Developmental Disabilities CSA Attachment A

I. Introduction

II. Applicable Statutes, Rules and Guidelines

III. Program Services

IV. Program Plan and Deliverables

V. Payment

VI. Eligibility Criteria

VII. Reporting Requirements

VIII. Special Conditions


I. Introduction

This document serves as an attachment to the Department of Human Services (DHS) standard Community Services Agreement and sets forth supplemental contractual obligations between the Provider and DHS. The attachment provides contractual requirements beyond and in addition to those in the Community Services Agreement and is intended to address the programmatic areas of the Division of Developmental Disabilities (the Division).

II. Applicable Statutes, Rules and Guidelines

The Provider must comply with all applicable federal, state, and local regulations and statutes; as well as Departmental directives, including, but not limited to, the following:

Federal

State

Statutes

Rules

Guidelines

III. Program Services

A. Program Requirements for All Services

The Provider agrees that the intended purpose of funding for services for individuals with developmental disabilities is to promote quality of life, functional independence and the health, safety and welfare for those individuals identified as eligible and appropriate for services.

The Provider shall ensure that individuals served are provided:

  1. Assessments conducted at least annually, by qualified staff;
  2. An Individual Service Plan (as used herein, refers to and is equivalent to "participant-directed support plan," "individual treatment plan," and "individual habilitation plan") that is developed through the interdisciplinary process based on the individual's choices, strengths, and needs; that states goal(s) with specified time frames and responsible persons; and that is coordinated across all Division-Funded Providers;
  3. Protection of their rights, including teaching skills necessary for person's to more fully exercise their rights;
  4. An opportunity to express their preferences and choice of services;
  5. Qualified Intellectual Disability Professional (QIDP) (formerly referred to as a Qualified Mental Retardation Professional - QMRP), assigned to monitor their programs; and
  6. Qualified and trained staff providing services.

B. Program Requirements for CILA Providers

  1. CILA services are provided in compliance with 59 Ill. Adm. Code 115 (Standards and Licensure Requirements for Community-Integrated Living Arrangements), 59 Ill. Adm. Code 116 (Administration of Medications in Community Settings) and 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Program for Individuals with Developmental Disabilities). The Provider, as a Community Integrated Living Arrangement provider, agrees to provide services to persons with developmental disabilities pursuant to these rules and shall comply with the DHS Division guidelines, Waiver Manual, Community-Integrated Living Arrangement (CILA) Individual Rate Determination Model User Guide, Cost Center Definitions, and Allowance Levels, and the Interpretative Guidelines to Rule 115, which are incorporated herein and are made a part hereof by this reference.
  2. The Provider shall design a procedure to evaluate the degree to which there is movement toward the goals established by and with individuals, and which are documented in the Individual Service Plan.
  3. The Department authorizes individual CILA capacity via a CILA Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the CILA Award Memorandum or CILA Pre-Award Memorandum prior to initiation of CILA services to the individual.
  4. For the initial twelve months subsequent to a new CILA provider entering into a Service Agreement with the Division, the Department may consider approval of no more than eight individuals.
  5. CILA payments during the initial 12 months of CILA services rendered by a new CILA provider will be initiated upon approval of each individual's Individual Service Plan by the Division of Developmental Disabilities, and effective the date of actual placement but no sooner than the date of the Department's Award Memorandum or Pre-Award Memorandum.
  6. The Provider will assume responsibility for providing directly, or by arrangement with other agencies or professionals, all necessary services for all individuals accepted for service.
  7. The Provider is to notify its local PAS/ISC Agency and Region staff of all CILA terminations within 5 working days or anticipated terminations as soon as possible. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) form.
  8. Payments for CILA services are initiated effective the later of the date of actual placement but no sooner than the date of the Department's Award Memorandum, Pre-Award Memorandum, the date the PAS/ISC agency completes the Pre-Admission Screening (PAS) assessment, or the date the individual is enrolled in Medicaid or is terminated from a conflicting DD program or other waiver. CILA payments are terminated effective the actual date the individual permanently departs the Community-Integrated Living Arrangement.
  9. The Department will not double pay for capacity when an individual transfers to another residential provider.
  10. Providers of CILA services shall ensure individuals enrolled in CILA do not receive funding from the DHS Division of Rehabilitation Services Waiver Programs or the Department on Aging Community Care Services or Adult Day Care Services, except for Vocational Rehabilitation, without approval from the Division.
  11. Provider shall enter timely and accurate vacancy data into the DHS Unified Health Systems database on an on-going basis but not less than monthly.

