Section 686.235 Enhanced Rate for Health Insurance Costs

Section 686.235  Enhanced Rate for Health Insurance Costs

An enhanced rate shall be paid to Homemaker Service

Providers that offer health insurance coverage as a benefit to their Homemaker

employees who provide services to customers under HSP.

a)         For

purposes of this Section, "health insurance" means a Type 1 plan or a

Type 2 plan as described in subsections (a)(1) and (2).

1)         Type 1 Plan

A Type 1 plan must comply with, be

comparable to, or exceed required mandated benefits, coverages, and co-payment

levels for individuals and group insurance policies and individual and group

contracts for health maintenance organizations under the Illinois Insurance

Code [215 ILCS 5], the Health Maintenance Organization Act [215 ILCS 125], and 50

Ill. Adm. Code 2001.

2)         Type 2 Plan

A Type 2 plan is employer-paid

health insurance as part of collective bargaining with unionized Homemaker

employees through a Taft-Hartley Multi-employer Health and Welfare Plan.  The

Labor Management Relations Act of 1947 (29 USC 141 et seq.) describes the

requirements and coverage at 29 USC 186(c)(5).

b)         Initial Application

1)         An

interested Homemaker Service Provider must submit an initial application at

least 120 days prior to the end of each State fiscal year.  The application may

be obtained from and must be submitted to the Home Services Liaison for Health

Insurance, Department of Human Services, 100 South Grand Avenue East, P.O. Box

19429, Springfield, Illinois 62794-9429.

2)       Homemaker

Service Providers that are found by HSP to have deficiencies may not apply for

the enhanced rate until deficiencies are corrected to the satisfaction of HSP.

c)         Eligibility

Eligibility

requirements include:

1)         Verification

of a current rate agreement as a Homemaker Service Provider under the HSP

Avenue East, P.O. Box

19429, Springfield, Illinois 62794-9429.

2)       Homemaker

Service Providers that are found by HSP to have deficiencies may not apply for

the enhanced rate until deficiencies are corrected to the satisfaction of HSP.

c)         Eligibility

Eligibility

requirements include:

1)         Verification

of a current rate agreement as a Homemaker Service Provider under the HSP.

2)         A

copy of a health insurance plan or a certification of insurance and the

effective date of that document, to establish that:

A)        the

Homemaker Service Provider provides health insurance at its own expense for its

Homemaker employees, which may include coverage for those employees'

dependents; or

B)        the

Homemaker Service Provider will provide for health insurance as part of

collective bargaining with unionized Homemaker employees, which may include

coverage for those employees' dependents through a Taft-Hartley Multi-employer

Health and Welfare Plan.

3)         Specification

of the total number of employees and the total number of Homemaker employees,

together with a certification from a responsible party for the Homemaker

Service Provider to the effect that:

A)        under a

Type 1 health insurance plan:

i)          health

insurance coverage is offered to all Homemaker employees who have worked at

least an average of 20 hours per week for three consecutive months under HSP;

and

ii)         at

least one quarter of the total number of Homemaker employees accept the offer

of health insurance.

B)        under a

Type 2 health insurance plan:

i)          health

insurance coverage is offered to all of the Homemaker employees subject to the

collective bargaining agreement who have worked at least an average of 20 hours

per week for three consecutive months under HSP; and

ii)         at

least one quarter of the total number of Homemaker employees, or any higher

percentage required under federal law, accept the offer of health insurance

health

insurance coverage is offered to all of the Homemaker employees subject to the

collective bargaining agreement who have worked at least an average of 20 hours

per week for three consecutive months under HSP; and

ii)         at

least one quarter of the total number of Homemaker employees, or any higher

percentage required under federal law, accept the offer of health insurance.

4)         Submission

of any other relevant information requested by HSP for administrative or audit

purposes.

d)         Notification

It is the responsibility of a

Homemaker Service Provider to notify HSP within 7 days of any change in its

eligibility status, including, but not limited to, cancellation or termination

of the health insurance plan or purchase of a new plan.  A Homemaker Service

Provider is only required to monitor participation by Homemaker employees in

order to submit the initial application, the Annual Insurance Review required

by subsection (e), and required financial reporting.

e)         Annual Insurance Review

1)         Once

a Homemaker Service Provider is determined eligible by HSP and is paid an

enhanced rate for health insurance costs, the Homemaker Service Provider must

thereafter substantiate its continued eligibility under subsection (c) by

submitting appropriate supporting documentation at the same time as its annual

financial report under Section 686.250.

2)         As

part of the Annual Insurance Review, an independent certified public accounting

firm for the Homemaker Service Provider must verify the actual, documented

expense for health insurance provided for the period listed as part of the

required financial reporting under Section 686.250

iate supporting documentation at the same time as its annual

financial report under Section 686.250.

2)         As

part of the Annual Insurance Review, an independent certified public accounting

firm for the Homemaker Service Provider must verify the actual, documented

expense for health insurance provided for the period listed as part of the

required financial reporting under Section 686.250.

3)         HSP

reserves the right to require a Homemaker Service Provider to engage an

independent certified public accounting firm, approved by HSP, to verify the

information and data submitted by the Homemaker Service Provider if HSP is in

possession of evidence to suggest the information and data submitted is

inaccurate, incomplete or fraudulent.  This audit will be performed at the

Homemaker Service Provider's expense.

4)         HSP

shall notify a Homemaker Service Provider in the event of a determination

during the Annual Insurance Review that:

A)        the

Homemaker Service Provider is no longer eligible for continued payment of the

enhanced rate for health insurance costs;

B)        the

total revenue from the enhanced rate for health insurance costs exceeds the

actual, documented expenses for health insurance costs for the reporting

period;

C)        there

was an error in eligibility of a Homemaker Service Provider for the prior

reporting period;

D)        there

was an error in the amount of revenue from the enhanced rate for health

insurance costs; or

E)        there

was an error in the amount of the health insurance costs.

5)         A

Homemaker Service Provider may appeal an adverse eligibility decision regarding

continued payment of the enhanced rate for health insurance costs or a

repayment decision in accordance with Section 686.230.  HSP will continue to

pay the enhanced rate for health insurance costs until the appeal is resolved

or

E)        there

was an error in the amount of the health insurance costs.

5)         A

Homemaker Service Provider may appeal an adverse eligibility decision regarding

continued payment of the enhanced rate for health insurance costs or a

repayment decision in accordance with Section 686.230.  HSP will continue to

pay the enhanced rate for health insurance costs until the appeal is resolved.

6)         Supporting

documentation may be subject to release under the Freedom of Information Act [5

ILCS 140] unless an exemption applies for confidentiality, privacy, or other

proprietary business purpose and is marked accordingly on the face of any

submission.