Current through Register Vol. 48, No. 12, March 22, 2024
An enhanced rate shall be paid to Homemaker Service Providers
that offer health insurance coverage as a benefit to their Homemaker employees
who provide services to customers under HSP.
a) For purposes of this Section, "health
insurance" means a Type 1 plan or a Type 2 plan as described in subsections
(a)(1) and (2).
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 individuals
and group insurance policies and individual and group contracts for health
maintenance organizations under the Illinois Insurance Code [215 ILCS 5 ], the
Health Maintenance Organization Act [215 ILCS 125 ], and 50 Ill. Adm. Code
2001.
2) Type 2 Plan
A Type 2 plan is employer-paid health insurance as part of
collective bargaining with unionized Homemaker employees through a Taft-Hartley
Multi-employer Health and Welfare Plan. The Labor Management Relations Act of
1947 (
29 USC
141 et seq.) describes the requirements and
coverage at
29 USC
186(c)(5).
b) Initial Application
1) An interested Homemaker Service Provider
must submit an initial application at least 120 days prior to the end of each
State fiscal year. The application may be obtained from and must be submitted
to the Home Services Liaison for Health Insurance, Department of Human
Services, 100 South Grand Avenue East, P.O. Box 19429, Springfield, Illinois
62794-9429.
2) Homemaker Service
Providers that are found by HSP to have deficiencies may not apply for the
enhanced rate until deficiencies are corrected to the satisfaction of
HSP.
c) Eligibility
Eligibility requirements include:
1) Verification of a current rate agreement
as a Homemaker Service Provider under the HSP.
2) A copy of a health insurance plan or a
certification of insurance and the effective date of that document, to
establish that:
A) the Homemaker Service
Provider provides health insurance at its own expense for its Homemaker
employees, which may include coverage for those employees' dependents;
or
B) the Homemaker Service
Provider will provide for health insurance as part of collective bargaining
with unionized Homemaker employees, 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 Homemaker employees,
together with a certification from a responsible party for the Homemaker
Service Provider to the effect that:
A) under
a Type 1 health insurance plan:
i) health
insurance coverage is offered to all Homemaker employees who have worked at
least an average of 20 hours per week for three consecutive months under HSP;
and
ii) at least one quarter of the
total number of Homemaker employees accept the offer of health
insurance.
B) under a
Type 2 health insurance plan:
i) health
insurance coverage is offered to all of the Homemaker employees subject to the
collective bargaining agreement who have worked at least an average of 20 hours
per week for three consecutive months under HSP; and
ii) at least one quarter of the total number
of Homemaker employees, or any higher percentage required under federal law,
accept the offer of health insurance.
4) Submission of any other relevant
information requested by HSP for administrative or audit purposes.
d) Notification
It is the responsibility of a Homemaker Service Provider to
notify HSP within 7 days of 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. A Homemaker Service Provider is only required to
monitor participation by Homemaker employees in order to submit the initial
application, the Annual Insurance Review required by subsection (e), and
required financial reporting.
e) Annual Insurance Review
1) Once a Homemaker Service Provider is
determined eligible by HSP and is paid an enhanced rate for health insurance
costs, the Homemaker Service Provider must thereafter substantiate its
continued eligibility under subsection (c) by submitting appropriate supporting
documentation at the same time as its annual financial report under Section
686.250.
2) As part of the Annual Insurance Review, an
independent certified public accounting firm for the Homemaker Service Provider
must verify the actual, documented expense for health insurance provided for
the period listed as part of the required financial reporting under Section
686.250.
3) HSP reserves the right
to require a Homemaker Service Provider to engage an independent certified
public accounting firm, approved by HSP, to verify the information and data
submitted by the Homemaker Service Provider if HSP is in possession of evidence
to suggest the information and data submitted is inaccurate, incomplete or
fraudulent. This audit will be performed at the Homemaker Service Provider's
expense.
4) HSP shall notify a
Homemaker Service Provider in the event of a determination during the Annual
Insurance Review that:
A) the Homemaker
Service Provider 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 a Homemaker Service Provider 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) A Homemaker Service Provider may appeal an
adverse eligibility decision regarding continued payment of the enhanced rate
for health insurance costs or a repayment decision in accordance with Section
686.230.
HSP 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 [5
ILCS 140 ] unless an exemption applies for confidentiality, privacy, or other
proprietary business purpose and is marked accordingly on the face of any
submission.