Frequently Asked Questions Regarding Service Facilitation and the Home-Based Services Program

Last updated September 2017

[Note:The most frequent updates will be toward the end of the document.]

HBS Frequently Asked Questions, March 2017

  1. What is the Home-Based Service Program?
    • The Home-Based Service (HBS) program is one option available to children and adults with intellectual and developmental disabilities through the Medicaid Waiver program. The HBS program provides individuals with a monthly allotment they can use to purchase needed services and supports that allow a person to continue to live in the family residence or a live in their own home in the community.
  2. How many people are in the HBS program in Illinois?
    • 6,784 adults and 1,368 children participated in the HBS program as of 12/31/16.
  3. How much money is available to people in the HBS program?
    • Adults participating in the HBS program receive a monthly allotment of $2,205 which is used to purchase services; children in special education receive a monthly allotment of $1,470 to purchase services.
  4. How can my family member participate in the HBS program?
    • If your family member is selected through the Prioritization of Urgency of Need for Services (PUNS) to receive Medicaid Waiver services, you can select this program from among the Medicaid Waiver options that your Independent Service Coordinator shares with you. If you feel that your family is in a crisis situation, you can ask your Independent Service Coordination (ISC) agency about applying for crisis funding.
  5. What change is occurring in the Home-Based Services (HBS) program?
    • Effective 7/1/17, HBS participants will now have the choice whether to purchase Service Facilitation (SF) from a community agency.
  6. Why is this change occurring?
    • The federal agency that oversees the Medicaid program, has informed Illinois that the current practice of requiring HBS participants to purchase Service Facilitation is no longer permissible, and that HBS participants must be free to choose whether or not they want to purchase this service.
  7. What does a Service Facilitator do?
    • Service Facilitators provide skills training to enable families and participants to independently direct and manage self-directed services. They provide information and assistance in recruiting, hiring, communicating with, and managing Personal Support Workers. They provide assistance with budgeting and funding allocation management. They provide training and assistance with completion of timekeeping and other employer-related tasks required to interface with the Fiscal Management Agency.
  8. Who will be responsible for completing Service Facilitator duties if I choose not to purchase it?
    • If you choose not to purchase Service Facilitation, you will be responsible for completing the tasks which are presently completed by a Service Facilitator.
  9. What happens to the current money being spent for Service Facilitation if I choose not to continue purchasing it?
    • Your total monthly allocation does not change; if you choose not to continue purchasing Service Facilitation, you can use the money you are currently spending on Service Facilitation to purchase other waiver authorized services.
  10. I'm not sure what I should do, is there someone I can talk to in person about this decision?
    • Yes, your current Service Facilitator and Individual Service Coordinator (ISC) can assist you in understanding the options available to you and assist you to decide what's best for you and your family.
  11. If I choose not to purchase Service Facilitation, can I change my mind?
    • Yes, choice is an important quality within all Medicaid Waiver programs. However, agencies are not required to provide Service Facilitation and some agencies are considering whether this is a service option they will continue offering in the future. Your ISC can help you find out which agencies in your community will be offering this service in the future and share information with you on how to contact them if you are interested in resuming Service Facilitation.
  12. What is the difference between a Service Facilitator and an Individual Service Coordinator?
    • Individual Service Coordinators fulfill the conflict-free case management duties that the federal government requires each state to include in their Medicaid Waiver program. "Conflict-free" means that ISC agencies only provide that service and do not also offer program services. The specific requirements that ISCs fulfill include:
      • Determine eligibility for Waiver services;
      • Advocacy;
      • Development of a Person-Centered Plan to guide service delivery;
      • Referral and linkage to services and resources;
      • Service monitoring;
      • Conflict resolution; and
      • Monitoring of a person in the DD Waiver to ensure the health, welfare, and safety.
    • Service Facilitators provide skills training to families so that they can more independently direct and manage self-directed services. They will assist the participants and families with issues related to hiring and managing personal support workers. See Question #7.
  13. Has the state received input about the changes to the HBS program?
    • Yes, the state has established a workgroup, consisting of a wide range of stakeholders including self-advocates, families, service providers, ISC agencies, statewide membership associations and state agency personnel to assist in creating resources and materials to help individuals and families understand the pending changes and what options they have. The workgroup continues to meet and share ideas and input with the state regarding Service Facilitation and other aspects of the HBS program to assure that everyone understands the purpose of the HBS program and requirements for participants.
