HBS Frequently Asked Questions

Home Based Supports and Services Frequently Asked Questions (FAQs)

Revised August 2018


Home Base Services (HBS) General Information

  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?
    • 9,100 children and adults are enrolled in the HBS program as of June 2018.
  3. How much money is available to people in the HBS program?
    • As of January 1, 2018, adults participating in the HBS program receive a monthly allotment of $2,250 to purchase services; children in special education receive a monthly allotment of $1,500 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 (ISC) shares with you. If you feel that your family is in crisis (homeless, abuse or neglect), you can ask your ISC agency about applying for crisis funding.

Changes in the Home Base Services (HBS) program

  1. What change has occurred in the HBS program?
    • From July 1, 2017 through June 30, 2018, the Division phased out the title and role of Service Facilitation based on changes within the Federal regulations. HBS participants are no longer required to have a Service Facilitator. Beginning July 1, 2017, the Division introduced a new service under HBS called Self-Direction Assistance (SDA). An SDA assists the participant (or the participant's family/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. 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 to be specified in the Personal Plan.
  2. Why is this change occurring?
    • The federal agency that oversees the Medicaid program, informed Illinois that the practice of requiring HBS participants to purchase a service, i.e. Service Facilitation, was no longer permissible. HBS participants must be free to choose whether or not they want to purchase a service with their monthly allotment. In addition, the Federal agency also required States to implement Conflict of Interest Free Case Management.  "Conflict Free" means that Case Management must be done by someone that is not a relative of the person served, a provider agency or someone who works at a provider agency, someone who has a financial interest in a provider or someone who would benefit from providing services.

Self-Direction Assistance or Assistant (SDA)

  1. If SDA has been hired to assist the Employer of Record with writing the PSW implementation strategy, can they also assist with (and bill for) monitoring progress?
    • No. SDAs will not monitor the Employer of Record Implementation Strategy for progress; monitoring services is the role of the ISC/case manager. A "PSW implementation strategy" does not exist.
  2. If there is no SDA, who will do monthly progress notes, or who will review the PSW documentation monthly?
    • There is no requirement to record monthly progress notes for PSWs hired directly by the individual/family. The ISC will be responsible for monitoring the progress on outcomes. PSWs hired through a provider agency will be managed by staff at the provider agency.
  3. Can each SDA agency decide how many visits, or how they carry out the SDA duties? Agencies need to plan their budget and services.
    • The details of what SDAs provide to an individual/family must be based on the outcomes and needs of the individual and reflected in the Personal Plan. The SDA should not perform case management or other duties that conflict with the ISC (i.e. conducting visits to monitor services).
  4. Can a SDA develop an Implementation Strategy for families who are acting as the Employer of Record?
  5. If an individual/family only hires agency-based PSWs, what services can a SDA provide?
    • If an individual/family only hires agency based PSWs, the SDA cannot be hired to supervise, manage or train the agency based staff. In this scenario, the individual/family would probably not need the support of a SDA, although the family is not prohibited from hiring one if they choose to do so. If the individual/family chooses, a SDA can be hired to conduct other tasks that are not associated with the agency-based PSWs, such as managing the HBS monthly allotment.
  6. Can the same person work as a SDA and a PSW (employed by a provider agency)?
    • Yes. The same person can work as a SDA and a PSW (employed by a provider agency). When this occurs, the provider agency must ensure the following:
      • The individual and/or family has requested both services from the provider agency. The provider agency cannot require an individual family to purchase both services.
      • When working as an SDA or PSW, the agency provides the approved services within the particular title and bills the appropriate bill code.
      • The provider agency does not bill the for SDA and PSW services simultaneously nor should they overlap. The provider is responsible for creating and keeping valid documentation to support the service(s) that was provided, the amount of services provided, and the billing code under which the service was billed.
      • The amount of services bill does not exceed what's listed on the HBS Service Agreement.
  7. Can parents of individuals in the HBS program become Self-Direction Assistants?
    • SDA can only be provided by community-based agencies. SDA cannot be provided by a relative, legally responsible person or legal guardian.
  8. Is there someone an individual/family can talk to about whether to purchase SDA and other services?
    • A service coordinator/case manager at the ISC agency can assist an individual/family with information on available services and provider options.
  9. What happens to the current money being spent on SDA if an individual/family chooses not to continue purchasing it?
    • If an individual/family chooses not to continue purchasing SDA, they can use this portion of the monthly allotment to purchase other authorized waiver services.
  10. If an individual/family does not purchase SDA now, can they change their mind later?
    • Yes, choice is an important quality within all Medicaid Waiver programs. However, agencies are not required to provide SDA and some agencies are considering whether this is a service option they will continue offering in the future. The ISC can help you find which agencies in a given community offer this service and help you contact them if you are interested in purchasing this service.
  11. If an individual/family does not purchase SDA, are there resources available to assist them if they have a problem?
    • Yes. The Consumer Handbook for Home-Based Services, Children's and Adult Medicaid Waivers is available on the DHS website at this link http://www.dhs.state.il.us/page.aspx?item=101181. In addition, the ISC agency staff is a partner in almost every aspect of establishing and managing Waiver services. If an individual/family chooses to hire personal support workers (PSWs) directly, the Fiscal Employer Agent will assist with the entire hiring process and be available for consultation if questions arise. Last, but certainly not least, friends, family, and other people in your community can help by sharing their ideas, information and personal experiences.
  12. If an individual/family chooses to purchase Self Direction Assistance, do they have to make a commitment to purchase it for a designated period?
    • No. The duration of services provided must be identified in the Personal Plan.
  13. Will DDD maintain a SDA provider list on the DDD Website?
  14. If there is no SDA and a behavior plan is needed for a person in HBS, who writes the behavior plan?
    • If the need for behavioral supports is identified in the Personal Plan, the ISC will assist the individual/family in finding a service or provider that is willing to address the behavioral needs.

