AUTHORITY: Implementing Section 3 of the Disabled Persons Rehabilitation Act [20 ILCS 2405/3].

SOURCE: Adopted at 19 Ill. Reg. 5104, effective March 21, 1995; amended at 20 Ill. Reg. 12479, effective August 28, 1996; recodified from the Department of Rehabilitation Services to the Department of Human Services at 21 Ill. Reg. 9325; amended at 22 Ill. Reg. 18945, effective October 1, 1998; amended at 22 Ill. Reg. 19262, effective October 1, 1998; amended at 23 Ill. Reg. 499, effective December 22, 1998; amended at 23 Ill. Reg. 6457, effective May 17, 1999; amended at 24 Ill. Reg. 7501, effective May 6, 2000; amended at 24 Ill. Reg. 10212, effective July 1, 2000; amended at 24 Ill. Reg. 18174, effective November 30, 2000; amended at 25 Ill. Reg. 6282, effective May 15, 2001; amended at 26 Ill. Reg. 3994, effective February 28, 2002; amended at 28 Ill. Reg. 6453, effective April 8, 2004; amended at 29 Ill. Reg. 16508, effective October 17, 2005; amended at 31 Ill. Reg. 14238, effective September 27, 2007; emergency amendment at 33 Ill. Reg. 7017, effective May 5, 2009, for a maximum of 150 days; emergency expired October 1, 2009; emergency amendment at 38 Ill. Reg. 6473, effective February 28, 2014, for a maximum of 150 days; amended at 38 Ill. Reg. 11519, effective May 15, 2014; amended at 38 Ill. Reg. 16978, effective July 25, 2014; amended at 41 Ill. Reg. 8454, effective August 1, 2017; amended at 43 Ill. Reg. 2133, effective January 24, 2019; emergency amendment at 45 Ill. Reg. 4178, effective March 10, 2021, for a maximum of 150 days; amended at 45 Ill. Reg. 10053, effective July 22, 2021; amended at 46 Ill. Reg. 20865, effective December 19, 2022; amended at 47 Ill. Reg. 19328, effective December 13, 2023.

SUBPART A: PERSONAL ASSISTANTS

 

Section 686.10  Personal Assistant (PA) Requirements

 

In order to be employed by a customer as a PA (89 Ill. Adm. Code 676.30), an individual must:

 

a)         have a Social Security number and provide the Department of Human Services (DHS) with documented verification of this number;

 

b)         be a minor between 14 and 16 years of age who is not employed during school hours, has an employment certificate and meets all other requirements of the Child Labor Law [820 ILCS 205] and has an adult who is at least 21 years of age and who is legally responsible for the customer who will supervise the PA; be 16 years of age or older, enrolled in school and not employed during school hours; or be 17 years of age or older and not enrolled in school;

 

c)         have provided to the customer at least two written or verbal recommendations from present or former employers, the recommendation of a Center for Independent Living (CIL), or, if never employed, references from at least two non-relatives;

 

d)         be able to communicate with the customer to the satisfaction of the customer and counselor;

 

e)         be able to follow directions to the satisfaction of the customer and counselor;

 

f)         have previous experience and/or training that is adequate and consistent with the specific tasks required for safe and adequate care of the customer;

 

g)         if the customer has a contagious infectious disease, have a physician, health care institution (i.e., hospital, nursing home, home health agency), or CIL certify, in writing, that he/she has the knowledge of precautionary procedures for the control of contagious infectious diseases, if it is anticipated that he/she will come into contact with bodily fluids, or be evaluated by a Registered Nurse licensed pursuant to the Nurse Practice Act [225 ILCS 65] to determine that he/she has knowledge of those procedures;

 

h)         complete an EMPLOYMENT AGREEMENT between the customer and PA that certifies the PA:

 

1)         shall provide services to the individual in accordance with his/her SERVICE PLAN (IL 499-1049) (89 Ill. Adm. Code 676.30(u));

 

2)         shall submit a bi-monthly calendar listing actual hours worked each pay period (1-15; 16-last working day of the month), as verified by the customer and in accordance with the number of hours authorized by DHS. The PA shall not claim more hours than approved by DHS unless prior approval has been granted by the counselor to address a temporary increased service need;

 

3)         shall make available to DHS and other designated agencies those records described in subsection (h)(2);

 

4)         shall maintain all customer information as confidential and not for release, either in writing or verbally, to anyone other than those designated by DHS in writing;

 

5)         shall not subcontract to any other person, any of the services he/she has agreed to provide;

 

6)         shall provide services only while the individual is in his/her home or during the period covered by Section 684.60 (Provision of Services);

 

7)         shall agree that the customer is responsible for locating, choosing, employing, supervising, training, and disciplining as necessary the PA.  Further, that the State of Illinois does not provide paid vacation, holiday, or sick leave; however, such absences shall be reported to the DHS counselor per the HOME SERVICES TIME SHEET (IL 488-2251) only for the purposes of processing payment;

 

8)         understands that DHS reports all payments made to a PA to the Illinois Department of Employment Security (DES) and that the PA may apply for unemployment benefits, but DES, not DHS, makes the determination as to whether the PA shall receive benefits;

 

9)         understands that he/she may apply for Workers' Compensation benefits through DHS and that some customers may carry such insurance coverage; however, DHS maintains that the customer, not DHS, is the employer for these purposes; and

 

10)       understands that DHS will withhold Social Security tax (FICA) from payments made to him/her. Federal and State income tax shall be withheld if the PA completes and returns to DHS two separate W-4 forms;

 

i)          complete an I-9 Immigration form, which must be retained by the customer;

 

j)          for PAs starting on or after April 13, 1992, complete a PA STANDARDS (IL 488-2112) to be returned to DHS;

 

k)         as of April 13, 1992, at the time of redetermination of eligibility of the customer by which he/she is employed, have completed by the customer, a PERSONAL ASSISTANT EVALUATION (IL 488-2089); and

 

l)          if requested by the customer, give permission and the necessary information for the customer to request a conviction background check from the Illinois State Police.  This permission will require the prospective PA to sign the appropriate form provided by the customer.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.20  Services That May Be Provided by a PA

 

A PA may perform or assist with:

 

a)         household tasks, shopping, or personal care; and

 

b)         incidental health care tasks that do not require independent judgement, with the permission of the customer and/or family; and

 

c)         monitoring to ensure the health and safety of the customer.

 

(Source:  Amended at 38 Ill. Reg. 16978, effective July 25, 2014)

 

Section 686.25  Criminal Background Check

 

a)         A Home Services Customer may require any PA candidate to submit to a criminal background investigation and to successfully complete a criminal background investigation as a condition of being selected as the PA to that Customer.

 

b)         In the event that a customer elects to require a PA candidate to submit to a criminal background investigation, the customer shall be obligated only to inform DHS-Division of Rehabilitation Services (DRS) of his/her decision and DHS-DRS will provide the Customer an appropriate form that the Customer may file with the Illinois State Police to initiate the criminal background investigation.  The results of the criminal background investigation will be sent directly to the customer, and the customer shall have no obligation to share the results of the investigation with DHS-DRS. Nothing contained in this Section shall restrict a customer from extending a conditional offer of employment to any PA candidate pending the results of the background investigation.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.30  Annual Review of PA Performance

 

a)         Pursuant to 686.10(k), annually, at the time of redetermination of the individual's eligibility, a Personal Assistant Evaluation (IL 488-2089) shall be completed, by the customer with assistance of the counselor, for each PA providing services through the Home Services Program (HSP).

 

b)         PAs shall be evaluated based upon:

 

1)         accuracy of work (e.g., ranging from making many errors to few errors);

 

2)         cleanliness of working area (e.g., ranging from very untidy to exceptionally clean);

 

3)         use of work time (e.g., ranging from very wasteful to very efficient);

 

4)         responsibility (e.g., ranging from irresponsible to responsible);

 

5)         attendance (e.g., ranging from frequently absent or late to always prompt); and

 

6)         attitude towards the customer (e.g., ranging from disrespectful to respectful).

 

c)         The outcome of the evaluation shall be mediated by the counselor between the PA and the customer regarding any unresolved issues, up to and including replacement of the PA by the customer, if necessary.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.40  Payment for PA Services

 

a)         PAs shall be paid at the hourly rate set by law, but never less than the current federal minimum wage.

 

b)         PAs shall be paid twice each month for services rendered.  The first payment shall be for any services rendered by the PA, pursuant to the customer's Service Plan, from the first day of the month through the fifteenth day of the month.  The second payment shall be for any services rendered by the PA, pursuant to the customer's Service Plan, from the sixteenth day of the month through the last day of the month.

 

c)         No PA shall be reimbursed by DHS-DRS for services rendered to one or more HSP customers for more than 16 hours in a 24-hour period.  The counselor may grant an exception should an emergency occur that results in the loss of a paid or unpaid primary caregiver who resides with the customer, and there is imminent danger to the health, safety and well being of the customer.  When this occurs, the additional hours may not exceed the annual service cost maximum (SCM). The 16-hour limitation does not apply to PAs providing respite services.

 

(Source:  Amended at 29 Ill. Reg. 16508, effective October 17, 2005)

SUBPART B: ADULT DAY CARE PROVIDERS

 

Section 686.100  Adult Day Care (ADC) Provider Requirements

 

a)         Adult Day Care (ADC) Providers (see 89 Ill. Adm. Code 676.40) must either be approved by DHS or by the Illinois Department on Aging (DoA) pursuant to DoA's rules found at 89 Ill. Adm. Code 240, with the exception that the term "the elderly" in 89 Ill. Adm. Code 240.1560(a)(1)(A)(ii) and (a)(2)(A)(iii) should be replaced with the term "individuals with disabilities". 

