AUTHORITY: Implementing and authorized by the Home Health, Home Services, and Home Nursing Agency Licensing Act [210 ILCS 55].
SOURCE: Adopted at 2 Ill. Reg. 31, p. 77, effective August 2, 1978; emergency amendment at 3 Ill. Reg. 38, p. 314, effective September 7, 1979, for a maximum of 150 days; amended at 3 Ill. Reg. 40, p. 153, effective October 6, 1979; emergency amendment at 4 Ill. Reg. 18, p. 129, effective April 21, 1980, for a maximum of 150 days; amended at 4 Ill. Reg. 40, p. 56, effective September 23, 1980; emergency amendment at 6 Ill. Reg. 5855, effective April 28, 1982, for a maximum of 150 days; amended at 6 Ill. Reg. 11006, effective August 30, 1982; amended at 7 Ill. Reg. 13665, effective October 4, 1983; codified at 8 Ill. Reg. 16829; amended at 9 Ill. Reg. 4836, effective April 1, 1985; amended at 14 Ill. Reg. 2382, effective February 15, 1990; amended at 15 Ill. Reg. 5376, effective May 1, 1991; amended at 18 Ill. Reg. 2414, effective January 22, 1994; emergency amendments at 20 Ill. Reg. 488, effective January 1, 1996, for a maximum of 150 days; emergency expired May 29, 1996; amended at 20 Ill. Reg. 3273, effective February 15, 1996; amended at 20 Ill. Reg. 10033, effective July 15, 1996; amended at 22 Ill. Reg. 3948, effective February 13, 1998; amended at 22 Ill. Reg. 22050, effective December 10, 1998; amended at 23 Ill. Reg. 1028, effective January 15, 1999; amended at 24 Ill. Reg. 17213, effective November 1, 2000; amended at 25 Ill. Reg. 6379, effective May 1, 2001; amended at 26 Ill. Reg. 11241, effective July 15, 2002; amended at 28 Ill. Reg. 3487, effective February 9, 2004; amended at 28 Ill. Reg. 8094, effective May 26, 2004; amended at 29 Ill. Reg. 20003, effective November 28, 2005; amended at 31 Ill. Reg. 9453, effective June 25, 2007; amended at 32 Ill. Reg. 8949, effective June 5, 2008; amended at 34 Ill. Reg. 5711, effective April 5, 2010; amended at 39 Ill. Reg. 16406, effective December 10, 2015; amended at 43 Ill. Reg. 9134, effective August 12, 2019; emergency amendment at 44 Ill. Reg. 5929, effective March 25, 2020, for a maximum of 150 days; emergency expired August 21, 2020; emergency amendment at 44 Ill. Reg. 14328, effective August 24, 2020, for a maximum of 150 days; emergency rule expired January 20, 2021; emergency amendment at 45 Ill. Reg. 1710, effective January 21, 2021, for a maximum of 150 days; emergency expired June 19, 2021; emergency amendment at 45 Ill. Reg. 6335, effective May 3, 2021, for a maximum of 150 days; amended at 45 Ill. Reg. 11077, effective August 27, 2021; amended at 46 Ill. Reg. 10410, effective May 31, 2022; amended at 47 Ill. Reg. 3765, effective March 2, 2023; amended at 47 Ill. Reg. 17468, effective November 8, 2023.
SUBPART A: GENERAL PROVISIONS
Section 245.10 Purpose
a) This Part has been adopted in accordance with Sections 6, 6.3 and 6.7 of the Home Health, Home Services and Home Nursing Agency Licensing Act (the Act) [210 ILCS 55/6, 6.3 and 6.7].
b) Home health agencies licensed under the Act and this Part may be eligible for participation in the federal Medicare program under the rules of the federal Centers for Medicare and Medicaid Services (42 CFR 484.1 through 484.40).
c) Health care and support services are provided in the consumer's home by three basic types of agencies: home health care, home nursing care, and home support services. Each type of agency delivers a different type and scope of care or service. (Section 1.01 of the Act)
(Source: Amended at 32 Ill. Reg. 8949, effective June 5, 2008)
Section 245.20 Definitions
Act the Home Health, Home Services and Home Nursing Agency Licensing Act.
