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Home and Community Based Services Waiver (1915c)

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.

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Home and Community Based Services Waiver (1915c)

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  1. Illinois Department of Human ServicesDivision of Rehabilitation ServicesHome Services Program (HSP)

  2. Home Services ProgramGoal: to prevent unnecessary institutionalization by providing in-home care support to people with disabilities who can safely and cost effectively live in the community

  3. 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

  4. HSP: Three Medicaid Waivers • Persons with Disabilities (PD) • Persons with Brain Injuries (BI) • Persons with HIV/AIDS

  5. 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

  6. 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)  

  7. Eligibility For Brain Injury Waiver (continued) • Functional limitations resulting from the brain injury

  8. 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)

  9. 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

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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

  15. 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

  16. Homemaker Services • Agency based with rate agreements • $15.32 per hour • Designed to provide backups • Hours of availability and task completion vary

  17. Home Health Services • Agency and Private duty • Certified Nurse Aid (CNA) • Licensed Practical Nurse (LPN) • Registered Nurse (RN)

  18. 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.)

  19. Home Health Rates • Agency Based • CNA - $13.75 per hour • LPN - $25.47 per hour • RN - $29.55 per hour

  20. 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

  21. Adult Day Care • Agency based with rate agreement • $7.02 per hour • Reimburse for transportation when agency sponsored

  22. 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)

  23. Emergency Home Response • Rate agreement with five providers • Rented units $28.00 per month • Can purchase adaptive technology • Requires a land line

  24. 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

  25. 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

  26. Assistive Equipment (continued) • No medical supplies • No medical treatment devices • Buy, rent or repair • No van modifications/vehicle purchases

  27. 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

  28. 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

  29. Services Available Only to Customers of BI Waiver • BI Behavioral/Cognitive • BI Habilitation • BI Pre-Vocational Services • BI Supported Employment

  30. Contacting an HSP Office • Office Locator (for Cook County per zip code) http://www.dhs.state.il.us/page.aspx?module=12

  31. Contacting an HSP Office (Continued) • Phone or fax request • Web referral link- https://drs.dhs.state.il.us/owr/setReferral.do

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