  14. I've heard about Person Centered Planning; how does this affect the HBS program?
    • Person Centered Planning is another requirement that Illinois must comply with to continue to receive Federal Medicaid Waiver funding. Person Centered Planning must be completed by a "conflict-free" entity that does not also provide direct services. Illinois is presently training ISC agencies on new tools that will be used for all participants in Medicaid Wavier programs, including the HBS program. The ISC will meet with the person and others the person invites to develop a plan that will guide service delivery. The plan address the areas listed below, recognizing that not all areas will be priorities or equally important for all people:
      • Relationships and Social Status
      • Life at Home and in the Community
      • Career
      • Health and Wellbeing
      • Choice and Decision-Making
    • The ISC will review ongoing service delivery to assure that services the person is receiving address the priorities outlined in the person-centered plan and are supporting the achievement of outcomes included in the plan.
  15. If I choose not to continue to purchase Service Facilitator services, who can I call if I have a problem?
    • Your first contact should be with your Individual Service Coordinator to see if they can assist you or direct you to a resource that may be helpful.
  16. If I choose to continue purchasing Service Facilitation, do I have to make a commitment to purchase it for a designated period?
    • Individual agencies may establish their own policies and practices for Service Facilitation requirements so that they can make hiring and other decisions necessary to assure the availability of sufficient personnel to provide the service.

HBS Frequently Asked Questions, June 2017

  1. We (as an ISC) believe that it would make a difference if DDD changed the name of Service Facilitation.
    • The Division is changing the name of Service Facilitation. It is officially known in the Waiver(s) as Information and Assistance in Support of Participant Direction. In Illinois, we will be referring to it as Self Direction Assistance (SDA).
  2. Will DDD continue to maintain the SDA (formerly known as Service Facilitation) provider list on the DDD Website?
    • Yes.
  3. If we have a new family enroll in Home-based Services in June, they will only have SDA (formerly known as Service Facilitation) for a month. Will the ISC be expected to re-discuss the SDA decision after July 1?
    • The Division would recommend that the ISC discuss the upcoming change and do the paperwork for both options at the time of the visit.
  4. How will crisis service implementation work in the absence of a family not choosing SDA? Who should sign the crisis application if there is no SDA?
    • The ISC agency is still responsible for making sure that crisis services begin within 72 hours and documenting the implementation of services. This will be covered under PAS hours. If there is no SDA (SF) then leave that signature blank.
  5. If an individual is new to services and they do not choose to purchase Self Directed Assistance (SDA) formerly known as Service Facilitation, who completes all the initial paperwork (contracts, fiscal forms, tax forms, background check information, etc.)?
    • The individual/family will be responsible, along with the FE/A to complete the paperwork (service authorization and agreement) as well as the enrollment forms for Personal Support Workers. The background check, tax forms will be completed by the FE/A and the individual/family
  6. If an individual/family chooses self-directed services and the ISC writes the personal plan, who writes the implementation strategy?
    • Requirements for implementation strategies for HBS Personal Support services are under discussion at the Division. At this point, we do not know what form that will take or when that will be implemented. Stakeholders will be included in these discussions before any decisions are made. In the meantime, there is not an implementation strategy requirement for HBS personal support services that would be effective July 1, 2017.
  7. If a form has a place for the SDA (formerly known as Service Facilitator) signature and the individual/family has elected not to purchase SDA, who should sign?
    • For now, if you don't have a SDA (Service Facilitator) you should leave it blank. We will be revising forms in the future to address the changes.
  8. If mother is guardian and PSW and she chooses not to have a SDA (Service Facilitator), does DHS require another person to sign off/approve her paperwork such as progress on goals and billing paperwork?
    • If mother is the PSW, she cannot also be the Employer of Record. The Employer of Record would be the one to deal with the billing paperwork. The guardian would be the one to sign off on any services/personal plan related paperwork.
  9. If an individual/family chooses to self-direct who finds the PSWs?
    • The individual/family need to find their PSWs either through an agency or on their own. They may also employ a Self Direction Agency to assist with this activity, consistent with the definition of SDA below.
