89 Ill. Adm. Code 679.50
Service Cost Maximums (SCMs)
Section 679
Section 679.50 Service Cost
Maximums (SCMs)
a) For each individual meeting the minimum required DON scores
for eligibility (see 89 Ill. Adm. Code 682), there is a corresponding Service
Cost Maximum (SCM) for his/her DON score which is the maximum amount that may
be expended for services through HSP for an individual who chooses HSP services
over institutionalization. This amount directly corresponds to the amount the
State would expect to pay for the nursing care component of
institutionalization if the individual chose institutionalization.
b) The monthly SCMs for individuals served under the HSP Disabled
Individual Medicaid Waiver are:
DON Range
11/1/03 SCM
8/1/04 SCM
8/1/05 SCM
8/1/06 SCM
8/1/07 SCM
29-32
$1,154
$1,194
$1,249
$1,329
$1,488
33-40
$1,326
$1,371
$1,435
$1,527
$1,710
41-49
$1,475
$1,526
$1,597
$1,699
$1,902
50-59
$1,766
$1,827
$1,912
$2,034
$2,277
60-69
$2,076
$2,147
$2,247
$2,390
$2,677
70-79
$2,244
$2,322
$2,430
$2,585
$2,894
80-100
$2,412
$2,495
$2,612
$2,778
$3,111
c) The monthly SCMs for individuals served under the HSP AIDS
Medicaid Waiver are:
DON Range
11/1/03 SCM
8/1/04 SCM
8/1/05 SCM
8/1/06 SCM
8/1/07 SCM
29-32
$1,486
$1,538
$1,609
$1,712
$1,917
33-40
$2,228
$2,305
$2,412
$2,566
$2,873
41-49
$2,970
$3,073
$3,216
$3,421
$3,831
50-59
$3,714
$3,842
$4,021
$4,278
$4,790
60-69
$4,458
$4,611
$4,827
$5,134
$5,749
70-79
$5,198
$5,378
$5,628
$5,987
$6,704
80-100
$5,943
$6,148
$6,435
$6,845
$7,664
d) The monthly SCMs for individuals served under the HSP Brain
Injury Medicaid Waiver are:
DON Range
11/1/03 SCM
8/1/04 SCM
8/1/05 SCM
8/1/06 SCM
8/1/07 SCM
29-32
$1,286
$1,331
$1,393
$1,482
$1,659
33-40
$1,427
$1,476
$1,545
$1,644
$1,841
41-49
$1,586
$1,640
$1,717
$1,826
$2,045
50-59
$1,901
$1,966
$2,058
$2,189
$2,451
60-69
$2,234
$2,311
$2,419
$2,573
$2,881
70-79
$2,415
$2,499
$2,615
$2,782
$3,115
80-100
$2,597
$2,686
$2,811
$2,990
$3,349
e) The SCM for an individual may be exceeded on a monthly basis
to meet a temporary increase in need for services as long as the average
monthly cost for services during the twelve month period does not exceed the
SCM. Such an increase in services shall not last more than 3 months.
f) The exceptional care rate (ECR) for individuals who cannot be
served under an HSP waiver's SCM is established by the Department of Healthcare
and Family Services (HFS) under 89 Ill. Adm. Code 140.569(i). This rate is
comparable to the assessed cost for institutionalization and shall not be
exceeded. To determine the exceptional care rate for an individual served
under an HSP waiver program:
1) the
nearest approved exceptional care nursing facility to the individual's
home is identified;
2) the
exceptional care rate for that facility is requested from HFS; and
3) the daily exceptional care rate is multiplied by 30.3 to
establish a monthly
average.