Section 676.10  Program Purpose and Types

 

a)         The Department of Human Services' (DHS) Home Services Program (HSP) is a Medicaid Waiver Program (42 CFR 440.180) designed to prevent the unnecessary institutionalization of individuals who may instead be satisfactorily maintained at home at a lesser cost to the State.

 

b)         The Medicaid Waiver for the State of Illinois is administered by the Illinois Department of Public Aid (DPA), as the State's approved Medicaid agency.  The operational responsibility for HSP, with the exception of hearings on customer appeals (see 89 Ill. Adm. Code 510), rests with DHS.

 

c)         Although DHS shall be responsible for ensuring that the funds available under the HSP are administered in accordance with all applicable laws, DHS shall not have control or input in the employment relationship between the customer and the personal assistants.

 

(Source:  Amended at 23 Ill. Reg. 6445, effective May 17, 1999)

 

Section 676.20  General Program Accessibility

 

a)         All communications given or sent to a customer shall be in a language, medium, and at a level which the customer can understand.

 

b)         At any time a non-English print version of any form or document, including the Service Plan, is used to meet the customer's needs and is placed in the case file, an English print copy must also be completed by the counselor or Case Manager and placed with the non-English print version in the case file.

 

c)         All locations in which customer meetings are held must be accessible for the customer and afford the maximum confidentiality for the customer.

 

(Source:  Amended at 23 Ill. Reg. 6445, effective May 17, 1999)

 

Section 676.30  Definitions

 

For the purposes of this Subchapter, unless otherwise stated, the following terms shall have the following meanings.

 

Activities of Daily Living or ADLs − those tasks an individual must do, or that an individual must have provided for them, in order to prevent institutionalization (i.e., bathing, dressing, shopping, cooking, housekeeping, etc.).

 

Brain Injury – conditions including traumatic brain injury, infection (encephalitis, meningitis), anoxia, stroke, aneurysm, electrical injury, malignant neoplasm, and toxic encephalopathy.  Congenital disabilities such as cerebral palsy or epilepsy are not eligible diagnoses, nor are degenerative or neurological disorders due to aging, such as dementia or Parkinson's or Alzheimer's Disease.

 

Brain Injury Habilitation Assessment – assessment that incorporates the results of neuropsychological, occupational therapy, and/or other appropriate clinical evaluations; this assessment reviews a brain injury Customer's ability to independently and safely complete activities for daily living.  This does not replace or duplicate the current HSP eligibility assessment tool (DON).

 

CMMS – the federal Centers for Medicare & Medicaid Services (formerly HCFA, the federal Health Care Financing Administration).

 

Customer

 

A Customer is anyone who:

 

has been referred to HSP for a determination of eligibility for services;

 

has applied for services through HSP;

 

is receiving services through HSP; or

 

has received services through HSP.

 

If the Customer is unable to satisfy some or all of their obligations under the HSP, including, without limitation, the obligation to serve as the employer of the IP or PA, the Customer's parent, family member, guardian, or duly authorized representative may act on behalf of the Customer and is included within the definition of "Customer," as used throughout this Part.

 

For purposes of the IP or PA services performed pursuant to the HSP, the Customer shall serve as the employer of the IP or PA.  In this capacity, the Customer is responsible for aspects of the employment relationship between the Customer and the IP or PA, including, without limitation, locating and hiring the IP or PA, training the IP or PA, directing, evaluating and otherwise supervising the work performed by the IP or PA, imposing (when, in the opinion of the Customer, it is appropriate or necessary) disciplinary action against the IP or PA, and terminating the employment relationship between the Customer and the IP or PA.

 

Collective Bargaining Agreement (CBA) – A signed agreement between the union representing Individual Providers and the State of Illinois as a result of a negotiation regarding topics such as wages, hours, and terms and conditions of employment by the Customer.  The current CBA is published on the Illinois Department of Central Management Services’ Website.

 

Counselor − the DHS-DRS staff person or contractual Case Manager who helps to ensure that the funds available under the HSP are properly distributed in accordance with the Service Plan, any applicable waiver programs, and all applicable laws.

 

Determination of Need or DON − the assessment tool used to determine an individual's non-financial eligibility for HSP services based on the individual's impairment and need for care.  This form measures the level of risk of institutionalization for the individual.

 

DHS − Illinois Department of Human Services.