C. Program Requirements for Pre-Admission Screening/Independent Services Coordination /Individual Services and Support Advocacy Providers (PAS/ISC/ISSA)

  1. The Provider agrees to take full responsibility for the activities of its subcontractors engaged pursuant to this agreement. The Provider will ensure the subcontractor meets all provisions in applicable sections of this contract.
  2. The Provider shall enforce conflict of interest procedures that include, at a minimum, the following provisions:
    1. The Board of Directors shall not include individuals who work for or are on the Board of Directors of entities that provide direct services, such as, but not limited to, residential, vocational, respite, day program, supported employment, or family support services;
    2. The Provider may not provide direct services, such as, but not limited to, residential, vocational, respite, day program, supported employment, or family support services;
    3. The Provider shall require that staff, including executive and management staff, do not provide direct services, such as, but not limited to, residential, vocational, respite, day program, supported employment, or family support services.
  3. The Provider ensures 24-hour per day, 365 days per year accessibility for PAS/ISC/ISSA responsibilities in times of crisis for individuals.
  4. The Provider shall, as requested by the Division, initiate face-to-face contact to inquire as to the need for services, provide follow-up, PAS, and other advocacy for individuals referred by the Division as part of the State's compliance with the Adult Protective Services Act.
  5. The Provider shall, as requested by the Division, conduct face-to-face screenings of individuals in crisis who present to local hospitals or emergency rooms.
  6. The Provider agrees that all contracted activities must be conducted with direct involvement by the individual to be served and his or her guardian. The individual must be presented with realistic choices to the maximum extent possible within regulations and funding constraints.
  7. The Provider agrees to report in a timely fashion through the designated computerized reporting system(s) all data required by the Division to monitor contracted activities.
  8. The Provider shall participate in all SODC transition activities as directed by the Division.
  9. The Provider shall submit funding request packets to the Division for individuals in accordance with the Division's crisis criteria (available on the Division's web page) in response to PUNS selections, or in accordance with special funds (e.g. SODC discharges) Packets for other individuals shall not be submitted to the Division.

