in eligibility of a Homemaker Service Provider for the prior
reporting period;
D) there
was an error in the amount of revenue from the enhanced rate for health
insurance costs; or
E) there
was an error in the amount of the health insurance costs.
5) A
Homemaker Service Provider may appeal an adverse eligibility decision regarding
continued payment of the enhanced rate for health insurance costs or a
repayment decision in accordance with Section 686.230. HSP will continue to
pay the enhanced rate for health insurance costs until the appeal is resolved.
6) Supporting
documentation may be subject to release under the Freedom of Information Act [5
ILCS 140] unless an exemption applies for confidentiality, privacy, or other
proprietary business purpose and is marked accordingly on the face of any
submission.
(Source: Added at 38 Ill.
Reg. 11519, effective May 15, 2014)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.240 PAYMENT INFORMATION FOR HOMEMAKER SERVICE PROVIDERS
Section 686.240 Payment Information
for Homemaker Service Providers
a) Payment
information for all Homemaker Service Providers
1) Payment for Homemaker Services shall be at the rate specified
in the rate agreement signed by HSP and the approved Homemaker Service Provider.
2) Services shall be paid in accordance with the time recorded by
the Homemaker employee pursuant to the Service Plan (see 89 Ill. Adm. Code
676.30) developed for the customer.
3) Homemaker Service Providers shall submit monthly billings for
approved services provided the previous month and monthly progress reports for
each customer served by the Homemaker Service Provider for the month being
billed.
4) Payment for Homemaker Services shall be allowed only for those
hours services are being provided to the HSP customer. No payment shall be
claimed for those periods that the Homemaker employee spends traveling, in
conferences, etc., or for expenses incurred by the Homemaker employee.
5) By
accepting any payment under HSP, a Homemaker Service Provider agrees to repay
the State of Illinois if:
A) the
total revenue from the monthly billings exceeds the actual, approved documented
services under this Section for the reporting period;
B) an
error occurred in the calculation of the monthly billing submitted to HSP and
the provider was overpaid;
C) the
Homemaker Service Provider received payment for services during a time the
provider was determined ineligible to provide services under HSP; or
D) the
Homemaker Service Provider misspent HSP funds or received funding from HSP
while participating in fraudulent activity.
b) Additional
Payment Information for Homemaker Service Providers with the Enhanced Rate for
Health Insurance Costs
1) If a
Homemaker Service Provider is determined eligible for the enhanced rate for
health insurance costs, HSP will thereafter calculate the appropriate payment
based on the number of units of Homemaker Service accepted as billed for the
eligible dates of service.
2) A
Homemaker Service Provider that makes a switch between a Type 1 and a Type 2
plan is not entitled to any retroactive payments for a period of time preceding
the date on which benefits are actually available under the new plan.
3) No
Homemaker Service Provider is entitled to a duplicate payment for the same
period of time or for the same units of Homemaker Service accepted as billed
per contract.
4) By
accepting any payment under HSP, a Homemaker Service Provider agrees to repay
the State of Illinois if:
A) the
total revenue from the enhanced rate for health insurance costs exceeds the
actual, documented expenses for its health insurance costs under this Section
for the reporting period;
B) an
error in eligibility of a Homemaker Service Provider, or the amount of revenue
from the enhanced rate for health insurance costs, or the amount of the health
insurance costs is subsequently determined by the Homemaker Service Provider or
HSP; or
C) the
Homemaker Service Provider misspent HSP funds or received funding from HSP for
the enhanced rate for health insurance costs while participating in fraudulent
activity.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.250 FINANCIAL REPORTING OF HOMEMAKER SERVICE PROVIDERS
Section 686.250 Financial
Reporting of Homemaker Service Providers
a) Homemaker
Service Providers shall be required to:
1) complete
and submit a Homemaker Cost Certification report that is based upon actual,
documented expenditures.
A) The report
must be submitted annually, within 60 days after the end of the reporting
period, and may be prepared as a part of the Homemaker Service Provider's
annual audit.
B) The
report may be based on a calendar year or on the Homemaker Service Provider's fiscal
year; however, once it is determined which time period is to be used, written
approval from HSP shall be required for a change in that determination.
C) The
report must demonstrate that the Homemaker Service Provider has expended a
minimum of 77% of the total revenues due from HSP, including the customer
incurred expense, for Homemaker costs as enumerated in Section 686.280. For
purposes of this report, the phrase "total revenues due from HSP"
does not include any amount received as an enhanced rate under Section 686.235
by a qualifying Homemaker Service Provider.
D) The
report shall identify the Homemaker Service Provider's expenditures for
Homemaker costs of Program support costs, and administrative costs as
enumerated in Section 686.280.
2) complete
and submit a Homemaker Cost Certification report to document compliance with
any rate-based wage increase for Homemaker employees who provide services under
HSP. The report must be submitted within 60 calendar days after issuance of
written notification of the increase by HSP.
b) The
accuracy of the reports identified in subsections (a)(1) and (2) must be
attested to by an authorized representative of the Homemaker Service Provider.
c) HSP
reserves the right to require the Homemaker Service Provider to engage an
independent certified public accounting firm, approved by HSP, to verify the
information and data submitted by the Homemaker Service Provider if HSP is in
possession of evidence to suggest the information and data submitted is
inaccurate, incomplete or fraudulent. This audit will be performed at the
Homemaker Service Provider's expense.
d) HSP may take appropriate
enforcement action in the following instances:
1) a
Homemaker Service Provider did not submit a report;
2) a
report is inaccurate, incomplete or fraudulent; or
3) a
Homemaker Service Provider did not increase the wages paid to its Homemaker
employees in the amount required by a rate increase under HSP.
e) Homemaker
Services Providers approved for the enhanced rate for health insurance costs:
1) shall
not report the enhanced rate for health insurance costs paid by HSP as part of their
revenue for purposes of the required financial reporting under this Section;
and
2) shall
not report health insurance for Homemaker employees as an incurred cost for
purposes of the required financial reporting under this Section, except for an
amount in excess of the enhanced rate paid by HSP during a reporting period.
f) Enforcement
action towards a Homemaker Service Provider includes, but is not limited to the
imposition of a corrective action plan, suspension of referrals from HSP,
and/or termination of rate agreements with HSP.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.260 UNALLOWABLE EXPENSES FOR HOMEMAKER SERVICE PROVIDERS
Section 686.260 Unallowable Expenses
for Homemaker Service Providers
The following Homemaker Service
Provider expenses shall not be considered by HSP:
a) expenses resulting from transactions with related parties or parent
organizations that are greater than the going market cost of the transactions
to the Homemaker Service Provider;
b) non-straightline depreciation;
c) bad debts;
d) special benefits to owners, including owner and key-man life
insurance;
e) compensation to non-working owners and officers;
f) discounts, rebates, allowances and charity grants offered by
the Homemaker Service Provider;
g) entertainment expenses;
h) fundraising;
i) legal fees for litigation with governmental agencies;
j) awards, grants and gifts to individuals;
k) fines and penalties;
l) contingency funds;
m) losses on other grants and contracts; and
n) health coverage costs as described under Section
686.250(e)(2).
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.270 MINIMUM HOMEMAKER COSTS FOR HOMEMAKER SERVICE PROVIDERS
Section 686.270 Minimum Homemaker
Costs for Homemaker Service Providers
a) As provided under Section 686.250(a)(1)(C), Homemaker Service
Providers are required to expend a minimum of 77% of the total revenues due
from the HSP, to include the customer incurred expense, for Homemaker costs, as
enumerated in Section 686.280, during a reporting year.
1) This percentage is to be adhered to on a statewide basis.
2) The remaining 23% of the total revenues may be spent by the
Homemaker Service Providers at their discretion on administrative or Program support
costs, also delineated in Section 686.280.
b) Failure of the Homemaker Service Provider to meet the
requirements in subsection (a) may result in the following:
1) Within 60 days, the Homemaker Service Provider will be
required to submit a corrective action plan that shall include Homemaker Service
Provider payments to current Homemakers in an amount that will, in total, bring
the Homemaker Service Provider into compliance with the requirements in
subsection (a). After HSP's review and approval of the corrective action plan,
the Homemaker Service Provider shall implement and observe it.
2) Failure by the Homemaker Service Provider to submit and/or
observe a corrective action plan that is acceptable to HSP shall result in
termination after 60 days notice.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.280 COST CATEGORIES FOR HOMEMAKER SERVICES
Section 686.280 Cost
Categories for Homemaker Services
Homemaker Service Providers will
provide for cost reporting based on the following categories:
a) Homemaker costs (costs paid to or on behalf of Homemakers)
that may include:
1) wages, time paid on behalf of the worker (i.e., vacation, sick
leave, holiday and personal leave);
2) health coverage for any Homemaker Service Provider that does
not qualify for the enhanced rate for health insurance costs from the HSP or
the amount of the cost incurred in excess of the enhanced rate paid to the
Homemaker Service Provider during a reporting period, life insurance and
disability insurance;
3) retirement coverage;
4) Federal Insurance Contributions Act (FICA) (26 USC 21);
5) uniforms;
6) worker's compensation;
7) Federal Unemployment Tax Act (FUTA) (26 USC 23);
8) travel time and travel reimbursement;
9) unemployment insurance; and
10) other costs approved, in advance, as Homemaker costs by HSP.
b) Administrative Costs:
1) personnel:
A) administrator;
B) assistant administrator;
C) accountant/bookkeeper;
D) clerical;
E) other office staff;
F) supervisor of Homemakers;
G) other personnel expenses;
2) consultant:
A) auditors;
B) management consultants;
C) management fees from the parent organization;
D) other related consultant costs;
E) other consultant expenses;
3) non-personnel:
A) office supplies;
B) office equipment (expense or depreciation based upon company
policy);
C) telephone/facsimile;
D) conferences, conventions, meeting expenses;
E) subscriptions and reference materials;
F) postage and shipping;
G) advertising;
H) outside printing and art work;
I) membership dues;
J) moving and recruiting;
K) other general operating expenses;
L) profit;
4) occupancy:
A) depreciation;
B) amortization of leasehold improvements;
C) rent;
D) property taxes;
E) interest;
F) other related occupancy costs.
c) Program support costs that include all allowable costs not
specifically made a part of Homemaker costs or administrative costs. These may
include:
1) training expenses;
2) malpractice insurance;
3) Homemaker supervisor costs.
(Source: Amended at 38 Ill.
Reg. 11519, effective May 15, 2014)
SUBPART D: ELECTRONIC HOME RESPONSE SERVICES
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.300 ELECTRONIC HOME RESPONSE SERVICES (EHRS) PROVIDER REQUIREMENTS
Section 686.300 Electronic
Home Response Services (EHRS) Provider Requirements
In order for a specific EHRS
Provider to be approved for use by DHS in obtaining services for individuals
served through HSP, the EHRS Provider must:
a) have, and make available on request:
1) articles of incorporation; or
2) if unincorporated, a statement of purpose and function; and
3) a list of the owners and/or the EHRS Provider's owners and/or
directors/officers;
b) have written policies, which are available to DHS and all
customers, governing:
1) the type and scope of services provided, which include clear
and concise distinctions between services, if more than one service is offered;
2) personnel policies, including:
A) salary schedules;
B) work hours;
C) employee attendance and leave;
D) written job descriptions, which include clear and concise
duties and qualifications for each position;
E) grievance procedures; and
F) requirements for staff training and in-service;
c) maintain adequate records for planning, budgeting,
administration and program evaluation and planning. These records shall be
available at all times to DHS and the United States Department of Health and
Human Services (HHS), or any entity designated by DHS or HHS, and shall be
maintained for a period of at least 5 years, or until advised that all State
and federal audits are completed. These records must include, but not be
limited to:
1) records of all referrals, including the disposition of each
referral;
2) customer records, which include:
A) dates and times of all signaling and the name of the responder
to each signaling;
B) dates and times of all equipment tests;
C) disposition of all emergency signaling;
3) administrative records including:
A) service statistics; and
B) billing and payment records;
4) personnel records, including:
A) schedules and attendance records for staff and volunteers of
the EHRS Provider;
B) staff and volunteer training reports;
C) annual performance review of all EHRS Provider staff;
d) accept all referrals made for services by DHS;
e) maintain and implement written procedures for the evaluation
of its programs and services, the outcome of which shall be to make
recommendations to its governing body for improving its services;
f) have and agree to maintain adequate liability insurance
coverage and provide DHS a copy of the Certificate of Insurance;
g) agree to hold harmless DHS against any and all liability,
loss, damage, cost, or expense arising from the wrongful or negligent action of
the EHRS Provider or any of its agents, which DHS may sustain, incur, or be
required to pay;
h) comply with all local, State, and federal laws, regulations,
and standards and DHS regulations and standards pertaining to HSP;
i) maintain as confidential any information obtained regarding a
customer of DHS and agree not to release this information without the written
approval of the DHS Secretary or the customer;
j) certify that the EHRS Provider and any of its agents have not
been convicted of bribery or attempting to bribe an officer or employee of the
State of Illinois, nor has the EHRS Provider or any of its agents made an
admission of guilt of such conduct which is a matter of record;
k) agree to provide all services listed in Section 686.310; and
l) have in place an Affirmative Action Plan approved by its
governing body.