    • Self Direction Assistance (previously known as Service Facilitation) assists the participant (or the participant's family or representative, as appropriate) in arranging for, directing and managing services. Practical skills training is offered to enable families and participants to independently direct and manage waiver services. Examples of skills training include providing information on recruiting and hiring personal support workers, managing workers, and providing information on effective communication and problem-solving. The service/function includes providing information to ensure that participants understand the responsibilities involved with directing their services. The extent of the assistance furnished to the participant or family is specified in the personal plan.
  10. Providers have always assisted families with Medicaid eligibility. We are hearing that DHS is considering charging ISCs with the responsibility beginning 7/1/17. Will this be approved as additional hours under ISSA?
    • There will be no additional hours approved for Medicaid issues. Families will also be held responsible for completing paperwork as needed and following up on the redeterminations.
  11. Will there be Spanish Translation of the Documents that are on the website?
    • The Division is currently working on getting a Spanish, Korean, and Polish translation of the explanatory documents that are on the website. Any forms that are revised in the future will be going through the forms committee and will have translations.
  12. Will there be a policy from the Fiscal Intermediaries related to how many times a family may not properly complete the time sheets, not properly coordinate hours between DT hours and PSW hours, and are over budget for any other reason? What will be the consequence to the family/consumer if the communication with the family/consumer is unsuccessful to correct these issues?
    • The proposed Waiver added a section on Involuntary Termination of Participant-Directed Home-based Support Services (HBS) for cases where the ISC and FE/A have determined and documented that the participant and/or his or her employer of record are not able to direct their own services, either with or without the assistance of a Service Facilitation agency. The HBS workgroup is developing guidelines for this process.
  13. We (ISC agency) agree that Medicaid redeterminations are an ISSA responsibility and are seeking better solutions to long standing issues. Medicaid Redeterminations for Children continue to be an issue. At the time of redetermination, it appears that Maximus is unable to verify or see a copy of the HBS award so they most frequently route the redetermination to HFS, creating enormous delays, often results in the person being dropped from Medicaid, and payments issues. The same issues can occur when the individual turns 19 and switches from All Kids to Medicaid. We would like to discuss issues with Medicaid redeterminations.
    • We would recommend checking redetermination dates on Medi, and then if Maximus is unable to verify the award, send them a copy. The Division is looking into doing some training regarding Medicaid issues/redeterminations. There is ongoing discussion about better processes for our individuals on Medicaid. In the meantime, please remember the special instructions contained in the Information Bulletin DD.16.080 regarding Children's Waivers and Medicaid eligibility located at Per the instructions in the Bulletin, contact Jay Bohn with questions or concerns.
  14. How will the FE/A complete the service agreements without SDA (service facilitation) since this drives the services the individual/family chooses?
    • The personal plan will state the services/supports that are needed/preferred by the individual. The family will work with the FE/A on completing this form. Currently there are two forms required: The Service Agreement and the Service Authorization forms. These two forms will be combined beginning July 1, 2017, in order to streamline things for the individual, guardian, family, and FE/A.
  15. Who will be assisting and sending in packets for 53C (temporary assistance), home modifications, adaptive equipment, vehicle modifications, etc.? Currently the SDA (SF) does a majority of the work with gathering the information needed for the packet and the ISSA signs and send it off.
    • The prior approval request should be done by the ISC with the individual/family. The family is going to have to take a greater role in the home modifications and vehicle modifications in getting the bids and hiring the work.
  16. The ISC/SF job duties chart on the web states that it's for the Children's Support Waiver. Is this also including the adult waiver?
    • Yes the job duties chart applies to both the children's home-based waiver and the adult waiver
  17. If the fiscal agent assists with the service authorization/agreement, how will they properly assist with the budget?
    • Currently they do not have knowledge of the additional services these families may receive (behavioral, counseling, day program, etc). How will the monthly budget stay current with the changes that can happen in a month (DT, behavioral, PSW)? Without the middle person SDA (SF) there will probably be billing rejections. Who would the ISC contact for referrals? Will they contact the fiscal agent directly to enroll new participants?
