Section 120.65  Department of Mental Health and Developmental Disabilities (DMHDD) Licensed Community-Integrated Living Arrangements

a)         Community-Integrated Living Arrangement (CILA) Services

1)         This Section applies to individuals receiving CILA services through an agency licensed by DMHDD.  CILA services are provided in approved settings where eight or fewer individuals with mental retardation (MR) or mental illness (MI) reside under the supervision of the agency licensed by DMHDD.  Individuals actively participate in choosing services designed to provide treatment, habilitation, training, rehabilitation and other community integrative supports and in choosing a home from among those living arrangements available to the general public and/or housing owned or leased by an agency licensed by DMHDD.

2)         The standards and licensure requirements for community-integrated living arrangements are found at 59 Ill. Adm. Code 115.

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)         The appropriate MANG Community Income Standard will be used (see Section 120.20).

d)         The individual shall be allowed an asset disregard in accordance with Section 120.382.  Assets are considered in accordance with 89 Ill. Adm. Code 113.140, 113.141 and 113.142.

e)         No payment will be made by the Department for the cost of room and board. The individual shall be responsible directly to the agency licensed by DMHDD for payment of any room and board costs.

f)          If 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 determined for the eligibility period before becoming eligible to receive medical assistance.  The spend-down 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 costs for CILA services. CILA services are considered incurred in total for the month on the first day of the month or the first day services are received if for less than an entire month.  If the cost of CILA services equals or exceeds the spend-down amount, the spend-down is met.  DMHDD will provide the local office with a statement of expected monthly charges for CILA services to ensure that the spend-down obligation is met.

h)         If 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 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 the client meets spend-down.

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 setting in which CILA services are received.

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

(Source:  Added at 15 Ill. Reg. 10101, effective June 24, 1991)