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.310 SERVICES WHICH MUST BE PROVIDED BY EHRS PROVIDERS
Section 686.310 Services
Which Must Be Provided by EHRS Providers
In order to be a DHS approved
EHRS Provider, the EHRS Provider must:
a) have trained employees or volunteers that install the EHRS
units in the individual's home. This service may not be sub-contracted;
b) be able to install the EHRS unit in the individual's home
within 48 hours upon referral of an individual by DHS to the EHRS provider;
c) assist the individual in arranging several appropriate
responders and provide training to those responders;
d) provide 24-hour monitoring;
e) provide instruction to the individual receiving EHRS services
on the proper use of the EHRS unit at the time the unit is installed. The
instruction must include:
1) provisions for monthly testing of the unit and its
transmission by the individual receiving the EHRS services; and
2) general care of the home unit; and
f) in the event of unit malfunction, the EHRS Provider must
repair or replace the unit within 24 hours of receiving the report.
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.320 MINIMUM SPECIFICATIONS FOR EHRS EQUIPMENT
Section 686.320 Minimum
Specifications for EHRS Equipment
a) All home units, at a minimum, must meet the requirements of
this subsection (a).
1) Home units must be able to be activated from:
A) a wireless remote; and
B) from the telephone, using a predetermined number;
2) The wireless remote activator must have:
A) a crystal or Surface Acoustic Wave (SAW) resonator controlled
transmitted frequency for long-term reliability;
B) digital encoding capability for at least 10 combinations;
C) a minimum transmission range of 175 feet;
D) an internal battery with a minimum life of 5 years;
E) low battery signal; and
F) certification under 47 CFR 15.
3) The base unit or communicator unit must:
A) be an integrated unit that connects to the individual's
telephone via a modular jack which does not interfere with the normal use of
the telephone or be an integrated unit that connects to a stable cellular network
available to the individual’s primary residence;
B) connect to a standard home electrical outlet, as its power
supply, by use of an Underwriter's Laboratory approved plug;
C) be able to seize the telephone line, even when a telephone in
the dwelling is connected via a modular jack and is off the hook, and dial the
EHRS Center to transmit an emergency signal;
D) the base unit must have an easily identifiable
"Ready" light to verify the unit is on-line with the EHRS Center;
E) the base unit must have an easily identifiable
"confirmation" light to indicate that, if activated, the EHRS Center
has received the call;
F) disconnect and redial, until the call is received at the EHRS
Center, if an emergency call does not reach the EHRS Center;
G) have a simple process by which signals may be aborted, in the
event an erroneous signal is sent;
H) have a battery, which is continuously charged while the unit is
on, that will maintain a charge for at least 12 hours in the event of an
electrical power failure;
I) transmit a message to the EHRS Center signifying maintenance
of the unit is required in the event of base unit battery failure; and
J) be certified under 47 CFR 15 and 68.
b) All EHRS Center equipment, at a minimum, must:
1) be capable of automatically receiving all signals and
displaying and printing all messages sent from home communicators connected to
the EHRS system;
2) have an audible and visual alarm for the notification of all
incoming signals;
3) display and print the incoming message, date, time, and Customer
identification for each incoming signal;
4) have a battery back-up which will automatically take over
should there be a power outage, or a single circuit failure. This battery
back-up must supply sufficient power to operate the entire system for a minimum
of 8 hours in the event of an outage;
5) have totally separate and independent primary and back-up
receivers. If the primary receiver should fail, the system must automatically
transfer to the back-up receiver to ensure no interruption in services;
6) monitor all connected telephone lines and give an audible
signal should one of the connected telephone lines be out of service for a
period of longer than one minute;
7) be able to identify each individual Customer account;
8) perform self-diagnostic testing and monitoring to indicate the
status of fault conditions, which could interfere with receiving signals and
monitoring telephone connections such as power loss, telephone line outages,
signals received with no messages, nonoperating transmitters, etc.; and
9) be certified under 47 CFR 15 and 68.
(Source:
Amended at 46 Ill. Reg. 20865, effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.330 COMPLIANCE REVIEW OF EHRS PROVIDERS
Section 686.330 Compliance
Review of EHRS Providers
a) DHS-ORS shall conduct a compliance review of any EHRS Provider
seeking an approval from DHS-ORS and at least every two years shall conduct a
review of all EHRS Providers that have current approval of DHS-ORS for the
purpose of determining compliance or continued compliance with the criteria for
approval set forth in this Subpart.
b) DHS-ORS shall, when contacted by an EHRS Provider, or when
notified by staff of the need to access the services of a specific EHRS
Provider, conduct the review within a period of 60 calendar days.
c) DHS-ORS shall notify all currently approved EHRS Providers, in
writing, at least 10 working days prior to the date of the review to determine
continued compliance.
(Source: Amended at 24 Ill. Reg. 7501, effective May 6, 2000)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.340 APPEAL OF COMPLIANCE REVIEW FOR EHRS PROVIDERS
Section 686.340 Appeal of
Compliance Review for EHRS Providers
a) EHRS Providers determined not to be in compliance with DHS-ORS
requirements as a result of the review may appeal the decision to the Chief of
the Bureau of Home Services. The Bureau Chief shall conduct a review of the
facts related to the rating and shall, within 15 working days, provide a
written decision to the EHRS Provider.
b) If the EHRS Provider is not satisfied with the decision of the
Bureau Chief, the EHRS provider may request review of the Bureau Chief's
decision by DHS-ORS Associate Director. The request must be in writing and
received by DHS-ORS Associate Director within 10 working days after the date
the decision was rendered by the Bureau Chief. The decision of DHS-ORS
Associate Director shall be final.
(Source: Amended at 24 Ill. Reg. 7501, effective May 6, 2000)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.350 RATE OF PAYMENT FOR EHRS SERVICES
Section 686.350 Rate of
Payment for EHRS Services
a) Installation
DHS-ORS shall pay up to the rate negotiated as a one time
installation fee for the installation of the EHRS unit, plus the charge of the
local telephone company for telephone service hook up for those customers who
do not have local telephone service at the time EHRS services are initiated.
b) Monthly Service Fees
DHS-ORS shall pay no more than the rate negotiated for EHRS
services, including all fees and charges. DHS-ORS will not pay the cost of the
monthly local telephone services required to have EHRS.
(Source: Amended at 24 Ill. Reg. 10212, effective July 1, 2000)
SUBPART E: MAINTENANCE HOME HEALTH SERVICE
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.400 MAINTENANCE HOME HEALTH PROVIDER REQUIREMENTS
Section 686.400 Maintenance
Home Health Provider Requirements
DHS shall use Maintenance Home
Health Providers which are approved Medicaid providers or licensed by the
Illinois Department of Public Health pursuant to the Home Health Agency
Licensing Act [210 ILCS 55].
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.410 RATE OF PAYMENT FOR MAINTENANCE HOME HEALTH SERVICES
Section 686.410 Rate of
Payment for Maintenance Home Health Services
DHS shall pay Maintenance Home
Health Providers the rate established by the Illinois Department of Public Aid
through the Medicaid Program for the same service.
SUBPART F: HOME DELIVERED MEALS
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.500 HOME DELIVERED MEALS PROVIDER REQUIREMENTS
Section 686.500 Home
Delivered Meals Provider Requirements
Any entity providing Home
Delivered Meals must be certified by the health department in the county in
which the program or facility is located and must meet the approval of the
customer and counselor.
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.510 RATE OF PAYMENT FOR HOME DELIVERED MEALS
Section 686.510 Rate of
Payment for Home Delivered Meals
Providers of Home Delivered
Meals may be paid up to the amount that would be paid a PA to prepare meals for
the customer.
SUBPART G: ENVIRONMENTAL MODIFICATION
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.600 DESCRIPTION
Section 686.600 Description
Environmental Modification – Services
to physically modify the customer's home to accommodate the customer's loss of
function in the completion of his/her Activities of Daily Living (ADLs).
(Source: Added at 31 Ill.
Reg. 14238, effective September 27, 2007)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.605 CRITERIA FOR THE PROVISION OF ENVIRONMENTAL MODIFICATIONS
Section 686.605 Criteria for the Provision of
Environmental Modifications
Environmental modifications may
be provided to a customer if:
a) the modification will
enable the customer to independently perform his/her ADLs,
will result in a decreased need
for assistance from another individual in the completion of his/her ADLs, will
prevent an anticipated increase in service costs, or will improve the safety of
the customer during the completion of his/her ADLs;
b) there
are no other resources, public or private, that will provide the modification;
and
c) the
HSP total cost for purchase of all environmental modifications and assistive
equipment purchases, rentals, and repairs (89 Ill. Adm. Code 686.705(d)) does
not exceed $25,000 over 5 years.
(Source: Added at 31 Ill.
Reg. 14238, effective September 27, 2007)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.608 ENVIRONMENTAL MODIFICATION PROVIDER REQUIREMENTS
Section 686.608
Environmental Modification Provider Requirements
All Environmental Modification providers
must:
a) meet the approval of the customer and counselor;
b) submit a completed 1413 A − Waiver Program Provider
Agreement for Participation in the Illinois Medical Assistance Program form;
c) submit a completed W-9 Request for Taxpayer Identification
Number and Certificate;
d) carry a minimum of $500,000 in liability insurance, and
provide DHS-DRS with a copy of the Certificate of Insurance verifying current
coverage;
e) provide proof of appropriate current contractor licenses, as
applicable;
f) perform all modifications so that they meet the standards
established by the Environmental Barriers Act, the Illinois Accessibility Code
[71 ILCS 400] and local zoning ordinances and codes; and
g)
obtain proper building permits as required by local municipalities.
(Source: Renumbered from Section
686.600 to Section 686.608 and amended at 31 Ill. Reg. 14238, effective September
27, 2007)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.610 COST OF ENVIRONMENTAL MODIFICATION (REPEALED)
Section 686.610 Cost of
Environmental Modification (Repealed)
(Source: Repealed at 31 Ill.
Reg. 14238, effective September 27, 2007)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.615 ENVIRONMENTAL MODIFICATION BIDDING PROCEDURES AND REQUIREMENTS
Section 686.615 Environmental Modification Bidding
Procedures and Requirements
a) For
environmental modification purchases costing $1,500 or less, bids are not
required.
b) For
environmental modification purchases costing more than $1,500, 3 bids must be
obtained using an Invitation to Bid form (IL 488-0293);
1) If an
item is available from fewer than 3 sources, the maximum number of bids possible
shall be obtained.
2) The
lowest bid received from an eligible provider will be accepted.
3) All exceptions
must have supervisory approval.
(Source: Added at 31 Ill.
Reg. 14238, effective September 27, 2007)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.620 PERMANENCY OF ENVIRONMENTAL MODIFICATION
Section 686.620 Permanency
of Environmental Modification
For environmental modifications that
cannot be detached from the dwelling, the home must be owned or mortgage held by
the customer. If the home is not owned by the customer, the customer, with the
assistance of the counselor, must obtain written permission of the homeowner/property
owner to make the modifications and to ensure that the homeowner/property owner
understands the permanency of the modifications and DHS-DRS' inability to
return the building to its previous condition. A Homeowner/Lessor Agreement
form (IL 488-0040) must be completed and signed by the homeowner/lessor,
customer/lessee, and the counselor prior to the installation of any
environmental modifications.
