Section 684.10  Service Plan

 

a)         All services provided to a Customer through HSP must be necessary to meet an unmet care need of the individual or to provide relief to the caregiver for Customers eligible for respite care services and listed on an HSP Service Plan that is developed for the Customer and agreed to and signed by the counselor and the Customer in accordance with 89 Ill. Adm. Code 676.130(a).

 

b)         Services shall be developed with Customer participation, provided in a manner that reflects the individual's choices, when applicable, and address his/her strengths, needs, and desired goals.

 

c)         Services provided through HSP to a Customer must be:

 

1)         safe and adequate;

 

2)         cost effective;

 

3)         the most economical in terms of the Customer's needs, unless a service is not available at the most economical level.  In these instances, the next higher service level may be used as long as services remain within the Service Cost Maximum (SCM) established for the Customer.  Documentation of an ongoing effort to locate services at the appropriate level must be in the Customer's case file; and

 

4)         in compliance with all HSP requirements and regulations.

 

(Source:  Amended at 45 Ill. Reg. 10046, effective July 22, 2021)

 

Section 684.20  Procuring an Appropriate Service Provider

 

a)         The counselor is responsible for identifying the appropriate level of service provider based on the Customer's level of service need, the Customer's ability to manage service delivery and the Customer's approval of the initial Service Plan.

 

b)         When a Customer seeks to hire an Individual Provider, the following requirements must be met:

 

1)         The Customer must have the ability to manage the Individual Provider in all aspects of the employment relationship.

 

A)        If the Customer is determined to be able to manage an Individual Provider, the Customer is responsible for identifying, interviewing, hiring, managing, disciplining and ending the employment relationship with the Individual Provider.

 

B)        The Customer must meet all HSP requirements, including those outlined in 89 Ill. Adm. Code 686, Subpart P (Individual Provider Overtime and Travel Time) and Subpart Q (Electronic Visit Verification).

 

2)         The Individual Provider must meet HSP requirements outlined in Section 684.30 and 89 Ill. Adm. Code 686.

 

3)         The Individual Provider must meet the requirements of the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system administered by the Illinois Department of Healthcare and Family Services (HFS).

 

c)         HSP retains the right to:

 

1)         amend the Customer's Service Plan if HSP determines the Customer is unable to manage an Individual Provider or the Customer is not compliant with HSP requirements; or

 

2)         condition any current or future funding of an Individual Provider based upon HSP:

 

A)        determining that the Customer is unable to manage an Individual Provider;

 

B)        determining that the Individual Provider is not compliant with HSP requirements;

 

C)        receiving a substantiated and verified report of abuse, neglect, or exploitation as determined by the Department on Aging under 89 Ill. Adm. Code 270;

 

D)        receiving a report of fraud or other illegal acts as determined by the Home Services Program under 89 Ill. Adm. Code 527 and 684.100(g); or by a law enforcement agency; or

 

E)        determining the Individual Provider violated any terms of the currently effective collective bargaining agreement.

 

(Source:  Amended at 46 Ill. Reg. 20860, effective December 19, 2022)

 

Section 684.30  Family Members as Service Providers

 

a)         The following individuals shall not be paid through HSP to be a Customer's service provider.

 

1)         The Customer's legally responsible family members (89 Ill. Adm. Code 676.30), including the Customer's spouse, a parent of a child who is under age 18 or a legal guardian of an individual who is under age 18;

 

2)         The Customer's minor child (under age 18);

 

3)         The Customer's foster parents if the Customer is under age 18; or

 

4)         The Customer's stepparents, if the Customer is a minor child (under age 18).

 

b)         During the COVID-19 Gubernatorial Disaster Proclamations, and subject to federal approval, individuals listed in subsections (a)(1) through (4) may be paid to provide personal care through HSP to be a Customer's service provider, if required due to the COVID-19 pandemic.

 

(Source:  Amended at 45 Ill. Reg. 10046, effective July 22, 2021)

 

Section 684.40  Distribution of the Service Plan

 

A copy of the approved HSP Service Plan for the Customer must be given to the Customer and each service provider, and a copy must be retained for the Customer's case file.

 

(Source:  Amended at 41 Ill. Reg. 8446, effective August 1, 2017)

 

Section 684.50  Service Plan Content

 

The HSP Service Plan shall include:

 

a)         the type of services to be provided to the Customer;

 

b)         the specific tasks involved;

 

c)         the frequency with which the specific tasks are to be provided;

 

d)         the number of hours each task is to be provided per month;

 

e)         the rate of payment for the services;

 

f)         the goals, including any personal goals, of the Customer and desired outcomes;

 

g)         for a Customer receiving Individual Provider services, the number of Individual Providers that are necessary to cover the weekly hours on the Service Plan as required by 89 Ill. Adm. Code 686.1520 and sufficient backup Individual Providers to cover those events when a regularly-scheduled Individual Provider is unavailable or unable to provide services required under 89 Ill. Adm. Code 686.1520;

 

h)         the next planned date for redetermination of eligibility; and

 

i)          signatures of the HSP counselor, the Customer, and each Individual Provider and/or agency provider who is to deliver the services identified in the Service Plan.  During the COVID-19 Gubernatorial Disaster Proclamations, and subject to federal approval, signatures may be obtained consistent with 89 Ill. Admin. Code 676.130(a).