 

b)         In order to be approved as an ADC Provider by DHS, the ADC Provider must meet all of the conditions specified by DoA, as cited above, and:

 

1)         employ a full-time program director;

 

2)         employ the equivalent of a full-time program coordinator/director;

 

3)         employ a program nurse who is on duty at least a portion of every standard business day;

 

4)         employ a nutrition staff;

 

5)         comply with the provisions of:

 

A)        Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 701), as amended;

 

B)        the Illinois Human Rights Act [775 ILCS 5];

 

C)        the Illinois Accessibility Code (71 Ill. Adm. Code 400);

 

D)        the Americans with Disabilities Act (42 U.S.C. 12101); and

 

E)        the Health Insurance Portability and Accountability Act (42 U.S.C. 1320d);

 

6)         record the administration of all prescribed medications for those Customers served through HSP who are unable to self-administer medication as documented by a physician licensed pursuant to the Medical Practice Act [225 ILCS 60], a registered nurse licensed pursuant to the Nursing Practice Act [225 ILCS 65], or as documented in the individual's Service Plan (IL 488-1049) (89 Ill. Adm. Code 676.30);

 

7)         provide DHS with a record of the amount of pre-service training each employee has;

 

8)         require, and provide DHS documentation of, at least 12 hours of in-service training for each staff person each fiscal year;

 

9)         successfully complete an Adult Day Care Provider Review (IL 488-2129) pursuant to Section 686.120;

 

10)        accept reimbursement at or below the federally-approved Medicaid rates pursuant to the currently active 1915(c) Home and Community Based Services Waiver;

 

11)        maintain adequate records for planning, budgeting, administration and program evaluation and planning.  These records shall be available to DHS and the United States Department of Health and Human Services (HHS), or any entity designated by DHS or HHS, and shall be maintained for a period of at least 5 years or until advised that all State and federal audits are completed. These records must include, but not be limited to:

 

A)        records of all referrals, including the disposition of each referral;

 

B)        all Customer records;

 

C)        administrative records, including:

 

i)          service statistics; and

 

ii)         billing and payment records;

 

D)        personnel records, including:

 

i)          schedules and attendance records for staff and volunteers;

 

ii)         training records for staff and volunteers;

 

iii)        annual performance evaluations for all staff and, as appropriate, all volunteers; and

 

12)        have an Affirmative Action Plan in place which is approved by its governing body.

 

c)         a facility that houses an adult day care program (including satellite sites) shall meet the criteria for the Centers for Medicare and Medicaid Services definition of a home and community-based setting pursuant to 42 CFR 441.301(c)(4) and 42 CFR 441.301(c)(5).

 

d)         if a provider meets the criteria listed in this Section, application to HSP should be made to:

 

Illinois Department of Human Services

Division of Rehabilitation Services

Home Services Program, Program Compliance

100 S. Grand Ave. East

Springfield IL  62794

 

(Source:  Amended at 46 Ill. Reg. 20865, effective December 19, 2022)

 

Section 686.110  Services Which Must Be Provided by ADC Providers

 

In order for an Adult Day Care Provider to be recognized by DHS and used to provide services to individuals receiving services through HSP, each Adult Day Care Center must agree to provide the following services:

 

a)         written and individualized care planning;

 

b)         assistance and arrangement of personal care, hygiene, and self-care training, as appropriate, based on each individual's needs;

 

c)         leisure time and recreation activities;

 

d)         assistance of a medical nature (e.g., medication, assessment, exercise);

 

e)         meals and snacks; and

 

f)         maintenance of a complete record for each individual served through the Adult Day Care Center, including full recording of all required services provided to the customer as listed in subsections (a) through (e), above.

 

Section 686.120  Compliance Review of ADC Providers

 

a)         DHS-DRS shall complete a review of each ADC Provider, at least every two years, to ensure compliance with the criteria set forth in this Subpart.

 

b)         The review shall consist of an on-site review conducted by HSP staff using the Adult Day Care Review form (IL 488-2129).  Written notification shall be provided to the ADC Provider prior to the review.

 

c)         Within 15 days after the completion of the review, a copy of the completed IL 488-2129, along with a letter stating the results of the review, shall be mailed to the ADC.

 

1)         If the ADC Provider is approved, included with the letter shall be an ADC Provider Rate Agreement for execution by the appropriate provider staff and return to DHS-DRS.

 

2)         If the ADC Provider is not approved, the letter shall contain specific information regarding:

 

A)        deficiencies found as a result of the review;

 

B)        the action necessary for the ADC Provider to come into compliance;

 

C)        the time frames within which the ADC Provider must come into compliance; and

 

D)        the information necessary for the ADC Provider to request re-evaluation after the compliance issues are addressed.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.130  Appeal of Compliance Review for ADC Providers

 

a)         ADC Providers determined not to be in compliance with DHS-DRS requirements as a result of the review may appeal the decision to the Bureau Chief of the Bureau of Home Services Program.  The Bureau Chief shall conduct a review of the facts related to the rating and shall, within 15 working days, provide a written decision to the ADC Provider.

 

b)         If the ADC Provider is not satisfied with the decision of the Bureau Chief, the ADC Provider may request review of the Chief's decision by the DHS-DRS Director.  The request must be in writing from the ADC provider and received by the DHS-DRS Director within 10 working days after the date the decision was rendered by the Bureau Chief.  The decision of the DHS-DRS Director shall be final.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.140  Payment for ADC Services

 

a)         DHS shall pay no more than the rate approved by DoA for Adult Day Care Services.  The rate established by DoA shall include meals, snacks, and, in some instances, transportation provided by the ADC Center.

 

b)         Adult Day Care Providers shall submit monthly billings for approved services provided the previous month and progress reports for each customer served by the provider for the month being billed.  Billings may be submitted less frequently at the discretion of the Adult Day Care Provider.

SUBPART C: HOMEMAKER SERVICES

 

Section 686.200  Homemaker Service Provider Requirements

 

In order to provide Homemaker Services under HSP (see 89 Ill. Adm. Code 676.40), a Homemaker Service Provider must be in compliance with all Medicaid provider requirements for the Illinois Department of Healthcare and Family Services (HFS) and DHS.

 

a)         Only Homemaker Service Providers with an approved Homemaker Agreement may be used to provide Homemaker Services to individuals being served through HSP.

 

b)         In order to be approved by HSP, the Homemaker Service Provider must comply with the following, to the satisfaction of HSP:

 

1)         provide a comprehensive array of services that include, but are not limited to, those services described in Section 686.210;

 

2)         assure HSP that all referrals will be responded to within 48 hours after receipt from HSP;

 

3)         have written billing procedures and provide a copy to HSP as part of the compliance review;

 

4)         have documented procedures to cover unexpected absences and emergencies to ensure services will be provided in an adequate and safe manner to all individuals served by the Homemaker Service Provider;

 

5)         have written procedures to respond to customer and counselor complaints regarding services;

 

6)         maintain comprehensive written job descriptions for, at a minimum, the positions of Executive Director or Administrator, supervisory staff, and Homemakers;

 

7)         have established a local presence to ensure regular and on-going contact with HSP and other appropriate community groups;

 

8)         have procedures for regular and on-going recruitment of Homemakers through local resources;

 

9)         be incorporated or provide HSP with a copy of a written statement of purpose and function;

 

10)         maintain adequate records for planning, budgeting, administration and program evaluation and planning. These records shall be available at all times to HSP and the United States Department of Health and Human Services (HHS), or any entity designated by HSP or HHS, and shall be maintained for a period of at least 5 years, or until advised that all State and federal audits are completed.  These records must include, but not be limited to:

 

A)        records of all referrals, including the disposition of each referral;

 

B)        customer records, which include:

 

i)          dates and times services were provided to each individual;

 

ii)         dates and times of supervisor-Homemaker weekly conferences;

 

iii)        semi-annual reports of supervisory visits with each customer served;

 

iv)        monthly service reports for each customer served that document a summary of services, actual or anticipated changes in the customer's condition, recommended changes in the current HSP Service Plan, and all customer contacts;

 

v)         records of all staffings held pertaining to the customer;

 

vi)        records of all financial transactions between the customer and any Homemaker Service Provider employee;

 

C)        administrative records, which include:

 

i)          cumulative service statistics pertaining to any agreement with HSP;

 

ii)         billing and payment records that pertain to HSP;

 

D)        personnel records, which include:

 

i)          attendance records;

 

ii)         schedules for all direct service staff;

 

iii)        documentation regarding each individual's qualification for the position held;

 

iv)        wage rate and effective date for each staff member;

 

v)         job performance evaluations for each staff person that include annual evaluations and at least one probationary evaluation completed within the first six months of employment;

 

vi)        orientation and training attendance information for each staff member, which must include the name of each instructor, the date, the time and the title of each training program attended; and

 

vii)       verification of liability insurance in the amounts of at least $15,000 per person bodily injury, $30,000 minimum per occurrence, and $10,000 in property damage, per occurrence, if the employee will or could be expected to transport customers in the course of his/her work;

 

11)         maintain insurance coverage against any and all liability, loss, damage and/or expense from wrongful or negligent acts of the Homemaker Service Provider or any of its employees and provide HSP with written verification of that coverage;

 

12)         maintain written procedures on reporting loss and damage arising from the wrongful or negligent acts of the Homemaker Service Provider or any of its employees;

 

13)         agree to hold harmless DHS and HSP against any and all liability, loss, damage, cost, or expense arising from wrongful or negligent acts of the Homemaker Service Provider or any of its employees;

 

14)         assist HSP in monitoring and evaluating the Homemaker Service Provider's performance under any agreement with HSP;

 

15)         maintain any and all information regarding individuals referred to the Homemaker Service Provider by HSP as confidential and not for public release without the written consent of HSP and the customer;

 

16)         maintain and have available for review by customers and purchasers of services policies governing:

 

A)        the nature and scope of each service provided by the Homemaker Service Provider;

 

B)        a two-way receipt system for any time an employee of the Homemaker Service Provider handles an individual's money, food stamps or other negotiable items or tender;

 

C)        personnel policies governing salary, leave time, hours of work, employee grievance procedures, and attendance at in and out-service trainings; and

 

17)         have in place an Affirmative Action Plan that is approved by its governing body.

 

c)         At a minimum, each Homemaker Service Provider must employ qualified staff in the positions of:

 

1)         Executive Director or Administrator for each local unit providing services, who is responsible for the administration of the Homemaker Services program and who, at a minimum, has or is making continued progress towards:

 

A)        a Bachelor's degree in health, human services, or a related field;

 

B)        licensure as a Registered Nurse pursuant to the Nurse Practice Act;

 

C)        certification as a home health care administrator, medical clinic administrator, or other health services administrator; or

 

D)        one year of related job experience in social services or in a health agency to replace each year of education required in subsections  (c)(1)(A) through (C), provided that at least one year of experience was in a program that provides services to individuals with disabilities.