 

Electronic Visit Verification (EVV) System – an electronic system that records authorized HSP services were performed, the Customer received the services, the location of the service delivery, the worker performing the service, and the precise time the service begins and ends.

 

Electronic Visit Verification Identification Number or EVV ID – a unique identification number that is assigned to each Service Provider for use with the HSP EVV system. Service Providers enter their unique EVV ID each time they record their time in or out of the EVV system.

 

Family − anyone related by blood, marriage, or adoption to the individual seeking services through HSP or anyone with whom the individual has a close inter-personal relationship and who resides with the individual.

 

Family Unit − for the purposes of determining financial eligibility, the number of persons derived when counting the individual seeking services through HSP and the number of persons in the household who are legally responsible for the individual seeking services and for whom the individual seeking services is legally responsible.

 

HFS – Illinois Department of Healthcare and Family Services.

 

Home Services Program or HSP − a State and federally funded program designed to allow Illinois residents, who are at risk of unnecessary or premature institutionalization, to receive necessary care and services in their homes, as opposed to being placed in an institution.

 

Home − a private residence where the Customer lives that is not an intermediate care or skilled nursing facility as defined at 77 Ill. Adm. Code 300, or a residential program operated by, or for which funding is provided by, the Illinois Department of Human Services, Division of Mental Health and Division of Developmental Disabilities as defined at 59 Ill. Adm. Code 120. For the purposes of this Subchapter, the term "home" shall include domestic violence shelters as defined in Section 1(c) of the Domestic Violence Shelter Act [20 ILCS 2210/1(c)] and publicly or privately administered shelters designed to provide temporary living accommodations for persons who are homeless.

 

Individual Provider or IP – an individual selected, employed, and supervised by the Customer to provide varied services that are identified on the Customer's approved HSP Service Plan.  An Individual Provider may be a Personal Assistant, Registered Nurse, Licensed Practical Nurse, Certified Nursing Assistant, Occupational Therapist, Physical Therapist or Speech Therapist.

 

Intermediate Care Facility or ICF − a nursing facility that provides regular health related care to its residents, as well as those services necessary for safe and adequate living.

 

Legally Responsible Family Member − a spouse, parent of a child who is under age 18 or a legal guardian of an individual who is under age 18.

 

Medicaid − the Medicaid program administered by HFS under the Public Aid Code [305 ILCS 5/11].

 

Medicaid Waiver − the waiver allowing HSP to claim federal reimbursement for approved levels of in-home care for individuals who would otherwise be placed in institutions for that care.  The Medicaid Waiver is overseen at the federal level by CMMS.

 

Non-Waivable Conviction – Criminal convictions listed within the current Collective Bargaining Agreement Provider Screening Policy for which the Customer may not consent to working with an Individual Provider with a criminal history.

 

Overtime – the time worked by an Individual Provider for an HSP Customer or Customers that exceeds 40 hours in a work week.

 

Pay Period – a semi-monthly period that runs from either the first day of the month through the 15^th day of the month or from the 16^th day of the month through the last day of the month.

 

Personal Assistant or PA − an individual employed by the Customer to provide varied HSP services as described in 89 Ill. Adm. 686.20.  A personal assistant may also be referred to as an Individual Provider.

 

Personal Assistant or Individual Provider Backup Plan − the plan developed by the Customer and designed to ensure that the Customer receives the necessary care and services under the HSP in the event that the Customer’s regular PA or IP is unavailable or unwilling to perform their obligations under the HSP.  The Customer is responsible for designating the backup personal assistant or backup Individual Provider.

 

Person-Centered Planning ( PCP) – a service planning process directed by the Customer or their representative that is intended to identify the Customer’s strengths, capacities, preferences, needs, and desired outcomes.  PCP includes participants freely chosen by the Customer who assist in identifying and accessing a personalized mix of services and supports in an inclusive community setting.

 

Physician − a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) licensed pursuant to the Medical Practice Act [225 ILCS 60].

 

Prescreening − an assessment to determine an individual's need for institutional care at the ICF or SNF level and to ensure Medicaid payment for such a placement is appropriate, and the assessment of whether HSP services are an appropriate alternative to institutional care for the individual.

 

Revalidation – The process whereby a person or entity currently enrolled in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) verifies and updates their enrollment information on file in accordance with 89 Ill. Adm. Code 140.11 and 42 CFR 455.414.

