5160:1-5-07 Medicaid: Specialized Recovery Services (SRS) program.  

  • Text Box: ACTION: Final Text Box: DATE: 07/21/2016 9:51 AM

     

     

     

    5160:1-5-07                 Medicaid: Specialized Recovery Services (SRS) program.

     

     

     

    (A)This rule sets forth the eligibility criteria for a State plan home and community-based services (HCBS) benefit authorized under section 1915(i) of the Social Security Act (as in effect on October 1, 2015). Section 1915(i) of the Act allows states the flexibility to provide HCBS to individuals who require less than an institutional level of care (LOC) and who would, therefore, not be eligible for HCBS under the more restrictive criteria of section 1915(c) waivers. The Specialized Recovery Services (SRS) program provides targeted services to individuals with severe and persistent mental illness (SPMI) as described in Chapter 5160-43 of the Administrative Code. Eligibility for this program shall be determined for applications for medical assistance filed on or after the effective date of this rule.

     

    (B)Eligibility for the SRS program State plan HCBS benefit. An individual must:

     

    (1)Be at least twenty-one years of age; and

     

    (2)Have been determined to meet the definition of disability used by the social security administration (SSA) for purposes of supplemental security income (SSI) or social security disability insurance (SSDI) benefits; and

     

    (3)Be in receipt of SSI benefits authorized by the SSA under Title XVI of the Social Security Act (as in effect on October 1, 2015) or SSDI benefits authorized by the SSA under Title II of the Social Security Act (as in effect on October 1, 2015); and

     

    (4)Meet the clinical diagnostic, needs assessment, and risk criteria described in rule 5160-43-02 of the Administrative Code; and

     

    (5)Reside in a home and community-based setting consistent with the qualities identified in 42 C.F.R. 441.710 (as in effect on October 1, 2015); and

     

    (6)Meet  the  financial  and  nonfinancial  eligibility  requirements  of  one  of  the following groups:

     

    (a) Group one.

     

    (i) Be in receipt of medicaid, as described in Chapters 5160:1-1 to 5160:1-5 of the Administrative Code; and

     

    (ii) Have countable income that does not exceed one hundred fifty percent of the federal poverty level (FPL), as determined using the same rules used for determining the individual's medicaid eligibility.

     

    (b) Group two.

     

    (i) Meet the conditions of eligibility outlined in rule 5160:1-2-10 of the

     

     

    Administrative Code; and

    (ii) Not be otherwise eligible for medicaid; and

    (iii) For the purpose of determining whether an individual is income eligible for the SRS program, the administrative agency must compare the individual's countable income to one hundred fifty percent of the FPL, as determined in accordance with Chapter 5160:1-3 of the Administrative Code.

    (a) If the individual's countable income exceeds one hundred fifty percent of the FPL, apply additional disregards in the following order:

    (i) Twenty dollar personal needs disregard; then

    (ii) Disregard income in the amount of the difference between one hundred fifty percent of the FPL for an individual and three hundred percent of the current supplemental security income (SSI) federal benefit rate (FBR) for an individual.

    (b) If the amount determined in subparagraph (B)(6)(b)(iii) of this rule is no more than one hundred fifty percent of the FPL, the individual meets the income eligibility requirement for the SRS program.

    (iv) There is no resource limit for individuals described in subparagraph (B)(6)(b) of this rule.

    (C) There is no retroactive eligibility for the SRS program State plan HCBS benefit. Coverage under this rule cannot begin prior to the first day of the month in which all financial, nonfinancial, and programmatic criteria are met.

    (D) An individual who is receiving the State plan HCBS benefit cannot be concurrently enrolled in another HCBS authority, such as a section 1915(c) waiver. Subject to the individual's choice, he or she will be enrolled in the HCBS authority best meeting the totality of his or her needs regardless of the order in which the individual applied for or became eligible for HCBS.

    Effective:

    08/01/2016

    Five Year Review (FYR) Dates:

    08/01/2021

     

    CERTIFIED ELECTRONICALLY

     

    Certification

     

     

    07/21/2016

     

    Date

     

     

    Promulgated Under:

     

    111.15

    Statutory Authority:

    5162.03, 5163.02

    Rule Amplifies:

    5162.03, 5163.02

Document Information

Effective Date:
8/1/2016
File Date:
2016-07-21
Last Day in Effect:
2016-08-01
Rule File:
5160$1-5-07_FF_N_RU_20160721_0951.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 5160:1-5-07. [Effective 8/1/2016] Medicaid: Specialized Recovery Services (SRS) program