 

2)         For the purposes of subsections (c)(1)(A) through (C) "continued progress" shall mean current registration and evidence of successful completion of course work in an accredited junior college, college, or university for a minimum of 2 semesters or 3 quarters of each academic year.  Successful completion shall mean a grade of at least "C" in undergraduate course work or a grade of "B" in graduate course work;

 

3)         Supervisors, in a ratio of no less than the equivalent of one full-time supervisor to the equivalent of every 20 full-time Homemakers, who are responsible for the supervision of Homemaker staff and who, at a minimum, have:

 

A)        a Bachelor's degree with course work in social science, home economics, or nursing;

 

B)        knowledge and skill equivalent to completion of a Bachelor's degree, as described in subsection (c)(1)(A); or

 

C)        a high school diploma or its equivalent plus health service experience including at least 2 years supervisory experience;

 

4)         Homemakers who have:

 

A)        been determined to be in good health;

 

B)        knowledge and skill equivalent to a high school diploma;

 

C)        experience as a homemaker, either in his or her own home or through employment; and

 

D)        knowledge of:

 

i)          nursing care;

 

ii)         first aid;

 

iii)        personal and environmental hygiene;

 

iv)        household budgeting;

 

v)         housekeeping;

 

vi)        nutrition;

 

vii)       food preparation; and

 

viii)      clothing care.

 

d)         Each supervisor and Homemaker must, at a minimum, participate in the following training programs:

 

1)         Orientation, which shall include:

 

A)        the philosophy and purpose of Homemaker Services; and

 

B)        the functions of Homemaker Services;

 

2)         In-service training, directed at increasing the Homemaker Service Provider's knowledge and skills, of not less than 12 hours each year in areas including:

 

A)        disability awareness; and

 

B)        Acquired Immunodeficiency Syndrome (AIDS).

 

e)         The Homemaker Service Provider shall have a written policy and procedures governing a self-evaluation process to evaluate services and case management with an outcome of written recommendations to the governing body of the Homemaker Service Provider to improve the services provided.

 

f)         The Homemaker Service Provider shall abide by provisions of the following federal and State laws and regulations regarding employment practices and compliance:

 

            1)         Laws and Regulations

 

                        A)        Title VI of the Civil Rights Act of 1964 (42 USC 2000d);

 

B)        Section 504 of the Rehabilitation Act of 1973 (29 USC 701);

 

C)        the Americans With Disabilities Act (42 USC 12101);

 

D)        the Illinois Human Rights Act [775 ILCS 5];

 

E)        the Health Care Worker Background Check Act [225 ILCS 46]; and

 

F)         the Health Insurance Portability and Accountability Act (42 USC 1320(d) et seq.).

 

2)         Further, the Homemaker Service Provider shall provide HSP with a letter certifying compliance with the provisions of the laws listed in subsection (f)(1) and a copy of the Affirmative Action Plan for the Homemaker Service Provider.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.210  Services That Must Be Provided by Homemaker Service Providers

 

An approved Homemaker Service Provider must provide professionally directed home management and personal care services through trained Homemaker employees to HSP customers when the customer does not have a responsible person or entity to assist him or her, and the customer requires teaching, performance and/or assistance with:

 

a)         household, financial and time management;

 

b)         nutrition, meal planning and food preparation, which includes specially prescribed diets and snacks;

 

c)         personal care and hygiene that is nonmedical in nature;

 

d)         observation and reporting of a customer's behavior and activities to HSP for the purpose of assessment and service planning; and

 

e)         emergency services to meet an unforeseen need in the areas listed in subsections (a) through (d) when required by the customer and preapproved by HSP.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.220  Compliance Review of Homemaker Service Providers

 

HSP shall conduct a compliance review on all Homemaker Service Providers as a condition of determining compliance, or continued compliance, with the criteria established under this Subpart.

 

a)         A Homemaker Service Provider seeking an HSP rate agreement shall undergo a compliance review as a condition of approval by HSP.

 

b)         A Homemaker Service Provider with a current HSP rate agreement shall undergo a compliance review at least every two years as a condition of determining continued compliance under the program.

 

c)         All Homemaker Service Providers with current HSP rate agreements shall be notified in writing by HSP, at least 10 working days prior to the date of the compliance review.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.230  Appeal Rights of Homemaker Service Providers

 

a)         Homemaker Service Providers not satisfied with a DHS program decision or an HSP compliance review, may submit an appeal request in writing to the Bureau Chief of the Home Services Program.  Appeal requests must be filed within 30 days after the program decision or compliance review.  The Bureau Chief shall conduct a review of the facts and shall, within 15 working days, provide a written decision to the Homemaker Service Provider.

 

b)         If the Homemaker Service Provider is not satisfied with the decision of the Bureau Chief, the Homemaker Service Provider may request review of the Bureau Chief's decision by the Director of DHS-DRS.  The request must be in writing and received by the DHS-DRS Director within 10 working days after the date the decision was rendered by the Bureau Chief.  The decision of the DHS-DRS Director shall be final.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.235  Enhanced Rate for Health Insurance Costs

 

An enhanced rate shall be paid to Homemaker Service Providers that offer health insurance coverage as a benefit to their Homemaker employees who provide services to customers under HSP.

 

a)         For purposes of this Section, "health insurance" means a Type 1 plan or a Type 2 plan as described in subsections (a)(1) and (2).

 

1)         Type 1 Plan

A Type 1 plan must comply with, be comparable to, or exceed required mandated benefits, coverages, and co-payment levels for individuals and group insurance policies and individual and group contracts for health maintenance organizations under the Illinois Insurance Code [215 ILCS 5], the Health Maintenance Organization Act [215 ILCS 125], and 50 Ill. Adm. Code 2001.

 

2)         Type 2 Plan

A Type 2 plan is employer-paid health insurance as part of collective bargaining with unionized Homemaker employees through a Taft-Hartley Multi-employer Health and Welfare Plan.  The Labor Management Relations Act of 1947 (29 USC 141 et seq.) describes the requirements and coverage at 29 USC 186(c)(5).

 

b)         Initial Application

 

1)         An interested Homemaker Service Provider must submit an initial application at least 120 days prior to the end of each State fiscal year.  The application may be obtained from and must be submitted to the Home Services Liaison for Health Insurance, Department of Human Services, 100 South Grand Avenue East, P.O. Box 19429, Springfield, Illinois 62794-9429.

 

2)       Homemaker Service Providers that are found by HSP to have deficiencies may not apply for the enhanced rate until deficiencies are corrected to the satisfaction of HSP.

 

c)         Eligibility

Eligibility requirements include:

 

1)         Verification of a current rate agreement as a Homemaker Service Provider under the HSP.

 

2)         A copy of a health insurance plan or a certification of insurance and the effective date of that document, to establish that:

 

A)        the Homemaker Service Provider provides health insurance at its own expense for its Homemaker employees, which may include coverage for those employees' dependents; or

 

B)        the Homemaker Service Provider will provide for health insurance as part of collective bargaining with unionized Homemaker employees, which may include coverage for those employees' dependents through a Taft-Hartley Multi-employer Health and Welfare Plan.

 

3)         Specification of the total number of employees and the total number of Homemaker employees, together with a certification from a responsible party for the Homemaker Service Provider to the effect that:

 

A)        under a Type 1 health insurance plan:

 

i)          health insurance coverage is offered to all Homemaker employees who have worked at least an average of 20 hours per week for three consecutive months under HSP; and

 

ii)         at least one quarter of the total number of Homemaker employees accept the offer of health insurance.

 

B)        under a Type 2 health insurance plan:

 

i)          health insurance coverage is offered to all of the Homemaker employees subject to the collective bargaining agreement who have worked at least an average of 20 hours per week for three consecutive months under HSP; and

 

ii)         at least one quarter of the total number of Homemaker employees, or any higher percentage required under federal law, accept the offer of health insurance.

 

4)         Submission of any other relevant information requested by HSP for administrative or audit purposes.

 

d)         Notification

It is the responsibility of a Homemaker Service Provider to notify HSP within 7 days of any change in its eligibility status, including, but not limited to, cancellation or termination of the health insurance plan or purchase of a new plan.  A Homemaker Service Provider is only required to monitor participation by Homemaker employees in order to submit the initial application, the Annual Insurance Review required by subsection (e), and required financial reporting.

 

e)         Annual Insurance Review

 

1)         Once a Homemaker Service Provider is determined eligible by HSP and is paid an enhanced rate for health insurance costs, the Homemaker Service Provider must thereafter substantiate its continued eligibility under subsection (c) by submitting appropriate supporting documentation at the same time as its annual financial report under Section 686.250.

 

2)         As part of the Annual Insurance Review, an independent certified public accounting firm for the Homemaker Service Provider must verify the actual, documented expense for health insurance provided for the period listed as part of the required financial reporting under Section 686.250.

 

3)         HSP reserves the right to require a Homemaker Service Provider to engage an independent certified public accounting firm, approved by HSP, to verify the information and data submitted by the Homemaker Service Provider if HSP is in possession of evidence to suggest the information and data submitted is inaccurate, incomplete or fraudulent.  This audit will be performed at the Homemaker Service Provider's expense.

 

4)         HSP shall notify a Homemaker Service Provider in the event of a determination during the Annual Insurance Review that:

 

A)        the Homemaker Service Provider is no longer eligible for continued payment of the enhanced rate for health insurance costs;

 

B)        the total revenue from the enhanced rate for health insurance costs exceeds the actual, documented expenses for health insurance costs for the reporting period;

 

C)        there was an error in eligibility of a Homemaker Service Provider for the prior reporting period;

 

D)        there was an error in the amount of revenue from the enhanced rate for health insurance costs; or

 

E)        there was an error in the amount of the health insurance costs.

 

5)         A Homemaker Service Provider may appeal an adverse eligibility decision regarding continued payment of the enhanced rate for health insurance costs or a repayment decision in accordance with Section 686.230.  HSP will continue to pay the enhanced rate for health insurance costs until the appeal is resolved.

 

6)         Supporting documentation may be subject to release under the Freedom of Information Act [5 ILCS 140] unless an exemption applies for confidentiality, privacy, or other proprietary business purpose and is marked accordingly on the face of any submission.

 

(Source:  Added at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.240  Payment Information for Homemaker Service Providers

 

a)         Payment information for all Homemaker Service Providers

 

1)         Payment for Homemaker Services shall be at the rate specified in the rate agreement signed by HSP and the approved Homemaker Service Provider.

 

2)         Services shall be paid in accordance with the time recorded by the Homemaker employee pursuant to the Service Plan (see 89 Ill. Adm. Code 676.30) developed for the customer.

 

3)         Homemaker Service Providers shall submit monthly billings for approved services provided the previous month and monthly progress reports for each customer served by the Homemaker Service Provider for the month being billed.

 

4)         Payment for Homemaker Services shall be allowed only for those hours services are being provided to the HSP customer.  No payment shall be claimed for those periods that the Homemaker employee spends traveling, in conferences, etc., or for expenses incurred by the Homemaker employee.

