Personal Support, Agency-Based (Home Based Services)

What is it?

Personal Support, Agency-Based, provides services that include training and assistance to enable participants to accomplish tasks that they would normally do for themselves if they did not have a disability.  These services may include:

  • Teaching adaptive skills to assist the individual to reach personal goals.
  • Personal assistance in activities of daily living.
  • Services provided on a short-term basis because of the absence, incapacity or need for relief of those persons who are normally provide care (typically referred to as respite). 
  • Assistance in performing age-appropriate housekeeping chores (bed-making, dusting, vacuuming) that are essential to the health and welfare of the individual.

What are the requirements to provide this service?

Providers must be enrolled in IMPACT as a DHS, Division of Developmental Disabilities Medicaid Waiver Provider and meet the following requirements BEFORE providing Personal Support Services.

  1. Providers must that meet the IL Department of Human Services (DHS) contractual requirements as outlined in the  Developmental Disabilities CSA Attachment A.
  2. Personal Support-Agency Based providers must have a Direct Support Person Training Program approved by the DHS, Division of Developmental Disabilities
  3. Providers must have staff with required qualifications and training.
  4. Providers must have access to the ROCS billing software to be able to submit the billing for this service.  Services are not eligible for payment from the Medicaid MCO plans.
  5. Personal Support Services may only be provided to persons enrolled in the Developmental Disabilities, Home Based Services program if
    1. Documented in the HBS participant's Personal Plan, and
    2. An IL462-2029 - HOME-BASED SUPPORT SERVICES (HBS) SERVICE AGREEMENT (pdf) must be completed and signed by the PSW agency and the HBS participant, legal guardian or other representative. 
      • NOTE: This agreement is used to authorize your company to bill for personal support services, establishes the pay rate and maximum number of hours that your company can provide each month.  All billing for personal support services must be submitted to DHS-DDD using the ROCS billing software or a system that can create and submit files compatible to the ROCS requirements. 

How Do I Become an enrolled Personal Support Agency-Based Provider?

  1. Submit the required enrollment documents to: 
    Department of Human Services
    Division of Developmental Disabilities
    600 East Ash, Building 400, Mail Stop 2 South
    Springfield, IL 62703
    Attention: Provider Enrollment
    1. Typed Cover Letter on company letter head on company's letterhead.  The cover letter must include the legal name and tax identification number of the organization, a brief description of services the organization will be providing, and the executive director's or owner's contact name, phone number and email address.
    2. IRS W-9 form  - Carefully review the IRS W-9 Guidelines and complete the IRS W-9 form based on the tax classification of the organization and determine if any additional IRS forms or other supporting documentation needs to be submitted with W-9.
    3. Community Provider FTP Registration Request Form
    4. Community Provider User ID and System Access Request (IL444-2022)  
  2. Submit an IMPACT Provider Enrollment application to enroll as a  Developmental Disabilities Medicaid Waiver Provider.
    1. You, the person sitting at the computer, must create an IMPACT account on the IMPACT login page and apply for approval for a Single Sign-On ID.  Please use the Single Sign-On ID PowerPoint Presentation found on the IMPACT Presentations and Materials page as a guide.
    2. When the Single Sign-On ID has been approved, return to the IMPACT login page and log into your account.  An IMPACT blue hyperlink will listed on your IMPACT home page under Access your applications.  Click on IMPACT hyperlink to access the IMPACT Provider Enrollment System. 
    3. Click on NEW ENROLLMENT. 
    4. On the next page, select the Enrollment Type:  Atypical Agency.  Use the Atypical Agency PowerPoint on the Presentations and Materials page as a guide.
      • The information listed below must be added to the IMPACT application:
        1. Add Specialty: Home Health; Home Services Agency; No Subspecialty Associate
        2. Billing Agent: DDD Billing Agent ID number 7094638;
        3. Associate Billing Provider: DDD Billing Agent ID Number 7094718
        4. Associate MCO Plan: DDD MCO Plan ID number 3000006
  3. Email when the application has been submitted and ready for State review.
  4. The IMPACT system will send you an email notification when your IMPACT application has been approved. 
  5. After receiving notification that your IMPACT application has been approved, submit your DPS Training Program for approval to the DHS, Division of Developmental Disabilities (see address below).
  6. Review the information available about Using ROCS and contact the ROCS helpdesk for Technical Support.

Personal Support-Agency Based providers must submit their DSP Training Programs for Approval to:

  • Illinois Department of Human Services
    Division of Developmental Disabilities
    Bureau of Quality Management
    600 East Ash, Building 400, Mail Stop 2 North
    Springfield, IL  62703

    Attention: DSP Training Program

Important Resources For Program Requirements