    • If there is no SDA (Service Facilitator), the individual/family is expected to take on a much greater role in managing their budget and submitting billing in a timely fashion. All of this must be governed by the personal plan developed by the ISC, which specifies the services, as well as their scope, frequency, and duration. Once the personal plan reflects the services/supports the individual needs, then the individual/family will complete the forms with the FE/A. The new enrollments will be completed by the individual/family with the FE/A. The individual/family will need to report any changes in hours/services to the FE/A.
  18. Is the Division planning on sending an Information Bulletin/Communication for the SDA (Service Facilitation) agencies to inform them regarding the change?
    • The Division sent an email to all Service Facilitation agencies, as well as other stakeholders, notifying providers of the change and the documents on the website.
  19. Have the service authorization and the service agreement forms been combined?
    • Yes, there is a draft that a group has been working on that should be posted soon for comments.
  20. How will the Bureau of Quality Management take into consideration the slow roll out of the personal plan and no implementation strategy in place for home-based individuals?
    • BQM is very aware of the transition period of the personal plan and the changes in the home-based services. They have stated they will not hold anyone to any standards that they have not trained in. The first year BQM anticipates that they will focus on technical assistance and coaching rather than a survey process to help providers cope with all the changes (Person Centered Plan, conflict free case management, settings rules). This will be a year of change and flexibility on the part of providers, ISC participants/families,
  21. Until the forms are revised, if there is a place for a SDA (service facilitator) signature and the family has elected to not purchase that service, should we leave the line blank or have the family sign it?
    • Leave it blank or write N/A
  22. Who will handle the transition of aging out children? 
    • The ISCs will handle the transition of aging out children and send paperwork to Region staff.
  23. If there is no Self Direction Assistant (SDA, formerly known as Service facilitator) who will do monthly progress notes, or who will review the PSW documentation monthly?
    • Currently there is no requirement for monthly documentation. The ISC will be responsible for monitoring the progress on outcomes. The documentation requirement is under discussion.
  24. Do these changes affect the children's waiver as well as adults?
    • Yes, the changes apply to children's home-based and adult home-based services
  25. If there is no SDA (formerly SF) and a behavior plan is needed for a home-based person, who writes the behavior plan since we cannot require a family to purchase services like a behavioral analyst?
    • ISC's will recommend that the family purchase Behavioral Therapy as part of the person centered plan.
  26. Will the ISCs be doing all the prior approvals (including CILA)? Can you clarify what the ISCs will be doing for the adaptive equipment, modifications (letter of need, cover letter etc.).
    • The ISCs will complete all the prior approval requests for individuals in the HBS program and submit them to the Division for consideration. The family will get the bids and hire the workers. For individuals residing in CILA settings, the CILA provider may initiate the request, but it must be reviewed and approved by the ISC agency prior to submission to the Division.
  27. Is the SDA (SF) rate the same or is it decreasing?
    • The rate continues to be $40.01 per hour.
  28. Will there be a Spanish Speaking person identified as a Resource person for questions and assistance?
    • ISC agencies must be able to communicate with individuals and guardians in the language spoken by them. If the ISC agencies do not have staff directly available to do this, they must have other resources to call upon. Through the Department's Office of Hispanic/Latino Affairs (OHLA), Division staff is able to secure communication resources when needed for questions and assistance in different languages.
  29. Are the billing procedures changing at all?
    • Nothing is changing in regards to billing procedures, the rates and codes are the same.
  30. Who is responsible for completing the ICAP? Not just in home-based, but in CILA as well?
    • Currently the ICAP has to be done by a Q. The ISC is responsible for securing the ICAP for the annual redetermination process. If a current ICAP has been completed by another entity, for example a CILA provider, as part of their on-going assessments of the individual, and the ISC believes that the ICAP accurately reflects the individual's abilities; the ISC may use that ICAP. Since there are not any entities that would otherwise complete an ICAP for someone in the HBS program, the ISC agencies will typically need to complete the ICAPs.
  31. In regards to requirements for SDA - can every agency decide how many visits, or how they carry out the duties since the bimonthly requirement has been removed? We are unsure how to budget, operate without duties being specified more.
    • It is important to remember the new definition of Self Direction Assistance in the Waivers, repeated below for reference.
    • Self Direction Assistance (previously known as Service Facilitation) assists the participant (or the participant's family or representative, as appropriate) in arranging for, directing and managing services. Practical skills training is offered to enable families and participants to independently direct and manage waiver services. Examples of skills training include providing information on recruiting and hiring personal support workers, managing workers, and providing information on effective communication and problem-solving. The service/function includes providing information to ensure that participants understand the responsibilities involved with directing their services. The extent of the assistance furnished to the participant or family is specified in the personal plan.