 

(Source:  Amended at 45 Ill. Reg. 10046, effective July 22, 2021)

 

Section 684.60  Provision of Services

 

a)         Except as provided in subsection (b) services shall not be provided to an eligible individual when he/she is:

 

1)         hospitalized;

 

2)         in a skilled nursing facility or intermediate care facility;

 

3)         not residing in his/her home or non-institutional residence; or

 

4)         outside the State of Illinois.

 

b)         With prior approval by the HSP counselor or case manager, Personal Assistance services for customers who have been formally found eligible for services can continue when the individual is:

 

1)         at his/her workplace; however, a P.A. shall only be paid to provide personal care comparable to what is provided in the customer's home and not to perform occupational tasks;

 

2)         away from his/her home or other non-institutional residence for a predetermined period; or

 

3)         hospitalized, if the customer has a DON score of 75 or greater, except that, during the COVID-19 Gubernatorial Disaster Proclamations, and subject to federal approval, the DON score requirement shall not apply to individuals hospitalized in connection with the COVID-19 pandemic.

 

c)         In these instances, the P.A. services, the number of hours of services and cost of services cannot exceed those contained in the customer's current service plan.  P.A. services are limited to personal care of the customer. When away from the home, the customer shall provide notification of his/her temporary address to his/her HSP counselor or case manager.

 

(Source:  Amended at 45 Ill. Reg. 10046, effective July 22, 2021)

 

Section 684.70  Service Planning Limitations

 

a)         For customers served under a Medicaid Waiver program administered by DHS-DRS, all services listed on the Service Plan must be necessary to meet an unmet care need of the individual or, for respite cases, to provide relief to the caregiver, and must be within the SCM for the DON score attained by the customer as a result of the determination or redetermination of eligibility.

 

b)         Customers who cannot be served under the HSP waiver programs' SCM and who meet the criteria established by HFS, may be eligible for an exceptional care rate (89 Ill. Adm. Code 140.569(a)(2)).  The monthly cost of these services provided through the Home Services Program shall not exceed the exceptional care rate.

 

(Source:  Amended at 31 Ill. Reg. 433, effective December 29, 2006)

 

Section 684.75  Required Physician's Certification of HSP Service Plan (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 16973, effective July 25, 2014)

 

Section 684.80  Interim Services

 

Prior to determination of eligibility (see 89 Ill. Adm. Code 682), the customer may receive interim services while an official determination of eligibility (see 89 Ill. Adm. Code 682) is being completed if enough information exists to presumptively establish eligibility based on:

 

a)         DON score;

 

b)         evidence of a disability as described at 89 Ill. Adm. Code 682.100(e) based on medical documentation, counselor observation, or oral information received from a knowledgeable medical professional;

 

c)         the customer's financial eligibility, per 89 Ill. Adm. Code 682:  Subpart C; and

 

d)         the customer meeting all eligibility criteria as listed in 89 Ill. Adm. Code 682.

 

(Source:  Amended at 38 Ill. Reg. 16973, effective July 25, 2014)

 

Section 684.90  Coordination of HSP and Other Services

 

a)         No HSP services may be provided to an individual who is a student under the age of 21 during the hours covered by the individual's Individualized Education Plan (IEP).  Services for which the customer is determined eligible through HSP may be provided during the period the customer is not receiving services through his/her IEP.

 

b)         Customers receiving services through HSP must, at the earliest possible date, apply for and accept, if eligible, all other benefits which may affect HSP eligibility or services.

 

c)         All individuals applying for HSP services must apply for, and have an eligibility determination made for, Medicaid benefits through DPA.  Customers in an active service status prior to October 1, 1991, may choose to apply for Medicaid.

 

(Source:  Amended at 24 Ill. Reg. 10220, effective June 27, 2000)

 

Section 684.100  Denial or Termination of HSP Services

 

HSP services shall be denied or terminated and case closure initiated at any time the Customer:

 

a)         moves from the State of Illinois or cannot be located or contacted;

 

b)         is determined to have a projected service cost above that of the projected cost of institutionalization, with the exceptions found at 89 Ill. Adm. Code 682.520;

 

c)         refuses services or further services;

 

d)         dies;

 

e)         is institutionalized and not expected to be released for a period to exceed 60 calendar days;

 

f)         has been referred to another agency for the same or similar services and no longer requires or is eligible for HSP services;

 

g)         fails to conduct himself or herself in an appropriate manner (e.g., commits physical, sexual or repeated verbal abuse against a DHS employee, provider or agent providing services through HSP; knowingly provides false information; or performs illegal activity that would have a direct and negative effect on the Home Services Program);

 

h)         is not, or is no longer, at risk of institutionalization due to improvement of his or her condition;

 

i)          fails to meet other eligibility criteria found at 89 Ill. Adm. Code 682 as a result of an initial determination of eligibility or redetermination of eligibility;

 

j)          fails to cooperate (e.g., refuses to complete and sign necessary forms, fails to keep appointments, fails to maintain adequate providers);

 

k)         cannot have a safe and adequate Service Plan developed for him or her as a result of the original determination of eligibility or redetermination of eligibility; or

 

l)          fails to comply with HSP requirements.

 

(Source:  Amended at 41 Ill. Reg. 8446, effective August 1, 2017)