Section 688.10  Authority and Purpose

 

a)         In conjunction with the Illinois Department on Aging, the Illinois Department of Insurance, and the Illinois Department of Public Aid, this Part is promulgated pursuant to Public Act 87-163, the Partnership for Long-Term Care Act.

 

b)         The purpose of this regulation is to implement Public Act 87-163 and Public Act 89-525 through the establishment of a private/public Long-Term Care Insurance Program.  This program will allow individuals who purchase private long-term care insurance that meets State standards, and who sustain extended periods of chronic illness that exhaust their private insurance benefits, to be eligible for continued in home support services through the Medicaid program based on their meeting specific resource eligibility requirements.

 

(Source:  Amended at 22 Ill. Reg. 5890, effective March 13, 1998)

 

Section 688.20  Eligibility Requirement

 

An individual under age 60 whose Long-Term Care Partnership Program benefits have been exhausted shall be considered eligible for the DHS Home Services Program, as set forth in 89 Ill. Adm. Code 682, with the following exceptions:

 

a)         points scored on the Determination of Need (DON) need only be at least 15 points on Part A of the DON, at least 10 points of which may be earned on the Mini-Mental State Exam (MMSE); and

 

b)         Non-exempt assets:

 

1)         cannot exceed the sum of qualifying insurance benefit payments made as the result of coverage under a Long-Term Care Partnership Insurance Policy as described in 50 Ill. Adm. Code 2018 provided that the person has received all of the qualifying insurance benefit payments that are payable under the policy plus non-exempt assets as contained within 89 Ill. Adm. Code 682.200; or

 

2)         shall be disregarded for a person who purchased a certified Long-Term Care Partnership Insurance policy with an amount of coverage equal to, or greater than, the average of 4 years of long-term care services in a nursing facility, provided that the person has received all the qualifying insurance benefit payments that are payable under the policy.

 

(Source:  Amended at 22 Ill. Reg. 5890, effective March 13, 1998)

 

Section 688.30  Appeals

 

a)         Pursuant to 50 Ill. Adm. Code 2018.100 individuals under age 60 have the right to appeal a determination of ineligibility for benefits or a designated plan of care under the Long-Term Care Partnership Program by contacting DHS.  These appeals will be conducted in accordance with 89 Ill. Adm. Code 510.  The Level I Hearing Officers for appeals under this Section will be the HSP Advisors.  Level II appeals will be heard pursuant to 89 Ill. Adm. Code 510.90.

 

b)         Individuals who have reached 60 years of age or more may appeal a determination of ineligibility pursuant to 89 Ill. Adm. Code 260.300.

 

(Source:  Amended at 22 Ill. Reg. 5890, effective March 13, 1998)

 

Section 688.40  Scope of Services

 

a)         Individuals qualifying for the DHS Home Services Program, as the result of having participated in the Long-Term Care Partnership Program, shall receive services as defined in 50 Ill. Adm. Code 2018.30, provided through the Partnership Program.

 

b)         Services provided through the Partnership Program cannot exceed the maximum payment levels described in 89 Ill. Adm. Code 682.250.

 

(Source:  Amended at 22 Ill. Reg. 5890, effective March 13, 1998)