 

5)         By accepting any payment under HSP, a Homemaker Service Provider agrees to repay the State of Illinois if:

 

A)        the total revenue from the monthly billings exceeds the actual, approved documented services under this Section for the reporting period;

 

B)        an error occurred in the calculation of the monthly billing submitted to HSP and the provider was overpaid;

 

C)        the Homemaker Service Provider received payment for services during a time the provider was determined ineligible to provide services under HSP; or

 

D)        the Homemaker Service Provider misspent HSP funds or received funding from HSP while participating in fraudulent activity.

 

b)         Additional Payment Information for Homemaker Service Providers with the Enhanced Rate for Health Insurance Costs

 

1)         If a Homemaker Service Provider is determined eligible for the enhanced rate for health insurance costs, HSP will thereafter calculate the appropriate payment based on the number of units of Homemaker Service accepted as billed for the eligible dates of service.

 

2)         A Homemaker Service Provider that makes a switch between a Type 1 and a Type 2 plan is not entitled to any retroactive payments for a period of time preceding the date on which benefits are actually available under the new plan.

 

3)         No Homemaker Service Provider is entitled to a duplicate payment for the same period of time or for the same units of Homemaker Service accepted as billed per contract.

 

4)         By accepting any payment under HSP, a Homemaker Service Provider agrees to repay the State of Illinois if:

 

A)        the total revenue from the enhanced rate for health insurance costs exceeds the actual, documented expenses for its health insurance costs under this Section for the reporting period;

 

B)        an error in eligibility of a Homemaker Service Provider, or the amount of revenue from the enhanced rate for health insurance costs, or the amount of the health insurance costs is subsequently determined by the Homemaker Service Provider or HSP; or

 

C)        the Homemaker Service Provider misspent HSP funds or received funding from HSP for the enhanced rate for health insurance costs while participating in fraudulent activity.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.250  Financial Reporting of Homemaker Service Providers

 

            a)         Homemaker Service Providers shall be required to:

 

1)         complete and submit a Homemaker Cost Certification report that is based upon actual, documented expenditures.

 

A)        The report must be submitted annually, within 60 days after the end of the reporting period, and may be prepared as a part of the Homemaker Service Provider's annual audit.

 

B)        The report may be based on a calendar year or on the Homemaker Service Provider's fiscal year; however, once it is determined which time period is to be used, written approval from HSP shall be required for a change in that determination.

 

C)        The report must demonstrate that the Homemaker Service Provider has expended a minimum of 77% of the total revenues due from HSP, including the customer incurred expense, for Homemaker costs as enumerated in Section 686.280.  For purposes of this report, the phrase "total revenues due from HSP" does not include any amount received as an enhanced rate under Section 686.235 by a qualifying Homemaker Service Provider.

 

D)        The report shall identify the Homemaker Service Provider's expenditures for Homemaker costs of Program support costs, and administrative costs as enumerated in Section 686.280.

 

2)         complete and submit a Homemaker Cost Certification report to document compliance with any rate-based wage increase for Homemaker employees who provide services under HSP.  The report must be submitted within 60 calendar days after issuance of written notification of the increase by HSP.

 

b)         The accuracy of the reports identified in subsections (a)(1) and (2) must be attested to by an authorized representative of the Homemaker Service Provider.

 

c)         HSP reserves the right to require the Homemaker Service Provider to engage an independent certified public accounting firm, approved by HSP, to verify the information and data submitted by the Homemaker Service Provider if HSP is in possession of evidence to suggest the information and data submitted is inaccurate, incomplete or fraudulent.  This audit will be performed at the Homemaker Service Provider's expense.

 

d)         HSP may take appropriate enforcement action in the following instances:

 

1)         a Homemaker Service Provider did not submit a report;

 

2)         a report is inaccurate, incomplete or fraudulent; or

 

3)         a Homemaker Service Provider did not increase the wages paid to its Homemaker employees in the amount required by a rate increase under HSP.

 

e)         Homemaker Services Providers approved for the enhanced rate for health insurance costs:

 

1)         shall not report the enhanced rate for health insurance costs paid by HSP as part of their revenue for purposes of the required financial reporting under this Section; and

 

2)         shall not report health insurance for Homemaker employees as an incurred cost for purposes of the required financial reporting under this Section, except for an amount in excess of the enhanced rate paid by HSP during a reporting period.

 

f)         Enforcement action towards a Homemaker Service Provider includes, but is not limited to the imposition of a corrective action plan, suspension of referrals from HSP, and/or termination of rate agreements with HSP.

                                                                                   

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.260  Unallowable Expenses for Homemaker Service Providers

 

The following Homemaker Service Provider expenses shall not be considered by HSP:

 

a)         expenses resulting from transactions with related parties or parent organizations that are greater than the going market cost of the transactions to the Homemaker Service Provider;

 

b)         non-straightline depreciation;

 

c)         bad debts;

 

d)         special benefits to owners, including owner and key-man life insurance;

 

e)         compensation to non-working owners and officers;

 

f)         discounts, rebates, allowances and charity grants offered by the Homemaker Service Provider;

 

g)         entertainment expenses;

 

h)         fundraising;

 

i)          legal fees for litigation with governmental agencies;

 

j)          awards, grants and gifts to individuals;

 

k)         fines and penalties;

 

l)          contingency funds; 

 

m)        losses on other grants and contracts; and

 

n)         health coverage costs as described under Section 686.250(e)(2).

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.270  Minimum Homemaker Costs for Homemaker Service Providers

 

a)         As provided under Section 686.250(a)(1)(C), Homemaker Service Providers are required to expend a minimum of 77% of the total revenues due from the HSP, to include the customer incurred expense, for Homemaker costs, as enumerated in Section 686.280, during a reporting year.

 

1)         This percentage is to be adhered to on a statewide basis.

 

2)         The remaining 23% of the total revenues may be spent by the Homemaker Service Providers at their discretion on administrative or Program support costs, also delineated in Section 686.280.

 

b)         Failure of the Homemaker Service Provider to meet the requirements in subsection (a) may result in the following:

 

1)         Within 60 days, the Homemaker Service Provider will be required to submit a corrective action plan that shall include Homemaker Service Provider payments to current Homemakers in an amount that will, in total, bring the Homemaker Service Provider into compliance with the requirements in subsection (a).  After HSP's review and approval of the corrective action plan, the Homemaker Service Provider shall implement and observe it.

 

2)         Failure by the Homemaker Service Provider to submit and/or observe a corrective action plan that is acceptable to HSP shall result in termination after 60 days notice.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

 

Section 686.280  Cost Categories for Homemaker Services

 

Homemaker Service Providers will provide for cost reporting based on the following categories:

 

a)         Homemaker costs (costs paid to or on behalf of Homemakers) that may include:

 

1)         wages, time paid on behalf of the worker (i.e., vacation, sick leave, holiday and personal leave);

 

2)         health coverage for any Homemaker Service Provider that does not qualify for the enhanced rate for health insurance costs from the HSP or the amount of the cost incurred in excess of the enhanced rate paid to the Homemaker Service Provider during a reporting period, life insurance and disability insurance;

 

3)         retirement coverage;

 

4)         Federal Insurance Contributions Act (FICA) (26 USC 21);

 

5)         uniforms;

 

6)         worker's compensation;

 

7)         Federal Unemployment Tax Act (FUTA) (26 USC 23);

 

8)         travel time and travel reimbursement;

 

9)         unemployment insurance; and

 

10)         other costs approved, in advance, as Homemaker costs by HSP.

 

b)         Administrative Costs:

 

1)         personnel:

 

A)        administrator;

 

B)        assistant administrator;

 

C)        accountant/bookkeeper;

 

D)        clerical;

 

E)        other office staff;

 

F)         supervisor of Homemakers;

 

G)        other personnel expenses;

 

2)         consultant:

 

A)        auditors;

 

B)        management consultants;

 

C)        management fees from the parent organization;

 

D)        other related consultant costs;

 

E)        other consultant expenses;

 

3)         non-personnel:

 

A)        office supplies;

 

B)        office equipment (expense or depreciation based upon company policy);

 

C)        telephone/facsimile;

 

D)        conferences, conventions, meeting expenses;

 

E)        subscriptions and reference materials;

 

F)         postage and shipping;

 

G)        advertising;

 

H)        outside printing and art work;

 

I)         membership dues;

 

J)         moving and recruiting;

 

K)        other general operating expenses;

 

L)        profit;

 

4)         occupancy:

 

A)        depreciation;

 

B)        amortization of leasehold improvements;

 

C)        rent;

 

D)        property taxes;

 

E)        interest;

 

F)         other related occupancy costs.

 

c)         Program support costs that include all allowable costs not specifically made a part of Homemaker costs or administrative costs.  These may include:

 

1)         training expenses;

 

2)         malpractice insurance;

 

3)         Homemaker supervisor costs.

 

(Source:  Amended at 38 Ill. Reg. 11519, effective May 15, 2014)

SUBPART D: ELECTRONIC HOME RESPONSE SERVICES

 

Section 686.300  Electronic Home Response Services (EHRS) Provider Requirements

 

In order for a specific EHRS Provider to be approved for use by DHS in obtaining services for individuals served through HSP, the EHRS Provider must:

 

a)         have, and make available on request:

 

1)         articles of incorporation; or

 

2)         if unincorporated, a statement of purpose and function; and

 

3)         a list of the owners and/or the EHRS Provider's owners and/or directors/officers;

 

b)         have written policies, which are available to DHS and all customers, governing:

 

1)         the type and scope of services provided, which include clear and concise distinctions between services, if more than one service is offered;

 

2)         personnel policies, including:

 

A)        salary schedules;

 

B)        work hours;

 

C)        employee attendance and leave;

 

D)        written job descriptions, which include clear and concise duties and qualifications for each position;

 

E)        grievance procedures; and

 

F)         requirements for staff training and in-service;

 

c)         maintain adequate records for planning, budgeting, administration and program evaluation and planning.  These records shall be available at all times to DHS and the United States Department of Health and Human Services (HHS), or any entity designated by DHS or HHS, and shall be maintained for a period of at least 5 years, or until advised that all State and federal audits are completed. These records must include, but not be limited to:

 

1)         records of all referrals, including the disposition of each referral;

 

2)         customer records, which include:

 

A)        dates and times of all signaling and the name of the responder to each signaling;

 

B)        dates and times of all equipment tests;

 

C)        disposition of all emergency signaling;

 

3)         administrative records including:

 

A)        service statistics; and

 

B)        billing and payment records;

 

4)         personnel records, including:

 

A)        schedules and attendance records for staff and volunteers of the EHRS Provider;

 

B)        staff and volunteer training reports;

 

C)        annual performance review of all EHRS Provider staff;

 

d)         accept all referrals made for services by DHS;

 

e)         maintain and implement written procedures for the evaluation of its programs and services, the outcome of which shall be to make recommendations to its governing body for improving its services;

 

f)         have and agree to maintain adequate liability insurance coverage and provide DHS a copy of the Certificate of Insurance;

 

g)         agree to hold harmless DHS against any and all liability, loss, damage, cost, or expense arising from the wrongful or negligent action of the EHRS Provider or any of its agents, which DHS may sustain, incur, or be required to pay;

 

h)         comply with all local, State, and federal laws, regulations, and standards and DHS regulations and standards pertaining to HSP;

 

i)          maintain as confidential any information obtained regarding a customer of DHS and agree not to release this information without the written approval of the DHS Secretary or the customer;

 

j)          certify that the EHRS Provider and any of its agents have not been convicted of bribery or attempting to bribe an officer or employee of the State of Illinois, nor has the EHRS Provider or any of its agents made an admission of guilt of such conduct which is a matter of record;

 

k)         agree to provide all services listed in Section 686.310; and

 

l)          have in place an Affirmative Action Plan approved by its governing body.

