DHS-DRS Presentation 2008 - The Arc of Illinois Family to Family

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Illinois Department of Human Services
Division of Rehabilitation Services
Home Services Program (HSP)
Home Services Program
Goal: to prevent unnecessary
institutionalization by providing in-home
care support to people with disabilities
who can safely and cost effectively live
in the community
Home and Community Based
Services Waiver (1915c)
Center for Medicare and Medicaid (CMS)
 Alternative to institutional care
 States identify core services to be offered
 Individuals can be served through only
one 1915C waiver
 Federal reimbursement for services
available

HSP: Three Medicaid Waivers
 Persons
with Disabilities (PD)
 Persons with Brain Injuries (BI)
 Persons with HIV/AIDS
Eligibility for Services
Identical criteria for all 3 waivers
 Waiver specific to type of disability
 Services identical among waivers
 BI Waiver has four additional services

Eligibility For Brain Injury Waiver

Medical diagnosis of an acquired brain injury
 Traumatic
Brain Injury (TBI)
 Brain Infection (Encephalitis)
 Lack of Oxygen (Anoxia/Hypoxia)
 Stroke (Cerebral Vascular Accident)
 Brain Bleeds (Aneurysm)
 Electric Shock (TBI)
 Brain Tumor (Malignant or Benign)
 Poisoning (Toxic Encephalopathy)
Eligibility For Brain Injury Waiver
(continued)

Functional limitations resulting from the
brain injury
Required criteria
to be eligible for HSP
US citizen or legal alien status
 Illinois resident
 Applicants must be under age 60

 BI
and HIV/AIDS (no age limit)
Required criteria
to be eligible for HSP (continued)
Severe disability last 12 months or more or
duration of life
 Scores on Determination of Need (DON)
reflect risk of nursing faculty placement
 Physicians approval for planned services

Required criteria
to be eligible for HSP (continued)

Services must be within Service Cost
Maximums (SCM)
 PD

Waiver $1,593 - $3,329 per month
Assets can not exceed $17,500 for an
individual over age 18 or total family
assets can not exceed $35,000 for
customers under age 18
Required criteria
to be eligible for HSP (continued)

Must apply and cooperate with Medicaid
application process
 Persons
deemed ineligible may or may not be
served through HSP
 Ex: Person with spinal cord injury resulting in
quadriplegia who is employed
Services through HSP
Customer driven by choice within scope of
services offered
 Personalized planning and coordination
 Services address the unmet needs



(Medicaid, Insurance, Medicare, other social/familial resources)
Multiple types of services (combined)
Personal Assistant (PA)
Selected, hired, fired, trained and
supervised by the customer
 $9.85 per hour paid twice monthly by HSP
 Representative/guardian may assist in
directing care by PA’s
 Tasks vary according to customer need
and physician approval

Who cannot be a paid PA?

Legally responsible relatives cannot be
paid caregivers
 Spouse
for spouse
 Parent for minor (under 18) child
 Minor child for parent
 Guardian of minor child
 Step-parent for minor child
 Foster-parent for minor child
Criteria to work as a PA
Photo ID or Drivers License
 Valid social security card
 Must be able to complete tasks on the
service plan
 Complete 1413B to enroll as a Medicaid
Waiver Provider

Homemaker Services
Agency based with rate agreements
 $15.32 per hour
 Designed to provide backups
 Hours of availability and task completion
vary

Home Health Services

Agency and Private duty
 Certified
Nurse Aid (CNA)
 Licensed Practical Nurse (LPN)
 Registered Nurse (RN)
Home Health Services (continued)
 Physical,
Occupational and Speech Therapy
Designed to evaluate then train lower level care
providers
 Time limited
 Must use all other resources (Medicaid, Insurance,
Medicare, etc.)

Home Health Rates

Agency Based
 CNA -
$13.75 per hour
 LPN - $25.47 per hour
 RN - $29.55 per hour
Home Health Rates (Continued)

Private Duty
 CNA -
$10.00 - $13.00 per hour
 LPN - $20.00 (max) per hour
 RN - $26.00 (max) per hour
 Must have current license/certification
Adult Day Care
Agency based with rate agreement
 $7.02 per hour
 Reimburse for transportation when agency
sponsored

Home Delivered Meals
Licensed entities who bring one or more
meals to the home
 Customer must be able to eat
independently
 Typically, eliminates the need for PA’s to
complete task
 Cost varies (Maximum $15 per day)

Emergency Home Response
Rate agreement with five providers
 Rented units $28.00 per month
 Can purchase adaptive technology
 Requires a land line

Respite Services
240 hours maximum per calendar year
 Other respite programs may affect
eligibility
 “Stand alone” service
 Level of providers/service: PA,
Homemaker, CNA, LPN, RN or ADC

Assistive Equipment
$25,000 over 5 years
 Must be denied by Medicaid, Medicare,
insurance, etc.
 Must meet one of the four reasons of
justification:

 Eliminate
a need or services
 Reduce services
 Prevent an increase in services
 Safety of customer during performance of
ADL’s
Assistive Equipment (continued)
No medical supplies
 No medical treatment devices
 Buy, rent or repair
 No van modifications/vehicle purchases

Environmental Modifications
$25,000 over 5 years
 Must be denied by all other known sources
 Structurally change environment for
accessibility
 No additions to homes and cannot add
square footage

Environmental Modifications
(Continued)

Must meet one of the four reason of
justifications:
 Eliminate
a need or services
 Reduce services
 Prevent an increase in services
 Safety of customer during performance of
ADL’s
Landlord agreement for rental property
 Vendor requirements

Services Available Only to
Customers of BI Waiver
BI Behavioral/Cognitive
 BI Habilitation
 BI Pre-Vocational Services
 BI Supported Employment

Contacting an HSP Office

Office Locator (for Cook County per zip code)
http://www.dhs.state.il.us/page.aspx?module=12
Contacting an HSP Office
(Continued)
Phone or fax request
 Web referral linkhttps://drs.dhs.state.il.us/owr/setReferral.do

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