Disabilities Guidebook: The Home Services Program

Disabilities Guidebook: The Home Services Program

Last updated: March 2006

(Chapter 10 Section 1 from Guidebook of Laws and Programs for People with Disabilities)

 


What Is It? The Home Services Program is a program which provides services which enable people with disabilities who would normally need institutional care to receive the needed care in their own home.

What Is Its Purpose? To provide an alternative to institutional care.

Who Can Benefit? Illinois residents with disabilities who are under age 60.

I. Your Legal Rights

In General
The Home Services Program (HSP) is a program intended to provide an alternative to institutional care for people with severe disabilities. You may be eligible for this program if you require a high level of care and it is possible to provide the needed services in your home at a lower cost than in a nursing home or other institution.

The Home Services Program is operated by the Illinois Department of Human Services-Office of Rehabilitation Services (ORS).

Who is Eligible for HSP Assistance?

In order to receive HSP assistance, you must:
Be a citizen of the United States, or be a lawful permanent resident alien and
a resident of the state of Illinois;

  • Have applied for Medicaid, or already be a recipient of Medicaid, or already be found eligible for a Medicaid "spend- down." If you applied for HSP assistance before October 1, 1991, you are not required to apply for Medicaid;
  • Be under the age of 60 at the time of application for HSP services, unless you have AIDS or a brain injury, in which case there is no age limit;
  • Have a severe disability which is expected to last for at least 12 months or for the rest of your life;
  • Be in need of long-term care;
  • Have a physician's certification that the long-term care you require can be safely be provided in your home; and
  • Be able to show that it is less expensive to provide your care in the home than in a nursing home or other institution.

Asset Limits
In order to be eligible for HSP, you must meet the asset limitation. If you are age 18 years or above, you may have no more than $10,000 in assets in order to receive services through HSP. If you are under 18, you and your family may have no more than $30,000 in assets.

If you are married and your spouse does not receive HSP services, your spouse may have assets valued up to $84,120 (this amount is adjusted annually). If you and your spouse together have assets that are less than $10,000 over this limit, you will still be eligible.

Many types of property are not counted in determining whether you meet the asset limit. These types of property are called "exempt assets."
Examples:
(1) Your home, including its furnishings and contents and the land on which it sits;
(2) Your cars and other vehicles, except those used primarily for recreation;
(3) Your personal property, such as clothing and other effects;
(4) In the case of a child, the value of the parents pension or IRA funds.

Your Contribution to Cost of Services
Because of a recent change in the law, there are no charges for HSP services, regardless of your income level.

The Determination of Need for Services (the DON)
In order to be eligible for HSP services, you must be in need of a high level of care which would normally be provided in a nursing home or other institution. In order to decide whether you need this level of care, ORS evaluates your mental and physical condition using an assessment test called the Determination of Need (DON).

ORS uses the DON to measure your need for help with the performance of necessary day-to-day activities, such as eating, bathing, grooming, dressing, transferring, incontinence care, preparing meals, being alone, telephoning, managing money, routine health care tasks, travel outside the home, laundry, and housework. The DON gives you a score with a numerical value. A higher score means that you have a greater need for services. In order to be eligible for any assistance under the HSP program, you must obtain a DON score of at least 37.

ORS uses the DON score to determine not only whether you are eligible for HSP services, but also how much assistance you will receive. The higher your DON score, the higher the maximum amount that may be spent for HSP services.

The amount that can be spent for HSP services based on your DON score is called the Service Cost Maximum (SCM). This amount reflects the amount that the State would expect to pay for your care if you were in a nursing home or other institution.
Example: If your DON score is between 41 and 49, the maximum monthly amount that could be spent on HSP services (your SCM), would be $1,034. If you have AIDS, or you are on a ventilator, the SCM amount is higher.

How to Apply for HSP Assistance
If you are between ages 18 and 59 and you seek admission to a nursing home through Medicaid, ORS will automatically determine your eligibility for HSP services. This is called pre-screening. The state pre-screens in order to cut down on nursing home costs paid by Medicaid and also to make sure that you are aware of the availability of HSP assistance.

If you are not seeking admission to a nursing home and you desire HSP services, then you must make an application. You may do this by contacting your local ORS office.

When ORS receives your request, a Home Services Counselor will come to your home to determine your eligibility. The counselor will administer the DON assessment, and will decide whether you meet the other financial and non-financial eligibility criteria.