 

Section 686.310  Services Which Must Be Provided by EHRS Providers

 

In order to be a DHS approved EHRS Provider, the EHRS Provider must:

 

a)         have trained employees or volunteers that install the EHRS units in the individual's home.  This service may not be sub-contracted;

 

b)         be able to install the EHRS unit in the individual's home within 48 hours upon referral of an individual by DHS to the EHRS provider;

 

c)         assist the individual in arranging several appropriate responders and provide training to those responders;

 

d)         provide 24-hour monitoring;

 

e)         provide instruction to the individual receiving EHRS services on the proper use of the EHRS unit at the time the unit is installed.  The instruction must include:

 

1)         provisions for monthly testing of the unit and its transmission by the individual receiving the EHRS services; and

 

2)         general care of the home unit; and

 

f)         in the event of unit malfunction, the EHRS Provider must repair or replace the unit within 24 hours of receiving the report.

 

Section 686.320  Minimum Specifications for EHRS Equipment

 

a)         All home units, at a minimum, must meet the requirements of this subsection (a).

 

1)         Home units must be able to be activated from:

 

A)        a wireless remote; and

 

B)        from the telephone, using a predetermined number;

 

2)         The wireless remote activator must have:

 

A)        a crystal or Surface Acoustic Wave (SAW) resonator controlled transmitted frequency for long-term reliability;

 

B)        digital encoding capability for at least 10 combinations;

 

C)        a minimum transmission range of 175 feet;

 

D)        an internal battery with a minimum life of 5 years;

 

E)        low battery signal; and

 

F)         certification under 47 CFR 15.

 

3)         The base unit or communicator unit must:

 

A)        be an integrated unit that connects to the individual's telephone via a modular jack which does not interfere with the normal use of the telephone or be an integrated unit that connects to a stable cellular network available to the individual’s primary residence;

 

B)        connect to a standard home electrical outlet, as its power supply, by use of an Underwriter's Laboratory approved plug;

 

C)        be able to seize the telephone line, even when a telephone in the dwelling is connected via a modular jack and is off the hook, and dial the EHRS Center to transmit an emergency signal;

 

D)        the base unit must have an easily identifiable "Ready" light to verify the unit is on-line with the EHRS Center;

 

E)        the base unit must have an easily identifiable "confirmation" light to indicate that, if activated, the EHRS Center has received the call;

 

F)         disconnect and redial, until the call is received at the EHRS Center, if an emergency call does not reach the EHRS Center;

 

G)        have a simple process by which signals may be aborted, in the event an erroneous signal is sent;

 

H)        have a battery, which is continuously charged while the unit is on, that will maintain a charge for at least 12 hours in the event of an electrical power failure;

 

I)         transmit a message to the EHRS Center signifying maintenance of the unit is required in the event of base unit battery failure; and

 

J)         be certified under 47 CFR 15 and 68.

 

b)         All EHRS Center equipment, at a minimum, must:

 

1)         be capable of automatically receiving all signals and displaying and printing all messages sent from home communicators connected to the EHRS system;

 

2)         have an audible and visual alarm for the notification of all incoming signals;

 

3)         display and print the incoming message, date, time, and Customer identification for each incoming signal;

 

4)         have a battery back-up which will automatically take over should there be a power outage, or a single circuit failure.  This battery back-up must supply sufficient power to operate the entire system for a minimum of 8 hours in the event of an outage;

 

5)         have totally separate and independent primary and back-up receivers.  If the primary receiver should fail, the system must automatically transfer to the back-up receiver to ensure no interruption in services;

 

6)         monitor all connected telephone lines and give an audible signal should one of the connected telephone lines be out of service for a period of longer than one minute;

 

7)         be able to identify each individual Customer account;

 

8)         perform self-diagnostic testing and monitoring to indicate the status of fault conditions, which could interfere with receiving signals and monitoring telephone connections such as power loss, telephone line outages, signals received with no messages, nonoperating transmitters, etc.; and

 

9)         be certified under 47 CFR 15 and 68.

 

(Source:  Amended at 46 Ill. Reg. 20865, effective December 19, 2022)

 

Section 686.330  Compliance Review of EHRS Providers

 

a)         DHS-ORS shall conduct a compliance review of any EHRS Provider seeking an approval from DHS-ORS and at least every two years shall conduct a review of all EHRS Providers that have current approval of DHS-ORS for the purpose of determining compliance or continued compliance with the criteria for approval set forth in this Subpart.

 

b)         DHS-ORS shall, when contacted by an EHRS Provider, or when notified by staff of the need to access the services of a specific EHRS Provider, conduct the review within a period of 60 calendar days.

 

c)         DHS-ORS shall notify all currently approved EHRS Providers, in writing, at least 10 working days prior to the date of the review to determine continued compliance.

 

(Source:  Amended at 24 Ill. Reg. 7501, effective May 6, 2000)

 

Section 686.340  Appeal of Compliance Review for EHRS Providers

 

a)         EHRS Providers determined not to be in compliance with DHS-ORS requirements as a result of the review may appeal the decision to the Chief of the Bureau of Home Services.  The Bureau Chief shall conduct a review of the facts related to the rating and shall, within 15 working days, provide a written decision to the EHRS Provider.

 

b)         If the EHRS Provider is not satisfied with the decision of the Bureau Chief, the EHRS provider may request review of the Bureau Chief's decision by DHS-ORS Associate Director.  The request must be in writing and received by DHS-ORS Associate Director within 10 working days after the date the decision was rendered by the Bureau Chief.  The decision of DHS-ORS Associate Director shall be final.

 

(Source:  Amended at 24 Ill. Reg. 7501, effective May 6, 2000)

 

Section 686.350  Rate of Payment for EHRS Services

 

a)         Installation

            DHS-ORS shall pay up to the rate negotiated as a one time installation fee for the installation of the EHRS unit, plus the charge of the local telephone company for telephone service hook up for those customers who do not have local telephone service at the time EHRS services are initiated.

 

b)         Monthly Service Fees

            DHS-ORS shall pay no more than the rate negotiated for EHRS services, including all fees and charges.  DHS-ORS will not pay the cost of the monthly local telephone services required to have EHRS.

 

(Source:  Amended at 24 Ill. Reg. 10212, effective July 1, 2000)

SUBPART E: MAINTENANCE HOME HEALTH SERVICE

 

Section 686.400  Maintenance Home Health Provider Requirements

 

DHS shall use Maintenance Home Health Providers which are approved Medicaid providers or licensed by the Illinois Department of Public Health pursuant to the Home Health Agency Licensing Act [210 ILCS 55].

 

Section 686.410  Rate of Payment for Maintenance Home Health Services

 

DHS shall pay Maintenance Home Health Providers the rate established by the Illinois Department of Public Aid through the Medicaid Program for the same service.

SUBPART F: HOME DELIVERED MEALS

 

Section 686.500  Home Delivered Meals Provider Requirements

 

Any entity providing Home Delivered Meals must be certified by the health department in the county in which the program or facility is located and must meet the approval of the customer and counselor.

 

Section 686.510  Rate of Payment for Home Delivered Meals

 

Providers of Home Delivered Meals may be paid up to the amount that would be paid a PA to prepare meals for the customer.

SUBPART G: ENVIRONMENTAL MODIFICATION

 

Section 686.600  Description

 

Environmental Modification – Services to physically modify the customer's home to accommodate the customer's loss of function in the completion of his/her Activities of Daily Living (ADLs).

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.605  Criteria for the Provision of Environmental Modifications

 

Environmental modifications may be provided to a customer if:

 

a)         the modification will enable the customer to independently perform his/her ADLs,

will result in a decreased need for assistance from another individual in the completion of his/her ADLs, will prevent an anticipated increase in service costs, or will improve the safety of the customer during the completion of his/her ADLs;

 

b)         there are no other resources, public or private, that will provide the modification; and

 

c)         the HSP total cost for purchase of all environmental modifications and assistive equipment purchases, rentals, and repairs (89 Ill. Adm. Code 686.705(d)) does not exceed $25,000 over 5 years.

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.608  Environmental Modification Provider Requirements

 

All Environmental Modification providers must:

 

a)         meet the approval of the customer and counselor;

 

b)         submit a completed 1413 A − Waiver Program Provider Agreement for Participation in the Illinois Medical Assistance Program form;

 

c)         submit a completed W-9 Request for Taxpayer Identification Number and Certificate;

 

d)         carry a minimum of $500,000 in liability insurance, and provide DHS-DRS with a copy of the Certificate of Insurance verifying current coverage;

 

e)         provide proof of appropriate current contractor licenses, as applicable;

 

f)         perform all modifications so that they meet the standards established by the Environmental Barriers Act, the Illinois Accessibility Code [71 ILCS 400] and local zoning ordinances and codes; and

 

g)                  obtain proper building permits as required by local municipalities.

 

(Source:  Renumbered from Section 686.600 to Section 686.608 and amended at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.610  Cost of Environmental Modification (Repealed)

 

 

 

(Source:  Repealed at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.615  Environmental Modification Bidding Procedures and Requirements

 

a)         For environmental modification purchases costing $1,500 or less, bids are not required.

 

b)         For environmental modification purchases costing more than $1,500, 3 bids must be obtained using an Invitation to Bid form (IL 488-0293);

 

1)         If an item is available from fewer than 3 sources, the maximum number of bids possible shall be obtained.

 

2)         The lowest bid received from an eligible provider will be accepted.

 

3)         All exceptions must have supervisory approval.

