3. Home Services Program

The Home Services Program (HSP) was established in December 1979, to prevent the premature or unnecessary institutionalization of individuals with disabilities by providing services in the home that do not exceed the cost of comparable services in a nursing facility. The program is dedicated to promoting customer independence, their choice, and their control of services. The program's goals support the desires and abilities of individuals with disabilities by enabling them:

• to remain at home rather than in a nursing facility with real choices and options for quality care;
• to retain control over the services they receive; and
• to live self-directed lives that enable them to actively participate at home and in the community.

The Home Services Program changes lives. For example, with the help of Personal Assistant services from HSP, Michelle, a 25-year-old customer with Cerebral Palsy can complete essential activities of daily living and remain independent in her own home while attending college and beyond, rather than having to reside in an institutional setting such as a long-term care facility. HSP is designed to allow eligible individuals in need of long-term care and who meet the criteria for blindness or disability as defined by the Social Security Act, to receive any or all the following services to remain in their homes:

1. personal assistant services
2. homemaker services
3. home health services
4. home-delivered meals
5. electronic home response
6. adult day care services
7. specialized services for customers in the brain injury waiver
8. home modification and/or assistive equipment
9. and other specialized services

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Program Highlights

A total of 32,171 customers were served in the program at an average monthly cost of $2,030.

Waiver	# Customers Served	Average Cost/Mo	Total Spending (in thousands)
Persons with Disabilities	28,527	$2,113	$681,555.5
Persons with Brain Injury	2,507	$2,643	$79,521.3
Persons with HIV/AIDS	1,137	$1,668	$22,758.8
Total	32,171	$2,030	$783,835.6

• The Home Services Program (HSP) received approval from Federal CMS on its renewal application for the Persons with Brain Injury Medicaid Waiver. The five-year renewal has an effective date of July 1, 2022.
• HSP implemented a mobile application to the Electronic Visit Verification (EVV) system which gives individual providers another option to record their time worked. The mobile application provides the user instant feedback on the success and accuracy of the information.
• Issued Pandemic Bonus payments to 24,860 Individual Providers using federal American Rescue Plan Act (ARPA) enhanced matching funds. These bonus payments, issued in December 2021, were intended to retain and reward providers who served HSP customers during the COVID-19 pandemic.
• DRS used ARPA funds to make made greater investments in Home Modification/Assistive Technology vendors tasked with performing evaluations for customers needing Home Modifications and/or Assistive Technologies. This investment will increase the capacity of these vendors and shorten wait times for services.

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Looking Ahead…FY23

In FY 2023, our goal is to ensure the continued growth of the Home Services Program to help individuals achieve and maintain their independence, to maintain timeliness of required assessments, and further invest in modernizing the program.

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Home Services Success Stories

Supporting independence through home modifications

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Program Services

HSP services are designed to preserve the dignity of individuals with disabilities, as well as to provide options that reflect their personal needs and preferences. Over 97% of HSP customers utilize Personal Assistant, Homemaker and/or Home Health services. Other program services are used either alone or as a supplement to these services to address the customer's unique needs. Brief descriptions of all available services follow below:

Personal Assistant (PA) Services:

Services provided by individuals who are selected, employed, trained, and supervised by the customer. These individuals may assist with household tasks, personal care and, with the permission of a physician, perform certain health care procedures. In order to use PA services, the customer or representative must be able to appropriately supervise a PA. This service has a uniform reimbursement rate statewide per a labor agreement with Service Employees International Union (SEIU).

Homemaker Services:

Personal care and household tasks provided by trained and professionally supervised staff employed by homemaker agencies. Instruction and assistance in household management and self-care are also available. This service has a uniform reimbursement rate statewide that is provided under a rate agreement with HSP. Homemaker services are used by customers who are unable to direct a PA, who have not found a PA, or who do not wish to direct a PA.

Home Health Services:

Home health services include services prescribed by a physician that are provided by a registered or licensed practical nurse, home health aide or certified nurse assistant, or physical, occupational or speech therapist. HSP home health services are beyond the scope of services covered under the Medicaid State Plan or private health insurance. These services must be provided in the customer's home and may be provided through an agency or by private individuals who are appropriately credentialed. The private individuals who provide this service have a uniform reimbursement rate statewide per a labor agreement with Service Employees International Union (SEIU).

Home-Delivered Meals:

One or more ready-to-eat hot meals per day which are delivered to the home. This service is provided to individuals who can feed themselves but are unable to prepare a meal and is more cost effective than personal assistant services.

Emergency Home Response:

A signaling device that provides 24-hour emergency alerting coverage for medical, fire or other emergencies. The device may be worn in a variety of ways and may have a variety of mechanisms to signal an emergency need. This service has uniform rates statewide and is provided under a rate agreement with HSP.

Adult Day Care:

The direct care and supervision of customers provided in a location outside the home by a community-based organization to promote social, physical and emotional well-being. This service has a uniform reimbursement rate statewide and is provided under a rate agreement with HSP. Transportation to adult day care may also be provided, if needed.

Brain Injury Services:

Specialized Services for customers receiving services through the Brain Injury Waiver which include day habilitation, pre-vocational services, supported employment, and behavioral services.