    • SDA (previously known as Service Facilitation) does not include visiting the person to monitor services. Only the activities listed in the above definition may be implemented and they must be specified in the personal plan.
  32. How can ISC monitor the outcomes if there is no implementation strategy or documentation expected from families that choose no SDA?
    • The ISC will talk with the individual/family to assess whether or not the supports provided are meeting the individual's expectations and are resulting in a general satisfaction that they are moving the person towards his/her desired outcomes.
  33. Could you clarify off of the (job duties checklist for ISCs) - "assist the individual with linkage and applications for any non-waiver services?"
    • Linkage is doing whatever you can do to help the individual/family access the things they have identified in their personal plan as wants/needs/desires. Some examples of non-waiver services would be ICF/DD, child care institutions, recreation programs, volunteer work, non-waiver day programs, etc.

HBS Frequently Asked Questions, September 2017

  1. When will Self-Direction Assistants (SDAs) be required to complete an Implementation Strategy and what will be required?
    • SDAs will be required to complete an Implementation Strategy beginning November 1st, 2017 for individuals who choose to purchase SDA and will have a Personal Plan due November 1st, 2017 or later. For individuals who have already had a Personal Plan developed prior to November 1st, there is no need to complete an Implementation Strategy this fiscal year unless warranted by changes in the Personal Plan or requested by individual/guardian.
    • The SDA should follow the Implementation Strategy Guidelines from June 2, 2017. These can be accessed through the DHS website at the following link: Implementation Strategy Guidelines . Within the Implementation Strategy, the SDA must provide a clear description of the supports the SDA will provide to the individual/family. It can also include the individual/family instructions to PSWs if the family chooses.
  2. When will HBS recipients, who do not purchase SDA, begin completing Implementation Strategies and what will be required of individuals/families?
    • Individuals, families and others acting as the Employer of Record will be required to complete an Implementation Strategy beginning November 1st, 2017 for individuals who have a Personal Plan due November 1st, 2017 or later. For individuals who have already had a Personal Plan developed prior to November 1st, 2017, there is no need to complete an Implementation Strategy this fiscal year unless warranted by changes or requested by individual/guardian.
    • Prior to November 1st, 2017, the Division will provide a format and guidelines for the Employer of Record to use when developing an Implementation Strategy.
  3. Can a SDA develop an Implementation Strategy for families who are acting as the Employer of Record?
    • Yes. The family can hire an SDA to write the Implementation Strategy.
  4. Can a SDA bill for the following:
    1. Developing and monitoring an Implementation Strategy?
      • Yes, but the implementation strategy and its monitoring need to be directed at the services the SDA will provide directly to the individual/family. The SDA can also assist the family in developing an Implementation Strategy when the PSW is employed by the individual or employer of record.
    2. Providing case management type services?
      • No, case management is solely the responsibility of the ISC. The following link distinguishes the duties between the ISC and the SDA: ISC/SF Job Duties.
    3. Assistance with communication and problem solving strategies for agency based PSWs? Would this be the responsibility of the agency supervisor instead of the SDA?
      • The SDA should not bill for this. The provider agency PSWs should be supervised by the provider agency and not the SDA.
    4. Providing training and assistance to individuals and families regarding timekeeping and other employer related tasks for agency based PSWs?
      • No, the SDA should not bill for this. The provider agency is responsible for timekeeping and payroll of agency based PSWs.
    5. Creating monthly progress notes?
      • Yes. A SDA can bill for progress notes but only regarding SDA duties; the SDA agency must maintain an adequate audit trail. The SDA cannot bill for documenting the progress of PSWs.
    6. Completing home visits?
      • The SDA can bill for home visits only if visits are requested by the individual/guardian and documented in the Personal Plan. The purpose of such visits cannot be to monitor services.
    7. Completing billing for the PSWs each month?
      • No. The SDA is not responsible for PSW billings. The SDA can train the family on billing for PSWs and bill the time spent training the family.