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.620  Permanency of Environmental Modification

 

For environmental modifications that cannot be detached from the dwelling, the home must be owned or mortgage held by the customer.  If the home is not owned by the customer, the customer, with the assistance of the counselor, must obtain written permission of the homeowner/property owner to make the modifications and to ensure that the homeowner/property owner understands the permanency of the modifications and DHS-DRS' inability to return the building to its previous condition.  A Homeowner/Lessor Agreement form (IL 488-0040) must be completed and signed by the homeowner/lessor, customer/lessee, and the counselor prior to the installation of any environmental modifications.

 

(Source:  Amended at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.630  Reason for Denial of Environmental Modification

 

Environmental modifications shall be denied when:

 

a)         the cost of the modifications does not comply with the provisions of Section 686.605(c);

 

b)         the customer has a poor history as a tenant, or is otherwise not expected to remain in the home to be modified for a period of at least 1 year;

 

c)         the past practices or reputation of the landlord is unfavorable; or

 

d)                  the modifications are for "value added" or cosmetic purposes.

 

(Source:  Amended at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.640  Verification of Environmental Modification

 

Within 30 days of the date of completion of the environmental modifications, the counselor must make a home visit to inspect the modifications and to ensure customer satisfaction with the modifications.  A signed Receipt for Appliances, Merchandise and Supplies form (IL 488-1694) from the customer shall be required to verify receipt and satisfaction with the modifications.

 

(Source:  Amended at 31 Ill. Reg. 14238, effective September 27, 2007)

SUBPART H: ASSISTIVE EQUIPMENT

 

Section 686.700  Description

 

Assistive Equipment − Items necessary to accommodate the customer's loss of function in the completion of his/her Activities of Daily Living (ADLs).  This does not include medical supplies, disposable personal hygiene items, or items necessary for medical treatment.

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.705  Criteria for the Purchase, Rental, or Repair of Assistive Equipment

 

Assistive equipment may be provided to a customer if:

 

a)         the equipment will enable the customer to independently perform his/her ADLs, will result in a decreased need for assistance from another individual in the completion of his/her ADLs, will prevent an anticipated increase in service costs, or will improve the safety of the customer during the completion of his/her ADLs;

 

b)         there is an official communication/documentation in the file of Medicaid denial by the Department of Healthcare and Family Services (HFS) for the requested assistive equipment;

 

c)         there are no other resources, public or private, that will provide the equipment; and

 

d)         the HSP total cost for purchases, rentals, and repairs of all assistive equipment and environmental modifications (89 Ill. Adm. Code 686.605(c)) does not exceed $25,000 over 5 years.

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.708  Purchase, Rental, or Repair of Assistive Equipment

 

A prescription from a physician or licensed therapist is required for all purchases or rentals of medically-oriented assistive equipment.

 

a)         Assistive equipment may be purchased when:

 

1)         the customer is expected to need the equipment for a period to exceed 1 year;

 

2)         the cost of renting the equipment exceeds the purchase price of the equipment; or

 

3)         the equipment is not available for rental.

 

b)         Assistive equipment may be rented when:

 

1)         the customer is not expected to need the equipment for an extended period of time (i.e., less than 1 year); and

 

2)         the rental cost for the equipment for the period the customer is expected to need the equipment is less than the purchase price for the equipment.

 

c)         Assistive equipment may be repaired when:

 

1)         the equipment is already in the possession of the customer;

 

2)         the repair cost is less than the rental or purchase price for the same equipment; and

 

3)         the equipment, when repaired, is expected to have an increased useful life of at least 1 year.

 

d)         If an item is available for purchase, rental, or repair through Medicaid, DHS-DRS will not provide additional funding if an approved provider refuses to accept the Medicaid approved rate.

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.710  Provision of Assistive Equipment (Repealed)

 

(Source:  Repealed at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.715  Assistive Equipment Provider Requirements

 

All assistive equipment providers must:

 

a)         meet the approval of the customer and counselor;

 

b)         submit a completed 1413A − Waiver Program Provider Agreement for Participation in the Illinois Medical Assistance Program form; and

 

c)         submit a completed W-9 Request for Taxpayer Identification Number and Certificate.

 

(Source:  Renumbered from Section 686.700 to Section 686.715 and amended at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.720  Verification of Receipt of Assistive Equipment (Repealed)

 

(Source:  Repealed at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.722  Assistive Equipment Bidding Procedures and Requirements

 

a)         For assistive equipment purchases costing $1,500 or less, bids are not required.

 

b)         For assistive equipment purchases costing more than $1,500, 3 bids must be obtained using an Invitation to Bid form (IL 488-0293);

 

1)         If an item is available from fewer than 3 sources, the maximum number of bids possible shall be obtained.

 

2)         The lowest bid received from an eligible provider will be accepted.

 

3)         All exceptions must have supervisory approval.

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

 

Section 686.730  Verification of Receipt of, and Customer Satisfaction with, Assistive Equipment

 

Assistive equipment that is purchased, rented or repaired requires customer contact for verification of equipment/services provided.  A Receipt for Appliances, Merchandise and Supplies form (IL 488-1694) must be completed and signed by the customer within 60 days after the equipment delivery, installation, or repair.

 

(Source:  Added at 31 Ill. Reg. 14238, effective September 27, 2007)

SUBPART I: RESPITE CARE

 

Section 686.800  Respite Care Provider Requirements

 

Any individual or agency providing respite services to an individual through HSP must meet the standards set forth in the appropriate Subpart for that service as listed in this Part.

SUBPART J: CASE MANAGEMENT SERVICES TO PERSONS WITH AIDS

 

Section 686.900  Program Overview

 

The Department of Human Services Division of Rehabilitation Services (DHS-DRS) shall enter into agreements with agencies to provide case management services to persons diagnosed with AIDS, which includes persons with human immunodeficiency virus (HIV) infection, who are eligible for services provided by the AIDS Medicaid Waiver.  For geographical areas in Illinois in which case management agencies are not located, case management shall be provided by DHS-DRS Home Services counselors, utilizing licensed home health nurses, as needed, to comply with the services offered and the requirements contained in Section 686.910(b), (c), (d), and (e).

 

(Source:  Amended at 47 Ill. Reg. 19328, effective December 13, 2023)

 

Section 686.910  Case Management Provider Responsibilities

 

a)         Case Management

 

1)         The case management agency shall receive Customer referrals from hospitals, the Illinois Department of Public Health's AIDS Hotline, HSP Ashburn Unit, other State and local agencies, and other referral services (e.g., doctors and individuals).  The provider shall assign a case manager to each Customer.

 

2)         There shall be two levels of case managers:  provisional case managers and case managers.

 

A)        Case managers are those who have achieved a competency score of 98% or greater for the on-site case reviews done by the HSP Ashburn Unit under Section 686.930(d).  The case manager shall have full responsibility for the determination of HSP eligibility including assessment and implementation of services to be provided.  The case manager shall develop services with Customer participation that are provided in a manner that reflects the Customer's choices, when applicable, and address the Customer's strengths, needs and desired goals.  Assessments, service plans and reassessments completed by case managers may be implemented without consultation with the HSP Ashburn Unit.

 

B)        The case manager shall act as a liaison with the hospital discharge planner, physician, home health agencies, and other medical provider agencies.

 

C)        Provisional case managers are those who have not achieved a competency score of 98% or greater for the on-site case reviews done by the HSP Ashburn Unit, per Section 686.930(d).  Provisional case managers shall submit all developed plans to the HSP Ashburn Unit for approval.  Approval of the plan will be based on a review to determine that:  the Determination of Need Assessment on which the plan is developed is complete and accurate; the plan meets the needs identified by the assessment; the plan does not place the Customer's health and safety at risk; and the plan is cost effective compared to comparable institutional care.

 

b)         The case manager shall provide the following services:

 

1)         initial assessment of eligibility and information gathering (89 Ill. Adm. Code 682);

 

2)         development of a person-centered service plan and implementation (89 Ill. Adm. Code 684);

 

3)         reassessment of level of care at least every 12 months for those cases in formal eligibility, three months for those cases that have been presumptively determined eligible for interim services (89 Ill. Adm. Code 684.80), or at such time when the Customer's financial or physical condition or need for services changes;

 

4)         networking/coordination/brokering services (i.e., referring and assisting the Customer in obtaining other agencies' services);

 

5)         assisting the Customer when Individual Provider and Agency Provider problems develop. Documentation of these problems and the case management team's responses will be kept in the Customer's case file;

 

6)         counseling and advocacy;

 

7)         acting as inter-agency liaison (e.g., with other DHS programs, Managed Care Organizations (MCOs), vendors, hospitals);

 

8)         making required Customer contact at least once a month, with a face-to-face contact bi-monthly, to ensure the Customer's needs are being met;

 

9)         maintaining and updating Customer records; and

 

10)         monitoring the cost effectiveness of the service plan (89 Ill. Adm. Code 679.50).

 

c)         Eligibility for AIDS Waiver

 

1)         Within 10 working days (exceptions being 2 working days for prescreening referrals from cooperating hospitals for interim/emergency services, 5 working days for all other prescreening for interim/emergency services) after receipt of a referral, the case manager shall complete an individual's eligibility determination for the AIDS Waiver program.

 

2)         The case manager shall determine Customer eligibility for the AIDS Waiver by completing an assessment from a home visit or while the applicant is hospitalized (89 Ill. Adm. Code 682).  To determine Customer eligibility, the case manager will utilize the HSP Determination of Need Assessment (89 Ill. Adm. Code 682).

 

3)         The case manager shall assess the Customer's limitations in activities of daily living (ADLs) (e.g., cooking, bathing, shopping) and what resources are available to assist the Customer in performing the ADLs (89 Ill. Adm. Code 682).

 

4)         Notice of eligibility must be mailed to the HSP Ashburn Unit within ten working days after the date on which a completed application is received by the case management agency.

 

d)         The case manager will provide a case action notice to each Customer informing the Customer of the eligibility determination, of all rights and responsibilities under the case management program, including the Customer's right to request an appeal, the appeals procedures promulgated by the Department, the right to receive assistance in filing the request for appeal and information about the services of the Home Care Ombudsman Program (HCOP) and how to reach HCOP.

 

e)         Service Plan

 

1)         If the DON assessment demonstrates a nursing facility level of care need such as the need for intermediate care facility (ICF), skilled nursing facility (SNF), or hospital care because of the disability of AIDS/HIV, the case manager shall develop a person-centered service plan that will allow the Customer to live at home.