Individual/Family Responsibilities in HBS

  1. If an individual is new to services and they do not choose to purchase Self-Direction Assistance (SDA), who completes all the initial paperwork (contracts, fiscal forms, tax forms, background check information, etc.)?
    • The HBS Employer of Record is responsible for completing the HBS Service Agreement and enrollment forms for Personal Support Workers. Once the forms are complete, the Fiscal Employer/Agent (FE/A) is responsible for running the Personal Support Worker background checks, processing the tax forms and paying taxes on behalf of the Employer of Record.
  2. If a family member is guardian and a PSW, and chooses not to purchase SDA, does DHS require another person to sign off/approve the paperwork, such as progress on goals and billing paperwork?
    • If a family member is the PSW, they cannot also be the Employer of Record. In this scenario, someone other than the family member/PSW should act as the Employer of Record and be responsible for completing paperwork and authorizations related to hiring, training, supervising and firing Personal Support Workers. A guardian, among other duties, is responsible for participating in the Person Centered Planning process which includes approving and signing the Personal Plan and provider's Implementation Strategies.
  3. If an individual/family chooses to self-direct, who finds the PSWs?
    • The individual/family is responsible for finding their own PSWs when they choose self-directed services. Individuals/families that need assistance can hire a SDA.

Home Base Services (HBS) Employer of Record

  1. Will there be any specific guidelines for the Employer of Record to reference regarding their role and responsibility?
  2. Is the Employer of Record responsible for tracking PSW related Implementation Strategies and if so, how should this be documented?
    • The Employer of Record will oversee the services and outcomes documented in their own Implementation Strategy. The Employer of Record is not required to keep documentation toward the attainment of outcomes. The provision of services will be documented through billing. No additional documentation is required at this time.
  3. What is the time frame for completing the Employer of Record Implementation Strategy once the Personal Plan is complete?
    • The Employer of Record Implementation Strategy should be completed within 20 calendar days of the Personal Plan date.
  4. What is the Employer of Record responsibility when there is a rights restriction?
    • The Employer of Record can direct individuals towards the Rights of Individuals [IL462-1201] document which is available through the DHS website at http://intranet.dhs.illinois.gov/onenetlibrary/12/documents/Forms/IL462-1201.pdf, as well as toward their ISC. People receiving services, their guardians, family members, or other representatives, may file complaints about their services as outlined in the Rights of Individuals document.
  5. Is the Employer of Record Implementation Strategy required for all individuals using their home-based funding for personal support workers or is it optional?
    • Program participants, family, and others who act as the Employer of Record in HBS, must develop an Implementation Strategy when they will arrange any service (i.e. hiring their own PSWs, hiring a SDA) or work on any outcome from the Personal Plan.