 

Service Cost Maximum or SCM − the maximum monthly amount that may be expended for HSP services for an eligible individual.  This amount is determined based on the individual's DON score and the specific programmatic component of HSP through which the individual is being served.

 

Service Plan − specifically, the Home Services Program Service Plan (IL 488-1049), Home Services Program Service Plan Addendum (IL 488-1050) or the Interim Agreement (IL 488-2344) forms, on which all services to be provided to an individual through HSP are listed.  The Service Plan is developed with the individual's consent and participation.

 

Service Provider – an individual or agency, defined within 89 Ill. Adm. Code 676.40, approved to provide services that are identified on the Customer's approved HSP Service Plan.  A Service Provider may be a Maintenance Home Health Agency, Homemaker Agency, Personal Assistant/Individual Provider, Registered Nurse, Licensed Practical Nurse, Certified Nursing Assistant, Occupational Therapist, Physical Therapist, or Speech Therapist.

 

Services − the necessary tasks provided to an individual, in one or more of the areas listed in Section 676.40 and listed on the individual's Service Plan, through HSP with the intent of preventing the unnecessary institutionalization of the individual.

 

Skilled Nursing Facility or SNF − a facility that provides regular and on-going nursing level care to its residents due to the residents' medical conditions, as well as those services necessary for safe and adequate living.

 

Task Identification Number or Task ID – a number which identifies an HSP service.  A Task ID is entered by a Service Provider when the Service Provider calls out of the EVV system.

 

Travel Time – the time an Individual Provider spends traveling between two or more different HSP Customers addresses on the same workday.

 

An IP will not be paid travel time for any trip to or from their home; if an IP lives with an HSP Customer, the IP cannot be paid for travel time to another Customer's home if the trip begins or ends at the IP’s home.

 

Travel time does not include the time an IP spends traveling on personal business between Customer work visits (e.g., lunch, breaks, errands, etc.).

 

Waivable Conviction – Criminal convictions listed within the current Collective Bargaining Agreement Provider Screening Policy where the Customer may consent to working with an Individual Provider with a criminal history.

 

Work Week – a work week begins each Sunday at 12:00 a.m. (midnight) and ends each Saturday at 11:59 p.m.

 

(Source:  Amended at 46 Ill. Reg. 20840, effective December 19, 2022)

 

Section 676.40  Service Description

 

The following is a listing of the services available through HSP.  The service level, combination of services, and amount of services for which a customer is eligible is dependent upon the needs of the customer as identified during the determination of eligibility (see 89 Ill. Adm. Code 682).

 

a)         Personal Assistant (PA) Services – services provided by an individual employed by the customer.

 

b)         Adult Day Care (ADC) Services – direct care and monitoring of customers in a community-based setting for any portion of a 24-hour day for the purpose of promoting social, physical, and emotional health and well-being and offering an alternative to an institutional setting.  ADC services are provided only when the social, emotional, and physical needs of the customer cannot be met in the home through other available services.

 

c)         Homemaker Services – general support provided by trained and professionally supervised individuals to maintain, strengthen, and safeguard the functioning of an individual in his/her home when no responsible person is available or capable of monitoring those services.  Homemaker services include the actual completion of, and the training in, completion of ADLs.

 

d)         Maintenance Home Health Services – services provided for a customer, in his/her home, that are prescribed or recommended by a physician or other health care professional.  These services include three basic categories of care, which are:

 

1)         direct health care provided by a registered nurse (RN) and/or a licensed practical nurse (LPN);

 

2)         direct health care provided by a Certified Nurse Aid (CNA) who is supervised by an RN or LPN; and

 

3)         in-home therapy, including the areas of physical, occupational and speech therapy.

 

e)         Home Delivered Meals – prepared food brought to the customer's home.  Usually, home delivered meals consist of a hot lunch and a smaller dinner meal that may be refrigerated and eaten later.  These services are provided when available and when they are more cost effective than PA services for an eligible individual who has a need for care in the area of meal preparation but who can adequately feed him/herself.

 

f)         Electronic Home Response Services (EHRS) – a 24-hour per day emergency communication link to assistance outside the customer's home for customers who have no other persons available for assistance should an emergency arise.

 

g)         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.  (See 89 Ill. Adm. Code 686, Subpart H.)

 

h)         Environmental Modification – services to physically modify the customer's home to accommodate the customer's loss of function in the completion of his/her ADLs.  (See 89 Ill. Adm. Code 686, Subpart G.)

