Current through Register Vol. 48, No. 38, September 20, 2024
The Department may be appropriated funds to pay an enhanced
rate under CCP to those in-home service provider agencies that offer health
insurance coverage as a benefit to their direct service worker
employees.
a) Definitions
For purposes of this Section:
"Direct service worker" means an employee who provides
homecare aide services for an in-home service provider agency under CCP.
"Health insurance" means a Type 1 plan or a Type 2
plan.
1) Type 1 Plan
A Type 1 plan must comply with, be comparable to, or exceed
required mandated benefits, coverages, and co-payment levels for individual and
group insurance policies under the Illinois Insurance Code [215 ILCS 5] and 50
Ill. Adm. Code, Subchapter ww and individual and group contracts for health
maintenance organizations under the Health Maintenance Organization Act [215
ILCS 125] and 50 Ill. Adm. Code 4521.
2) Type 2 Plan
A Type 2 plan is employer-paid health insurance as part of
collective bargaining with unionized direct service workers through a
Taft-Hartley Multi-employer Health and Welfare Plan that defines the
eligibility requirements and coverage under section 302(c)(5) of the Labor
Management Relations Act of 1947 (29 U.S.C.
141).
b) Initial Application
An interested in-home service provider agency must submit an
initial application at least 120 days prior to the end of each State fiscal
year. Applications will be accepted by the Department at its main office
located in Springfield.
c)
Eligibility
Eligibility requirements include:
1) Verification of a current contract as an
in-home service provider agency with the Department under CCP.
2) A copy of a health insurance plan or a
certificate of insurance, and the effective date of that document, to establish
that:
A) the in-home service provider agency
provides health insurance at its own expense to its direct service workers,
which may include coverage for those employees' dependents; or
B) the in-home service provider agency will
provide for health insurance as part of collective bargaining with unionized
direct service workers, which may include coverage for those employees'
dependents through a Taft-Hartley Multi-employer Health and Welfare
Plan.
3) Specification
of the total number of employees and the total number of direct service
workers, together with a certification from a responsible party for the in-home
service provider agency to the effect that:
A)
under a Type 1 health insurance plan:
i)
health insurance coverage is offered to all direct service workers who have
worked at least an average of 20 hours per week for three consecutive months
under the CCP; and
ii) at least 25%
of the total number of direct service workers accept the offer of health
insurance.
B) under a
Type 2 health insurance plan:
i) health
insurance coverage is offered to all of the direct service workers subject to
the collective bargaining agreement who have worked at least an average of 20
hours per week for three consecutive months under the CCP; and
ii) at least 25% of the total number of
direct service workers, or any higher percentage required under federal law,
accept the offer of health insurance.
4) Submission of any other relevant
information requested by the Department for administrative or audit
purposes.
d) Impact on
Financial Reporting
1) An in-home service
provider agency shall not report the enhanced rate for health insurance costs
paid by the Department under this Section as part of its revenue for purposes
of the required financial reporting under Subpart T.
2) An in-home service provider agency shall
not report health insurance for direct service workers as an incurred cost for
purposes of the required financial reporting under Subpart T, except for an
amount in excess of the enhanced rate paid by the Department during a reporting
period.
e) Payment
1) If an in-home service provider agency is
determined eligible for this enhanced rate, the Department will thereafter
calculate the appropriate payment based on the number of units of in-home
service accepted as billed per contract once the provider agency submits its
VRFP under the CCP (see Section
240.1520) for reimbursement
under this Section. Payments may be adjusted by the Department to properly
account for services provided to participants. Payment is subject to the
availability of appropriations during the State fiscal year.
2) An in-home service provider agency that
makes a switch between a Type 1 and a Type 2 plan is not entitled to any
retroactive payments for a period of time preceding the date on which benefits
are actually available under the new plan.
3) No in-home service provider agency is
entitled to a duplicate payment for the same period of time or for the same
units of in-home service accepted as billed per contract.
4) By accepting any payment under the CCP, an
in-home service provider agency agrees to repay the State of Illinois if:
A) the total revenue from the enhanced rate
for health insurance costs exceeds the actual, documented expenses for its
health insurance costs for the reporting period; or
B) an error in eligibility of an in-home
service provider agency or the amount of revenue from the enhanced rate for
health insurance or the amount of the health insurance costs is subsequently
determined by an in-home service provider agency or the Department.
5) In the case of a financial or
operational hardship, the Department may deduct an overpayment from future
VRFPs submitted by the in-home service provider agency instead of collecting a
lump-sum amount.
f)
Notification
It is the responsibility of an in-home service provider
agency to notify the Department within seven days after any change in its
eligibility status, including, but not limited to, cancellation or termination
of the health insurance plan or purchase of a new plan. An in-home service
provider agency is only required to monitor participation by direct service
workers in order to submit the initial application, the annual insurance
review, and required financial reporting.
g) Annual Insurance Review
1) Once an in-home service provider agency is
determined eligible by the Department and is paid an enhanced rate for health
insurance costs, the provider agency shall thereafter substantiate its
continued eligibility under subsection (c) by submitting appropriate supporting
documentation at the same time as its annual financial report under Subpart
T.
2) As part of the annual
insurance review, an independent certified public accounting firm for the
in-home service provider agency must verify the actual, documented expense for
health insurance for the period listed as part of the required financial
reporting under Subpart T.
3) The
Department reserves the right to require an in-home service provider agency to
engage an independent certified public accounting firm to verify the
information and data submitted by the provider agency if the Department is in
possession of evidence to suggest the information and data submitted is
inaccurate, incomplete or fraudulent. This audit will be performed at the
in-home service provider agency's expense.
4) The Department shall notify an in-home
service provider agency in the event of a determination during the annual
insurance review that:
A) the in-home service
provider agency is no longer eligible for continued payment of the enhanced
rate for health insurance costs;
B)
the total revenue from the enhanced rate for health insurance costs exceeds the
actual, documented expenses for health insurance costs for the reporting
period;
C) there was an error in
eligibility of an in-home service provider agency for the prior reporting
period;
D) there was an error in
the amount of revenue from the enhanced rate for health insurance costs;
or
E) there was an error in the
amount of the health insurance costs.
5) An in-home service provider agency may
appeal from an adverse eligibility decision regarding continued payment of the
enhanced rate for health insurance costs or a repayment decision in accordance
with Section 240.1661. The Department will
continue to pay the enhanced rate for health insurance costs until the appeal
is resolved.
6) Supporting
documentation may be subject to release under the Freedom of Information Act
unless an applicable exemption for confidentiality, privacy, or other
proprietary business purpose is marked on the face of any submission.