You are entitled to receive a written decision on your eligibility for HSP services within 60 days of the date of your application. If ORS finds you ineligible for HSP services, you may file an appeal, as explained below. You also may reapply for HSP at any time, if you believe that there has been a change in your circumstances.

Once ORS finds you eligible for HSP services, they will redetermine your continuing eligibility once a year. If there is a change in your circumstances which may cause you to require more or less services, they will redetermine your eligibility at that time.

The HSP Services Plan

Once ORS determines that you are eligible for HSP services, the customer (you) and ORS together will create a written plan, called the HSP Services Plan, to identify the specific type of services that you will receive. You and the HSP counselor create this plan jointly, and your doctor must approve it.
 

The HSP Service Plan must indicate the type of service(s) to be provided, the specific tasks involved, how often each task will be performed, the number of hours each task is to be provided per month, and the amount that will be paid for the service(s).

Appropriate Service Providers
If you need a Personal Assistant (PA), you can chose whomever you wish to hire as your PA. If you need help finding a PA, your counselor must help you.

However, ORS cannot pay your legally responsible family members, or a family member for whom you are legally responsible, through the HSP.
Examples: ORS will not pay for PA services from a spouse, a parent of a customer minor child, or a minor child of the customer receiving services.

ORS may pay other relatives to provide services only when no other appropriate service providers can be located and the family member is the most appropriate provider under the circumstances.
Examples: Aunts, uncles, first cousins, grandparents, siblings.

Services Available Under the HSP Program

The types of services that may be provided to you under the HSP Program include the following:

1. Personal Assistant (PA) Services. A PA may assist you with:

  • Household tasks, shopping, or personal care;
  • Simple health care tasks which do not require medical skill; and
  • Monitoring to ensure your health and safety.

2. Adult Day Care (ADC) Services. You may receive ADC services, which provide you with direct care and monitoring in a group setting for some portion of the day.

3. Homemaker Services. You may receive Homemaker Services to assist you in performing necessary home management and personal care tasks, if no
one else is available to do these things for you. This includes teaching you about or providing direct assistance with the following:

  • Managing your household, your finances, or your time;
  • Meal planning and preparation; and
  • Personal care and hygiene of a non-medical nature.

4. Maintenance Home Health Services. You may receive health care services prescribed by your doctor which require professional skill. This includes:

  • Health care provided by a registered nurse (RN) and/or a licensed practical nurse (LPN), or by a Certified Nurse Aid (CNA) who is supervised by a RN or LPN; and
  • In-home therapy, including physical, occupational and speech therapy.

5. Home Delivered Meals. Agencies can bring prepared food to your home. Meals may consist of a hot lunch and a smaller dinner meal that may be refrigerated and eaten later. These services are available if you need help in meal preparation but you can feed yourself.

6. Electronic Home Response Services (EHRS). You may receive a 24-hour per day emergency communication link to assistance outside your home, if there is no one in your home who can help you in an emergency.

7. Assistive Equipment. You may receive assistive devices which increase your ability to independently perform the activities of daily living. With HSP money, you may purchase, rent, or repair assistive equipment, depending on how long it is anticipated that you will need the item.

8. Environmental Modification. You may receive services to modify your home so that you may be more independent in performing basic daily activities.

Examples: Doorways can be widened to accommodate a wheelchair, or special kitchen or bathroom fixtures may be installed.

9. Respite Services. You may receive Personal Assistant, Homemaker, and Maintenance Home Health services on a short-term basis while the person who normally provides these services is unavailable. ORS provides these services to allow the normal care-giver time for vacations, rest, errands, family crises and emergency situations. ORS provides respite services in the maximum amount of 240 hours per calendar year, regardless of financial need.

Note: You may qualify for Respite Care services even if your DON score is too low to qualify for other HSP services.

Additional Services for Individuals with a Brain Injury
If you have a brain injury, you may be entitled to one or more of the following services, in addition to those listed above:

1. Day Habilitation Services. If you have a brain injury, ORS can give you this assistance so that you may learn, retain and improve self-help, socialization and adaptive skills. ORS provides these services in a setting outside of your home.

2. Pre-Vocational Services. If you have a brain injury, ORS provides services that are aimed at preparing you for paid or unpaid employment, but are not job task oriented. Specific services include teaching concepts such as compliance, attendance, task completion, problem solving and safety.

3. Supported Employment Services. ORS can provide you these services if you have a brain injury, competitive employment is unlikely, and because of your disabilities, you need intensive, ongoing support to perform in a work setting. These services consist of job supervision, training, and paid employment.