Activities of Daily Living or ADL − include, but are not limited to, eating, dressing, bathing, toileting, transferring, or personal hygiene.
Advanced Practice Registered Nurse or APRN a person who is licensed as an advanced practice registered nurse under the Nurse Practice Act.
Advocate a person who represents the rights and interests of an individual as though they were the person's own, to realize the rights to which the individual is entitled, obtain needed services, and remove barriers to meeting the individual's needs.
Agency a home health agency, home nursing agency, or home services agency, unless specifically stated otherwise. (Section 2.03a of the Act)
Agency Manager the individual designated by the governing body or the entity legally responsible for the agency, who has overall responsibility for the organization and day-to-day operation of the home services or home nursing agency.
Applicant − a firm, partnership, or association, or any of their members, or, if the applicant is a corporation, any of its officers or directors, or the person designated to manage or supervise the agency.
Audiologist a person who has received a license to practice audiology pursuant to the Illinois Speech-Language Pathology and Audiology Practice Act.
Branch Office an office location or site other than the parent agency from which an agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the agency and is located sufficiently close to share administration, supervision and services on a daily and emergency basis in a manner that renders it unnecessary for the branch to be independently licensed.
Bylaws or Equivalent a set of rules adopted by an agency for governing the agency's operation.
Client an individual receiving services from a home nursing agency, a home services agency or a placement agency. This term includes the client's advocate or designee.
Client Record − a written or electronic record that includes, but is not limited to, personal information, emergency notification information, plans of service agreed to between the client and the home services agency, a copy of the home services contract or agreement, and documentation of the services provided at each visit.
Clinical Note a dated, written notation or electronic entry by a member of the health team of a contact with a patient, containing a description of signs and symptoms, treatment and any drug given, the patient's reaction, and any changes in physical or emotional condition.
Clinical Record an accurate account of services and care provided for each patient that is maintained by a home health or home nursing agency in accordance with accepted professional standards.
Companionship services that provide fellowship, care and protection for a client who, because of advanced age or physical or mental infirmity, cannot care for his or her own needs. Services requested may include, but are not limited to: household work related to the care of the client, such as meal preparation, bed making, or laundry; shopping or errands; or other similar services.
"Data Driven" an agency uses quality indicator data, including patient care, and other relevant data, in the design of its program. The data collected is used to monitor the effectiveness and safety of services and quality of care and to identify opportunities and priorities for improvement. The frequency and detail of the data collection is approved by the governing body of the agency.
Department or IDPH the Department of Public Health of the State of Illinois. (Section 2.01 of the Act)
Director the Director of Public Health of the State of Illinois, or his or her designee. (Section 2.02 of the Act)
Discharge Summary the written report of services rendered, goals achieved, and final disposition at the time of discharge from service of a home health or home nursing agency.
Documentary Evidence evidence that an agency covered under this Part maintains as documentation of its quality assessment and performance improvement program. Documentary evidence used to demonstrate the agency's operation to the Centers for Medicare and Medicaid Services includes program scope, program data, program activities, performance improvement projects, and executive responsibilities.
Drop-site an office or site of the parent agency that does not render services but is used by the parent agency only as a location for administrative tasks, which may include hiring or training staff and a location for staff to obtain supplies.
Employee − a person who works in the service of another person, or company, under an express or implied contract for hire, under which the employer has the right to control the details of work performance for wages, salary, fee or payment.
Geographic Service Area an area of contiguous counties (recognizable boundaries) in which the agency has been approved by the Department to provides services.
Health Care Professional a physician licensed to practice medicine in all of its branches, a podiatrist, an advanced practice registered nurse (APRN) licensed under the Nurse Practice Act, or a physician assistant, licensed under the Physician Assistant Practice Act of 1987.
Home Health Agency a public agency or private organization that provides skilled nursing services and at least one other home health service as defined in this Part. (Section 2.04 of the Act)
Home Health Agency Administrator an employee of the home health agency who is any one of the following:
A physician who has experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs;
A registered professional nurse (RN) who has experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs;
An individual with an undergraduate degree with experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs; or
An individual who meets the requirements for Public Health Administrator as contained in Section 600.310 of the Certified Local Health Department Code who has experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs.