D. Program Requirements for Children's Group Home (CGH) Providers

  1. Children's Group Home (CGH) services are provided in compliance with 89 Ill. Adm. Code 384 (Behavior Treatment in Residential Child Care Facilities), 89 Ill. Adm. Code 401 (Licensing Standards for Child Welfare Agencies), 89 Ill. Adm. Code 403 (Licensing Standards for Group Homes), 59 Ill. Adm. Code 116 (Administration of Medications in Community Settings) and 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Programs for Individuals with Developmental Disabilities). The Provider, as a Children's Group Home provider, agrees to provide services to persons with developmental disabilities pursuant to these rules and the Waiver Manual, which are incorporated herein and are made a part hereof by this reference.
  2. The Provider shall develop an Individual Service Plan for each individual that is in compliance with all service plan requirements contained in the Waiver Manual.
  3. Restrictive interventions to modify behavior must be reviewed and approved in writing by the support planning team, and the Human Rights Committee.
  4. At least annually, the Provider shall provide to individuals and/or their legal representatives written information about protections against abuse, neglect and exploitation. Information shall include the process for reporting allegations to the appropriate investigatory authority, depending on the age of the individual served and that anyone who suspects abuse, neglect, or exploitation may report an allegation.
  5. The Provider shall design a procedure to evaluate the degree to which there is movement toward the goals established by and with individuals, and which are documented in the Individual Service Plan.
  6. The Department authorizes individual CGH capacity via a CGH Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the CGH Award Memorandum or Pre-Award Memorandum prior to initiation of CGH services to the individual.
  7. For the initial twelve months subsequent to a new CGH provider entering into a Service Agreement with the Division of Developmental Disabilities, the Department may consider approval of no more than 10 individuals.
  8. CGH payments during the initial twelve (12) months of CGH services rendered by a new CGH provider will be initiated upon approval of each individual's Service Plan by the Division of Developmental Disabilities, and effective the date of actual placement but no sooner than the date of the Department's Award Memorandum.
  9. The Provider shall assume responsibility for providing directly, or by arrangement with other agencies or professionals, all necessary services for all individuals accepted for service.
  10. Staff shall receive training in DCFS reporting requirements for allegations of abuse, neglect, or exploitation at least every two years.
  11. The Provider shall send a copy of each final report of Child Welfare Agency or CGH licensure survey conducted by DCFS staff to the Division's Bureau of Quality Management within 30 calendar days of receiving the report.
  12. The Provider shall send a copy of each final report by DCFS/OIG of substantiated abuse/neglect investigations involving individuals whose services are funded by the Division and employees or contractors of the provider.
  13. Providers of CGH services shall ensure individuals enrolled in CGH do not receive funding from the DHS Division of Rehabilitation Services (DRS) Waiver Programs or the Department on Aging Community Care or Adult Day Care Services, except for Vocational Rehabilitation without approval from the Division.
  14. The Provider is to notify its local PAS/ISC Agency and Network staff of all terminations within 5 working days or anticipated terminations as soon as possible. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) form.
  15. Payments for CGH services are initiated effective the date of the actual placement but no sooner than the date of the Department's Award Memorandum, the date the PAS/ISC agency completes the PAS assessment, or the date the individual is enrolled in Medicaid or is terminated from a conflicting DD program or other waiver, and are terminated effective the actual date the person permanently departs the CGH.
  16. The Department will not double pay for capacity when an individual transfers to another residential provider.
  17. Provider shall enter timely and accurate vacancy data into the Unified Health Systems database on an on-going basis but not less than monthly.

E. Program Requirements for Service Facilitation Providers

  1. Service Facilitation is provided in compliance with 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Programs for Individuals with Developmental Disabilities). The Provider, as a Service Facilitation provider, agrees to provide services to persons with developmental disabilities pursuant to this rule and the Waiver Manual, which are incorporated herein and are made a part hereof by this reference.
  2. The Provider shall develop an Individual Service Plan for each individual that is in compliance with all requirements contained in the Waiver Manual.
  3. At least annually, the Provider shall provide to individuals and/or their legal representatives written information about protections against abuse, neglect, and exploitation. Information shall include the process for reporting allegations to the appropriate investigatory authority, depending on the age of the individual served and that anyone who suspects abuse, neglect, or exploitation may report an allegation.
  4. The Provider shall design a quality assurance procedure to evaluate the degree to which there is movement toward the goals established by and with individuals, and which are documented in the Individual Service Plan.
  5. The Provider shall assume responsibility for providing directly, or by arrangement with other agencies, professionals, or independent providers, all necessary services included in the support plan for all individuals accepted for service.
  6. Staff shall receive training in DCFS reporting requirements for allegations of abuse, neglect or exploitation at least every two years.
  7. The Department authorizes individual capacity via a HBS Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the HBS Award Memorandum or Pre-Award Memorandum prior to the initiation of services to the individual.
  8. The Provider is to notify its local PAS/ISC Agency and Region staff of all terminations within 5 working days or anticipated terminations as soon as possible. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) form.
  9. Service Facilitation Providers shall ensure individuals enrolled in Service Facilitation services do not receive funding from the DHS Division of Rehabilitation Service (DRS) Waiver Programs or the Department on Aging Community Care or Adult Day Care Services, except for Vocational Rehabilitation without approval from the Division.