(Source: Amended at 31 Ill.
Reg. 14238, effective September 27, 2007)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.630 REASON FOR DENIAL OF ENVIRONMENTAL MODIFICATION
Section 686.630 Reason for
Denial of Environmental Modification
Environmental modifications
shall be denied when:
a) the cost of the modifications does not comply with the
provisions of Section 686.605(c);
b) the customer has a poor history as a tenant, or is otherwise
not expected to remain in the home to be modified for a period of at least 1
year;
c) the past practices or reputation of the landlord is
unfavorable; or
d) the
modifications are for "value added" or cosmetic purposes.
(Source: Amended at 31 Ill.
Reg. 14238, effective September 27, 2007)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.640 VERIFICATION OF ENVIRONMENTAL MODIFICATION
Section 686.640 Verification
of Environmental Modification
Within 30 days of the date of
completion of the environmental modifications, the counselor must make a home
visit to inspect the modifications and to ensure customer satisfaction with the
modifications. A signed Receipt for Appliances, Merchandise and Supplies form
(IL 488-1694) from the customer shall be required to verify receipt and
satisfaction with the modifications.
(Source: Amended at 31 Ill.
Reg. 14238, effective September 27, 2007)
SUBPART H: ASSISTIVE EQUIPMENT
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.700 DESCRIPTION
Section 686.700 Description
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.
(Source: Added at 31 Ill.
Reg. 14238, effective September 27, 2007)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.705 CRITERIA FOR THE PURCHASE, RENTAL, OR REPAIR OF ASSISTIVE EQUIPMENT
Section 686.705 Criteria for the Purchase, Rental, or
Repair of Assistive Equipment
Assistive equipment may be provided to a customer if:
a) the
equipment will enable the customer to independently perform his/her ADLs, will
result in a decreased need for assistance from another individual in the
completion of his/her ADLs, will prevent an anticipated increase in service
costs, or will improve the safety of the customer during the completion of
his/her ADLs;
b) there
is an official communication/documentation in the file of Medicaid denial by
the Department of Healthcare and Family Services (HFS) for the requested
assistive equipment;
c) there
are no other resources, public or private, that will provide the equipment; and
d) the
HSP total cost for purchases, rentals, and repairs of all assistive equipment
and environmental modifications (89 Ill. Adm. Code 686.605(c)) does not exceed
$25,000 over 5 years.
(Source: Added at 31 Ill. Reg. 14238,
effective September 27, 2007)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.708 PURCHASE, RENTAL, OR REPAIR OF ASSISTIVE EQUIPMENT
Section 686.708 Purchase, Rental, or Repair of Assistive
Equipment
A prescription from a physician or licensed therapist is
required for all purchases or rentals of medically-oriented assistive
equipment.
a) Assistive equipment may
be purchased when:
1) the
customer is expected to need the equipment for a period to exceed 1 year;
2) the
cost of renting the equipment exceeds the purchase price of the equipment; or
3) the equipment is not
available for rental.
b) Assistive equipment may
be rented when:
1) the
customer is not expected to need the equipment for an extended period of time
(i.e., less than 1 year); and
2) the
rental cost for the equipment for the period the customer is expected to need
the equipment is less than the purchase price for the equipment.
c) Assistive equipment may
be repaired when:
1) the equipment is
already in the possession of the customer;
2) the
repair cost is less than the rental or purchase price for the same equipment;
and
3) the equipment,
when repaired, is expected to have an increased useful life of at least 1 year.
d) If an
item is available for purchase, rental, or repair through Medicaid, DHS-DRS
will not provide additional funding if an approved provider refuses to accept the
Medicaid approved rate.
(Source: Added at 31 Ill.
Reg. 14238, effective September 27, 2007)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.710 PROVISION OF ASSISTIVE EQUIPMENT (REPEALED)
Section 686.710 Provision of
Assistive Equipment (Repealed)
(Source: Repealed at 31 Ill.
Reg. 14238, effective September 27, 2007)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.715 ASSISTIVE EQUIPMENT PROVIDER REQUIREMENTS
Section 686.715 Assistive
Equipment Provider Requirements
All assistive equipment
providers must:
a) meet the approval of the customer and counselor;
b) submit a completed 1413A − Waiver Program Provider
Agreement for Participation in the Illinois Medical Assistance Program form;
and
c) submit a completed W-9 Request for Taxpayer Identification
Number and Certificate.
(Source: Renumbered from Section
686.700 to Section 686.715 and amended at 31 Ill. Reg. 14238, effective September
27, 2007)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.720 VERIFICATION OF RECEIPT OF ASSISTIVE EQUIPMENT (REPEALED)
Section 686.720 Verification
of Receipt of Assistive Equipment (Repealed)
(Source: Repealed at 31 Ill.
Reg. 14238, effective September 27, 2007)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.722 ASSISTIVE EQUIPMENT BIDDING PROCEDURES AND REQUIREMENTS
Section 686.722 Assistive Equipment Bidding Procedures
and Requirements
a) For assistive equipment
purchases costing $1,500 or less, bids are not required.
b) For
assistive equipment purchases costing more than $1,500, 3 bids must be obtained
using an Invitation to Bid form (IL 488-0293);
1) If an
item is available from fewer than 3 sources, the maximum number of bids possible
shall be obtained.
2) The
lowest bid received from an eligible provider will be accepted.
3) All
exceptions must have supervisory approval.
(Source: Added at 31 Ill.
Reg. 14238, effective September 27, 2007)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.730 VERIFICATION OF RECEIPT OF, AND CUSTOMER SATISFACTION WITH, ASSISTIVE EQUIPMENT
Section 686.730 Verification
of Receipt of, and Customer Satisfaction with, Assistive Equipment
Assistive equipment that is
purchased, rented or repaired requires customer contact for verification of
equipment/services provided. A Receipt for Appliances, Merchandise and
Supplies form (IL 488-1694) must be completed and signed by the customer within
60 days after the equipment delivery, installation, or repair.
(Source: Added at 31 Ill.
Reg. 14238, effective September 27, 2007)
SUBPART I: RESPITE CARE
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.800 RESPITE CARE PROVIDER REQUIREMENTS
Section 686.800 Respite Care
Provider Requirements
Any individual or agency
providing respite services to an individual through HSP must meet the standards
set forth in the appropriate Subpart for that service as listed in this Part.
SUBPART J: CASE MANAGEMENT SERVICES TO PERSONS WITH AIDS
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.900 PROGRAM OVERVIEW
Section 686.900 Program
Overview
The Department of Human Services
Division of Rehabilitation Services (DHS-DRS) shall enter into agreements with
agencies to provide case management services to persons diagnosed with AIDS,
which includes persons with human immunodeficiency virus (HIV) infection, who
are eligible for services provided by the AIDS Medicaid Waiver. For
geographical areas in Illinois in which case management agencies are not
located, case management shall be provided by DHS-DRS Home Services counselors,
utilizing licensed home health nurses, as needed, to comply with the services
offered and the requirements contained in Section 686.910(b), (c), (d), and
(e).
(Source: Amended at 47 Ill. Reg. 19328, effective December 13, 2023)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.910 CASE MANAGEMENT PROVIDER RESPONSIBILITIES
Section 686.910 Case
Management Provider Responsibilities
a) Case Management
1) The case management agency shall receive Customer referrals
from hospitals, the Illinois Department of Public Health's AIDS Hotline, HSP Ashburn
Unit, other State and local agencies, and other referral services (e.g.,
doctors and individuals). The provider shall assign a case manager to each Customer.
2) There shall be two levels of case managers: provisional case
managers and case managers.
A) Case managers are those who have achieved a competency score of
98% or greater for the on-site case reviews done by the HSP Ashburn Unit under
Section 686.930(d). The case manager shall have full responsibility for the
determination of HSP eligibility including assessment and implementation of
services to be provided. The case manager shall develop services with Customer
participation that are provided in a manner that reflects the Customer's
choices, when applicable, and address the Customer's strengths, needs and
desired goals. Assessments, service plans and reassessments completed by case
managers may be implemented without consultation with the HSP Ashburn Unit.
B) The case manager shall act as a liaison with the hospital
discharge planner, physician, home health agencies, and other medical provider
agencies.
C) Provisional case managers are those who have not achieved a
competency score of 98% or greater for the on-site case reviews done by the HSP
Ashburn Unit, per Section 686.930(d). Provisional case managers shall submit
all developed plans to the HSP Ashburn Unit for approval. Approval of the plan
will be based on a review to determine that: the Determination of Need
Assessment on which the plan is developed is complete and accurate; the plan
meets the needs identified by the assessment; the plan does not place the Customer's
health and safety at risk; and the plan is cost effective compared to comparable
institutional care.
b) The case manager shall provide the following services:
1) initial assessment of eligibility and information gathering
(89 Ill. Adm. Code 682);
2) development of a person-centered service plan and
implementation (89 Ill. Adm. Code 684);
3) reassessment of level of care at least every 12 months for
those cases in formal eligibility, three months for those cases that have been
presumptively determined eligible for interim services (89 Ill. Adm. Code
684.80), or at such time when the Customer's financial or physical condition or
need for services changes;
4) networking/coordination/brokering services (i.e., referring
and assisting the Customer in obtaining other agencies' services);
5) assisting the Customer when Individual Provider and Agency
Provider problems develop. Documentation of these problems and the case
management team's responses will be kept in the Customer's case file;
6) counseling and advocacy;
7) acting as inter-agency liaison (e.g., with other DHS programs,
Managed Care Organizations (MCOs), vendors, hospitals);
8) making required Customer contact at least once a month, with a
face-to-face contact bi-monthly, to ensure the Customer's needs are being met;
9) maintaining and updating Customer records; and
10) monitoring the cost effectiveness of the service plan (89
Ill. Adm. Code 679.50).
c) Eligibility for AIDS Waiver
1) Within 10 working days (exceptions being 2 working days for
prescreening referrals from cooperating hospitals for interim/emergency
services, 5 working days for all other prescreening for interim/emergency
services) after receipt of a referral, the case manager shall complete an
individual's eligibility determination for the AIDS Waiver program.
2) The case manager shall determine Customer eligibility for the
AIDS Waiver by completing an assessment from a home visit or while the
applicant is hospitalized (89 Ill. Adm. Code 682). To determine Customer
eligibility, the case manager will utilize the HSP Determination of Need
Assessment (89 Ill. Adm. Code 682).
3) The case manager shall assess the Customer's limitations in
activities of daily living (ADLs) (e.g., cooking, bathing, shopping) and what
resources are available to assist the Customer in performing the ADLs (89 Ill.
Adm. Code 682).
4) Notice of eligibility must be mailed to the HSP Ashburn Unit
within ten working days after the date on which a completed application is
received by the case management agency.
d) The case manager will provide a case action notice to each Customer
informing the Customer of the eligibility determination, of all rights and
responsibilities under the case management program, including the Customer's
right to request an appeal, the appeals procedures promulgated by the
Department, the right to receive assistance in filing the request for appeal
and information about the services of the Home Care Ombudsman Program (HCOP)
and how to reach HCOP.
e) Service Plan
1) If the DON assessment demonstrates a nursing facility level of
care need such as the need for intermediate care facility (ICF), skilled
nursing facility (SNF), or hospital care because of the disability of AIDS/HIV,
the case manager shall develop a person-centered service plan that will allow the
Customer to live at home.
2) The service plan will be retained during the time the case is
opened and for five years after closure, unless an audit exception has
occurred. In the case of an audit exception, the service plan will be retained
until the audit exception has been resolved. Copies of the service plan will
be maintained in the case management team's locations and the HSP Ashburn
Unit. Closed cases will be retained in the HSP Ashburn Unit for two years then
archived pursuant to the DHS records retention policy.
3) If implementation of services is delayed beyond required time
limits in subsection (c), the case manager must inform the HSP Ashburn Unit and
assist the Customer to obtain an alternative provider.
f) Records of contact with the Customer will be entered and
maintained in the Customer's confidential case records. All contacts, verbal
or written, with or on behalf of a Customer shall be documented in a
confidential case record. The case manager is responsible for obtaining
consents for the release of information as necessary and when required by law
or regulation (Confidentiality of Records (42 U.S.C. 290dd-2); Health Insurance
Portability and Accountability Act (42 U.S.C. 1320(d) et seq.); AIDS
Confidentiality Act [410 ILCS 305]; 89 Ill. Adm. Code 505 (Confidentiality of
Information).