Home Health Aide a person who provides nursing, medical, or personal care and emotional comfort to assist the patient toward independent living in a safe environment. A person may not be employed as a home health aide unless the person meets the requirements of Section 245.70.
Home Health Services services provided to a person at his or her residence according to a plan of treatment for illness or infirmity prescribed by a physician licensed to practice medicine in all its branches, a licensed physician assistant, or a licensed advanced practice registered nurse. Such services include part-time and intermittent nursing services and other therapeutic services such as physical therapy, occupational therapy, speech therapy, medical social services or services provided by a home health aide. (Section 2.05 of the Act)
Home Nursing Agency an agency that provides services directly, or acts as a placement agency, in order to deliver skilled nursing and home health aide services to persons in their personal residences. A home nursing agency provides services that would be required to be performed by an individual licensed under the Nurse Practice Act. Home health aide services are provided under the direction of a registered professional nurse or advanced practice registered nurse. A home nursing agency does not require licensure as a home health agency under the Act. "Home nursing agency" does not include an individually licensed nurse acting as a private contractor or a person that provides or procures temporary employment in health care facilities, as defined in the Nurse Agency Licensing Act. (Section 2.11 of the Act)
Home Nursing Services services that would be required to be performed by an individual licensed under the Nurse Practice Act on a shift schedule, one-time, full-time or part-time, and/or intermittent basis.
Home Services Agency an agency that provides services directly, or acts as a placement agency, for the purpose of placing individuals as workers providing home services for consumers in their personal residences. Home services agency does not include agencies licensed under the Nurse Agency Licensing Act, the Hospital Licensing Act, the Nursing Home Care Act, the ID/DD Community Care Act, the MC/DD Act, the Specialized Mental Health Rehabilitation Act of 2013, or the Assisted Living and Shared Housing Act and does not include an agency that limits its business exclusively to providing housecleaning services. Programs providing services exclusively through the Community Care Program of the Illinois Department on Aging, the Department of Human Services Office of Rehabilitation Services, or the United States Department of Veterans Affairs are not considered to be a home services agency under the Act. (Section 2.08 of the Act)
Home Services or In-Home Services or In-Home Support Services assistance with activities of daily living, housekeeping, personal laundry, and companionship provided to an individual in his or her personal residence, which are intended to enable that individual to remain safely and comfortably in his or her own personal residence. "Home services" or "in-home services" does not include services that would be required to be performed by an individual licensed under the Nurse Practice Act. (Section 2.09 of the Act) Home services are focused on providing assistance that is not medical in nature, but is based upon assisting the client in meeting the demands of living independently and maintaining a personal residence, such as companionship, cleaning, laundry, shopping, meal preparation, dressing, and bathing.
Home Services Worker or In-Home Services Worker an individual who provides home services to a consumer in the consumer's personal residence. (Section 2.10 of the Act) The terms homemaker and companion are commonly used to refer to this type of worker.
Licensed Practical Nurse a person who is licensed as a licensed practical nurse under the Nurse Practice Act.
Occupational Therapist a person who is licensed as an occupational therapist under the Illinois Occupational Therapy Practice Act.
Occupational Therapy Assistant a person who is licensed as an occupational therapy assistant under the Illinois Occupational Therapy Practice Act.
Parent Agency − the agency location responsible for developing and maintaining administrative control of all DPH-approved locations. The parent agency address/location appears on the Department-issued license.
Part-Time or Intermittent Care home health services given to a patient at least once every 60 days or as frequently as a few hours a day, several times per week.
Patient a person who is under treatment or care for illness, disease, injury or conditions appropriately responsive to home health or home nursing services to maintain health or prevent illness.
Patient Care Plan a coordinated and combined care plan prepared by and in collaboration with each discipline providing service to the patient, to the patient's family, or, for home health agencies, to both.
Person any individual, firm, partnership, corporation, company, association or any other legal entity. (Section 2.03 of the Act)
Personal Care Services services that are furnished to a client in the client's personal residence to meet the client's physical, maintenance, and supportive needs, when those services are not considered skilled personal care, as described in Section 245.40(c), and do not require a health care provider's orders or the supervision of a nurse.
Physical Therapist a person who is licensed as a physical therapist under the Illinois Physical Therapy Act.
