Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 240 - COMMUNITY CARE PROGRAM
Subpart B - SERVICE DEFINITIONS
Section 240.260 - Care Coordination Service
Universal Citation: 89 IL Admin Code ยง 240.260
Current through Register Vol. 48, No. 12, March 22, 2024
Care coordination service is defined as the provision of a comprehensive needs assessment and service coordination by CCUs to assist an older person to gain access to and receive needed services. The participant/authorized representative is provided the opportunity to lead the person-centered planning process.
a) Service Components
Specific components of care coordination service include the following:
1) Review of all inquiries
to determine if a request for CCP services is desired, and maintenance of a
referral request log.
2)
Distribution and assistance with completion of CCP applications for charitable,
private, and public benefits provided by federal, State and local agencies,
including assistance with the initial application and redetermination for
Medicaid benefits.
3) Performance
of determinations/redeterminations of eligibility, including a comprehensive
needs assessment, the development of a person-centered plan of care and
authorization/referral of CCP services.
4) Completion of a minimum of 1 face-to-face
contact with the participant in between initial assessment and annual
reassessment. The face-to-face visit is to occur between 4 and 8 months after
the last determination or redetermination of eligibility.
5) Reporting of critical events includes
critical incidents, service improvement program complaints, and requests for
change of status in the Department's automated reporting system. Completing
initial critical event reports will occur within 7 days after the date the
event occurred or was identified to have occurred. All critical event reports
will be closed to reflect mandatory follow-up with CCP participants within 60
days after the date the event occurred or was identified to have occurred.
Critical event report closure will occur through completion of the 60-day
review summary housed in the Department's automated reporting system.
6) Availability to receive inquiries and
requests for services and supports, by telephone or in person, and respond to
those inquiries and requests.
7)
Choices for Care prescreenings and postscreenings (see Section
240.1010
).
8) Department of Healthcare and
Family Services (HFS) OBRA-1 (Level I ID Screen).
9) Provide referrals to other needed
services.
10) Implementation of
services and participant transfers.
11) Authorization of all actions related to
the disposition of CCP services as required by this Part.
b) Comprehensive Assessments
1) A comprehensive assessment is required
when a participant needs services to remain living independently in the
community or is at imminent risk of nursing facility placement.
2) A comprehensive assessment is not
warranted when a participant only requires a referral to services (e.g.,
providing contact information for a vendor).
3) Conditions triggering a comprehensive
assessment may include, but are not limited to:
A) multiple or complex health problems which
are often chronic in nature, and may affect the ability of the participant to
live independently, such as musculoskeletal disorders, strokes, heart
disorders, or mental health issues (e.g., Alzheimer's disease, major
depression, or organic brain syndrome).
B) lack of sufficient formal or informal
supports; or
C) sudden and
permanent loss of a primary caregiver.
4) The Care Coordinator will appropriately
complete the comprehensive assessment tool authorized by the Department, or any
successor assessment tool, used to determine need for community-based or
long-term services and supports, that is relevant to the participant in a
manner consistent with the responsibilities set forth under Section
240.1420.
c) Goals of Care
1) Each participant/authorized representative
is provided the opportunity to lead the person-centered planning process where
possible. The participant's authorized representative should have a
participatory role, as needed and defined by the participant, unless State law
confers decision-making authority to the legal representative.
2) If a participant's Goals of Care cannot be
developed to create an adequate person-centered plan of care, the Care
Coordinator is required to discuss the risks associated with the preferences
and selections made regarding one or more specific goals by the
participant/authorized representative and suggest any alternative options
and/or referrals that might be available to mitigate risk.
3) Each participant will be advised by the
Care Coordinator of his/her right to accept or refuse some or all offered
services developed in participants' Goals of Care.
d) Reassessments
1) A reassessment will be conducted
face-to-face on at least an annual basis to determine if the participant
remains eligible for the program or if changes in the participant's services
under the person-centered plan of care are needed and/or the Goals of Care need
to be revised.
2) A reassessment
will also be conducted when requested by a participant/authorized
representative or when a participant may have experienced a change in his/her
needs.
3) The
participant/authorized representative develops his/her own revised Goals of
Care with input from the Care Coordinator consistent with the responsibilities
set forth in Section 240.1420.
e) Unit of Service
Several different types of assessments constitute a care coordination unit of service for which reimbursement is made.
1) Completion of 1 initial eligibility
determination for CCP services constitutes 1 unit.
2) Completion of 1 required continuous
eligibility redetermination of CCP eligibility constitutes 1 unit. A
redetermination shall be completed at least annually.
3) Completion of either 1 face-to-face
prescreening or postscreen of a participant constitutes 1 unit.
4) Completion of 1 HFS Interagency
Certification of Screening Results form constitutes 1 unit.
5) Availability to receive participant
inquiries and requests, by telephone or in person, and to respond to those
inquiries and requests for each active participant per month constitutes 1
unit.
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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