Section 120.63  Department of Mental Health and Developmental Disabilities (DMHDD) Approved Home and Community Based Residential Settings

a)         In-Home Care Services

1)         This Section applies to individuals receiving remedial care services through the Department of Mental Health and Developmental Disabilities (DMHDD) in Home and Community Based Residential Settings approved by DMHDD.  Remedial care services are those services (except for room and board) provided by DMHDD that are directed toward meeting the needs of disabled clients who are not receiving services through the Department's In-Home Care Program (see Section 120.62).  The remedial care services are provided in the following Home and 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 Home and Community Based Residential Settings 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. The client shall be responsible directly to DMHDD for payment of room and board costs.  No payment will be made by the Department for the cost of room and board.

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 amount by which the client's non-exempt income exceeds the MANG Standard and the amount on non-exempt assets in excess of the applicable asset disregard.

g)         The client may meet the spend-down by incurring costs for remedial care services.  Remedial care costs are the cost of all services reported by DMHDD that exceed the MANG Community Income Standard and the Income Disregard amount.  Remedial care 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 remedial care services equal 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 remedial care 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.  Covered services, less the client's liability, received from the spend-down met date until the end of the eligibility period will be paid for by the Department.  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 Home and Community Based 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)