Independent Service Coordination (ISC)/Case Management

  1. Who is responsible for completing the ICAP? Not just in home-based, but in CILA as well?
    • The ISC is responsible for completing the ICAP.
  2. 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?
    • This part of the crisis form should be left blank. The ISC agency is still responsible for making sure that crisis services begin within 72 hours and documenting the implementation of services.
  3. Who will handle the transition of aging out children?
    • The ISCs will continue to handle the transition of aging out children and send the required paperwork to the Bureau of Community Services region staff.
  4. Will the ISC complete all the prior approvals (including those for CILA)? Can you clarify what the ISCs will be doing for the adaptive equipment, home and vehicle modifications, etc.?
    • The ISC is responsible for completing any necessary prior approval applications for Waiver services. This includes, but is not limited to, completing the application, ensuring all documents are included and submitting the request to the Division. The Division is working to update guidelines specific to each type of service request and will make them available to all stakeholders as they are complete.

Person Centered Planning

  1. I've heard about Person Centered Planning; how does this affect the HBS program?
    • Individuals enrolled in a DDD Waiver program, including HBS, will participate in the Person Centered Planning process. Person Centered Planning is a Center for Medicare and Medicaid Services regulation that addresses the balance between what is important to a person and what is important for a person in service planning. The Person Centered Planning process focuses on outcomes that are identified by the person receiving services in collaboration with their guardian and family. The ISC will document those desired outcomes and assist the individual/family to locate and select agencies that are willing and qualified to provide the needed supports.
  2. Should an individual/family in HBS who does not purchase SDA sign the Provider Signature page of the Personal Plan?
    • No, individuals and families are not required to sign the Provider Signature Page of a Personal Plan.
  3. How are situations handled when an Employer of Record doesn't agree with the Personal Plan outcome related to personal support services?
    • The outcomes in the Personal Plan represent the desires and preferences of the person served. Ultimately, anyone serving as the Employer of Record should work on behalf of individual receiving services.

