Illinois Administrative Code
Title 59 - MENTAL HEALTH
Part 120 - MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES
Subpart A - GENERAL PROVISIONS
Section 120.40 - Service descriptions
Universal Citation: 59 IL Admin Code ยง 120.40
Current through Register Vol. 48, No. 12, March 22, 2024
This Section describes the services covered under the Medicaid home and community-based services waiver program. All services shall be rendered in accordance with a written individual service/support plan and shall be designed to ensure the continuity of supports and services for individuals.
a) Respite
1) This service is designed to provide relief
on a short-term basis for the primary caregiver (that person responsible for
the care and supervision of the individual on a daily basis) in times of
emergencies and on a regularly scheduled basis to reduce stress, thereby
reducing the potential for crises.
2) Respite may be provided at the
individual's natural or foster home. The respite worker may accompany the
individual on day outings, consistent with the individual's needs, the
individual service/support plan, and the direction of the primary caregiver.
Respite may not be provided in day habilitation sites or to residents of
Department-funded 24-hour residential settings.
3) The respite provider is responsible for
the following:
A) The individual's health and
well-being;
B) Continuation of the
individual service/support plan as indicated by the primary caregiver,
and;
C) Assumption of duties held
by the primary caregiver, i.e., supervision and personal care.
b) Habilitation services
1) Habilitation services are designed
to assist individuals in acquiring, retaining and improving the self-help,
socialization, and adaptive skills necessary to reside successfully in home and
community-based settings. Habilitation services do not include the following:
A) Special education and related services (as
defined in Sections 602(16) and (17) of the Individuals with Disabilities
Education Act ( 30 U.S.C.A. 1400(1996) ) which otherwise are available to the
individual through a local education agency; and
B) Vocational rehabilitation services which
otherwise are available to the individual through a program funded under
Section 110 of the Rehabilitation Act of 1973 ( 29 U.S.C.A. 794(1995)
).
2) Habilitation
services may vary in intensity and duration in accordance with the individual
service/support plan. Habilitation may be provided in a variety of settings and
includes:
A) Support and training provided in
a developmental training (DT) program as defined in the Department's rules at
59 Ill. Adm. Code 119;
B) Temporary
behavior interventions, training and intensive therapy designed to reduce
maladaptive behaviors and assist in the transition from more restrictive to
less restrictive options in the community;
C) Supports and services provided in the
individual's home or in a community residential setting, including a community
living facility (CLF), community residential alternative (CRA), home individual
program (HIP), or special home placement (SHP);
D) Supports and services provided through the
community integrated living (CILA) program as described in the Department's
rules at 59 Ill. Adm. Code 115; and
E) Supported employment (SEP), limited to
individuals who previously resided in a Medicaid-certified State-operated
developmental center, community ICF/MR or nursing facility. Standards for
supported employment program regulations at
34 CFR
363.3,
363.4,
363.6 and
363.11(e)
(2-3) (1996).
c) Adaptive equipment and minor modifications to the home
1) Adaptive equipment and minor
modifications to the home shall be covered only when they are necessary to
prevent institutional placement, to deinstitutionalize an individual, or to
allow the individual to participate in specialized services for individuals
with developmental disabilities.
2)
Adaptive equipment and minor modifications to the home shall be for the direct
benefit of the individual and shall not be otherwise available under the State
Medicaid Plan (the Illinois Public Aid Code [305 ILCS 5 ]).
3) Personal adaptive equipment includes
mobility devices, seating and positioning supports, transfer assists or lifts,
communication devices, and sensory aids. Personal adaptive equipment shall be
prescribed by a physician, or by a qualified health professional who meets
State standards as an occupational therapist pursuant to the Illinois
Occupational Therapy Practice Act [225 ILCS 75 ], physical therapist pursuant
to the Illinois Physical Therapy Act [225 ILCS 90 ], or speech and language
therapist pursuant to the Illinois Speech-Language Pathology and Audiology
Practice Act [225 ILCS 110 ], as appropriate to the disability.
4) Professional evaluations for personal
adaptive equipment needs are covered but only when not covered as a part of the
PASARR process or under the State Medicaid Plan.
5) Other adaptive equipment includes:
A) Specialized beds;
B) Carrying equipment;
C) Adaptive equipment for timing, measuring
and self-administering medications;
D) Feeding machines;
E) Adaptive utensils and equipment for
eating, bathing, grooming, self-care, cooking and household chores;
F) Adaptive labels, controls and
instructions;
G) Environmental
controls;
H) Closed caption
decoders;
I) Adapted or
programmable telephones;
J)
Prerecorded message players; and
K)
Pagers, intercoms, emergency signalers and adapted alarm clocks.
6) Minor modifications to the home
includes grab bars or handrails, ramps, widening of doorways and halls, lowered
or adaptive door handles, accessible kitchen and bathroom appliances, pullout
shelving and adapted fire alarms, smoke detectors and doorbells.
7) Other adaptive equipment, minor
modifications to the home and professional evaluations for personal adaptive
equipment needs shall be authorized as part of the individual service/support
plan and be approved by the planning team.
Disclaimer: These regulations may not be the most recent version. Illinois may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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