 

2)         The service plan will be retained during the time the case is opened and for five years after closure, unless an audit exception has occurred.  In the case of an audit exception, the service plan will be retained until the audit exception has been resolved.  Copies of the service plan will be maintained in the case management team's locations and the HSP Ashburn Unit.  Closed cases will be retained in the HSP Ashburn Unit for two years then archived pursuant to the DHS records retention policy.

 

3)         If implementation of services is delayed beyond required time limits in subsection (c), the case manager must inform the HSP Ashburn Unit and assist the Customer to obtain an alternative provider.

 

f)         Records of contact with the Customer will be entered and maintained in the Customer's confidential case records.  All contacts, verbal or written, with or on behalf of a Customer shall be documented in a confidential case record.  The case manager is responsible for obtaining consents for the release of information as necessary and when required by law or regulation (Confidentiality of Records (42 U.S.C. 290dd-2); Health Insurance Portability and Accountability Act (42 U.S.C. 1320(d) et seq.); AIDS Confidentiality Act [410 ILCS 305]; 89 Ill. Adm. Code 505 (Confidentiality of Information).

 

(Source:  Amended at 47 Ill. Reg. 19328, effective December 13, 2023)

 

Section 686.920  Provider Staffing Requirements, Qualifications, and Training

 

a)         Each case management agency shall designate an individual who will be responsible for the administration of the case management program.  The designated individual shall have or be actively enrolled in a program to obtain:

 

1)         a bachelor's degree in health, human services, or a related field;

 

2)         licensure as a registered nurse pursuant to the Nurse Practice Act [225 ILCS 65]; or

 

3)         at least one year of experience as a home health care administrator, medical clinic administrator, or other health services administrator.

 

b)         The qualifications for case managers shall be as follows:

 

1)         A registered nurse, with a current license and a bachelor's degree in nursing, social work, social sciences, or counseling or one year of case management experience; or

 

2)         A social worker with a bachelor's degree in either social work, social sciences, or counseling.  A Bachelor of Social Work or a Master of Social Work degree from a school accredited by any organization nationally recognized for the accreditation of schools of social work is preferred; or

 

3)         An individual with a Bachelor's Degree in a human services field (including, but not limited to, sociology, special education, or rehabilitation counseling) and with a minimum of one year of case management experience.

 

c)         In addition, it is mandatory that the case manager has:

 

1)         a broad knowledge of community resources and networking, case management, and home care; and

 

2)         experience in working with racial and ethnic minorities, as well as one or more of the following:

 

A)        domestic abuse;

 

B)        the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community;

 

C)        persons living with HIV/AIDS; or

 

D)        persons with substance use disorders.

 

d)         Each full-time case manager shall have no more than 30 fee-for-service customers and 70 Managed Care Organization (MCO) customers, or an appropriately weighted combination of fee-for-service customers and MCO customers that shall not exceed 100 total customers.  For half-time case managers, the full-time requirements may be met proportionately (e.g., 15 fee-for-service customers and 35 MCO customers and shall not exceed 50 total customers).

 

e)         Annually, each case manager shall undergo a minimum of 12 hours of in-service training that shall be:

 

1)         furnished by the case management agency; and

 

2)         relevant to the provision of services to persons with HIV/AIDS (e.g., infectious disease control procedures, sensitivity training, and updates on information relating to treatment procedures).

 

(Source:  Amended at 47 Ill. Reg. 19328, effective December 13, 2023)

 

Section 686.930  Monitoring and Liability of Provider

 

a)         The HSP Ashburn Unit shall monitor the case management agency to assure compliance with this Subpart by:

 

1)         reviewing and approving the assessment (Section 686.910(c)).  The review will be conducted pursuant to the DHS' Home Services Program (89 Ill. Adm. Code 682), the service plan, and payments for services;

 

2)         reviewing provisional case managers as set forth in subsection (d);

 

3)         reviewing, on an annual basis, a random sample 10% of the cases handled in the preceding 12 months or two cases, whichever is greater;

 

4)         visiting, at least annually, all contracting case management agencies.

 

b)         The HSP Ashburn Unit shall monitor the service plans of customers served by a case manager to ensure that:

 

1)         The case manager is monitoring the customer's case at least monthly by carrying out at least one face-to-face visit and two other contacts with the customer;

 

2)         The case manager is reassessing the service plan at least every 12 months for those cases in formal eligibility and every three months for those cases which have been presumptively determined eligible;

 

3)         Each of the reassessments undertaken by the case manager is complete and accurate;

 

4)         Any amendments to the service plan are consistent with the findings of the reassessment; and

 

5)         The service plan remains cost effective (i.e., the cost of the service plan is equal to or less than the long term care costs).

 

c)         DHS-DRS, Central Office quality assurance staff shall:

 

1)         monitor the quality of the reviews conducted annually;

 

2)         provide case reviews of selected cases Statewide; and

 

3)         tabulate the findings from all reviews to determine accuracy levels, Statewide need for training and individual training needs.

 

d)         All provisional case managers and case management supervisors will work toward meeting the case manager standards within six months after receiving the HSP Ashburn Unit's Case Management Training.  Case managers and case management supervisors with a gap in service of greater than one year must complete the certification process.  Complete case manager status will be granted when six case file reviews attain a competency score of 98-100% using the review process described in this subsection (d).

 

1)         The HSP Ashburn Unit will review at least six case files within six months after the date of the provisional case manager's completion of the Case Management Training for the case manager.  A combination of the following case types and amounts may be used to satisfy the requirement:

 

A)        six fee-for-service initial assessments;

 

B)        three fee-for-service initial assessments and three fee-for service reassessments; or

 

C)        two fee-for-service initial assessments, two fee-for-service reassessments, and four Managed Care Organization (MCO) assessments of any type.

 

2)         The HSP Ashburn Unit will review each case file using the HSP Ashburn Unit case file review quality assurance form.

 

3)         The HSP Ashburn Unit will discuss areas of deficiency with the case manager.

 

4)         The HSP Ashburn Unit will work with the case manager to resolve all deficiencies in the case files.

 

5)         The case manager will correct and complete all deficient areas prior to the next review of case files.

 

6)         The HSP Ashburn Unit will re-review all deficient files for compliance with case management practices.

 

7)         The above process will continue, within the six-month review period, until the cases reviewed for the case manager meet a 98-100% compliance score.

 

e)         Return to Provisional Status

 

1)         A case manager shall return to provisional status when any of the following events occur:

 

A)        A review of files, per this Section, results in a score of 89% or less; or

 

B)        Within the last year, the HSP Ashburn Unit has made five requests for materials that were not submitted on time or for assessments not completed timely; or

 

C)        Sufficient documentation is not available to demonstrate that the case manager has successfully completed case management training.

 

2)         Prior to the initiation of action to return a case manager to provisional status, the case management agency of the case manager will be sent a letter outlining the issues.  The case management agency will have 10 days to respond.  The case manager will return to provisional status unless the case management agency can prove the event causing the action did not occur.  Once a case manager is returned to provisional status, the case manager must complete the measures outlined in subsection (d).

 

f)         Liability

 

1)         DHS shall assume no liability for actions of the case management agency.

 

2)         The case management agency shall agree to hold DHS harmless against any and all liability, loss, damage, cost or expenses arising from wrongful or negligent acts of the provider.

 

3)         The case management agency shall certify that it has maintained and will maintain liability insurance coverage.  Upon request, the provider shall make available policies, certificates of insurance or current letters documenting all insurance coverage.

 

4)         The case management agency shall remain liable for the performance of any person, organization, unincorporated association or corporation with which it contracts.

 

(Source:  Amended at 47 Ill. Reg. 19328, effective December 13, 2023)

 

Section 686.940  Provider Compliance Requirements

 

In order to participate in the DHS-DRS program to provide services to persons with HIV/AIDS, the provider agrees to meet the following minimum requirements that shall be reviewed by DHS annually for compliance.

 

a)         Organization and Administration:  The provider shall make available, upon request, its articles of incorporation, or if an unincorporated association (e.g., partnerships and limited partnerships) shall provide a statement of purpose and functions, and the names and addresses of its owners, partners, or general partners.

 

b)         Audits:  DHS reserves the right to audit all records and accounts pertinent to the provision of services and billing at any time within five years after the provider stopped providing services under the HIV/AIDS waiver.

 

c)         Policies and Procedures:  The provider shall have written policies approved by its governing authority (e.g., Board of Directors) and available for review by customers and purchasers of the service.  Such policies shall at a minimum cover:

 

1)         Service Provided:  Policy shall designate the type and scope of service provided.  When more than one type of service is offered, there shall be a clear distinction between each type provided.

 

2)         Personnel Policies:  Policies shall cover salary schedules, hours of work, sick leave, provision for handling employee grievances, and requirements for attendance at work conferences and training sessions.  There shall be written job descriptions identifying required qualifications and duties for each title. Policies shall also include the Centers for Disease Control and Prevention (CDC) recommendations for health care workers for provision of services to persons with HIV/AIDS and any requirements within the Illinois Compiled Statutes regarding HIV/AIDS, including the AIDS Confidentiality Act [410 ILCS 305].

 

d)         State and Federal Statutes

 

1)         All providers shall be subject to compliance with Illinois Compiled Statutes governing conflict of interest [30 ILCS 500/50-13].

 

2)         All providers shall agree to comply with the Civil Rights Restoration Act of 1987 P.L. 100-259), Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), the Illinois Human Rights Act [775 ILCS 5], the Constitution of the United States, the 1970 Constitution of the State of Illinois and any laws, regulations or orders, State or federal, that prohibit discrimination on the basis of, including but not limited to, race, color, sex (including sexual harassment), religion, national origin, ancestry, age (40 and over), order of protection status; marital status, sexual orientation (including gender-related identity), physical or mental disability, or unfavorable discharge from military service, pregnancy, citizenship status, employment discrimination based on arrest record, and discrimination in real estate transactions based on familial status or arrest record.

 

e)         Non-compliance:  If the provider is not in compliance with the requirements of this Subpart, corrective actions up to and including termination of the provider as an approved provider shall be taken.

 

(Source:  Amended at 47 Ill. Reg. 19328, effective December 13, 2023)

SUBPART K: CASE MANAGEMENT SERVICES TO PERSONS WITH BRAIN INJURIES

 

Section 686.1000  Program Overview

 

The Department of Human Services (DHS) shall enter into agreements with community-based organizations to provide case management to persons diagnosed with brain injuries who are eligible for services provided by the Medicaid Waiver for Persons with a Brain Injury.  For geographic areas in Illinois in which case management agencies are not located, case management shall be provided by DHS Home Services counselors.