4. Behavioral Services. If you have a brain injury, ORS can provide you with therapies to decrease severe maladaptive behaviors, to better manage your behavior and help you become more independent.

Case Management Services for Persons with HIV/AIDS or Brain Injuries
The Department of Human Services (DHS) has agreements with agencies to provide case management services to persons diagnosed as having HIV+ or AIDS, or as having brain injuries, and who are or may be eligible for the Home Services Program.

These agencies must assign case managers to all persons with HIV/AIDS or brain injuries who are referred to them. If you are such a person, the case managers have the responsibility to give you services which include:

  • Assessing your eligibility for the HSP and gathering information;
  • Developing a care plan;
  • Re-assessing your needed level of care periodically;
  • Networking and coordinating services to help you obtain other agencies' services;
  • Assisting you when personal assistance problems develop; and
  • Counseling and advocacy.

Denial or Termination of HSP Services
ORS can deny or terminate your HSP services at any time that you:

  • Move from Illinois or cannot be located;
  • Are determined to have service costs that are greater than what it would cost to serve you in an institution;
  • Refuse services or fail to cooperate in other ways;
  • Are institutionalized and not expected to be released for more than 60 days;
  • Fail to conduct yourself in an appropriate manner, such as being abusive or threatening to a provider or to a DHS employee; or
  • Your condition has improved, so that you are no longer at risk for institutionalization.

 

II. How to Protect or Enforce Your Rights

The Right to Notice and Appeal
You are entitled to file an appeal if ORS denies your application to participate in the Home Services Program. If you are already an HSP participant, you may file an appeal if ORS terminates your services, refuses you services that you request, or fails to take timely action on your request for services.

ORS must send you a written service notice at least 15 working days before any change, reduction, or termination of your services. The notice must include the following:

  • A statement of the action being taken;
  • A statement of the basis for the action;
  • The effective date of the action;
  • A statement of your right to a hearing and how to initiate the hearing; and
  • The name, address and telephone number of the person to whom the request for a hearing must be made.

Services Continue While Your Appeal is Pending
If you appeal the change, reduction, or termination of your services, ORS must continue to provide the disputed services until a final decision has been made. This is not true if the services being provided were obtained through misrepresentation or criminal conduct on your part.

The Appeal Process in General
Any time you are not satisfied with any action taken by ORS, or with any inaction, you can request a hearing. If you request a hearing, you will have an opportunity to try to resolve the grievance informally through an "Informal Resolution Conference."

Requesting a Hearing
You must make the request for a hearing through the Hearings Coordinator or by completing a request for hearing form (IL 488-1949) and presenting it to ORS.

You must submit the request for a hearing so that it is received by ORS:

  • within 30 calendar days after the date you received notice of the action being appealed (or within 35 calendar days after the date of the postmark on a mailed notice, if that is later) or
  • if there is no notice, within 30 calendar days after the date that you knew or should have known of the issue being appealed.

The request for hearing must state whether you are unable to attend a hearing in the local ORS office due to disability. If so, the Hearings Coordinator will contact you or your representative to determine a mutually acceptable place for the hearing. In general, the hearing must be held no later than 45 calendar days after ORS receives your request.

At least 30 days before the scheduled date of the hearing, the Hearings Coordinator must send you a letter by certified mail which tells you:

  • The date, time and location of the hearing;
  • The name and address of the hearing officer;
  • The issue which will be the subject of the hearing, and your rights at the hearing; and
  • How to request an informal resolution conference.

The Informal Resolution Conference
You can request this conference at any time in between your filing of the appeal and the hearing decision. You have the right to be represented at this conference.

The supervisor of the ORS employee responsible for the action being grieved must schedule and conduct the conference. ORS must hold the conference at a time and date which is convenient to you. ORS will hold the conference in the ORS office, except they can hold it in your home if that is necessary due to your disability.

During the conference, the chairperson should do the following:

  • Clarify the issues;
  • Present a fair and complete discussion of the relevant information;
  • Summarize ORS' position and your position; and
  • Provide an opportunity to discuss settlement.

If there are any agreements, they must be put in writing and signed by you and by the chairperson. The agreement should list both those issues on which agreement has been reached and those issues where there is still disagreement. All agreed issues should be withdrawn from the hearing. If some issues cannot be
resolved, you must be advised of the next step in the process, which is the hearing.

