PM 11-03-04

For an allowance to be considered for care in a home not subject to licensing, the specific home in which the client is receiving care must be currently approved.

Outside Cook County

  1. (FCRC) Complete Evaluation of Home Not Subject to Licensing (Form 330) in duplicate and submit both copies to the BLTC Regional Supervisor.
  2. (FCRC) One copy of the form will be returned to the Family Community Resource Center indicating approval or disapproval of the home.

    If approved, the level of care and period for which the approval is given will be stated. 

  3. (FCRC) Complete Form 330 at least annually to determine if the home is adequate. Send Form 330 to the BLTC Regional Supervisor.
  4. (FCRC) Complete Evaluation of Need for Care (Form 184b) to determine a person's need for care and point count assessment in a home not subject to licensing.
    1. See WAG 11-03-02 for completing Form 184b.
    2. Submit Form 184b along with Form 330 to the BLTC Regional Supervisor for review and disposition.
    3. Keep a copy of Form 184b in the case record.
  5. (FCRC) Disposition will be indicated on Form 330 and returned to the Family Community Resource Center within 14 calendar days of the date the form is submitted by the Family Community Resource Center.

Cook County

In Cook County, when placement in a home not subject to licensing is indicated:

  1. (FCRC)  Send Medical Evaluation for Nursing or Sheltered Care (Form 184c) to the person's attending doctor.
  2. (FCRC) Use Form 330 to make a referral to Medical Field Operations upon receipt of the completed Form 184c. Complete only the case identification information and basic information regarding the operator, including:
    • name,
    • address, and
    • telephone number.
  3. (Medical Field Operations) Receives Form 330 from Family Community Resource Center and makes both the patient and home evaluation.
  4. (Medical Field Operations) Informs the Family Community Resource Center of the determination by memorandum.
  5. (FCRC) If the case is approved for placement:
    • make appropriate changes on Form 552 and in the case record, and
    • transfer the case to Medical Field Operations.

See WAG 11-03-02 to determine the amount allowed for care based on individual need.