 

i)          Respite Services – limited PA, Homemaker, and Maintenance Home Health services provided to a customer to provide for the customer's ADLs during periods of time it is necessary for the family/primary care giver to be absent.  Respite services are provided to a customer to allow the family/primary care giver relief for vacations, rest, errands, family crises and emergency situations.  Respite services are provided in the maximum amount of 240 hours per calendar year and are provided regardless of financial need.  During the COVID-19 Gubernatorial Disaster Proclamations, and subject to federal approval, customers who exhaust 240 hours as a direct result of the COVID-19 pandemic may have additional respite hours added to the Service Plan, dependent upon the customer's needs and availability of customer's unpaid caregiver, up to a maximum of 240 additional hours per calendar year.  Any additional Service Plan hours under this subsection are subject to the advance approval of the Counselor or Managed Care Organization Care Coordinator.

 

j)          Day Habilitation Services – assistance provided to a person with a brain injury to assist with the acquisition, retention and improvement in self-help, socialization and adaptive skills.  These services are provided in a setting separate from the residence in which the customer is residing.

 

k)         Pre-Vocational Services – services provided to a person with a brain injury that are aimed at preparing the individual for paid or unpaid employment but are not job task oriented.  Specific services include teaching concepts such as compliance, attendance, task completion, problem solving and safety.

 

l)          Supported Employment Services – services provided to a customer with a brain injury that consist of paid employment for persons for whom competitive employment is unlikely, when the customer, because of his/her disabilities, needs intensive, ongoing support to perform in a work setting.  Supported employment includes, but is not limited to, activities needed to sustain the customer in supported employment (i.e., supervision and training).

 

m)        Behavioral Services – remedial therapies provided to a person with a brain injury to decrease the individual's severe maladaptive behaviors.  These services are intended to enable the customer to better manage his or her behavior and to make the customer more capable of living independently.

 

(Source:  Amended at 45 Ill. Reg. 10034, effective July 22, 2021)

 

Section 676.100  Case Files (Repealed)

 

(Source:  Repealed at 23 Ill. Reg. 6445, effective May 17, 1999)

 

Section 676.110  Sharing of Customer Information Between HSP and Other DHS Programs

 

a)         All information received by DHS-ORS for the purpose of providing HSP services to a customer shall only be used for such purposes and may not be shared with any other program of DHS unless the individual consents to the release of such information and a release of information is signed by the customer authorizing the release.

 

b)         No information may be obtained from a case file of another program of DHS by HSP for the purposes of providing services to a customer unless the customer consents to the release of such information and a release of information is signed by the customer authorizing the release.  DHS-ORS shall only release information pursuant to the Health Insurance Portability and Accountability Act (42 USC 1320(d) et seq.) and the regulations promulgated thereunder.

 

(Source:  Amended at 28 Ill. Reg. 6445, effective April 8, 2004)

 

Section 676.120  Documentation of Information

 

All records and information which may effect the determination of eligibility, services, or future services must be maintained in the customer's case file.

 

(Source:  Amended at 23 Ill. Reg. 6445, effective May 17, 1999)

 

Section 676.130   Customer Signatures and Information Required to Receive Services Under the HSP

 

a)         In order to receive services, or continue to receive HSP services, for which DHS-DRS would pay on behalf of the customer, a customer is required to sign all forms, and supply any information required to complete those forms, which are necessary to comply with all applicable State and federal laws or the provisions of the Medicaid Waiver or are necessary to process payments through the Comptroller's Office.  During the duration of Executive Order 2020-20 and any subsequent re-issuance and extension, and subject to federal approval, with respect to any DHS-DRS forms, where a signature cannot be expeditiously obtained due to the COVID-19 pandemic and associated social distancing, customers may take the following actions which will constitute a signature for immediate purposes:

 

1)         Provide electronic approval or digital signature in writing via fax, email, or similar method of program-approved submission; or

 

2)         Provide verbal assent by telephone, constituting a telephonic signature.

 

b)         Consistent with its obligation to ensure that the HSP funds are properly distributed, the Department shall have the authority to develop sample forms that may be used as guidance to the customer in the exercise of his/her obligations under the HSP.  Except as required by law or specific provisions of the HSP, the customer is not obligated to use such sample forms and may deviate from or alter such sample forms.

