HSP Customer Compliance

HSP Customers who utilize Individual Providers (IPs) are responsible for hiring, scheduling, and monitoring the work hours of all IPs who work for them. HSP has several compliance policies designed to ensure customers are fulfilling the customer responsibilities. Failure to follow the policies described below may result in a non-compliance occurrence being recorded in the customer's case file.

Key points on Home Services Program (HSP) Compliance Policies:

  • Customers cannot approve more hours than are listed on their monthly service plan.
  • Customer cannot approve more hours 16 hours in a 24-hour period by the same IP.
  • Customers with Legally Responsible Individual (LRI) providers cannot approve their LRI to work more weekly hours than are listed in the signed LRI Agreement Form.
  • Customer must require all IPs to use an Electronic Visit Verification (EVV) to clock in and clock out of every work shift.
  • An occurrence is defined as an individual incident of a customer failure to follow a compliance policy. Repeated occurrences may result in changes to the customer's service plan, up to and including case closure.


Service Plan Utilization Policy

Summary: A customer cannot allow an IP to work more hours than are authorized on their monthly service plan. The service plan indicates how many days per month specific tasks are required by the customer. Work schedules are set by the customer and, though flexible, should follow the service plan. The service plan is approved by the customer, along with their HSP counselor, or managed care organization (MCO) care coordinators. Weekly service plan hours equal the monthly service plan hours divided by 4.35. Example: 130.5 monthly service plan hours divided by 4.35 equals 30. 130.5/4.35=30

Exceptions:

Customers must request and receive pre-approval from their HSP counselor or MCO care coordinator before exceeding their approved monthly service plan, except in emergency situations.

Acceptable reasons for overages include:

  • The Customer received prior approval from the HSP counselor or MCO care coordinator for the additional hours.
  • An emergency requiring the IP to work more hours in the evening or weekend when the HSP counselor or MCO care coordinator could not be contacted in advance

Unacceptable reasons include:

  • Failure to keep track of the approximate number of hours worked each period.
  • Disagreements between the Customer and Provider over the number of hours worked.
  • Disagreement with the number of hours authorized on the service plan.
  • Provider working more hours for personal gain when services are not needed.
  • Provider turned in a late timesheet showing reduced hours

Occurrences:

  • Customers will receive a Service Plan Utilization Occurrence if they approve a provider to work more than the hours listed on the monthly service plan.
  • Customers who receive three (3) active Service Plan Utilization occurrences within a 6-month period may receive changes to their service plan, up to and including case closure

Dispute:

  • Customers may appeal the service plan provider changes or case closure with the DHS Bureau of Administrative Hearings.
  • Customers enrolled with a managed care organization may appeal service plan provider changes through the MCO's internal appeal process.

Contact:

Customers enrolled with a MCO should contact the assigned MCO care coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.

Customers not enrolled with MCO should contact their local HSP counselor or coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.


16 -Hour Policy

Summary: An IP cannot work more than 16 hours in a 24-hour period for one or more HSP customers. Pursuant to 89 Illinois Administrative Code Section 686.40

Exceptions:

  • The customer's HSP counselor may grant an exception, should an emergency occur that results in the loss of a paid or unpaid primary caregiver who resides with the customer, and there is imminent danger to the health, safety, and wellbeing of the customer. Customers enrolled with an MCO should contact the care coordinator to request an exception.

Note: The 16-hour limitation does not apply to IPs providing respite services.

Occurrences:

  • Customers will receive a 16-hour Policy occurrence if they approve an IP to work more than 16 hours in a 24-hour period.
  • Customers can only receive one (1) 16-hour Policy occurrence in a pay period.
  • Customers who receive three (3) active 16-hour Policy occurrences within a 6-month period may receive changes to their service plan, up to and including case closure

Dispute:

  • Customers may appeal the service plan provider changes or case closure with the DHS Bureau of Administrative Hearings.
  • Customers enrolled with a managed care organization may appeal service plan provider changes through the MCO's internal appeal process.

Contact:

Customers enrolled with a MCO should contact the assigned MCO care coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.

Customers not enrolled with MCO should contact their local HSP counselor or coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.

LRI Utilization Policy

Summary: A customer cannot allow an LRI provider to work more hours in a week than are authorized on their approved LRI Agreement Form. The service plan indicates how many days per month specific tasks are required by the customer and the LRI Agreement form allocates a number of those hours to the Customer's approved LRI provider. Work schedules are set by the customer and, though flexible, should follow the service plan and LRI agreement. The service plan is approved by the customer, along with their HSP counselor, or managed care organization (MCO) care coordinators. The LRI Agreement Form is approved by the customer, along with the approved LRI provider.