Home Modifications & Assistive Equipment:

Devices, equipment and/or home modifications that increase an individual's independence and capability to perform household or personal care tasks safely in the home. Must be able to reduce the need for another service or address a health or safety need. Respite Services: Intermittent care for adults and children with disabilities designed to relieve caregiver stress.

Background Screening:

Background screenings are now provided through the Department of Healthcare and Family Services Illinois Medicaid Program Advanced Cloud Technology (IMPACT) program on all Medicaid providers including PAs and agency providers to ensure the safety of the customer and the suitability of the potential employee.

Case Management:

The Division utilizes Case Management Agencies to provide targeted services to Customers eligible for the Medicaid Waivers it administers who have either HIV/AIDS or Traumatic Brain Injury (TBI) to assist with the management, monitoring, and follow-up of these specialized cases.

Prescreening:

Prescreening of individuals conducted prior to nursing facility admission to ensure they receive the same minimum Determination of Need (DON) score required for eligibility for the HSP or the Department on Aging Community Care Program (DoA CCP), and to ensure they are offered the option of receiving home care. The screening of individuals coming from hospitals to nursing facilities is performed for both programs by community-based Case Coordination Units. Prescreening for individuals under age 60 who are going from home to nursing facility may be conducted by either CCU or HSP staff.

Special Services

Home Services also provides specialized services for people with HIV/AIDS and/or traumatic brain injuries (TBI).

The Community Reintegration Program helps individuals with disabilities who live in nursing homes move into community with the supports they need to live as independently as possible.

The Home Care Ombudsman Program helps customers of the Home Services Program receive quality services by advocating for their interests and helping them identify resources, understand procedures, resolve problems, and protect their rights. You can learn more about the Home Care Ombudsman Program by visiting the Illinois Department on Aging's Long Term Care Ombudsman Program website.

Type of Services	# Customers	Total Spending (in thousands)
Personal Assistant	29,450	$736,200.9
CNA	122	$2,521.7
LPN	32	$1,118.1
RN	22	$717.7
Homemaker	1,939	$35,982.1
Maintenance Home Health	31	$122.8
Home-Delivered Meals	529	$1,282.1
Electronic Home Response (duplicated Count)	1,323	$335.2
Adult Day Care (duplicated count)	33	$375.1
Brain Injury Services (duplicated count)	29	$138.6
Home Remodeling	167	$1,404.9
Assistive Equipment	43	$89.6
Background Checks	390	$14.0
Case Management Services	2,777	$3,373.1
Other Misc Services (duplicated count)	450	$44.4
Prescreening	1,130	$115.2
Total (with Prescreening)	32,171	$783,835.6

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Program Eligibility Determination and Service Planning

Prospective customers, or those representing them, may request services by contacting any one of the Division of Rehabilitation offices around the state, or they may submit a request via a web-based referral for services on the Department of Human Services (DHS) website at http://www.dhs.state.il.us. A counselor or case management representative will assess the individual in his or her home and administer the Determination of Need (DON) tool to determine program eligibility. The tool evaluates an individual's care needs and identifies an individual's available resources for meeting those needs. Based on the results of the DON, a service plan is developed jointly with the customer to address his or her unmet needs and to assist the customer in coordinating safe, quality, consumer-directed (when possible) services that are also cost-effective. In order to be eligible to receive HSP services, an individual must:

• Be under age 60 at time of application unless applying for the HIV/AIDS or Brain Injury Waiver Programs. *Have a severe disability lasting at least 12 months or for the duration of life.
• Be at imminent risk of nursing facility placement as indicated by receiving a minimum of 29 points on the Determination of Need (DON) eligibility determination tool, with at least 15 points in the "Need for Care" category.
• Require services whose cost will not exceed that of nursing or other health care facility services.
• For customers aged 18 or older, have less than $17,500 in non-exempt personal assets; for customers under age 18, have less than $35,000 in family assets.
• Apply for Medicaid and cooperate with the application process.
• Be a resident of Illinois and a U.S. Citizen or legal resident.

$ in thousands

DON Score	# of Customers	% of Customers	Total Spending (in thousands)	% of Spending	Average Monthly Cost
Under 29	494	1.5%	$3,755.5	0.5%	$1,288
29-32	4,261	13.2%	$63,481.2	8.1%	$1,242
33-40	7,314	22.7%	$136,213.0	17.4%	$1,552
41-49	6,463	20.1%	$142,308.5	18.2%	$1,835
50-59	5,562	17.3%	$145,625.9	18.6%	$2,182
60-69	3,858	12.0%	$122,292.0	15.6%	$2,642
70-79	2,604	8.1%	$97,606.4	12.5%	$3,124
80-100	1,615	5.0%	$72,553.1	9.3%	$3,744
Total	32,171		$783,835.6		$2,030

The average Don Score is 47.0

Additionally, given the multiple Medicaid Waiver programs in Illinois, including those through the Department's Division of Developmental Disabilities; individuals who are eligible for more than one waiver are evaluated and assisted in making an informed choice as to which waiver most appropriately meets their needs.

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Operational Spending Overview

Category	FY22 Spending (in thousands)
Program Administration	$27,994.5
Other Provider Costs & Benefits	$95,173.1
Total Waiver Services	$783,835.6
---Persons with Disabilities	$681,555.5
---Persons with Brain Injury	$79,521.3
---Persons with HIV/AIDS	$22,758.8
Total Spending	$907,003.2
% Admin to Total Spending	3.09%