Implementation Strategy

  1. Does the SDA need to write an Implementation Strategy?
    • Effective July 2018, SDAs are no longer required to develop an Implementation Strategy for the services they will provide as a SDA. When an individual/family purchases SDA, the details of what will be provided should be included in the Employer of Record Implementation Strategy.  
  2. When should the Employer of Record complete an Employer of Record Implementation Strategy form?
    • If the Individual/family is hiring Personal Support Workers (PSWs) directly, then the Employer of Record should complete an Employer of Record Implementation Strategy.
    • If the individual/family is hiring PSWs directly and hire a SDA, the Employer of Record should complete the Employer of Record Implementation Strategy and ensure all SDA services that will be provided are included. This Strategy should also include services the PSW will provide.
    • If the individual/family is arranging nursing or non-medical transportation, for example, the Employer of Record should complete the Employer of Record Implementation Strategy.
    • If the individual/family is using PSWs that they hire directly and purchasing Community Day Services (formerly known as DT), then the Employer of Record should complete the Employer of Record Implementation Strategy to include PSWs only. The day program provider will develop their own Implementation Strategy according to the guidelines provided by DDD.
    • If the individual/family only purchases agency based services (such as Community Day Services or agency based PSWs) and the individual/family will not oversee any outcomes, the Employer of Record Implementation Strategy form is not required. In this scenario, the agency providers must develop an Implementation Strategy according to the guidelines provided by DDD.
  3. Should there be anything on the Employer of Record Implementation Strategy relating to a review date, ending date, etc. for each of the Outcomes?
    • No.
  4. If the ISC writes the Personal Plan, who writes the implementation strategy?
    • The HBS Employer of Record will complete the Employer of Record Implementation Strategy form when the individual/family will arrange or oversee outcomes or services from the Personal Plan. Some provider agencies, as outlined below, will develop Implementation Strategies when they have agreed to provide services.
    • The following provider types are required to develop Implementation Strategies: Adult Day Care, Agency-based Personal Support Worker (HBS only), Child Group Home, Community Integrated Living Arrangement, Community Day Services (formerly known as Developmental Training), Community Living Facility and Supported Employment Program
    • The following provider types can develop Implementation Strategies OR use current Assessment/Treatment Documents: Behavior Counseling, Nursing (HBS only), Occupational Therapy, Physical Therapy, Psychotherapist and Speech Therapy.
    • The following service providers are not required to develop an Implementation Strategy: Adaptive Equipment, Assistive Technology, Home Modifications, Non-Medical Transportation (HBS only), Self Direction Assistant (HBS only), Vehicle Modifications.
  5. Can a provider agency delegate the responsibility of writing implementation strategies to the SDA? For example, if the agency is providing behavior intervention, Community Day Services (formerly known as DT) and SDA, can this agency have the SDA write the Implementation Strategies?
    • A provider agency should not delegate the responsibility of writing Implementation Strategies to the SDA and bill the code 55A. Providers are not required to develop an implementation Strategy for SDA services. In the scenario above, the provider agency would develop an Implementation Strategy based on what they will provide in Community Day Services (program 31U) and Behavior Intervention (program 56U).
  6. Does there need to be an outcome in every provider agency's Implementation Strategy?
    • No. In some cases, the provider has not agreed to work toward any of the desired outcomes so their Implementation Strategy will not contain outcomes. In such cases, the provider agencies that are required to develop an Implementation Strategy would  still address service(s) in their Implementation Strategies.

Forms and Documents

  1. Has the HBS service authorization and the service agreement forms been combined?
  2. If there is a place for a "service facilitator" signature on a form, should we leave the line blank, have the family sign it, or have the SDA sign it?
    • This should be left blank. The Division will be revising forms to address the changes.
  3. Should STAR forms be completed and sent to the Division if someone drops SDA services with a provider?
    • No. If an individual/family no longer wants to use SDA services, they should notify their ISC and adjust their Service Agreement to reflect the change.
  4. When will the online version of the DD Waiver Manual be updated?
    • The Division is in the process of updating its Rules, manuals and forms, including the DD Waiver Manual. A completion date for this manual has not been set.
  5. Should a SDA complete and/or sign an Application for Individual Service Authorization (for HBS requests)?
    • No. If the SDA provider has been identified, the ISC should include the provider's name on page 3 of the application under "Provider Name". No SDA provider signature is necessary for HBS services.
  6. Are SDAs required to ensure and document that the individual and guardian have received an explanation of their Rights?
    • No.
  7. What documents are SDAs expected to maintain in their file?
    • When a SDA has been hired by an individual/family, the SDA should maintain an individual file that includes a copy of the Discovery Tool, Personal Plan, Service Agreement(s), the Employer of Record Implementation Strategy, Release of Information and adequate documentation for audit purposes and to verify billing.

Fiscal Employer/Agents (F/EA)

  1. Will there be a policy from the F/EA regarding consequences to individuals/families who continue to make errors in completing the required paper work or processes (example: completing the time sheets incorrectly, not properly coordinating hours between day program and PSWs, and going over budget)? What will be the consequence to an individual/family if the communication to resolve the issue is unsuccessful?
    • According to the approved Waiver, the ISC and FE/A can document and jointly determine 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 SDA agency. In certain cases, the Division will restrict someone's right to hire PSWs directly and require that HBS participants use agency-based services instead. These determinations are subject to an appeal; the outcome of the appeal is final.
  2. If the Fiscal Agent assists with the service agreement, how will they properly assist with the budget?
    • It is not the FE/As role to complete Service Agreements or manage monthly budgets. If individual/families are unable to complete service agreements or manage their monthly allocation, they can hire a SDA to assist, train and/or provide information about the process.

Miscellaneous

  1. 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 their spoken language. 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 can secure communication resources when needed for questions and assistance.