The Hearing
You are entitled to be represented by any person of your choice, including an attorney. You also may represent yourself. At the hearing, you have the following rights:

  • To present your testimony and other witnesses in support of your claim;
  • To present documents that support your case;
  • To examine the records relied on by ORS; and
  • To cross-examine other witnesses.

You are entitled to assistance under the ORS Client Assistance Program (CAP) in the preparation, presentation and representation of your appeal.

If you desire, you may waive the right to an in-person hearing, and you may instead submit your evidence in writing to the hearing officer. The Hearing Officer will review the case file and any new evidence or information submitted by you, and he or she will make a decision based on that information.

You are entitled to the services of an interpreter or reader at the hearing. The interpreter or reader can be either sign language (if you rely on sign-language as your usual mode of communication) or non-English spoken language (if your normally spoken language is other than English). You should make your request for an interpreter or a reader at least 10 days before the date of the hearing.

If you are visually impaired, you may either request a reader to read materials provided by ORS in preparation for the hearing or request that the materials be provided in Braille, large print or audio tape. You must make this request within 5 working days after you have been informed of the date of the hearing.

An impartial hearing officer appointed by ORS will conduct the hearing. This officer must be randomly selected from a list of approved hearing officers maintained by ORS.

At least 3 working days before the hearing, you and the ORS staff person responsible for the action being appealed must provide each other and the Hearing Officer with a list of witnesses, copies of documents to be used which are not in the possession of the other party, and a summary of the evidence which you each plan to present at the hearing.

The hearing is conducted following more formal legal rules about what evidence can be used. It is strongly recommended that you be represented by an attorney or other trained Advocate in the appeal.

The Hearing Officer will make an audio tape recording of the hearing proceedings. In order to assist you in any further appeal, you may obtain one copy at no cost. If an audio tape is not an acceptable format for you due to your disability or mode of communication, at your request, ORS must prepare a transcript in an acceptable format, and provide one copy of the transcript to you at no cost.

You are entitled to any reasonable accommodation necessary to be able to file an appeal or to participate in the hearing. ORS must hold the hearing in the ORS office, or if necessary due to your disability, in your home. Hearing officers in HSP cases must be "approved" by the Illinois Department of Public Aid.

The Decision
Within 15 days of the conclusion of the hearing, the Hearing Officer will issue a written decision. The decision will explain the findings of facts and the relevant laws which are the basis of the decision.

The decision of the Hearing Officer is final, and is binding on ORS. ORS must start to implement the decision on the date specified in the decision, but no later than 20 calendar days after it is received.

Appeal to Illinois Circuit Court
You can appeal to the Illinois circuit court any ORS decision that is final.

The lawsuit in court is done under a procedure called "common law certiorari." You should file your lawsuit within 35 days from the date that the ORS decision is final. It is strongly recommended that you be represented by an attorney in these proceedings because of the complex legal rules that must be followed.

III. Where to Go for More Information

Related Home Services Programs

1. Home Based Support Program. The Illinois Department Human Services administers this program. It is for people between the age of 18-60 with a qualifying mental disability who need home-based support services, but not 24-hour a day supervision. See the section in this Chapter titled "Home Based Support Services for Adults with Mental Disabilities."

2. Home and Community Based Services Waiver Program. The Illinois Division of Specialized Care for Children (DSCC) administers this program. It helps families care for children with severe and persistent disabilities and illnesses in their own home rather than in a hospital or nursing home. See the section of this guidebook titled "Specialized Care and Treatment for Children with Severe Physical Disabilities," in Chapter 3, Care of Children with Disabilities.

3. Community Care Program. If you are age 60 or over, you may receive similar services through the Community Care Program of the Illinois Department on Aging. That program is not described in this guidebook, but you can get further information from the Department on Aging.

Statutes and Regulations
The portion of the Disabled Persons Rehabilitation Act, which outlines the purposes of the Home Services Program, can be found at 20 ILCS 2405/3.

The regulations of the Illinois Department of Human Services which govern the operation of the Home Services program are at 89 Ill.Admin Code Parts 676 through 686.

The regulations concerning the appeal process can be found at 89 Ill.Admin. Code Part 510. Further rules governing Level II hearings are found at 89 Ill.Admin.Code Part 104.

The federal regulation which permits the State to operate the Home Services Program with Medicaid funding as a Medicaid Waiver program are found at 42 CFR 440.180.

Who to Call
For more information about the Home Services Program and to locate the nearest ORS office call:

(800) 843-6154 (V)
(800) 447-6404 (V/TTY)

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