(Source: Amended at 47 Ill.
Reg. 19328, effective December 13, 2023)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.920 PROVIDER STAFFING REQUIREMENTS, QUALIFICATIONS, AND TRAINING
Section 686.920 Provider
Staffing Requirements, Qualifications, and Training
a) Each case management agency shall designate an individual who
will be responsible for the administration of the case management program. The
designated individual shall have or be actively enrolled in a program to obtain:
1) a
bachelor's degree in health, human services, or a related field;
2) licensure
as a registered nurse pursuant to the Nurse Practice Act [225 ILCS 65]; or
3) at
least one year of experience as a home health care administrator, medical
clinic administrator, or other health services administrator.
b) The qualifications for case managers shall be as follows:
1) A registered nurse, with a current license and a bachelor's
degree in nursing, social work, social sciences, or counseling or one year of
case management experience; or
2) A social worker with a bachelor's degree in either social
work, social sciences, or counseling. A Bachelor of Social Work or a Master of
Social Work degree from a school accredited by any organization nationally
recognized for the accreditation of schools of social work is preferred; or
3) An individual with a Bachelor's Degree in a human services field
(including, but not limited to, sociology, special education, or rehabilitation
counseling) and with a minimum of one year of case management experience.
c) In addition, it is mandatory that the case manager has:
1) a broad knowledge of community resources and networking, case
management, and home care; and
2) experience in working with racial and ethnic minorities, as
well as one or more of the following:
A) domestic abuse;
B) the lesbian, gay, bisexual, transgender, queer (LGBTQ+)
community;
C) persons living with HIV/AIDS; or
D) persons with substance use disorders.
d) Each full-time case manager shall have no more than 30 fee-for-service
customers and 70 Managed Care Organization (MCO) customers, or an appropriately
weighted combination of fee-for-service customers and MCO customers that shall
not exceed 100 total customers. For half-time case managers, the full-time
requirements may be met proportionately (e.g., 15 fee-for-service customers and
35 MCO customers and shall not exceed 50 total customers).
e) Annually, each case manager shall undergo a minimum of 12
hours of in-service training that shall be:
1) furnished by the case management agency; and
2) relevant to the provision of services to persons with HIV/AIDS
(e.g., infectious disease control procedures, sensitivity training, and updates
on information relating to treatment procedures).
(Source: Amended at 47 Ill. Reg. 19328, effective December 13, 2023)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.930 MONITORING AND LIABILITY OF PROVIDER
Section 686.930 Monitoring
and Liability of Provider
a) The HSP Ashburn Unit shall monitor the case management agency
to assure compliance with this Subpart by:
1) reviewing and approving the assessment (Section 686.910(c)).
The review will be conducted pursuant to the DHS' Home Services Program (89
Ill. Adm. Code 682), the service plan, and payments for services;
2) reviewing provisional case managers as set forth in subsection
(d);
3) reviewing, on an annual basis, a random sample 10% of the
cases handled in the preceding 12 months or two cases, whichever is greater;
4) visiting, at least annually, all contracting case management
agencies.
b) The HSP Ashburn Unit shall monitor the service plans of
customers served by a case manager to ensure that:
1) The case manager is monitoring the customer's case at least
monthly by carrying out at least one face-to-face visit and two other contacts
with the customer;
2) The case manager is reassessing the service plan at least
every 12 months for those cases in formal eligibility and every three months
for those cases which have been presumptively determined eligible;
3) Each of the reassessments undertaken by the case manager is
complete and accurate;
4) Any amendments to the service plan are consistent with the
findings of the reassessment; and
5) The service plan remains cost effective (i.e., the cost of the
service plan is equal to or less than the long term care costs).
c) DHS-DRS, Central Office quality assurance staff shall:
1) monitor the quality of the reviews conducted annually;
2) provide case reviews of selected cases Statewide; and
3) tabulate the findings from all reviews to determine accuracy
levels, Statewide need for training and individual training needs.
d) All provisional case managers and case management supervisors will
work toward meeting the case manager standards within six months after
receiving the HSP Ashburn Unit's Case Management Training. Case managers and
case management supervisors with a gap in service of greater than one year must
complete the certification process. Complete case manager status will be
granted when six case file reviews attain a competency score of 98-100% using
the review process described in this subsection (d).
1) The HSP Ashburn Unit will review at least six case files
within six months after the date of the provisional case manager's completion
of the Case Management Training for the case manager. A combination of the
following case types and amounts may be used to satisfy the requirement:
A) six fee-for-service initial assessments;
B) three fee-for-service initial assessments and three fee-for
service reassessments; or
C) two fee-for-service initial assessments, two fee-for-service
reassessments, and four Managed Care Organization (MCO) assessments of any type.
2) The HSP Ashburn Unit will review each case file using the HSP Ashburn
Unit case file review quality assurance form.
3) The HSP Ashburn Unit will discuss areas of deficiency with the
case manager.
4) The HSP Ashburn Unit will work with the case manager to
resolve all deficiencies in the case files.
5) The case manager will correct and complete all deficient areas
prior to the next review of case files.
6) The HSP Ashburn Unit will re-review all deficient files for
compliance with case management practices.
7) The above process will continue, within the six-month review
period, until the cases reviewed for the case manager meet a 98-100% compliance
score.
e) Return to Provisional Status
1) A case manager shall return to provisional status when any of
the following events occur:
A) A review of files, per this Section, results in a score of 89%
or less; or
B) Within the last year, the HSP Ashburn Unit has made five
requests for materials that were not submitted on time or for assessments not
completed timely; or
C) Sufficient documentation is not available to demonstrate that
the case manager has successfully completed case management training.
2) Prior to the initiation of action to return a case manager to
provisional status, the case management agency of the case manager will be sent
a letter outlining the issues. The case management agency will have 10 days to
respond. The case manager will return to provisional status unless the case management
agency can prove the event causing the action did not occur. Once a case
manager is returned to provisional status, the case manager must complete the
measures outlined in subsection (d).
f) Liability
1) DHS shall assume no liability for actions of the case
management agency.
2) The case management agency shall agree to hold DHS harmless
against any and all liability, loss, damage, cost or expenses arising from
wrongful or negligent acts of the provider.
3) The case management agency shall certify that it has
maintained and will maintain liability insurance coverage. Upon request, the
provider shall make available policies, certificates of insurance or current
letters documenting all insurance coverage.
4) The case management agency shall remain liable for the
performance of any person, organization, unincorporated association or
corporation with which it contracts.
(Source: Amended at 47 Ill.
Reg. 19328, effective December 13, 2023)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.940 PROVIDER COMPLIANCE REQUIREMENTS
Section 686.940 Provider
Compliance Requirements
In order to participate in the
DHS-DRS program to provide services to persons with HIV/AIDS, the provider
agrees to meet the following minimum requirements that shall be reviewed by DHS
annually for compliance.
a) Organization and Administration: The provider shall make
available, upon request, its articles of incorporation, or if an unincorporated
association (e.g., partnerships and limited partnerships) shall provide a
statement of purpose and functions, and the names and addresses of its owners,
partners, or general partners.
b) Audits: DHS reserves the right to audit all records and
accounts pertinent to the provision of services and billing at any time within
five years after the provider stopped providing services under the HIV/AIDS
waiver.
c) Policies and Procedures: The provider shall have written
policies approved by its governing authority (e.g., Board of Directors) and
available for review by customers and purchasers of the service. Such policies
shall at a minimum cover:
1) Service Provided: Policy shall designate the type and scope
of service provided. When more than one type of service is offered, there
shall be a clear distinction between each type provided.
2) Personnel Policies: Policies shall cover salary schedules,
hours of work, sick leave, provision for handling employee grievances, and
requirements for attendance at work conferences and training sessions. There
shall be written job descriptions identifying required qualifications and
duties for each title. Policies shall also include the Centers for Disease
Control and Prevention (CDC) recommendations for health care workers for
provision of services to persons with HIV/AIDS and any requirements within the
Illinois Compiled Statutes regarding HIV/AIDS, including the AIDS
Confidentiality Act [410 ILCS 305].
d) State and Federal Statutes
1) All providers shall be subject to compliance with Illinois Compiled
Statutes governing conflict of interest [30 ILCS 500/50-13].
2) All providers shall agree to comply with the Civil Rights
Restoration Act of 1987 P.L. 100-259), Title VI of the Civil Rights Act of 1964
(42 U.S.C. 2000d), Section 504 of the Rehabilitation Act of 1973, as amended
(29 U.S.C. 794), the Illinois Human Rights Act [775 ILCS 5], the Constitution
of the United States, the 1970 Constitution of the State of Illinois and any
laws, regulations or orders, State or federal, that prohibit discrimination on
the basis of, including but not limited to, race, color, sex (including sexual
harassment), religion, national origin, ancestry, age (40 and over), order of
protection status; marital status, sexual orientation (including gender-related
identity), physical or mental disability, or unfavorable discharge from
military service, pregnancy, citizenship status, employment discrimination
based on arrest record, and discrimination in real estate transactions based on
familial status or arrest record.
e) Non-compliance: If the provider is not in compliance with the
requirements of this Subpart, corrective actions up to and including
termination of the provider as an approved provider shall be taken.
(Source: Amended at 47 Ill. Reg. 19328, effective December 13, 2023)
SUBPART K: CASE MANAGEMENT SERVICES TO PERSONS WITH BRAIN INJURIES
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1000 PROGRAM OVERVIEW
Section 686.1000 Program
Overview
The Department of Human Services
(DHS) shall enter into agreements with community-based organizations to provide
case management to persons diagnosed with brain injuries who are eligible for
services provided by the Medicaid Waiver for Persons with a Brain Injury. For
geographic areas in Illinois in which case management agencies are not located,
case management shall be provided by DHS Home Services counselors.
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1010 CASE MANAGEMENT PROVIDER RESPONSIBILITIES
Section 686.1010 Case
Management Provider Responsibilities
a) Case Managers
1) The Case Manager shall receive referrals from hospitals, other
health providers, and other State and local agencies.
2) The Case Manager shall have responsibility for the
implementation of services to be provided. The services, developed by the HSP
Counselor with Customer participation, shall be provided in a manner that
reflects the Customer's choice, when applicable, and shall address his/her
strengths, needs and desired goals.
b) The Case Manager shall provide the following services:
1) networking/coordination/brokering services (i.e., referring
and assisting the Customer in obtaining other agencies' services);
2) counseling and advocacy;
3) contacting the Customer a minimum of one time per month;
4) maintaining and updating Customer records; and
5) monitoring the cost effectiveness of the service plan (89 Ill.
Adm. Code 679.50).
c) Service Plan
1) The person-centered service plan will be retained during the
time the case is opened and for five years after closure, unless an audit
exception has occurred. In the case of an audit exception, the service plan
will be retained until the audit exception has been resolved. Copies of the
service plan will be maintained in the Case Manager's location and the HSP
office. Closed cases will be retained in the HSP Central Office.
2) If implementation of services is delayed beyond required time
limits in subsection (c), the Case Manager must inform the HSP administration
and assist the Customer in obtaining another provider.
d) Records of contact with Customer will be entered and
maintained by the Case Manager in the Customer's confidential case record. All
contacts, oral or written, with or on behalf of a Customer shall be documented
in a confidential case record. The Case Manager is responsible for obtaining
consents for the release of information as necessary and when required by
regulation (89 Ill. Adm. Code 505) and the Health Insurance Portability and
Accountability Act (42 USC 1320(d) et seq.).
(Source: Amended at 43 Ill.