 

c)         A customer employing a personal assistant is required to enter into an Employment Agreement with his/her personal assistant to confirm their understanding of the nature of the employment relationship involved and the extent of control that the customer retains over the services performed by the personal assistant, as prescribed by 89 Ill. Adm. Code 686.10.

 

(Source:  Amended at 45 Ill. Reg. 10034, effective July 22, 2021)

 

Section 676.140  Application by DHS-ORS Employees, Individuals Holding Contracts with DHS-ORS, DHS-ORS Advisory Council Members, Family Members of DHS-ORS Employees, or Close Friends of DHS-ORS Employees

 

a)         At any time a DHS-ORS employee, an individual holding a contract with DHS-ORS, a DHS-ORS Advisory Council member, a family member of a DHS-ORS employee, or a close friend of a DHS-ORS employee applies for services from DHS-ORS, and it is brought to the attention of the counselor, the counselor must notify his/her supervisor who shall notify the Home Services Administration in writing.

 

b)         After review of the situation, the Home Services Administration shall make assignment of the case to an appropriate staff member to ensure propriety of services.

 

c)         For the purposes of this Section, "family member" shall mean spouse, sibling, child, parent, parent-in-law, sibling-in-law, or any other blood relative who resides in the household of the employee or employee's spouse.

 

d)         For the purpose of this Section, "close friend" shall mean any individual who has such a relationship with the employee that would cause a conflict of interest or the appearance of impropriety.

 

e)         Any employee who knows of or suspects that services to another DHS-ORS employee, individual who holds a contract with DHS-ORS, DHS-ORS Advisory Council member, family member of a DHS-ORS employee, or close friend of a DHS-ORS employee have not been reported as required in subsection (a), above, shall report the situation to his/her immediate supervisor.  The immediate supervisor must investigate the situation and take appropriate action.  Appropriate action may include reassignment of the case and discipline of the employee violating these requirements if there is evidence the employee knew the individual to be an individual described in subsection (a), above, and failed to report the situation.

 

(Source:  Amended at 23 Ill. Reg. 6445, effective May 17, 1999)

 

Section 676.150  Geographic Case Assignment

 

A customer will be served by the office which is assigned the geographic area of the customer's residence.  Exceptions to such assignment may be made only with the written approval of the Home Services Program, Chief of the Bureau of Field Operations.

 

(Source:  Amended at 23 Ill. Reg. 6445, effective May 17, 1999)

 

Section 676.200  Vendor Payment

 

Because HCFA regulations (42 CFR 447.10(d)) prohibit re-assignment of provider claims, no payment will be made directly to any customer of the HSP. In order to ensure that HSP funds are administered properly, no payment, on behalf of any customer, will be made to any vendor unless the services for which the payment is to be made were approved by DHS-HSP.  No payment, on behalf of any customer, shall be made until after service has been rendered and verified.

 

(Source:  Amended at 23 Ill. Reg. 6445, effective May 17, 1999)

 

Section 676.210  Reporting and Collection of Misspent Funds

 

Any funds authorized through HSP thought to have been misspent shall be reported and collected, as appropriate pursuant to DHS rules found at 89 Ill. Adm. Code 527 - Misspent Funds.

 

Section 676.300  Criteria for Referral to DoA

 

In accordance with the provisions of the interagency agreement between DHS and DoA, individuals meeting the following criteria shall be referred to DoA to receive services through DoA's Community Care Program (CCP) and their HSP cases closed after the initiation of CCP services.  These individuals are those who:

 

a)         are at least 60 years of age at the time of the referral to DoA;

 

b)         are receiving only homemaker services, adult day care services, home delivered meals, or any combination of these services;

 

c)         have a DON score of at least 15 points on Part A, which includes the 10 points from the Mini-Mental Status Examination (89 Ill. Adm. Code 679.20(a)), if applicable, with a total score of not less than 29 points; and

 

d)         have agreed to being referred to DoA to receive services.

 

(Source:  Amended at 21 Ill. Reg. 2678, effective February 7, 1997)

 

Section 676.310  Disposition of Cases not Appropriate for Referral to DoA

 

Any customer not meeting the criteria for referral to DoA stated in Section 676.300 shall have his/her case maintained by DHS and shall continue to receive services through HSP as long as he/she continues to meet the eligibility criteria established by DHS.

 

(Source:  Amended at 23 Ill. Reg. 6445, effective May 17, 1999)