Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 240 - COMMUNITY CARE PROGRAM
Subpart C - RIGHTS AND RESPONSIBILITIES
Section 240.350 - Participant/Authorized Representative Cooperation
Universal Citation: 89 IL Admin Code ยง 240.350
Current through Register Vol. 48, No. 12, March 22, 2024
Participants/authorized representatives shall cooperate with the representatives of the Department/CCUs/providers in determinations of eligibility, redeterminations, other necessary or required face-to-face visits, or provision of CCP services.
a) Failure to cooperate in the actions specified below shall be considered non-cooperative and shall be cause for suspension.
1) A participant/authorized representative
shall notify the office of the provider at least 1 day in advance when the
participant will not be present in his/her home to receive scheduled services.
A) If the participant's absence from his/her
home on a day services are scheduled is due to an emergency, the
participant/authorized representative shall advise the office of the provider
as quickly as possible and it will not be considered non-cooperative.
B) The provider shall document the absences
of the participant without prior notification (except any absence caused by an
emergency) and shall be reimbursed by the Department for 2 such absences (see
Section
240.210
).
C) Two such documented absences
within a State fiscal year shall be cause for suspension of the participant's
services pending termination. The provider has the option of not reporting
non-cooperative absences; however, if the second non-cooperative absence is
reported with request for reimbursement, suspension procedures shall be
implemented.
D) The provider shall
verbally advise the CCU on the same day, if possible, but not later than the
next work day after the date of the second non-cooperative absence. A written
report including, at a minimum, the names of the participant and the worker,
and the dates of the first and second non-cooperative absence, shall be
submitted by the provider to the CCU within 2 work days after the date of the
second non-cooperative absence. The written report may be submitted in person
or through mail, facsimile or electronic means.
E) Upon receipt of verbal notification of the
second documented non-cooperative absence within a State fiscal year, the CCU
shall suspend the participant's services as required in Section
240.930. The date
of suspension shall be the date that the second non-cooperative absence
occurred.
2) A
participant/authorized representative shall notify the office of an adult day
service provider at least 1 day in advance when the participant will not be
attending the adult day service site or will not be in need of transportation
to or from the adult day service site, as scheduled and required by the
person-centered plan of care.
A) If the
participant's absence from the adult day service site or refusal to accept
transportation to the adult day service site is due to an emergency, the
participant/authorized representative shall advise the office of the provider
as quickly as possible and it will not be considered non-cooperative.
B) The provider shall document the
participant's absence or refusal to accept transportation without prior
notification thereof (except any absence caused by an emergency) and shall be
reimbursed by the Department for 2 such absences or refusals (refer to Section
240.230
).
C) Two such documented absences
or refusals within a State fiscal year shall be cause for suspension of the
participant's services pending termination. The provider has the option of not
reporting non-cooperative absences; however, if the second non-cooperative
absence is reported with request for reimbursement, suspension procedures shall
be implemented.
D) The provider
shall verbally advise the CCU on the same day, if possible, but not later than
the next work day after the date of the second non-cooperative absence or
refusal. A written report including, at a minimum, the names of the participant
and the worker and the dates of the first and second non-cooperative absence or
refusal, shall be mailed by the provider to the CCU within 2 work days after
the date of the second non-cooperative absence or refusal. The written report
may be submitted in person or through mail, facsimile or electronic
means.
E) Upon receipt of verbal
notification of the second documented non-cooperative absence or refusal within
a State fiscal year, the CCU shall suspend the participant's adult day service
(including transportation if specified in the person-centered plan of care) as
required in Section 240.930. The date of suspension shall be the date that the
second non-cooperative absence or refusal occurred.
3) A participant/authorized representative
shall not refuse to allow the provider into the participant's home to provide
services.
A) The provider shall document the
refusal to allow services to be provided and shall be reimbursed by the
Department for 2 such refusals (see Section 240.210).
B) Two such documented refusals within a
State fiscal year shall be cause for suspension of the participant's services
pending termination. The provider shall verbally advise the CCU on the same
day, if possible, but not later than the next work day after the date of the
second refusal. A written report including, at a minimum, the names of the
participant and the worker and the dates of the first and second refusal, shall
be mailed by the provider to the CCU within 2 work days after the date of the
second refusal. The written report may be submitted in person or through mail,
facsimile or electronic means.
C)
Upon receipt of verbal notification of the second documented refusal within a
State fiscal year, the CCU shall suspend the participant's services as required
in Section 240.930. The date of suspension shall be the date that the second
refusal to allow service occurred.
4) A participant/authorized representative
shall not interfere with provision of the services specified in the
person-centered plan of care, either in the participant's home or in any adult
day service site.
A) The provider shall
document the interference with provision of the services specified in the
person-centered plan of care.
B)
Two such documented instances of interference within a State fiscal year shall
be cause for suspension of the participant's services pending termination. The
provider shall verbally advise the CCU on the same day, if possible, but not
later than the next work day after the date of the second occurrence. A written
report including, at a minimum, the names of the participant and the worker and
the dates of the first and second occurrence, shall be submitted by the
provider to the CCU within 2 work days after the date of the second occurrence.
The written report may be submitted in person or through mail, facsimile or
electronic means.
C) Upon receipt
of verbal notification of the second documented occurrence of interference
within a State fiscal year, the CCU shall suspend the participant's services as
required in Section 240.930. The date of suspension shall be the date of the
second occurrence of interference occurrence.