Reg. 2133, effective January 24, 2019)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1020 CASE MANAGER STAFFING REQUIREMENTS, QUALIFICATIONS AND TRAINING
Section 686.1020 Case
Manager Staffing Requirements, Qualifications and Training
a) Every agency providing case management services shall
designate an individual who has overall responsibility for the administration
of case management services.
b) A Case Manager shall meet one of the following qualifications:
1) a Registered Nurse, licensed pursuant to the Illinois Nursing
Act of 1987 [225 ILCS 65];
2) a Certified or Licensed Social Worker, certified or licensed
pursuant to the Illinois Clinical Social Work and Social Work Practice Act [225
ILCS 20];
3) a Social Worker with a minimum of a Bachelor's degree in
social work, social sciences or counseling. A Bachelor's of Social Work or a
Master's of Social Work from a school accredited by any organization nationally
recognized for the accreditation of schools of social work is preferred;
4) a Vocational Specialist holding a certification in
Rehabilitation Counseling or a minimum of 3 years working with people with
disabilities;
5) Licensed Clinical Professional Counselor (LCPC), licensed
pursuant to the Professional Counselor and Clinical Professional Counselor
Licensing Act of 1998 [225 ILCS 107];
6) Licensed Professional Counselor (LPC), licensed pursuant to
the Professional Counselor and Clinical Professional Counselor Licensing Act
[225 ILCS 107];
7) Certified Case Manager (CCM) with certification in case
management from an appropriate certifying organization.
c) Each Case Manager shall have no more than 30 customers.
Incremental increases may be considered when the Case Manager demonstrates the
capacity to competently provide case management services for Brain Injury
Waiver cases. Subsequent to this determination, cases may be increased in
increments of up to 15 cases. This capacity will be determined when the Case
Manager maintains a competence rate of at least 98% for a period of at least
three months at a full caseload size of 30 customers, using the process
outlined in 89 ILL. ADM. CODE CH. I SECTION 686.1025(b).
d) Annually, each Case Manager shall receive at least 12 hours of
in-service training. The training must be relevant to the provision of
services to persons with brain injuries.
(Source: Amended at 25 Ill. Reg. 6282, effective May 15, 2001)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1025 PROVISIONAL CASE MANAGER
Section 686.1025 Provisional
Case Manager
a) There shall be two levels of case management staff:
Provisional Case Manager and Case Manager. A Provisional Case Manager is one
who has not achieved a competency score of 98% or greater on the case reviews
done by the Home Services Program (HSP) administrative staff per Section
686.1030(d). Assessments, service plans and reassessments completed by a Case
Manager may be implemented without consultation with the HSP administrative
staff. Provisional Case Managers shall submit all developed plans to HSP for
approval. Approval of the plan will be based on a review to determine that: the
DON assessment on which the plan is developed is complete and accurate; the
plan meets the needs identified by the assessment; and the plan is cost
effective compared with comparable institutional care.
b) All Provisional Case Managers will work toward meeting Case
Manager standards within six months after receiving the HSP Case Manager
Training. Case Manager status will be granted when six case file reviews
attain a competency score of 98-100% using the review process described in this
subsection (b).
1) The HSP administrative staff will review three case files
within three months from the end date of the Case Manager Training. The Case
Manager will be present and have the Case Manager Training Manual.
2) The HSP staff will review each case using the HSP case file
review quality assurance form.
3) Using the Case Manager Training Manual, HSP staff will discuss
each deficiency with the Case Manager.
4) A corrective action plan will be developed by HSP staff for
the Case Manager to resolve all deficiencies in the case file.
5) The Case Manager will implement the corrective action plan and
complete all items prior to the next review of the case files.
6) HSP staff will review all files noted in the corrective action
plan for compliance with case management practices.
7) The above process will continue until the cases reviewed for
the Case Manager meet a 98-100% compliance score on six case file reviews.
c) Return to Provisional Status
1) A Case Manager shall return to provisional status when any of
the following events occur:
A) A review of files, per this Section, results in a score of 89%
or less; or
B) Within the last year, HSP staff have made five requests for
materials that were not submitted on time.
2) Prior to the initiation of action to return a Case Manager to
provisional status, the Case Manager will be sent a letter outlining
deficiencies and shortcomings. The Case Manager will have 10 days to respond.
The Case Manager will be returned to provisional status unless the Case Manager
can prove the Department is incorrect.
(Source: Amended at 38 Ill.
Reg. 16978, effective July 25, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1030 MONITORING AND LIABILITY
Section 686.1030 Monitoring
and Liability
a) The HSP staff shall monitor the Case Manager to assure
compliance with this Subpart by:
1) reviewing Provisional Case Managers as set forth in subsection
(d);
2) reviewing, on an annual basis, a random sample of 10% of the
cases handled in the preceding 12 months or two cases, whichever is greater;
and
3) visiting, at least annually, all contracting case management
agencies.
b) The HSP supervisory staff shall monitor the service plans of
customers served by a Case Manager to ensure that:
1) The Case Manager is monitoring the customer's case by carrying
out at least one contact monthly;
2) The Case Manager is reassessing the service plan at least
every six months;
3) Each of the reassessments undertaken by the Case Manager is
complete and accurate;
4) Any amendments to the service plan are consistent with the
findings of the reassessment; and
5) The service plan remains cost effective (i.e., the cost of the
service plan is equal to or less than the State's costs for nursing facility
care).
c) Liability
1) DHS is not liable for actions of the Case Manager and the Case
Manager must agree to hold DHS harmless against any and all liability, loss,
damage, costs or expenses arising from wrongful or negligent acts of the Case
Manager.
2) The Case Management provider shall certify that it has
maintained and will maintain liability insurance coverage. Upon request, the
Case Management provider shall make available policies, certificates of
insurance or current letters documenting all insurance coverage.
3) The Case Management agency shall remain liable for the
performance of any person, organization, unincorporated association or
corporation with which it contracts.
(Source: Amended at 38 Ill.
Reg. 16978, effective July 25, 2014)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1040 PROVIDER COMPLIANCE REQUIREMENTS
Section 686.1040 Provider
Compliance Requirements
In order to participate in the
DHS program for providing services to persons with brain injuries, the provider
of case management services agrees to meet the following minimum requirements,
which shall be reviewed by DHS annually for compliance.
a) Organization and Administration: The agency providing case
management services shall make available, upon request, its articles of
incorporation, or if an unincorporated association, it shall provide a
statement of purpose and functions and the names and addresses of its owners,
partners or general partners.
b) Audits: DHS reserves the right to audit all records and
accounts pertinent to the Agreement at anytime within five years after the
final completion date of the Agreement.
c) Policies and Procedures: The provider of case management
services shall have written policies approved by its governing authority and
available for review by customers and purchasers of the service. Such policies
shall at a minimum cover:
1) Services Provided: the type and scope of services provided.
When more than one type of service is offered, there shall be a clear
distinction between each type of service.
2) Personnel Policies: salary schedules, hours of work, sick
leave, provision for handling employee grievances and requirements for
attendance at work conferences and training sessions. There shall be written
job descriptions identifying required qualifications and duties for each title.
d) State and Federal Statutes
1) All providers of case management services are subject to
compliance with Illinois statutes governing conflict of interest (Sections
50-13 and 50-20 of the Illinois Procurement Code [30 ILCS 500/50-13 and
50-20]).
2) All providers shall agree to comply with Title VI of the Civil
Rights Act of 1964 (42 USC 2000d), Section 504 of the Rehabilitation Act of
1973, as amended (29 USC 794), the Illinois Human Rights Act [775 ILCS
5/1-101], the Constitution of the United States, the 1970 Constitution of the
State of Illinois and any laws, regulations or orders, State or Federal, that
prohibit discrimination on the basis of race, color, sex, religion, national
origin, ancestry, age, marital status, inability to speak or comprehend the
English language, physical or mental disabilities, or unfavorable discharge from
military service.
e) Non-compliance: If the provider of case management services is
not in compliance with the requirements of this Subpart, corrective actions up
to and including termination of the contract shall be taken.
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
SUBPART L: BEHAVIORAL SERVICES FOR PERSONS WITH BRAIN INJURIES
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1100 BEHAVIORAL SERVICES PROVIDER REQUIREMENTS
Section 686.1100 Behavioral
Services Provider Requirements
HSP shall use Behavioral Service
Providers that are licensed under the Illinois Clinical Psychologist Licensing
Act [225 ILCS 15], the Illinois Professional Counselor and Clinical
Professional Counselor Licensing Act [225 ILCS 107], or the Illinois Clinical
Social Work and Social Work Practice Act [225 ILCS 20].
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1110 RATE OF PAYMENT FOR BEHAVIORAL SERVICES
Section 686.1110 Rate of
Payment for Behavioral Services
HSP shall pay Behavioral Service
Providers at rates established per 89 Ill. Adm. Code 545, "Ratemaking".
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
SUBPART M: DAY HABILITATION SERVICES FOR PERSONS WITH BRAIN INJURIES
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1200 DAY HABILITATION SERVICES PROVIDER REQUIREMENTS
Section 686.1200 Day
Habilitation Services Provider Requirements
a) All
Habilitation Service Agency providers (hereafter referred to as providers) who
provide services to Customers of the DHS-DRS HSP shall have habilitation
services accredited by an appropriate accrediting organization or shall be
certified by DHS according to the criteria set forth in this Subpart.
1) DHS
shall apply its criteria to certify a provider that provides HSP approved
services as identified on a Customer's service plan, when the provider has not
yet received national accreditation.
2) DHS certification
shall be granted for two years, after which time the provider must be
accredited for Brain Injury Habilitation Services in accordance with subsection
(b).
b) A provider
may be accredited by any of the following accreditation organizations:
1) Commission
on Accreditation of Rehabilitation Facilities.
2) The Joint
Commission.
3) Developmental
Training Program under the DHS Division of Developmental Disabilities (59 Ill.
Adm. Code 119 (Minimum Standards for Certification of Developmental Training
Programs)).
c) A
facility that houses a habilitation service program (including satellite sites)
shall meet the criteria for the Centers for Medicare and Medicaid Services
definition of a home and community-based setting pursuant to 42 CFR
441.301(c)(4) and 42 CFR 441.301(c)(5).
d) If a provider
meets the criteria listed in this Section, application to HSP should be made
to:
Illinois Department of Human
Services
Division of Rehabilitation
Services
Home Services Program, Program
Compliance
100 S. Grand Ave. East
Springfield IL 62794
(Source:
Amended at 46 Ill. Reg. 20865, effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1210 RATE OF PAYMENT FOR DAY HABILITATION SERVICES
Section 686.1210 Rate of
Payment for Day Habilitation Services
HSP shall pay Day Habilitation
Providers the rate established per 59 Ill. Adm. Code 120, "Medicaid Home
and Community-Based Services Waiver Program for Individuals with Developmental
Disabilities."
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1220 CERTIFICATION OF DAY HABILITATION AGENCY PROVIDERS
Section 686.1220 Certification of Day Habilitation
Agency Providers
a) With
the submission of an application to HSP, a provider described in Section
686.1200(a)(1) shall be evaluated by representatives of DHS.
b) The
provider service program shall be in operation for a period of one year prior
to application.
c) DHS
shall apply the standards set forth in Sections 686.1230 and 686.1240 to the
provider.
d) DHS
shall contact the provider to arrange the evaluation date and time that is
convenient for all parties, provide written confirmation of that date and time,
and explain the on-site evaluation procedure.
e) During
the evaluation process, the DHS representative may review case records, program
descriptions and documents, and may interview staff and Customers to ensure
that standards are being met.
f) DHS
shall hold an exit interview with the provider. The interview shall identify
areas in which the provider does and does not comply with Sections 686.1230 and
686.1240.
g) A
written report of the results of the certification evaluation shall be sent to
the provider within 30 calendar days. The results may indicate that remediation
is needed to address noncompliance with Sections 686.1230 and 686.1240.
1) If
remediation is indicated, the provider shall submit a corrective action plan
(CAP) to DHS within 30 calendar days after receipt of the report. The CAP shall
identify how the provider will comply with areas of Sections 686.1230 and
686.1240 in which the provider was found noncompliant. The CAP shall include
time frames for the remediation.
A) Upon
acceptance of the CAP, DHS shall notify the provider of the decision to certify
the program and services offered by the provider for two years if compliance
with the standards are met.
B) If the
provider fails to submit a CAP and/or is unable to institute a plan
satisfactorily in compliance with the standards of Sections 686.1230 and
686.1240, DHS shall notify the provider in writing of the decision not to
certify the provider.
2) Further
application for habilitation certification shall not be accepted by HSP until
at least one year after the date of the previous habilitation certification
denial.
3) The
provider has the right to appeal the certification evaluation by submitting an
appeal request in writing to the Bureau Chief of the Home Services Program.