F. Program Requirements for Agencies Providing Personal Support

  1. Personal Support services are provided in compliance with 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Programs for Individuals with Developmental Disabilities.) The Provider, as a Personal Support provider, agrees to provide services to persons with developmental disabilities pursuant to this rule and the Waiver Manual, which are incorporated herein and are made a part hereof by this reference.
  2. Restrictive interventions to modify behavior must be reviewed and approved in writing by the support planning team, and the Human Rights Committee.
  3. Staff serving individuals aged 17 or younger shall receive training in DCFS reporting requirements for allegations of abuse, neglect, or exploitation at least every two years.
  4. The Department authorizes individual capacity via an HBS Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the HBS Award Memorandum or Pre-Award Memorandum prior to the initiation of services to the individual.
  5. Providers of Personal Support services shall ensure individuals enrolled in Personal Support Services do not receive any funding from the DHS Division of Rehabilitation Services (DRS) Waiver Programs or the Department on Aging Community Care or Adult Day Care Services, except for Vocational Rehabilitation without approval from the Division.

G. Program Requirements for Agencies Providing Supported Employment

  1. Supported Employment services are provided in compliance with 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Programs for Individuals with Developmental Disabilities). The Provider, as a Supported Employment Provider, agrees to provide services to persons with developmental disabilities pursuant to this rule and the Waiver Manual, which are incorporated herein and are made a part hereof by this reference.
  2. The Provider shall develop an Individual Service Plan for each individual that is in compliance with all support plan requirements contained in the Waiver Manual.
  3. The Provider agrees to provide flexible hours of service to permit full or partial shift work, work on weekends, and work at night or evenings.
  4. Supported Employment services shall be delivered in integrated work settings. There must be interaction with co-workers without disabilities and the public. The amount of integration should be the same as that for individuals without disabilities in comparable jobs.
  5. The Provider is to notify its local PAS/ISC Agency and Region staff of all terminations within 5 working days or anticipated terminations as soon as possible. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) form.
  6. Payments for SEP services are initiated effective the actual placement but no sooner than the date of the Department's Award Memorandum, the date the PAS/ISC agency completes the PAS assessment, or the date the individual is enrolled in Medicaid or is terminated from a conflicting DD program or other waiver, and payments are terminated effective the actual date the person permanently departs or is last served in SEP.
  7. Providers of SEP services shall ensure individuals enrolled in SEP do not receive funding from the DHS Division of Rehabilitation Services (DRS) Waiver Programs or the Department on Aging Community Care or Adult Day Care Services, except Vocational Rehabilitation, without approval from the Division.

H. Program Requirements for Agencies Providing Developmental Training

  1. Developmental Training services are provided in compliance with 59 Ill. Adm. Code 119 (Minimum Standards for Certification of Developmental Training Programs), and 59 Ill. Adm. Code 120 (Medicaid Home and Community Based Waiver Program for Individuals with Developmental Disabilities). The Provider as a Developmental Training Provider, agrees to provide services to persons with developmental disabilities pursuant to these rules and shall comply with the DHS Division guidelines, Waiver Manual, and the Interpretative Guidelines to Rule 119, which are incorporated herein and are made a part hereof by this reference.
  2. Agencies providing Developmental Training services to residents of long-term care settings that are certified for participation in the Medicaid program as Intermediate Care Facilities for individuals with Mental Retardation (ICF/MR) must comply with the federal regulations governing ICF/MR facilities (42 CFR 440 and 42 CFR 483).
  3. The Department authorizes individual DT capacity via a DT, POS, HBS, or CILA Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the Award Memorandum prior to the initiation of DT services to the individual.
  4. The Provider is to notify its local PAS/ISC Agency and Region staff of all terminations within 5 working days or anticipated terminations as soon as possible. Notification of terminations or anticipated terminations must be in writing on the Service Termination Approval Request (STAR) form.
  5. Payments for DT services are initiated effective the date of the actual placement but no sooner than the date of the Department's Award Memorandum, the date the PAS/ISC agency completes the PAS assessment, or the date the individual is enrolled in Medicaid or is terminated from a conflicting DD program or other waiver, and payments are terminated effective the actual date the person permanently departs or is last served in DT.
  6. Providers of DT services shall ensure individuals enrolled in DT do not receive funding from the DHS Division of Rehabilitation Service (DRS) Waiver Programs or the Department on Aging Community Care or Adult Day Care Services, except Vocational Rehabilitation, without approval from the Division.
  7. Provider shall enter timely and accurate vacancy data into the Unified Health Systems database on an on-going basis but not less than monthly.