Exceptions:

  • Not Applicable

Occurrences:

  • Customers will receive an LRI Utilization Occurrence if they approve a provider to work more than the hours listed on the signed LRI Agreement plan.
  • Customers can only receive one (1) LRI Utilization Occurrence in a pay period.
  • Customers who receive three (3) active LRI Utilization occurrences within a 6-month period may receive changes to their service plan, up to and including case closure

Dispute:

  • Customers may appeal the service plan provider changes or case closure with the DHS Bureau of Administrative Hearings.
  • Customers enrolled with a managed care organization may appeal service plan provider changes through the MCO's internal appeal process.

Contact:

Customers enrolled with a MCO should contact the assigned MCO care coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.

Customers not enrolled with MCO should contact their local HSP counselor or coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.

Electronic Visit Verification (EVV) Policy

Summary: Pursuant to Section 12006 of the federal 21st Century CURES Act (42 U.S.C. 1396b(l) and the Illinois SMART Act (Public Act 97-0689, Sec 5-5f (g)), all HSP Individual Providers must use an EVV system to electronically track and document time spent providing services to a HSP customer.

Customers and IPs are encouraged to sign up for the EVV portal at www.DRS.Illinois.gov/EVV

The EVV Portal allows IPs to view work hours and customers can edit and approve IP work hours. IPs are encouraged to download the Sandata Mobile Connect (SMC) mobile application to easily clock in and clock out. If you would like to receive access to the portal and SMC, you can find more information by visiting www.dhs.state.il.us and search "Sandata Mobile Connect".

Exceptions:

  • EVV is mandatory for all IPs providing services to customers in the Home Services Program. Please contact DHS.EVV@Illinois.gov or your local HSP counselor or coordinator for questions.

Occurrences:

Non-compliance occurs if one or more of the following applies:

  1. NO IL488-2251 Home Services Program Time Sheet is submitted
  2. NO EVV visits in the EVV Portal
  3. MORE THAN 5 visits from the time sheet are missing in the EVV portal
  4. MORE THAN 5 visits on the time sheet DO NOT match call times in the EVV portal by ten minutes
  5. MORE THAN 5 visits in the portal are from an unregistered EVV telephone number
  6. MORE THAN 5 visits in the portal are ADDED/EDITED due to an error made by the IP

Customers and IPs with 3 occurrences listed above within a 6-month period may have their service plan transitioned from IP to homemaker agency services.

Dispute:

  • If there is a dispute regarding the application of the EVV policy, the local office will verify the provider's EVV data and time sheets.
  • Customers may appeal the service plan provider changes or case closure with the DHS Bureau of Administrative Hearings.
  • Customers enrolled with a managed care organization may appeal service plan provider changes through the MCO's internal appeal process.

Contact:

  • Customers can learn more about EVV at:  www.DRS.Illinois.gov/EVV
  • Customers enrolled with a MCO should contact the assigned MCO care coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.
  • Customers not enrolled with MCO should contact their local HSP counselor or coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.


Overtime Policy

Summary: An IP cannot work more than 60 hours in a work week unless their customer(s) have an approved overtime exception. A work week is defined as Sunday at 12:00am to Saturday at 11:59pm. Not to be confused with a pay period of the 1st-15th or 16th-end of month. Neither the 60-hour overtime limit, nor an approved overtime exception, allow an IP to work more hours than listed on their customer(s) service plan.

Exceptions:

  • Customers may apply for an overtime exception. If approved, their IP(s) can work more than 60 hours in a work week if the customer's monthly service plan has enough hours.
  • To apply for an overtime exception, customers can visit www.dhs.state.il.us and search "HSP overtime", contact DHS.HSPOvertime@Illinois.gov , or contact their local HSP counselor.
  • A Legally Responsible Individual (LRI) cannot work more than the total extraordinary care hours in the customer's monthly service plan or 40 hours in a week, whichever is less. LRIs cannot work more than 40 hours in a week, even if the customer has an overtime exception.

Occurrences:

  • IPs will receive an occurrence every time they work more than 60 hours in a work week unless their customer has an approved overtime exception.
  • For every 4th active OT occurrence in a 24-month period, an IP will be issued a 1-month payment ineligibility period.
  • Payment ineligibility periods never expire. After 3 payment ineligibility periods, an IP will be permanently unfunded as an HSP provider.

Dispute:

  • Customers may appeal the denial of an overtime exception through the Bureau of Administrative Hearings (BAH).
  • IPs may file a grievance with their union for overtime occurrences or periods of payment ineligibility.

Contact:

  • Customers can email DHS.HSPOvertime@Illinois.gov (overtime topics only) or visit www.dhs.state.il.us and search "HSP overtime" for more information on Overtime.
  • Customers enrolled with a MCO should contact the assigned MCO care coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.
  • Customers not enrolled with MCO should contact their local HSP counselor or coordinator to discuss occurrence details or voluntarily transition to Homemaker agency services.