 

(Source:  Added at 23 Ill. Reg. 6457, effective May 17, 1999)

 

Section 686.1010  Case Management Provider Responsibilities

 

a)         Case Managers

 

1)         The Case Manager shall receive referrals from hospitals, other health providers, and other State and local agencies.

 

2)         The Case Manager shall have responsibility for the implementation of services to be provided.  The services, developed by the HSP Counselor with Customer participation, shall be provided in a manner that reflects the Customer's choice, when applicable, and shall address his/her strengths, needs and desired goals.

 

b)         The Case Manager shall provide the following services:

 

1)         networking/coordination/brokering services (i.e., referring and assisting the Customer in obtaining other agencies' services);

 

2)         counseling and advocacy;

 

3)         contacting the Customer a minimum of one time per month;

 

4)         maintaining and updating Customer records; and

 

5)         monitoring the cost effectiveness of the service plan (89 Ill. Adm. Code 679.50).

 

c)         Service Plan

 

1)         The person-centered service plan will be retained during the time the case is opened and for five years after closure, unless an audit exception has occurred. In the case of an audit exception, the service plan will be retained until the audit exception has been resolved.  Copies of the service plan will be maintained in the Case Manager's location and the HSP office.  Closed cases will be retained in the HSP Central Office.

 

2)         If implementation of services is delayed beyond required time limits in subsection (c), the Case Manager must inform the HSP administration and assist the Customer in obtaining another provider.

 

d)         Records of contact with Customer will be entered and maintained by the Case Manager in the Customer's confidential case record.  All contacts, oral or written, with or on behalf of a Customer shall be documented in a confidential case record.  The Case Manager is responsible for obtaining consents for the release of information as necessary and when required by regulation (89 Ill. Adm. Code 505) and the Health Insurance Portability and Accountability Act (42 USC 1320(d) et seq.).

 

(Source:  Amended at 43 Ill. Reg. 2133, effective January 24, 2019)

 

Section 686.1020  Case Manager Staffing Requirements, Qualifications and Training

 

a)         Every agency providing case management services shall designate an individual who has overall responsibility for the administration of case management services.

 

b)         A Case Manager shall meet one of the following qualifications:

 

1)         a Registered Nurse, licensed pursuant to the Illinois Nursing Act of 1987 [225 ILCS 65];

 

2)         a Certified or Licensed Social Worker, certified or licensed pursuant to the Illinois Clinical Social Work and Social Work Practice Act [225 ILCS 20];

 

3)         a Social Worker with a minimum of a Bachelor's degree in social work, social sciences or counseling. A Bachelor's of Social Work or a Master's of Social Work from a school accredited by any organization nationally recognized for the accreditation of schools of social work is preferred;

 

4)         a Vocational Specialist holding a certification in Rehabilitation Counseling or a minimum of 3 years working with people with disabilities;

 

5)         Licensed Clinical Professional Counselor (LCPC), licensed pursuant to the Professional Counselor and Clinical Professional Counselor Licensing Act of 1998 [225 ILCS 107];

 

6)         Licensed Professional Counselor (LPC), licensed pursuant to the Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107];

 

7)         Certified Case Manager (CCM) with certification in case management from an appropriate certifying organization.

 

c)         Each Case Manager shall have no more than 30 customers. Incremental increases may be considered when the Case Manager demonstrates the capacity to competently provide case management services for Brain Injury Waiver cases. Subsequent to this determination, cases may be increased in increments of up to 15 cases.  This capacity will be determined when the Case Manager maintains a competence rate of at least 98% for a period of at least three months at a full caseload size of 30 customers, using the process outlined in 89 ILL. ADM. CODE CH. I SECTION 686.1025(b).

 

d)         Annually, each Case Manager shall receive at least 12 hours of in-service training.  The training must be relevant to the provision of services to persons with brain injuries.

 

(Source:  Amended at 25 Ill. Reg. 6282, effective May 15, 2001)

 

Section 686.1025  Provisional Case Manager

 

a)         There shall be two levels of case management staff: Provisional Case Manager and  Case Manager.  A Provisional Case Manager is one who has not achieved a competency score of 98% or greater on the  case reviews done by the Home Services Program (HSP) administrative staff per Section 686.1030(d). Assessments, service plans and reassessments completed by a Case Manager may be implemented without consultation with the HSP administrative staff.  Provisional Case Managers shall submit all developed plans to HSP for approval. Approval of the plan will be based on a review to determine that: the DON assessment on which the plan is developed is complete and accurate; the plan meets the needs identified by the assessment; and the plan is cost effective compared with comparable institutional care.

 

b)         All Provisional Case Managers will work toward meeting Case Manager standards within six months after receiving the HSP Case Manager Training.  Case Manager status will be granted when six case file reviews attain a competency score of 98-100% using the review process described in this subsection (b).

 

1)         The HSP administrative staff will review three case files within three months from the end date of the Case Manager Training.  The Case Manager will be present and have the Case Manager Training Manual.

 

2)         The HSP staff will review each case using the HSP case file review quality assurance form.

 

3)         Using the Case Manager Training Manual, HSP staff will discuss each deficiency with the Case Manager.

 

4)         A corrective action plan will be developed by HSP staff for the Case Manager to resolve all deficiencies in the case file.

 

5)         The Case Manager will implement the corrective action plan and complete all items prior to the next review of the case files.

 

6)         HSP staff will review all files noted in the corrective action plan for compliance with case management practices.

 

7)         The above process will continue until the cases reviewed for the Case Manager meet a 98-100% compliance score on six case file reviews.

 

c)         Return to Provisional Status

 

1)         A Case Manager shall return to provisional status when any of the following events occur:

 

A)        A review of files, per this Section, results in a score of 89% or less; or

 

B)        Within the last year, HSP staff have made five requests for materials that were not submitted on time.

 

2)         Prior to the initiation of action to return a Case Manager to provisional status, the Case Manager will be sent a letter outlining deficiencies and shortcomings. The Case Manager will have 10 days to respond.  The Case Manager will be returned to provisional status unless the Case Manager can prove the Department is incorrect.

 

(Source:  Amended at 38 Ill. Reg. 16978, effective July 25, 2014)

 

Section 686.1030  Monitoring and Liability

 

a)         The HSP staff shall monitor the Case Manager to assure compliance with this Subpart by:

 

1)         reviewing Provisional Case Managers as set forth in subsection (d);

 

2)         reviewing, on an annual basis, a random sample of 10% of the cases handled in the preceding 12 months or two cases, whichever is greater; and

 

3)         visiting, at least annually, all contracting case management agencies.

 

b)         The HSP supervisory staff shall monitor the service plans of customers served by a Case Manager to ensure that:

 

1)         The Case Manager is monitoring the customer's case by carrying out at least one contact monthly;

 

2)         The Case Manager is reassessing the service plan at least every six months;

 

3)         Each of the reassessments undertaken by the Case Manager is complete and accurate;

 

4)         Any amendments to the service plan are consistent with the findings of the reassessment; and

 

5)         The service plan remains cost effective (i.e., the cost of the service plan is equal to or less than the State's costs for nursing facility care).

 

c)         Liability

 

1)         DHS is not liable for actions of the Case Manager and the Case Manager must agree to hold DHS harmless against any and all liability, loss, damage, costs or expenses arising from wrongful or negligent acts of the Case Manager.

 

2)         The Case Management provider shall certify that it has maintained and will maintain liability insurance coverage.  Upon request, the Case Management provider shall make available policies, certificates of insurance or current letters documenting all insurance coverage.

 

3)         The Case Management agency shall remain liable for the performance of any person, organization, unincorporated association or corporation with which it contracts.

 

(Source:  Amended at 38 Ill. Reg. 16978, effective July 25, 2014)

 

Section 686.1040  Provider Compliance Requirements

 

In order to participate in the DHS program for providing services to persons with brain injuries, the provider of case management services agrees to meet the following minimum requirements, which shall be reviewed by DHS annually for compliance.

 

a)         Organization and Administration: The agency providing case management services shall make available, upon request, its articles of incorporation, or if  an unincorporated association, it shall provide a statement of purpose and functions and the names and addresses of its owners, partners or general partners.

 

b)         Audits: DHS reserves the right to audit all records and accounts pertinent to the Agreement at anytime within five years after the final completion date of the Agreement.

 

c)         Policies and Procedures: The provider of case management services shall have written policies approved by its governing authority and available for review by customers and purchasers of the service.  Such policies shall at a minimum cover:

 

1)         Services Provided: the type and scope of services provided. When more than one type of service is offered, there shall be a clear distinction between each type of service.

 

2)         Personnel Policies: salary schedules, hours of work, sick leave, provision for handling employee grievances and requirements for attendance at work conferences and training sessions. There shall be written job descriptions identifying required qualifications and duties for each title.

 

d)         State and Federal Statutes

 

1)         All providers of case management services are subject to compliance with Illinois statutes governing conflict of interest (Sections 50-13 and 50-20 of the Illinois Procurement Code [30 ILCS 500/50-13 and 50-20]).

 

2)         All providers shall agree to comply with Title VI of the Civil Rights Act of 1964 (42 USC 2000d), Section 504 of the Rehabilitation Act of 1973, as amended (29 USC 794), the Illinois Human Rights Act [775 ILCS 5/1-101], the Constitution of the United States, the 1970 Constitution of the State of Illinois and any laws, regulations or orders, State or Federal, that prohibit discrimination on the basis of race, color, sex, religion, national origin, ancestry, age, marital status, inability to speak or comprehend the English language, physical or mental disabilities, or unfavorable discharge from military service.

 

e)         Non-compliance: If the provider of case management services is not in compliance with the requirements of this Subpart, corrective actions up to and including termination of the contract shall be taken.

 

(Source:  Added at 23 Ill. Reg. 6457, effective May 17, 1999)

SUBPART L: BEHAVIORAL SERVICES FOR PERSONS WITH BRAIN INJURIES

 

Section 686.1100  Behavioral Services Provider Requirements

 

HSP shall use Behavioral Service Providers that are licensed under the Illinois Clinical Psychologist Licensing Act [225 ILCS 15], the Illinois Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107], or the Illinois Clinical Social Work and Social Work Practice Act [225 ILCS 20].

 

(Source:  Added at 23 Ill. Reg. 6457, effective May 17, 1999)

 

Section 686.1110  Rate of Payment for Behavioral Services

 

HSP shall pay Behavioral Service Providers at rates established per 89 Ill. Adm. Code 545, "Ratemaking".

 

(Source:  Added at 23 Ill. Reg. 6457, effective May 17, 1999)

SUBPART M: DAY HABILITATION SERVICES FOR PERSONS WITH BRAIN INJURIES