Appeal requests must be filed within 30 days after the certification evaluation
results are received by the provider. The Bureau Chief shall conduct a review
of the facts and shall, within 15 working days, provide a written decision to
the provider.
4) If the
provider is not satisfied with the decision of the Bureau Chief, the provider
may request review of the Bureau Chief's decision by the Director of DHS-DRS.
The request must be in writing and received by the DHS-DRS Director within 10
working days after the date the decision was rendered by the Bureau Chief. The
decision of the DHS-DRS Director shall be final.
(Source: Added at 43 Ill. Reg. 2133,
effective January 24, 2019)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1230 PROVIDER STANDARDS
Section 686.1230 Provider Standards
a) The provider
must be a legally constituted agency or organization, or an entity operated by
a state or political subdivision of a state under an appropriate federal, state
or local statute.
b) The
provider's governing body shall:
1) establish
in writing the organization's mission, policies, and necessary financial
support;
2) employ
a full-time Director and delegate to that person the authority and
responsibility for the management of the provider agency in accordance with
established policies;
3) meet with
its executive committee and Director at least quarterly;
4) review
and approve the provider agency budget and the independent, certified audit
annually, and the income and expense reports at least quarterly;
5) identify
a designated staff member or group that shall be responsible for making
admission decisions;
6) include
written policy that safeguards against possible conflicts of interest between
its members and the operation of the provider agency as part of its
constitution or bylaws; and
7) provide
documentation of current liability insurance to protect assets and to ensure
compensation for staff, individuals with disabilities, volunteers, and the
public, in the event compensation would be required for occurrences for which
the provider agency is liable.
c) The provider
shall employ staff numbers and types to meet the needs of the individuals
served in a manner consistent with the purposes and objectives of the
organization. Provider employed staff shall receive training in accordance with
the provider's policies and procedures.
d) The
provider shall provide all services in a safe environment and establish an
executive safety committee with clearly defined responsibilities, including the
responsibility to:
1) develop
a written emergency plan that details staff action and responsibilities in the
event of fire, power failure, and natural disasters;
2) maintain
an accident prevention program;
3) maintain
an accident reporting system that includes a review of the incident reports
made and the recommendations for corrective action;
4) ensure
staff currently certified in first aid and cardiopulmonary resuscitation are
available at all times in all locations where Customers are present in the
provider's facilities;
5) ensure
test drills are completed at least quarterly and the results of the drills are
sent to the executive safety committee;
6) ensure
that independent, comprehensive safety education is conducted at least every
two years by qualified safety specialists; and
7) ensure
that, at least annually, inspections are completed by local or state fire
control agencies.
A) A
satisfactory rating for each site operated by the provider is required.
B) If an
unsatisfactory rating is given, the provider must take immediate corrective
action to address the rating.
e) The provider
shall have public information materials that identify:
1) the programs
and services available;
2) the
population to be served;
3) how
programs and services can be obtained; and
4) its
nondiscrimination policy.
f) The
provider shall comply with applicable federal and State regulations.
1) The provider
shall offer programs and services that are accessible to persons with
disabilities in accordance with section 504 of the federal Rehabilitation Act
of 1973, as amended (29 USC 794), the Americans With Disabilities Act (42 USC
12001), and the Illinois Accessibility Code (71 Ill. Adm. Code 400).
2) The provider
shall engage in an Affirmative Action Program that provides documentation of
its nondiscrimination policy and staff characteristics as required by section
504 of the federal Rehabilitation Act of 1973.
3) The provider
shall show evidence of compliance with both federal and State Department of
Labor rules and regulations governing wage reimbursement and the Workers' Compensation
Act [820 ILCS 305].
4) The provider
shall comply with Department of Human Services rules regarding Fiscal/Administrative
Recordkeeping and Requirements (89 Ill. Adm. Code 509).
(Source: Added
at 43 Ill. Reg. 2133, effective January 24, 2019)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1240 PROGRAM AND SERVICE REQUIREMENTS
Section 686.1240 Program and Service Requirements
a) When
HSP refers a Customer to a provider for services, the provider shall notify HSP,
in writing, of the disposition of the referral within 15 calendar days after
receipt of the referral. This notification shall include the expected date after
admission and any pertinent information regarding the Customer's entry into the
program.
b) All
Customers referred for services shall receive a personal interview that
includes an explanation of why the individual was referred, service
opportunities available to the individual, and the right to appeal services
under 89 Ill. Adm. Code 510.
c) Customers
on waiting lists shall be contacted monthly, apprised of their status, and
given sufficient information to decide whether to remain on the waiting list or
seek services elsewhere.
d) There
shall be clearly written entrance and exit criteria for each service offered by
the agency.
e) Customer
case records shall be kept secure, confidential, and available only to
authorized personnel. Customers referred for services shall be notified in
writing of their acceptance or non-acceptance into the program.
f) Assessment
methods, techniques, and work sites shall be relevant to the Customer's needs.
g) Each
Customer served by the provider shall receive a Brain Injury Habilitation
Assessment and participate in the provider's development of his/her Habilitation Plan.
1) Each
Customer shall be provided goal and service options that assist him/her in
choosing a habilitation goal.
2) Each
Customer shall be enabled to choose his/her habilitation goals and services and
express his/her degree of satisfaction with the results achieved.
3) A
written report or narrative of the Brain Injury Habilitation Assessment shall
include:
A) background
information regarding the person;
B) interpersonal/personal
observations made by agency staff;
C) a life
skills appraisal of the person;
D) a
recommended habilitation goal;
E) recommended
objectives and services to attain the stated habilitation goal; and
F) a
summary of the conference or staffing conducted, including Customer comments.
4) The
Habilitation Plan shall identify:
A) a
habilitation goal;
B) understandable, measurable objectives to achieve
the habilitation goal;
C) services
needed to meet the objectives;
D) time
frames to achieve the goal and objectives;
E) measures
to assess the outcome of objectives, including review dates; and
F) the
persons responsible for implementing the plan.
5) All
persons involved in the plan development shall receive a copy of the service
plan within five State working days after the plan's development.
h) Services
purchased by HSP on a full time weekly basis shall offer at least 25 hours of
program time per week. The program hours must relate to the Customer's needs
and activities as outlined in the Customer's Habilitation Plan.
i) Staffings
shall be held on a scheduled basis to allow for review and discussion of the
Customer's progress towards achieving his/her habilitation goal and objectives,
as follows:
1) at
the completion of the Brain Injury Assessment; and
2) at
least once every eight weeks for habilitation training services, up to the date
of completion of program objectives.
j) All
persons identified in the Habilitation Plan shall receive a copy of each staffing
report within 10 State working days after the staffing.
k) Customer
habilitation trainings shall include individually designed services that meet
the Customer's specific needs and desires and enable the Customer to achieve
his/her habilitation goal as a direct result of service provided.
(Source: Added at 43 Ill. Reg. 2133,
effective January 24, 2019)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1250 PROGRAM OUTCOMES AND REPORTING
Section 686.1250 Program Outcomes and Reporting
a) The provider
shall complete and submit to HSP an annual written evaluation of all its
programs and services that shows evidence of:
1) maintenance
of a safe and accessible program;
2) a
review of the quality and appropriateness of the services offered;
3) a
review of the effectiveness of the services as measured by outcomes achieved;
and
4) Customer
satisfaction with the services received and habilitation outcomes achieved.
b) The
provider shall complete and submit to HSP a monthly Customer Habilitation Training
Report that summarizes the following:
1) accomplishment
of the objectives;
2) remaining
services needed by the Customer to achieve the habilitation goal; and
3) a
summary of the staffings conducted, including the Customer's comments.
c) The
provider shall submit a monthly Customer Outcome Report on each Customer, based
upon successful completion of objectives outlined in the Customer Habilitation
Plan.
1) A
habilitation outcome is considered successful when:
A) the
Customer has a diagnosis of brain injury that, for the individual, causes, or
may cause, a substantial impediment to habilitation; has an active HSP service plan;
and participates in services offered by the provider as evidenced by
habilitation provider billings submitted to HSP;
B) it is
consistent with the Customer's abilities, interests and needs;
C) the
Customer performs life skill activities effectively and efficiently;
D) the
habilitation services are not contraindicated based on the Customer's
disability; and
E) the
Customer will not jeopardize the health and safety of himself/herself or others
while at the program site.
2) Successful
habilitation outcomes are determined by the HSP Counselor (see 89 Ill. Adm.
Code 676.30).
(Source: Added at 43 Ill. Reg. 2133,
effective January 24, 2019)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1260 PROVIDER BILLING AND RECORD RETENTION
Section 686.1260 Provider Billing and Record Retention
a) The
provider shall submit a monthly IL488-1200 Group Billing statement to the HSP
field office managing the HSP Customer case within 15 days after the end of the
service period.
b) Each
statement must be accompanied by a monthly Customer Outcome Report as required
under Section 686.1250(c).
c) Expenditures
may not exceed the service hours or fees indicated on the active Vendor
Authorization for Services form, unless express written approval has been given
by the HSP.
d) Supplemental
billing for additional hours in a service period that was previously paid, or that
is in the process of being paid, is not allowed. If HSP or the provider
determines that the previous billing was in error, all payments received for
that billing must be refunded to HSP before submitting a corrected statement
for the period.
e) Providers
shall keep the following records for a minimum of 5 years:
1) copies
of all forms and billings required by, and submitted to, HSP;
2) records
of Customer service hours kept by time clock, time cards, or time sheets signed
by the Customer;
3) confidential
case records (see Section 686.1240(e)); and
4) documentation
of credentials and/or licensing for all rendering service staff.
(Source: Added at 43 Ill. Reg. 2133,
effective January 24, 2019)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1270 COMPLIANCE REVIEW OF DAY HABILITATION PROVIDERS
Section 686.1270 Compliance Review of Day Habilitation
Providers
a) HSP will
complete a review of each Day Habilitation Provider, at least every two years,
to ensure compliance with the requirements of this Subpart.
b) The
review shall consist of an on-site review conducted by HSP staff. Written
notification shall be provided to the provider prior to the review.
c) Within
15 days after the completion, a copy of the completed review shall be sent to
the provider.
d) If
the provider is found deficient in the review, the written notification shall
include:
1) the deficiencies
found as a result of the review;
2) the
action necessary for the provider to come into compliance;
3) the
time frames within which the provider must come into compliance; and
4) the
information necessary for the provider to request new review after the
compliance issues are addressed.
e) Day
Habilitation Providers who are not satisfied with an HSP compliance review may
submit an appeal request in writing to the HSP Bureau Chief. Appeal requests
must be filed within 30 days after the compliance review. The Bureau Chief
shall conduct a review of the facts and shall, within 15 working days, provide
a written decision to the Day Habilitation Provider.
f) If
the Day Habilitation Provider is not satisfied with the decision of the Bureau
Chief, the provider may request review of the Bureau Chief's decision by the
Director of DHS-DRS. The request must be in writing and received by the
DHS-DRS Director within 10 working days after the date the decision was
rendered by the Bureau Chief. The decision of the DHS-DRS Director shall be
final.
(Source: Added at 43 Ill. Reg. 2133,
effective January 24, 2019)
SUBPART N: PREVOCATIONAL SERVICES FOR PERSONS WITH BRAIN INJURIES
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1300 PREVOCATIONAL SERVICES PROVIDER REQUIREMENTS
Section 686.1300
Prevocational Services Provider Requirements
HSP shall use Prevocational
Services Providers that meet standards as set forth in 89 Ill. Adm. Code 530,
Criteria for the Evaluation of Programs of Services in Rehabilitation
Facilities. A facility that houses a Prevocational Service program (including
satellite sites) shall also meet the criteria for the Centers for Medicare and
Medicaid Services definition of a home and community-based setting pursuant to
42 CFR 441.301(c)(4) and 42 CFR 441.301(c)(5).
(Source:
Amended at 46 Ill. Reg. 20865, effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1310 RATE OF PAYMENT FOR PREVOCATIONAL SERVICES
Section 686.1310 Rate of
Payment for Prevocational Services
HSP shall pay Prevocational
Services Providers rates as established per 89 Ill. Adm. Code 545, Ratemaking.
