89 Ill. Adm. Code 240.260
Care Coordination Service
Section 240
Section 240.260 Care
Coordination Service
Care coordination service is
defined as the provision of a comprehensive needs assessment and service
coordination by CCUs to assist an older person to gain access to and receive
needed services. The participant/authorized representative is provided the
opportunity to lead the person-centered planning process.
a) Service Components
Specific
components of care coordination service include the following:
1) Review of all inquiries to determine if a request for CCP
services is desired, and maintenance of a referral request log.
2) Distribution and assistance with completion of CCP applications
for charitable, private, and public benefits provided by federal, State and
local agencies, including assistance with the initial application and
redetermination for Medicaid benefits.
3) Performance of determinations/redeterminations of eligibility,
including a comprehensive needs assessment, the development of a
person-centered plan of care and authorization/referral of CCP services.
4) Completion of a minimum of one face-to-face contact with the
participant in between initial assessment and annual reassessment. The face-to-face
visit is to occur between four and eight months after the last determination or
redetermination of eligibility.
5) Reporting of critical events includes critical incidents,
service improvement program complaints, and requests for change of status in
the Department's automated reporting system. Completing initial critical event
reports will occur within seven days after the date the event occurred or was
identified to have occurred. All critical event reports will be closed to
reflect mandatory follow-up with CCP participants within 60 days after the date
the event occurred or was identified to have occurred. Critical event report
closure will occur through completion of the 60-day review summary housed in the
Department's automated reporting system.
6) Availability to receive inquiries and requests for services
and supports, by telephone or in person, and respond to those inquiries and
requests.
7) Choices for Care prescreenings and postscreenings (see Section
240.1010).
8) Department of Healthcare and Family Services (HFS) Level I
Screen.
9) Provide referrals to other needed services.
10) Implementation of services and participant transfers.
11) Authorization
of all actions related to the disposition of CCP services as required by this
Part.
b) Comprehensive
Assessments
1) A
comprehensive assessment is required when a participant needs services to
remain living independently in the community or is at imminent risk of nursing
facility placement.
2) A
comprehensive assessment is not warranted when a participant only requires a
referral to services (e.g., providing contact information for a vendor).
3) Conditions
triggering a comprehensive assessment may include, but are not limited to:
A) multiple
or complex health problems which are often chronic in nature, and may affect
the ability of the participant to live independently, such as musculoskeletal
disorders, strokes, heart disorders, or mental health issues (e.g., Alzheimer's
disease, major depression, or organic brain syndrome);
B) lack
of sufficient formal or informal supports; or
C) sudden
and permanent loss of a primary caregiver.
4) The
Care Coordinator will appropriately complete the comprehensive assessment tool
authorized by the Department, or any successor assessment tool, used to
determine need for community-based or long-term services and supports, that is
relevant to the participant in a manner consistent with the responsibilities
set forth under Section 240.1420.
c) Goals
of Care
1) Each
participant/authorized representative is provided the opportunity to lead the
person-centered planning process where possible. The participant's authorized representative
should have a participatory role, as needed and defined by the participant,
unless State law confers decision-making authority to the legal representative.
2) If a
participant's Goals of Care cannot be developed to create an adequate
person-centered plan of care, the Care Coordinator is required to discuss the
risks associated with the preferences and selections made regarding one or more
specific goals by the participant/authorized representative and suggest any
alternative options and/or referrals that might be available to mitigate risk.
3) Each
participant will be advised by the Care Coordinator of their right to accept or
refuse some or all offered services developed in participants' Goals of Care.
d) Reassessments
1) A
reassessment will be conducted face-to-face on at least an annual basis to
determine if the participant remains eligible for the program or if changes in
the participant's services under the person-centered plan of care are needed
and/or the Goals of Care need to be revised.
2) A
reassessment will also be conducted when requested by a participant/authorized
representative or when a participant may have experienced a change in their
needs.
3) The
participant/authorized representative develops their own revised Goals of Care
with input from the Care Coordinator consistent with the responsibilities set
forth in Section 240.1420.
e) Unit
of Service
Several
different types of assessments constitute a care coordination unit of service
for which reimbursement is made.
1) Completion of one initial eligibility determination for CCP
services constitutes one unit.
2) Completion of one required continuous eligibility
redetermination of CCP eligibility constitutes one unit. A redetermination
shall be completed at least annually.
3) Completion of either one face-to-face prescreening or
postscreen of a participant constitutes one unit.
4) Completion of one HFS Interagency Certification of Screening
Results form constitutes one unit.
5) Availability to receive participant inquiries and requests, by
telephone or in person, and to respond to those inquiries and requests for each
active participant per month constitutes one unit.