Section 120.40  Service descriptions


This Section describes the services covered under the Medicaid home and community-based services waiver program.  All services shall be rendered in accordance with a written individual service/support plan and shall be designed to ensure the continuity of supports and services for individuals.


a)         Respite


1)         This service is designed to provide relief on a short-term basis for the primary caregiver (that person responsible for the care and supervision of the individual on a daily basis) in times of emergencies and on a regularly scheduled basis to reduce stress, thereby reducing the potential for crises.


2)         Respite may be provided at the individual's natural or foster home.  The respite worker may accompany the individual on day outings, consistent with the individual's needs, the individual service/support plan, and the direction of the primary caregiver.  Respite may not be provided in day habilitation sites or to residents of Department-funded 24-hour residential settings.


3)         The respite provider is responsible for the following:


A)        The individual's health and well-being;


B)        Continuation of the individual service/support plan as indicated by the primary caregiver, and;


C)        Assumption of duties held by the primary caregiver, i.e., supervision and personal care.


b)         Habilitation services


1)         Habilitation services are designed to assist individuals in acquiring, retaining and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.  Habilitation services do not include the following:


A)        Special education and related services (as defined in Sections 602(16) and (17) of the Individuals with Disabilities Education Act (30 U.S.C.A. 1400 (1996)) which otherwise are available to the individual through a local education agency; and


B)        Vocational rehabilitation services which otherwise are available to the individual through a program funded under Section 110 of the Rehabilitation Act of 1973 (29 U.S.C.A. 794 (1995)).


2)         Habilitation services may vary in intensity and duration in accordance with the individual service/support plan.  Habilitation may be provided in a variety of settings and includes:


A)        Support and training provided in a developmental training (DT) program as defined in the Department's rules at 59 Ill. Adm. Code 119;


B)        Temporary behavior interventions, training and intensive therapy designed to reduce maladaptive behaviors and assist in the transition from more restrictive to less restrictive options in the community;


C)        Supports and services provided in the individual's home or in a community residential setting, including a community living facility (CLF), community residential alternative (CRA), home individual program (HIP), or special home placement (SHP);


D)        Supports and services provided through the community integrated living (CILA) program as described in the Department's rules at 59 Ill. Adm. Code 115; and


E)        Supported employment (SEP), limited to individuals who previously resided in a Medicaid-certified State-operated developmental center, community ICF/MR or nursing facility.  Standards for supported employment program regulations at 34 CFR 363.3, 363.4, 363.6 and 363.11(e)(2-3) (1996).


c)         Adaptive equipment and minor modifications to the home


1)         Adaptive equipment and minor modifications to the home shall be covered only when they are necessary to prevent institutional placement, to deinstitutionalize an individual, or to allow the individual to participate in specialized services for individuals with developmental disabilities.


2)         Adaptive equipment and minor modifications to the home shall be for the direct benefit of the individual and shall not be otherwise available under the State Medicaid Plan (the Illinois Public Aid Code [305 ILCS 5]).


3)         Personal adaptive equipment includes mobility devices, seating and positioning supports, transfer assists or lifts, communication devices, and sensory aids.  Personal adaptive equipment shall be prescribed by a physician, or by a qualified health professional who meets State standards as an occupational therapist pursuant to the Illinois Occupational Therapy Practice Act [225 ILCS 75], physical therapist pursuant to the Illinois Physical Therapy Act [225 ILCS 90], or speech and language therapist pursuant to the Illinois Speech-Language Pathology and Audiology Practice Act [225 ILCS 110], as appropriate to the disability.


4)         Professional evaluations for personal adaptive equipment needs are covered but only when not covered as a part of the PASARR process or under the State Medicaid Plan.


5)         Other adaptive equipment includes:


A)        Specialized beds;


B)        Carrying equipment;


C)        Adaptive equipment for timing, measuring and self-administering medications;


D)        Feeding machines;


E)        Adaptive utensils and equipment for eating, bathing, grooming, self-care, cooking and household chores;


F)         Adaptive labels, controls and instructions;


G)        Environmental controls;


H)        Closed caption decoders;


I)         Adapted or programmable telephones;


J)         Prerecorded message players; and


K)        Pagers, intercoms, emergency signalers and adapted alarm clocks.


6)         Minor modifications to the home includes grab bars or handrails, ramps, widening of doorways and halls, lowered or adaptive door handles, accessible kitchen and bathroom appliances, pullout shelving and adapted fire alarms, smoke detectors and doorbells.


7)         Other adaptive equipment, minor modifications to the home and professional evaluations for personal adaptive equipment needs shall be authorized as part of the individual service/support plan and be approved by the planning team.


(Source:  Amended at 20 Ill. Reg. 4762, effective March 8, 1996)