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
SUBPART O: SUPPORTED EMPLOYMENT SERVICES FOR PERSONS WITH BRAIN INJURIES
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1400 SUPPORTED EMPLOYMENT SERVICE PROVIDER REQUIREMENTS
Section 686.1400 Supported
Employment Service Provider Requirements
HSP shall use Supported
Employment Service providers that meet standards as set forth in 89 Ill. Adm.
Code 530, Criteria for the Evaluation of Programs of Services in Rehabilitation
Facilities.
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1410 RATE OF PAY FOR SUPPORTED EMPLOYMENT SERVICES
Section 686.1410 Rate of Pay
for Supported Employment Services
HSP shall pay Supported
Employment Service Providers rates as established per 89 Ill. Adm. Code 545, "Ratemaking."
(Source: Added at 23 Ill. Reg. 6457, effective May 17, 1999)
SUBPART P: INDIVIDUAL PROVIDER OVERTIME AND TRAVEL TIME
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1500 DEFINITIONS
Section 686.1500 Definitions
Definitions
for this Part can be found at 89 Ill. Adm. Code 676.30.
(Source: Added
at 41 Ill. Reg.8454, effective August 1, 2017)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1510 GENERAL OVERVIEW
Section 686.1510 General
Overview
a) An Individual Provider working for a Customer under HSP shall
not work more than the maximum hours in a work week, as defined within the
currently effective Collective Bargaining Agreement (CBA), unless the Customer
is approved for an exception under Section 686.1530. The currently effective
Collective Bargaining Agreement is available on the Illinois Department of Central
Management Services website.
b) An Individual Provider working for multiple Customers shall
not work more than the maximum hours in a work week, as defined within the
currently effective CBA, unless a Customer is approved for an exception under Section
686.1530. The Individual Provider shall apply the following calculations:
1) Add
the hours worked for each Customer together; the combined total shall not
exceed the maximum hours in a work week, as defined within the currently
effective CBA.
2) Add the time spent traveling to the combined total of work
time in subsection (b)(1) if the Individual Provider is approved to receive
reimbursement for travel time under Section 686.1560. The combined total of
work time and travel time shall not exceed the maximum hours in a work week, as
defined within the currently effective CBA.
c) All individual providers must follow the requirements of 89
Ill. Adm. Code 684.60 and 686.40.
(Source: Amended at 46 Ill. Reg. 20865, effective December 19, 2022)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1520 HIRING INDIVIDUAL PROVIDERS AND BACKUP INDIVIDUAL PROVIDERS
Section 686.1520 Hiring
Individual Providers and Backup Individual Providers
a) Customers
must hire sufficient Individual Providers to cover the weekly hours on their
Service Plans without incurring unauthorized overtime.
b) The Customer is required to identify a backup caregiver on
their service plan. The backup caregiver can be a non-paid caregiver, an
additional Individual Provider, or agency to cover those times when a
regularly-scheduled Individual Provider is unable to work or provide services.
c) Before paid services can be provided to a Customer, all Individual
Providers must:
1) meet program requirements for HSP;
2) complete all required enrollment forms that are available
through the HSP local offices, the Department’s website, or if applicable, the
Customer’s Managed Care Organization (MCO);
3) be enrolled in the program's electronic timekeeping system;
and
4) be enrolled in the Illinois Department of Healthcare and
Family Services' Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system.
(Source: Amended at 46 Ill. Reg. 20865,
effective December 19, 2022)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1530 OVERTIME EXCEPTIONS
Section 686.1530 Overtime Exceptions
a) An
Individual Provider working under HSP shall not work more than the maximum
hours in a work week as defined within the currently effective Collective
Bargaining Agreement (CBA), unless the Customer meets one of the following
exceptions described in this Section.
1) Provider
Capacity Exception: A Customer may apply for this exception when an IP no longer
works for the Customer, is unfunded, no longer meets qualifications, has
expired credentials, and/or there is no qualified IP within 45 miles of the
Customer's service location who is able and willing to provide needed services.
A) This
exception must be applied for in advance or within two weeks of the Customer's need.
B) This
exception will be renewed after one year and automatically renewed for
successive one-year periods unless and until HSP determines not to renew the
exception pursuant to the CBA.
2) Unique/Complex
Needs Exception: A Customer may apply for this exception when the Customer's
health and safety would be compromised by adding additional IPs to the Service
Plan, which may include court-ordered service plans, Customers with a DON score
at or above 70, Customers who cannot tolerate multiple IPs because of medical
or behavioral needs, and Exceptional Care Customers.
A) This
exception must be applied for at the time of the Customer's application to HSP
or when the exception is first known to the Customer.
B) This
exception will be renewed after one year and automatically renewed for
successive one-year periods unless and until HSP determines not to renew the
exception pursuant to the CBA.
3) Out-of-Town
Situations Exception: A Customer may apply for this exception when the
Customer requires care to ensure their health and safety while out-of-town and
it is not feasible for the Customer to bring additional IPs.
A) This
exception must be applied for in advance of the out-of-town travel date.
B) The
Customer may be approved to use this exception up to 14 days per year.
Approval for this exception applies to personal care services as noted in 89
Ill. Adm. Code 684.60(c).
4) Emergency
Need Exception: A Customer must apply for this exception when an urgent need
for care arises and working more than the maximum hours defined within the
currently effective CBA in a work week is unavoidable without risking the
health and safety of the Customer.
A) This
exception must be applied for within two weeks of the Customer’s need arising.
B) This
exception may be approved up to four times per year for up to 10 hours per pay
period.
b) To
apply for an exception, the Customer must submit a request for exception form
to HSP Central Office Policy Unit. The Customer will be notified in writing if
they are approved or denied for an exception under this Section. The Customer
has the right to appeal the determination under 89 Ill. Adm. Code 510.
c) If a
Customer wishes to submit a request for exception form, applications should be
submitted by the options listed on the DHS HSP Overtime website page or mailed
to the address below:
Illinois Department of Human
Services
Division of Rehabilitation
Services
Home Services Program, Policy Unit
100 S. Grand Ave. East
Springfield, IL 62794
d) If a
complete exception form has been submitted and no determination has been made
within 30 days, the Individual Provider shall be deemed conditionally approved
to work the overtime hours until the determination is made.
(Source: Amended at 46 Ill. Reg. 20865,
effective December 19, 2022)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1540 CUSTOMER AND INDIVIDUAL PROVIDER RESPONSIBILITIES
Section
686.1540 Customer and Individual Provider Responsibilities
a) The
Customer and the Individual Provider are responsible for monitoring work hours
to ensure that the Individual Provider does not work more than the maximum
hours defined within the currently effective Collective Bargaining Agreement
(CBA) in a work week unless approved for an exception under Section 686.1530.
b) Individual
Providers who do not comply risk becoming unfunded by the HSP. Continued
noncompliance by a Customer or Individual Provider may result in a change in
the Customer's Service Plan to a different Individual Provider or to an agency
provider.
c) The
Individual Provider and the Customer will be notified in writing of any final
determination of overtime found to be unauthorized.
1) If
time worked in excess of the maximum hours defined within the currently
effective CBA is found to be an unauthorized use of overtime, Section 686.1570
will apply.
2) Overtime
usage will be monitored for abuse or fraud. Allegations of fraud will be
referred to law enforcement authorities for review.
(Source: Amended at 46 Ill. Reg. 20865,
effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1550 INDIVIDUAL PROVIDERS WORKING FOR MULTIPLE CUSTOMERS (REPEALED)
Section 686.1550 Individual Providers Working for
Multiple Customers (Repealed)
(Source: Repealed at 46 Ill. Reg. 20865,
effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1560 TRAVEL TIME
Section 686.1560 Travel Time
a) An
Individual Provider working for more than one Customer may be paid for travel
time. Travel time is the time spent traveling between two different Customer
addresses on the same workday that meets the requirements defined in 89 Ill.
Adm. Code 676.30.
b) An
Individual Provider will not be paid travel time for any trip to or from their
home. If an Individual Provider lives with a Customer, they cannot be paid for travel
time to another Customer's home if the trip begins or ends at the Individual
Provider's home.
c) The
combined total of travel time and work time cannot exceed the maximum hours
defined within the currently effective Collective Bargaining Agreement (CBA)
per work week unless a Customer is approved for an exception under Section
686.1530.
d) If an
Individual Provider works for more than one Customer and chooses to claim
travel time, they must complete the Home Services Program Travel Agreement form
and the Home Services Program Travel Time Sheet form as applicable; the forms
are available through the HSP local offices or on the Department's website.
1) The
Individual Provider must submit the Home Services Program Travel Agreement form
to the HSP local office where the first Customer on the form is served. The
Individual Provider will be notified of the final determination in writing.
2) An
Individual Provider with an approved Travel Agreement must complete a Home
Services Program Travel Time Sheet form for each work week that travel between
Customers occurs on the same workday.
A) The
completed Travel Time Sheet form must be attached to the HSP Time Sheet and
both forms must be submitted to the HSP local office where the first Customer
is served as stated in subsection (d)(1).
B) Incomplete
forms will not be considered for reimbursement under this Section.
C) Approved
travel time will be processed and paid on the next available pay date.
e) The
Individual Provider is responsible for monitoring work time and travel time to
ensure they do not work unauthorized overtime.
(Source: Amended at 46 Ill. Reg. 20865,
effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1570 UNAUTHORIZED OVERTIME AND SANCTIONS
Section 686.1570 Unauthorized Overtime and Sanctions
a) The
Customer is required to manage their Individual Provider and both the Customer
and the Individual Provider are required to comply with all HSP requirements.
This shall include monitoring of the Individual Provider's work time by both
the Customer and the Individual Provider to ensure unauthorized overtime does
not occur.
b) Appropriate
action will be taken when unauthorized overtime occurs or when a Customer
and/or Individual Provider does not comply with HSP requirements. Unauthorized
overtime will result in a documented occurrence of noncompliance (i.e., more
than the maximum hours defined within the currently effective Collective
Bargaining Agreement (CBA) in a work week not approved for an exception under
Section 686.1530).
1) An
Individual Provider will be given a written warning for the first three
occurrences of unauthorized overtime. Each written notification of an
occurrence of unauthorized overtime shall be valid for a rolling twenty-four
(24) month period.
2) If
within any rolling 24 month period a fourth occurrence of unauthorized overtime
occurs, the Individual Provider will be notified in writing that they are
temporarily ineligible for funding from HSP for 3 months.
3) After
the Individual Provider has been temporarily ineligible for funding three times
pursuant to subsections (b)(1) and (b)(2), the Individual Provider will be
notified in writing that they are permanently ineligible for funding from the
HSP.
4) If an
Individual Provider has been deemed permanently ineligible for funding under
subsection (b)(3), the Individual Provider may request a review after 12 months
for reinstatement to the HSP, except in cases of substantiated fraud, abuse,
neglect, or exploitation.
5) If an
Individual Provider is deemed permanently ineligible under this Subpart, the
Customer will have the opportunity to replace the Individual Provider with
another qualified Individual Provider of the Customer’s choosing or the
Customer may change to an agency provider or HSP may amend the Customer’s Service
Plan to an agency provider.
6) A
Customer who has continued noncompliance with other HSP requirements in
addition to the overtime noncompliance may have their Service Plan amended to
an agency provider.
7) If
any changes to the Customer's Service Plan are made under this Subpart, a
Service Notice with the effective date of any changes will be issued. The
Customer has the right to appeal the action under 89 Ill. Adm. Code 510.
(Source: Amended at 46 Ill. Reg. 20865,
effective December 19, 2022)
SUBPART Q: ELECTRONIC VISIT VERIFICATION
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1600 DEFINITIONS
Section 686.1600 Definitions
Definitions for this Part can be found at 89 Ill. Adm. Code
676.30.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1610 GENERAL OVERVIEW
Section
686.1610 General Overview
a) Pursuant
to the Save Medicaid Access and Resources Together Act (SMART Act) (305 ILCS
5/5-5f(g)), and the 21st Century Cures Act (42 U.S.C. 1396b), DHS shall implement an Electronic Visit
Verification (EVV) system for personal care services and home health care
services provided under the Home Services Program (HSP).
b) The EVV system shall be based on global
positioning or other cost-effective technology and shall record:
1) the
type of service performed;
2) the
Customer receiving the service;
3) the
date and precise time the service begins and ends;
4) the
location of the service delivery; and
5) the
worker providing the service.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1620 EVV REQUIREMENTS FOR INDIVIDUAL PROVIDERS
Section
686.1620 EVV Requirements for Individual Providers
a) Individual
Providers shall use HSP’s Electronic Visit Verification (EVV) system when
providing services to a Customer.
