RESPITE CARE SERVICES PROVIDER IN ILLINOIS

SUPPORTING CAREGIVERS AND PROMOTING PARTICIPANT WELL-BEING THROUGH TEMPORARY RELIEF SERVICES

Respite Care Services in Illinois provide short-term, temporary relief to family caregivers of individuals with disabilities, chronic illnesses, or age-related conditions. These services allow primary caregivers to rest, attend to personal matters, or recover from caregiver fatigue, while ensuring the participant’s safety and well-being. Respite Care is authorized under Illinois Medicaid Home and Community-Based Services (HCBS) Waiver programs.​​​​​

​1. GOVERNING AGENCIES

Agency: Illinois Department of Healthcare and Family Services (HFS)

Role: Administers Medicaid waiver funding for Respite Care Services and manages provider enrollment, service authorization, and reimbursement

Agency: Illinois Department of Human Services (DHS) — Division of Developmental Disabilities (DDD) and Division of Rehabilitation Services (DRS)

Role: Oversees service quality, participant protections, and respite service compliance under HCBS waiver programs

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Medicaid-funded Respite Care Services meet HCBS quality, person-centered planning, and participant protection standards

2. RESPITE CARE SERVICE OVERVIEW

Respite Care Services offer planned or emergency relief for unpaid caregivers while ensuring participants receive appropriate supervision, personal care, and support services.

Approved providers may deliver:

• In-home respite services in the participant’s residence

• Facility-based respite care in licensed community settings

• Overnight, weekend, or extended respite, depending on caregiver needs

• Assistance with Activities of Daily Living (ADLs) such as bathing, grooming, feeding, mobility, and toileting

• Medication reminders and basic health monitoring (non-skilled tasks)

• Engagement in recreational or therapeutic activities based on the participant’s interests and care plan

All respite care must align with the participant’s Individualized Service Plan (ISP) and reflect the participant’s health and safety needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Illinois Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Enroll as a Medicaid Waiver Respite Care provider through the Illinois Medicaid Provider Enrollment Portal (IMPACT system)

• Obtain facility licensure (if providing facility-based respite) from DHS DDD or IDPH as applicable

• Maintain general liability and professional liability insurance

• Develop comprehensive policies for participant intake, caregiver communication, incident reporting, participant health and safety, and emergency procedures

• Ensure all direct care staff meet background screening, health screenings, and training requirements

4. ILLINOIS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application through the IMPACT system for Respite Care Services under the appropriate HCBS waivers

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, liability insurance certificates, staff credentialing documentation, and service policies

Program Readiness Review:

• DHS reviews provider readiness, including staff qualifications, care and supervision protocols, participant safety plans, and documentation systems

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for In-Home and/or Facility-Based Respite Services using assigned billing codes

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Illinois Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Facility License (for facility-based respite providers)

• Proof of general and professional liability insurance

• Respite Care Services Policy & Procedure Manual, including:

  • Participant intake, care planning, and service scheduling procedures

  • Health and safety monitoring, medication reminders, and supervision protocols

  • Emergency preparedness, abuse prevention, and critical incident reporting policies

  • Participant rights, HIPAA confidentiality procedures, and grievance handling

  • Staff credentialing, background checks, and first aid/CPR certification documentation

  • Medicaid billing, service tracking, and audit readiness procedures

6. STAFFING REQUIREMENTS

Role: Respite Services Program Director / Supervisor

Requirements: Bachelor’s degree in human services, healthcare, or related field preferred; background clearance; supervisory experience in direct care settings preferred

Role: Respite Care Workers / Direct Support Professionals

Requirements: High school diploma or GED; CPR/First Aid certification; completion of respite-specific or direct care training; background screening and health clearance

All staff must complete:

• Participant safety and emergency preparedness training

• HIPAA compliance and participant rights training

• Abuse, neglect, and exploitation prevention training

• Infection control and wellness monitoring training

• Annual competency evaluations and continuing education

7. MEDICAID WAIVER PROGRAMS

Respite Care Services are available under the following Illinois Medicaid Waivers:

• Adults with Developmental Disabilities Waiver

• Children and Young Adults with Developmental Disabilities Waiver

• Persons with Brain Injury (BI) Waiver

• Persons with Disabilities (PD) Waiver

• Elderly Waiver (Community Care Program) — limited to certain caregiver respite needs

Approved providers may deliver:

• Short-term in-home or facility-based supervision and care

• Temporary support allowing unpaid caregivers to attend to personal needs

• Assistance with basic ADLs and wellness monitoring during respite periods

• Emergency or crisis respite services when caregiver availability is compromised

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: IMPACT Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Respite Care Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Illinois Department of Human Services (DHS) — Division of Developmental Disabilities

Website: https://www.dhs.state.il.us/page.aspx?item=48540

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ILLINOIS RESPITE CARE SERVICES PROVIDER

WCG assists respite service agencies, home care organizations, and community support providers in launching Medicaid-compliant Respite Care Services across Illinois.

​​​​​​​​​​​​​​Scope of Work:

• Business registration, Medicaid enrollment, and facility licensure support (if applicable)

• Development of Respite Care Services Policy & Procedure Manual

• Staff credentialing templates, participant intake forms, and emergency planning templates

• Medicaid billing system setup and audit-ready claims management

• Website, domain, and professional branding development

• Caregiver training program templates and participant satisfaction surveys

• Quality assurance systems for incident reporting, service tracking, and compliance monitoring

• Community outreach strategies for caregiver engagement and referral network development

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