I. Program Roster

  1. The following is a listing of service programs funded by the Division covered by the contract to which this attachment is a part.
  2. The Program name is followed by program code and method of payment
    (GIA = Grant in Aid, FFS = Fee for service). Program descriptions can be found in the Division Program Manual.
  • PRE-ADMISSION SCREENING Program 780, GIA
  • INDIVIDUAL SERVICE AND SUPPORT ADVOCACY Program 50D, FFS
  • INDEPENDENT SERVICE COORDINATION Program 500, GIA
  • PRE-ADMISSION SCREENING-BOGARD Program 781, GIA
  • SUPPORTED LIVING ARRANGEMENT Program 42D, FFS
  • SPECIAL HOME PLACEMENT Program 41D, FFS
  • HOME/INDIVIDUAL PROGRAM Program 68D, FFS
  • CHILDREN'S GROUP HOME Program 17D, FFS
  • CHILD CARE INSTITUTION RESIDENTIAL SCHOOL Program 19D, FFS
  • COMMUNITY LIVING FACILITY Program 67D, FFS
  • COMMUNITY-INTEGRATED LIVING ARRANGEMENT Programs 60D and 61D, FFS
  • COMMUNITY-INTEGRATED LIVING ARRANGEMENT (INTERMITTENT), Program 65H, FFS
  • DEVELOPMENTAL TRAINING Programs 31U and 31A, FFS
  • DEVELOPMENTAL TRAINING, SODC, Program 31S, FFS
  • REGULAR WORK/SHELTERED EMPLOYMENT Program 38U, FFS
  • SUPPORTED EMPLOYMENT-NO JOB COACH-GROUP Program 36G, FFS
  • SUPPORTED EMPLOYMENT-NO JOB COACH-INDIVIDUAL Program 36U, FFS
  • SUPPORTED EMPLOYMENT-WITH JOB COACH-GROUP Program 39G, FFS
  • SUPPORTED EMPLOYMENT-WITH JOB COACH-INDIVIDUAL Program 39U, FFS
  • OTHER DAY Program 30U, FFS
  • ADULT DAY CARE Program 35U, FFS
  • AT HOME DAY PROGRAM Program 37U, FFS
  • SERVICE FACILITATION Program 55A, FFS
  • PERSONAL SUPPORT (AGENCY-PROVIDED) Program 55D, FFS
  • RELATED SUPPORT - ADULT (73D) FFS
  • IN-HOME RESPITE Program 87D, FFS
  • RESIDENTIAL RESPITE Program 89D, FFS
  • GROUP RESPITE Program 880, GIA
  • DEMONSTRATION/SPECIAL PROJECTS Program 450, GIA
  • EPILEPSY Program 250, GIA
  • DENTAL SERVICES Program 400, GIA

IV. Program Plan and Deliverables

AGENCY PLAN FORMS

The Provider of grant funded services agrees to execute Agency Plan forms provided by the Department and to submit completed forms to the Department  when requested and within time frames specified by the Department. The Provider must have an approved Agency Plan on file with the Division of Developmental Disabilities and is required to comply with all conditions and provisions therein.

V. Payment

A. Types of Funding

  1. GRANT PROGRAMS (GIA)

    Grant funded programs receive all or part of the funding in advance of the actual delivery of services. This includes prorated prospective payments and payments made by the Department on an estimated basis or any other basis when the Department does not know the actual amount earned by the Provider. This does not include advance payments made under the authority of Section 9.05 of the Illinois Finance Act (30 ILCS 105/9.05).