Physical Therapist Assistant a person who is licensed as a physical therapist assistant under the Illinois Physical Therapy Act.
Physician any person licensed to practice medicine in all of its branches under the Medical Practice Act of 1987. For a patient who has received medical care in another state, or has moved from another state, and who has not secured the services of a physician licensed in Illinois, an individual who holds an active license to practice medicine in another state will be considered the physician for the patient during this emergency (as determined by the physician) as provided in Section 3 of the Medical Practice Act of 1987. An emergency may not extend more than six months in any case.
Physician Assistant - any person who meets the licensing requirements of the Physician Assistant Practice Act of 1987.
Placement Agency any person engaged for gain or profit, regardless of the agency tax status, in the business of securing or attempting to secure work for hire for persons seeking work or workers for employers. The term includes a private employment agency and any other entity that places a worker for private hire by a consumer in that consumer's residence for purposes of providing home services. The term does not include a person that provides or procures temporary employment in health care facilities, as defined in the Nurse Agency Licensing Act. (Section 2.12 of the Act) For the purposes of this Part, there are two types of placement agencies: Home Nursing Placement Agencies (see Section 245.212) and Home Services Placement Agencies (see Section 245.214). A placement agency does not provide ongoing, continuous client support and management of services.
Plan of Treatment a plan based on the patient's diagnosis and the assessment of the patient's immediate and long-range needs and resources. The plan of treatment is established in consultation with, in the case of a home health agency, the home health services team, which includes the attending physician or podiatrist, pertinent members of the agency staff, the patient, and members of the family.
Podiatrist a person who is licensed to practice under the Podiatric Medical Practice Act of 1987.
Progress Notes a dated, written notation by a member of the health team, summarizing facts about care and the patient's response during a given period of time.
Purchase of Services or Contractual the provision of services through a written agreement with other providers of services.
Quality Assessment and Performance Improvement or QAPI the coordinated application of two mutually-reinforcing aspects of a quality management system. QAPI takes a systematic, comprehensive, and data-driven approach to maintaining and improving safety and quality in home health agencies while involving all home health caregivers in practical and creative problem solving. Quality assessment is the specification of standards for quality of service and outcomes, and is a process used throughout the organization to ensure care is maintained at acceptable levels in relation to those standards. Performance improvement is the continuous study and improvement of processes with the intent to better services or outcomes, and to decrease the likelihood of problems, by identifying areas of opportunity.
Registered Professional Nurse or RN a person who is licensed as a registered professional nurse under the Nurse Practice Act.
Service Plan a plan based on the client's needs and identification of the client's immediate and long-range goals and resources needed to meet these goals.
Service Contract a written contract between the client and the agency, printed in no less than 12-point font, which includes, at a minimum, all elements listed in Sections 245.220 and 245.225, as applicable.
Skilled Nursing Services those services that, due to their nature and scope, would require the performing individual to be licensed under the Nurse Practice Act. These services are acts requiring the basic nursing knowledge, judgment and skills acquired by means of completion of an approved nursing education program and include, but are not limited to: assessment of healthcare needs; nursing diagnosis; planning, implementation and nursing evaluation; counseling; patient education; health education; the administration of medications and treatments; and the coordination or management of a nursing or medical plan of care.
Skilled Personal Care care that may be provided by a home health aide, a registered professional nurse, a licensed practical nurse, a social worker, an occupational therapist, a physical therapist, or a speech-language pathologist as ordered by a health care professional.
Social Work Assistant a person who has a baccalaureate degree in social work, psychology, sociology, or other field related to social work and has at least one year of social work experience in a health care setting.
Social Worker a person who is a licensed social worker or a licensed clinical social worker under the Clinical Social Work and Social Work Practice Act.
Speech-Language Pathologist a person who is licensed as a speech-language pathologist under the Illinois Speech-Language Pathology and Audiology Practice Act.
Student an individual who is enrolled in an educational institution and who is receiving training in a health-related profession.
Substantially Meets meeting requirements except for variance from the strict and literal performance, which results in unimportant omissions or defects given the particular circumstances involved.
Supervision authoritative procedural guidance by a qualified person of the appropriate discipline.
(Source: Amended at 47 Ill. Reg. 17468, effective November 8, 2023)