Section l20.62  Department of Mental Health and Developmental Disabilities (DMHDD) Approved Home and Community Based Residential Settings Under 89 Ill. Adm. Code 140.643

a)         Community-based Residential Settings

1)         The following rule applies to individuals receiving in-home care services through the Department of Mental Health and Developmental Disabilities (DMHDD) in accord with 89 Ill. Adm. Code 140.643.  The in-home care services are provided in the following community based residential settings.

A)        Community Living Facilities (CLF)

B)        Special Home Placements (SHP)

C)        Supported Living Arrangement (SLA)

D)        Home Individual Program (HIP)

E)         Community Residential Alternatives (CRA)

2)         A definition of the above quoted Home and Community based residential settings as well as a description of the Title XIX waiver services can be found at 59 Ill. Adm. Code 120.

b)         A one-month eligibility period will be used. Eligibility begins the first day of the eligibility period or the day during the month that spend-down is met.

c)         A one-person MANG Community Income Standard will be used (see Section 120.20).

d)         The client shall be allowed an asset disregard in the amount for one client in accord with Section 120.382. Assets are considered in accord with 89 Ill. Adm. Code 113.140, 113.141, 113.142 and 113.154.

e)         If the client has SSI income, the SSI income will be applied by DMHDD toward the cost of room and board. However, no payment will be made by the Department for the cost of room and board.  The client shall be responsible directly to DMHDD for payment of room and board costs.

f)          If the client's non-exempt income is greater than the MANG standard and/or non-exempt assets are over the applicable asset disregard, the client must meet the spend-down obligation determined for the eligibility period before becoming eligible to receive Medical Assistance. The spend-down obligation is the sum of the amount by which the client's non-exempt income exceeds the MANG standard and the amount of non-exempt assets in excess of the applicable asset disregard.

g)         The client may meet the spend-down by incurring Title XIX waiver (in-home care) services.  Waiver services are considered incurred in total for the month on the first day of the month or the first day of stay for a month that the client resides in the approved residential setting if for less than an entire month.  If the cost of waiver services equals or exceeds the spend-down amount, the spend-down obligation is met.  DMHDD will provide the local office a statement of expected monthly charges for waiver services to ensure that the spend-down obligation is met.

h)         If the client's non-exempt income is equal to or less than the MANG Standard and non-exempt assets are not in excess of the applicable asset disregard, the client is eligible for medical assistance from the first day of the eligibility period.

i)          If the client's non-exempt income exceeds the MANG Standard and/or non-exempt assets are over the applicable asset disregard, eligibility for medical assistance shall begin effective the first day that the spend-down obligation is met.  The Department will pay for covered services less the client's liability (excluding Title XIX waiver services) received from the date the spend-down obligation is met date until the end of the eligibility period.  The client shall be responsible directly to the provider for payment for services provided prior to the time client meets the spend-down obligation.

j)          A new application and/or a redetermination of eligibility will not be required for eligible clients who move from an institutional setting to an approved Home and Community based residential setting.

k)         A case review is required for eligible cases placed in an approved residential setting.

l)          A full redetermination of eligibility shall be made every twelve months.

(Source:  Amended at 14 Ill. Reg. 4233, effective March 5, 1990)