5) A participant/authorized representative or
any family member/friend/acquaintance of the participant/authorized
representative shall not threaten or act abusively (e.g., physical, verbal,
sexual) or display a weapon (e.g., gun, knife) against any representative of
the Department, CCU or provider who is present in the participant's home or at
an adult day service site. The participant/authorized representative shall be
responsible for any animal present in the home of the participant and shall
prevent the animal from physically harming a representative of the
Department/CCU/provider.
A) If the threat or
abuse takes place in a participant's home, the party who has been threatened or
abused shall leave the premises immediately and verbally advise the CCU on the
same day, if possible, but not later than the next work day.
B) If the threat or abuse takes place in an
adult day service site, the family/authorized representative shall be advised
immediately and the CCU shall verbally be advised on the same day, if possible,
but not later than the next work day.
C) A written report including, at a minimum,
the name of the participant and the in-home worker/adult day service site
worker, and the date and details of the threat or abuse, shall be submitted by
the provider to the CCU within 2 work days after the date that the threat or
abuse occurred. The written report may be submitted in person or through mail,
facsimile or electronic means.
D)
Upon receipt of verbal notification of threat or abuse, the CCU shall, on the
same day, if possible, but not later than the next work day:
i) suspend a participant's services in the
participant's home and/or at an adult day service site, as required in Section
240.930; or
ii) suspend a
participant's determination of eligibility process as required in Section
240.930.
E) The date of
suspension shall be the date that the threat or abuse occurred.
6) A participant/authorized
representative and/or any family member/friend/acquaintance of the
participant/authorized representative will be responsible for damages to or
loss of the AMD equipment or Emergency Home Response base unit or activation
devices unless a law enforcement report of theft or intentional damage has been
filed.
A) The provider will document the
damages/loss of the equipment.
B)
One documented occurrence of intentional damages/loss of equipment will be
cause for suspension of the participant's services, pending termination. The
provider shall verbally advise the CCU on the same day, if possible, but not
later than the next work day after the date of the occurrence. A written
report, including, at a minimum, the names of the participant and the worker
and the date of the occurrence, will be submitted by the provider to the CCU
within 2 work days after the date of the occurrence. The written report may be
submitted in person or through mail, facsimile or electronic means.
C) Upon receipt of verbal notification of the
documented occurrence of intentional damages or loss of equipment within a
State fiscal year, the CCU will suspend the participant's services as required
in Section 240.930. The date of suspension will be the date of the occurrence
of damages to or loss of equipment.
7) The CCU shall notify the
participant/authorized representative and the provider of the suspension in
accordance with Section
240.930(c) and
(d).
8) The CCU shall develop a memorandum of
understanding between the participant/authorized representative of the CCU and
the provider, in accordance with Section
240.930(e).
9) Upon the execution of the memorandum of
understanding, the participant's services or the participant's determination of
eligibility process, as appropriate, shall be reinstated in accordance with
Section
240.930(f).
10) Failure to sign a memorandum of
understanding shall be grounds for termination or denial, as
appropriate.
11) If, following
reinstatement, the requirements of the memorandum of understanding have not
been adhered to by the participant/authorized representative, the request for
services shall be denied or services shall be terminated, as
appropriate.
12) Notification of
denial or termination shall be in accordance with Section
240.910
or
240.945, as
appropriate.
b) Failure to cooperate in the actions specified in this subsection (b) shall be considered non-cooperation and shall be cause for denial of a request for services or termination of service, as appropriate.
1) A participant/authorized representative or
any family member/friend/acquaintance of the participant/authorized
representative shall not inflict physical injury upon any representative of the
Department, CCU or provider, either in the participant's home or while the
participant is attending an adult day service site.
A) If the infliction of physical injury takes
place in the participant's home, the injured party shall leave the premises
immediately and verbally advise the CCU on the same day, if possible, but not
later than the next work day.
B) If
the infliction of physical injury takes place in an adult day service site, the
family/authorized representative shall be advised immediately and the
participant shall be removed immediately. The CCU shall verbally be advised on
the same day, if possible, but not later than the next work day.
C) A written report including, at a minimum,
the names of the participant and the worker/adult day service site worker, and
the date and details of the infliction of physical injury, shall be mailed by
the provider to the CCU within 2 work days after the date that the physical
injury was inflicted. The written report may be submitted in person or through
mail, facsimile or electronic means.
D) Upon receipt of verbal notification of
physical injury the CCU shall, on the same day, if possible, but not later than
the next work day:
i) institute immediate
denial of a request for services or termination of services. The effective date
of denial or termination shall be the date that the infliction of physical
injury occurred;
ii) verbally
notify the participant/authorized representative of the denial or termination.
Written notification shall be sent by certified mail to the
participant/authorized representative, and by regular mail to the provider
within 5 calendar days after the date of the verbal notification; and
iii) verbally notify the Department of the
denial or termination followed by a written report within 5 calendar days after
the date of the verbal notification.
2) Participants/authorized representatives
shall provide assistance in securing documentation and/or factual information
to be utilized in the determination of initial and continuing eligibility for
CCP services, as well as the type, level and amount of services to be provided.
Refusal to provide the specified assistance needed shall be cause for denial of
a request for service or termination of a participant's services as
appropriate.
3)
Participants/authorized representatives shall provide a mailing address,
including sufficient information to enable the Department/CCU/provider to
locate the participant/authorized representative (i.e., the name, address and
telephone number of a contact through whom the participant may be located; it
may be necessary to provide directions to the participant's home). Refusal to
provide the specified assistance needed shall be cause for denial of a request
for service or termination of a participant's services as
appropriate.
4) Notification of
denial or termination shall be in accordance with Section
240.910
or 240.945, except as specified in subsection (b)(1)(D).
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