  5. Can an agency delegate the responsibility of writing implementation strategies to the SDA? For example, if the agency is providing behavior intervention, Developmental Training (DT) and (SDA), can this agency have the SDA write the Implementation Strategies?
    • The SDA should not write an Implementation Strategy for other services, such as DT or Behavior Intervention. The DT provider or Behavior Analyst would write the Implementation Strategy based on what they will provide in DT (program 31U) or Behavior Intervention (program 56U).
  6. Can a SDA who was selected by the individual/guardian, choose to write an Implementation Strategy that address outcomes in the Personal Plan?
    • If the Employer of Record request assistance, the SDA can assist in developing and implementing Implementation Strategy based on outcomes in the Personal Plan.
  7. Should the SDA sign the Provider Signature Page on the Personal Plan?
    • Yes. The SDA provider agency should sign the Provider Signature Page of the Personal Plan if have agreed to address any of the outcomes and/or provide services identified in the Personal Plan.
  8. Should an individual/family in HBS who does not purchase SDA sign the Provider Signature page?
    • No. An individual/family is not required to sign the Provider Signature Page of a Personal Plan.
  9. Are all providers required to write Implementation Strategies (i.e., DT, SEP, Behavior Analyst, OT/PT/SLT, Transportation, etc.)?
    • Community Integrated Living Arrangement, Community Living Facility, Child Group Home, Developmental Training, Supported Employment Program, Adult Day Care providers who have agreed to work toward an outcome and/or provide services should develop an Implementation Strategy.
    • Self-Direction Assistants (SDA) will be required to develop an Implementation Strategy as of November 1, 2017, for individuals in HBS who have a Personal Plan developed on or after this date. SDAs can develop an Implementation Strategy prior to this date if they choose to or at the request of the individual/family.
    • Individuals, families and others serving as the Employer of Record in HBS will be required to develop an Implementation Strategy as of November 1, 2017. This will be for individuals in HBS who have a Personal Plan developed on or after this date. Prior to this date, the Division will provide a format for HBS Employers of Record to.
    • Behavior Analyst, Counselors, Psychotherapist, Speech Therapist, Physical Therapist, Occupational Therapist and HBS Nurses can develop an Implementation Strategy or use their existing assessments and treatment documents to outline the supports and services they will provide. In either case, these services must be reflected in the Personal Plan. When these providers use existing documents for individuals in HBS, the services they provide must be included in the Employer of Record's Implementation Strategy.
    • Agencies that provide Adaptive Equipment, Home or Vehicle Modifications, Assistive Technology or HBS Non-Medical Transportation are not required to develop Implementation Strategies. These services must be reflected in the Personal Plan. For individuals in HBS, these services must be included in the Employer of Record's Implementation Strategy. DD Waiver providers that request Adaptive Equipment, Home Modifications or Assistive Technology, in order to meet the needs of the individual, must include these supports in their Implementation Strategy.
  10. If an individual/family only hires agency based PSWs what services can a SDA provide? If the PSWs are employed by a provider agency wouldn't the provider agency be responsible for the support and supervision since the contract is with the agency?
    • In these cases, the individual/family would probably not need the support of a SDA, although, the family is not prohibited from hiring an SDA if they choose to do so.
  11. If guardians and families choose to opt out of HBS Service Facilitation (SF) and the ISC is unable to begin the Person Centered Planning process at this time, are individuals required to continue SF until the Personal Plan is written or can they opt out before?
    • SDA services will be phased-in over State Fiscal Year 2018 (FY18), which began July 1, 2017. The federal Centers for Medicare and Medicaid Services and the Division realize that the nearly 9,000 individuals receiving Wavier HBS services cannot all immediately implement the new services. The new services will be transitioned when the annual planning dates come due. Until the Personal Plan is developed, the current plan with its current services should remain in place. That means service facilitation in its current form including plan monitoring and home visits should continue to be delivered and SF agencies should continue to bill for the service.
    • Families/individuals may request of their ISC agency that their Plan be updated prior to the annual due date; however, please recognize that the ISC agencies are being asked to take on additional responsibilities right now and may need time to accommodate such requests in their schedules.
  12. Are SDAs required to be Qualified Intellectual Disability Professionals (QIDPs)?
    • Yes.
  13. Should a SDA complete and/or sign an Application for Individual Service Authorization (HBS request packet)?
    • No.