    All funds paid as a grant are subject to the Illinois Grant Funds Recovery Act (30 ILCS 705). All funds dispersed by the Department on a grant basis are subject to reconciliation and the recovery of lapsed funds. Any funds remaining after reconciliation are subject to the Illinois Grant Funds Recovery Act. The reconciliation will be based on one of the following methods at the election of the Department:

    Eligible Expenditures v. Program Revenue: This method compares the eligible expenditures to the total Department grant revenues by program. An independent audit and associated supplemental revenue and expense schedule may be required from the provider. Eligible expenditures will be determined based on 89 Ill. Adm. Code 509.20, Allowable/Unallowable Costs and specific program costs, if applicable.

    Eligible Services Delivered v. Services Projected: This method compares the actual eligible services delivered to the services projected in the Agreement. If the services were based on a rate or unit or cost methodology, the number of eligible service units delivered multiplied by the rate or unit is compared to the total of all grant payments for that service.

    Payment for grants shall be issued in prorated prospective monthly payments except where other specific payment terms are otherwise noted in this provider agreement. Payment is made contingent upon funds being made available by the Illinois General Assembly and the Governor.

  2. FEE-FOR-SERVICE (FFS)

    Fee-for-service programs receive payment at a Department approved rate subsequent to delivery of services. Fee-for-service program providers receive payments that are made on the basis of a rate, unit cost, or allowable cost incurred, and are based on a statement or bill as required by the Department. Payment is contingent upon funds being made available by the Illinois General Assembly and the Governor.

    Billings are submitted by the Provider upon delivery of services and must include the complete and correct name, social security number, and Recipient Identification Number (if one has been assigned), for all individuals. The Provider shall be paid for services at a specified rate(s) as authorized by the Department. Submission of provider enrollments, individual service authorizations, and billings must be timely and accurate. The Provider shall maintain adequate substantiating documentation of services provided.

    The Provider agrees that it will not assess the individual nor his/her family a fee or any other type of financial obligation that supplements the rate established by the Department for the individual. The Provider understands that individuals enrolled in some funded services do contribute a specified portion of earned income or entitlement benefits toward the cost of care in accordance with the formula established by the Department for each service.

    The Provider may be issued an advance that will be deducted from billings before the end of the contract period.

    Some fee-for-service programs are paid through an "advance and reconcile" payment mechanism that advances fee-for-service payments that are then reconciled against actual fee-for-service bills submitted by the Provider.

B. Debt Service Deduction

If the Provider is approved by the Department for a debt service deduction contract to participate in a pooled loan program or other loan program where the debt service deduction will be performed by the Department, the Provider hereby authorizes the Department to deduct Provider's debt service payments from the Provider's award and forward payment directly to the trustee bank or other designated party. The Provider agrees to execute a Debt Service Deduction contract in a form provided by the Department if so participating.

The Provider agrees to provide 90 calendar days written notice to the Department of its intention to enter into pooled-loan financing, or any other financing transaction that would require the use of a debt-service deduction mechanism by the Department. If the Provider fails to provide such notice, the Department shall not execute any debt-service deduction contracts until the Department has had 90 days for project review. The Department retains the right to accept or decline to participate through debt service deduction in any financed projects. Additionally, providers specifically acknowledge that if they enter into a debt service deduction contract with the Department to secure a loan based on fee-for-service funding, such funding is based upon individual recipients, each authorized for placement by the Department, at rates set by the Department. Accordingly, if and when funding for a particular recipient terminates, the Department does not guarantee replacement of equivalent funding. Therefore, any such debt service deduction contract will be honored only to the extent of currently supported fee-for-service funding at the time of any required debt service deduction.

The Provider shall supply to the Department an estimated debt-service deduction payment schedule thirty (30) days before closing of the loan transaction.

VI. Eligibility Criteria

A. Individual Eligibility

General eligibility and specific program eligibility can be found in the Division Program Manual. The Division of Developmental Disabilities reserves the right to review and reverse any PAS determination.

B. Eligibility Residential Programs

All individuals accepted in adult residential programs and Children's Group Homes must be determined to be eligible for Home and Community-Based Services Waiver funding. Exceptions to this requirement can only be approved by written notification by the Director of the Division of Developmental Disabilities or designee.

