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Illinois Department of Human Services Division of Rehabilitation Services Home Services Program (HSP)

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Presentation on theme: "Illinois Department of Human Services Division of Rehabilitation Services Home Services Program (HSP)"— Presentation transcript:

1 Illinois Department of Human Services Division of Rehabilitation Services Home Services Program (HSP)

2 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

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 - $ $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)

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


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