1) Once
approved by HSP to work for Customers, Individual Providers shall be assigned a
unique EVV identification number or other user account information. Individual
Providers shall keep the EVV ID and/or other user account information
confidential.
2) Individual
Providers shall record the visit start time and visit end time in the EVV
system from the Customer’s registered telephone, or other HSP authorized method
of recording time worked, at the beginning and end of each service visit.
A) Individual
Providers shall enter their assigned EVV ID or other user account information
each time they record the start time and record the end time of the visit in
the EVV system.
B) Individual
Providers shall enter the appropriate task identification number or service
information each time that they record the end time in the EVV system.
b) Individual
Providers shall be responsible for maintaining timekeeping records which shall
include the exact times recorded in the EVV system.
c) At
the end of each pay period, Individual Providers and Customers shall review, reconcile,
and approve the Provider’s accounting of time worked on a timesheet or other
HSP authorized method.
d) The Customer shall review the timekeeping
information to ensure that it is complete, accurate, and in accordance with the
Customer’s Service Plan and within the Customer’s Service Plan hours. The
Customer shall confirm that the Individual Provider properly
recorded time worked in the EVV system for each visit. The Customer shall
discuss any discrepancies with the Individual Provider and work
cooperatively with the Individual Provider to correct the timekeeping
information in a timely manner. Once the Customer verifies the accuracy and
completeness for all hours worked, the Customer shall approve the timekeeping
information in a manner consistent with the policies of HSP.
e) Timekeeping records shall be reviewed by
the HSP local office for payment processing.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1630 EVV REQUIREMENTS FOR IN-HOME AGENCY PROVIDERS
Section 686.1630 EVV Requirements for In-home Agency
Providers
a) In-home
agency providers who provide homemaker services, maintenance home health
services, and/or respite services shall utilize their choice of an Electronic
Visit Verification (EVV) system that meets the requirements of this section
when providing services to HSP Customers and shall:
1) provide
documentation to verify implementation and use of the EVV system that meets the
requirements of this section;
2) adopt
internal policies and procedures regarding the EVV system;
3) provide
training and technical assistance to in-home agency field workers who use the
EVV system; and
4) submit
monthly billing statements to the HSP local office or health plan managing the
Customer case within 15 days of the end of the service period.
A) Each
statement must correspond to the providers EVV data, as defined in
686.1630(c)(3), for the same time period; and
B) should
not exceed the service hours or fees indicated on the active Vendor
Authorization for Services form unless express written approval has been given
by the HSP.
b) In-home
agency providers that employ fewer than 10 field workers may choose to utilize
HSP’s EVV system at no cost to the agency provider; all other in-home agency
providers must utilize an EVV system at the agency provider’s expense.
c) In-home
agency providers who utilize an alternative vendor EVV system shall require
their alternative EVV vendor to submit all visit verification data to the HSP’s
EVV aggregator component.
d) Minimum
EVV System Requirements:
1) Technical Functionality
A) System
must capture, identify, and track all relevant service data, including: the
type of service performed, the Customer receiving the service, the date and precise
time the service begins and ends, the location of the service delivery, and the
agency worker providing the service.
B) System
must be accessible to agency workers for input 24 hours a day, 7 days a week.
C) System
must support changes in services, Customers, and agency workers.
D) System
must allow for multiple shifts per Customer and per agency worker per day
including multiple sign in and sign out activities.
E) System
must allow for real time data capture.
F) System
must identify and track adjustments or edits made to EVV visits after the
agency worker has input time worked.
2) Data
Storage, Security, and Recovery Standards
A) System
must retain all EVV data for up to seven years from the Customer’s last date of
service with the agency.
B) Archived
data must be retrievable in a timely manner.
C) System
must comply with electronic data interchange standards under the Health
Insurance Portability and Accountability Act (HIPAA) Administrative
Simplification regulations detailed in 45 CFR 160, 162, and 164.
D) System
must incorporate a disaster recovery plan, including offsite electronic and
physical storage, recovery procedures, defined plan activation prompts, restart
capabilities, and backup hardware and operating system software.
3) Data
Collection and Aggregator Interface Standards
A) System
must collect data in a manner consistent with the HSP EVV aggregator data
collection specifications.
B) System
must submit all visit verification data to the HSP’s EVV aggregator in
compliance with the approved interface and submission data specifications as
provided by HSP.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
| SUBPART R: CRIMINAL BACKGROUND SCREENING
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1700 DEFINITIONS
Section 686.1700 Definitions
Definitions for this Part can be found at 89 Ill. Adm. Code 676.30.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1710 GENERAL OVERVIEW
Section 686.1710 General Overview
a) As a
condition of enrollment or revalidation in the Department of Human Services,
Division of Rehabilitation Services, Home Services Program, Individual
Providers shall be enrolled in the Illinois Medicaid Program Advanced Cloud
Technology (IMPACT) system prior to being paid with funds administered by the
State. As part of enrollment in IMPACT, a background screening shall be
completed. An Individual Provider’s enrollment in the Home Services Program
will also be reviewed for continued eligibility, including a background
screening. If such screenings return a result matching the Individual
Provider, this Subpart shall apply for Individual Providers paid with funds
administered by the State.
b) Notwithstanding
anything in this Subpart to the contrary, Individual Providers with misdemeanor
convictions not involving bodily harm or fraud may be employed at the
Customer’s discretion.
c) The
State shall not terminate or defund an Individual Provider from the Home
Services Program for any conviction or screening or background check result not
referenced in this Subpart.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1720 WAIVABLE CONVICTIONS
Section
686.1720 Waivable Convictions
a) If
such screening as stated in Section 686.1710(a) indicates a potential felony
criminal conviction for any of the crimes listed in this Section within the
five years prior to the date of application for enrollment or revalidation, the
State shall provide notification as set forth in Section 686.1740(b).
1) Lewd
and lascivious conduct;
2) Assaults;
3) Unlawful
restraint;
4) Recklessly
endangering another;
5) Frauds,
including forgery;
6) Larceny,
including thefts and robbery;
7) Burglary;
8) Embezzlement;
9) Extortion;
10) Stalking;
11) Cruelty
to children or animals;
12) Kidnapping;
13) Possession
of child pornography;
14) Arson;
15) Drug-related;
16) DUI;
17) Firearms
violations;
18) All
forms of non-intentional homicide;
19) Aggravated
crimes not involving bodily harm; or
20) Aggravated
crimes involving bodily harm, including but not limited to, aggravated battery,
aggravated battery of a senior citizen, aggravated battery of a child,
aggravated domestic battery, provided that 10 years or more have passed since
the date of conviction or end of incarceration, whichever is later;
b) If
the results of the background screening are listed in this Section, the State
shall provide the results of the background screening to the Customer and
Individual Provider, along with any additional information from the Individual
Provider submitted in a form approved by the Department, and allow the Customer
the option to consent to or decline working with the Individual Provider with a
criminal history.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
|
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.1730 NON-WAIVABLE CONVICTIONS
Section 686.1730 Non-waivable Convictions
a) If the
screening under Subsection 686.1710(a) indicates a potential felony criminal
conviction for any of the crimes listed in this Section, the State shall notify
the Individual Provider and Customer of the background screening result and
give the Individual Provider the opportunity to dispute the screening results
and submit additional information as stated in Section 686.1740.
1) Conviction
of theft or fraud from a government-funded program.
2) Having
been excluded from participation in Medicaid (federal or State) or Medicare
programs, or from a similar program in another state, as reflected in
sanction/exclusion databases.
3) A
substantiated verified record of abuse, neglect, or exploitation of an adult as
determined by the Department on Aging pursuant to the Adult Protective Services
(APS) Act [320 ILCS 20], resulting in placement on the APS registry and a
waiver of such placement has not been granted.
4) All
forms of intentional homicide, including but not limited to, solicitation of
murder, solicitation of murder for hire, first degree murder, second degree
murder.
5) All
sexual crimes, including but not limited to, criminal sexual assault, criminal
sexual abuse, sexual exploitation of a child, and sexual misconduct with a
person with a disability.
6) Aggravated
crimes involving bodily harm, including but not limited to, aggravated battery,
aggravated battery of a senior citizen, aggravated battery of a child,
aggravated domestic battery, provided that less than 10 years have passed since
the date of the conviction or end of incarceration, whichever is later.
7) Conviction
of abuse, neglect, or exploitation of a child.
b) If the
screening under Section 686.1710(a) indicates a potential felony criminal
conviction for any of the crimes listed in this section and are verified
through the processes stated in Section 686.1740(a), any defunding,
termination, or denial of enrollment of an Individual Provider by the State
will not be subject to the Customer waiver process described in Section
686.1720(b), but may be appealed through the Illinois Department of Healthcare
and Family Services Administrative Hearing process as outlined in 89 Ill. Adm.
Code 104, if applicable.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM PART 686 PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT SECTION 686.1740 BACKGROUND SCREENING DISPUTE
Section 686.1740 Background Screening Dispute
a) If a
dispute arises between the Individual Provider and the State regarding the
accuracy or correctness of the background screening results, the State shall
verify the screening results through a reliable background check process.
b) If
the background screening result shows a potential conviction for one of the
crimes listed in Section 686.1720(a) or Section 686.1730(a) within the
specified time period, the State shall notify the Individual Provider and
Customer of the background screening result. The State shall give the
Individual Provider the opportunity to confirm or dispute the accuracy of the
background screening results and to submit additional information to the State
regarding the criminal conviction no later than 20 days from the date of the
notification. Exceptions to this timeframe may be granted for good cause,
which may include but is not limited to, illness or incapacity, family crisis,
unexpected emergency, and limitations to an individual’s literacy.
c) The
Individual Provider may submit additional information that may supplement their
dispute of the background screening results. The additional information
submitted to the State may include, but need not be limited to:
1) Whether
the Individual Provider disputes the accuracy or correctness of the screening
results;
2) The
nature of the seriousness of the offense(s);
3) Circumstances
surrounding the offense;
4) Time
elapsed since the offense(s);
5) Number
or repeated offenses and number of times each offense has been repeated;
6) Age
at the time of offense(s);
7) Involvement,
since the date of the criminal offense, with the criminal justice system and/or
child or adult protective services;
8) Disclosure
of the criminal conviction(s) by the prospective worker to the person receiving
services, the surrogate, and the legal guardian, if any;
9) Prospective
worker’s unique caregiving relationship with the person receiving services;
10) Unavailability
of other workers who could reasonably be expected to perform the care required;
11) Any
other information the Individual Provider believes will assist in disposing of
their application or assisting the Customer in making the decision regarding
whether or not to consent to working with the Individual Provider as described
below; and
12) Any
other information requested by the State or Customer.
d) Failure
of the Individual Provider to either confirm or dispute the accuracy of the
background screening results may result in termination from the program without
penalty and without prejudice to the ability to reenroll in the program upon
compliance with this policy.
(Source: Added at 46 Ill. Reg. 20865,
effective December 19, 2022)
| Section 686.APPENDIX A Acceptable Human Service Degrees
 | TITLE 89: SOCIAL SERVICES
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: HOME SERVICES PROGRAM
PART 686
PROVIDER REQUIREMENTS, TYPE SERVICES, AND RATES OF PAYMENT
SECTION 686.APPENDIX A ACCEPTABLE HUMAN SERVICE DEGREES
Section 686.APPENDIX A Acceptable
Human Service Degrees
The following degrees will be
accepted as human service degrees:
Child, Family and Community Services
Early Childhood Development
Guidance and counseling
Home Economics – Child and Family Services
Human Development Counseling
Human Service Administration
Human Services
Master of Divinity
Pastoral Care
Pastoral Counseling
Psychiatric Nursing
Psychiatry
Psychology
Public Administration
Rehabilitation Counseling
Social Science
Social Services/Social Work
Sociology
(Source: Added at 24 Ill. Reg. 18174, effective November 30, 2000)
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