C. Selection Criteria and Priority Populations

Authorizations for Fee-for-service programs are subject to appropriation levels and applicable maximum capacities for programs (e.g., Waiver capacity). Individuals potentially in need of these services are enrolled in the Division's Prioritization of Urgency of Need for Services (PUNS) database by one of the PAS/ISSA agencies serving as access points. This database records demographic and clinical information regarding the individual and his/her circumstances, services currently received, and services needed. New individuals are selected from the Prioritization of Urgency of Need For Services (PUNS) database.

Adult residential

As appropriations are available, individuals are selected for authorization via an automated process that focuses on the individual's needs and the family's circumstances (where applicable). Entrance to the waiver for adults with developmental disabilities of otherwise eligible applicants is deferred via this process until capacity becomes available as a result of turnover or the appropriation of additional funding by the legislature. Authorizations for adult residential services are established in accordance with the following priority populations, in priority order, beginning with the most critical need:

  1. Individuals who are in crisis situations, (e.g., including, but not limited to, participants who have lost their caregivers, participants who are in abusive or neglectful situations);
  2. Individuals who are wards of the Department of Children and Family Services and are approaching the age of 18 and individuals who are aging out of children's residential services funded by the Division of Developmental Disabilities,
  3. Individuals who reside in State Operated Developmental Centers (SODCs),
  4. Bogard class members, i.e., certain individuals with developmental disabilities who currently reside or previously resided in a nursing facility;
  5. Individuals with Intellectual Disabilities who reside in State-Operated Mental Hospitals,
  6. Individuals who reside in private ICFs/MR, and
  7. Individuals with aging care-givers.

Children's Residential Services

The selection criteria will provide for selection of individuals on several bases, including urgency of need, length of time on the database, and randomness. As appropriations are available, children are selected for authorization via an automated process that focuses on the child's needs and the family's circumstances. Entrance to the Children's Residential Waiver of otherwise eligible applicants is deferred via this process until capacity becomes available as a result of turnover or the appropriation of additional funding by the legislature.

Adult Support Services

As appropriations are available, individuals are selected for authorization that focuses on the individual's needs and the family's circumstances (where applicable). The State gives service priority to eligible persons who have been identified as individuals who are currently not receiving any support services from the Division or the Division of Rehabilitation Services (except vocational rehabilitation services). Within this population, if requests exceed available capacity, the State will prioritize:

  1. Individuals whose primary care-giver is age 60 or older, but is not yet in crisis;
  2. Individuals who have exited special education within the last five years;
  3. Individuals who are living with only one care giver.

Children's Support Services

As appropriations are available, children are selected for authorization that focuses on the child's needs and the family's circumstances. The number of individuals served each year will be based on available appropriations. New enrollees will be selected from the Prioritization of Urgency of Need For Services (PUNS) database, a database maintained by the Division of Developmental Disabilities of individuals potentially in need of state-funded DD services within the next five years. Entrance to the Children's Support Waiver of otherwise eligible applicants is deferred via this process until capacity becomes available as a result of turnover or the appropriation of additional funding by the legislature. The selection criteria will provide for selection of individuals on several bases, including urgency of need, length of time on the database, and randomness.

VII. Reporting Requirements

A. Service Reporting for Grant Programs

The Provider must submit complete and accurate service reports the month following the month in which services were delivered. Grant payments may be suspended if service reports are not submitted in the proper format and accepted by the Department within sixty (60) calendar days following the end of the service month.

B. Data

The Provider must submit any and all data required by rule or requested by the Department concerning the operation of its funded programs. The Provider must submit data in a timely manner in a format prescribed by the Department. The Provider shall complete and transmit service reporting accurately and timely in accordance with 59 Ill. Adm. Code 103, Section 103.170(b)(1).

When reporting or billing for services, the complete name, Social Security number, and Recipient Identification Number (if one has been assigned), are required for all individuals.

VIII. Special Conditions

A. Registry and Criminal Background Checks

  • Providers serving adults and/or children must comply with all Acts referenced in this section, check all of the following registries and adhere to the employment restrictions based on the results of these checks. Provider must maintain documentation of the checks in each individual's personnel file.
    1. Health Care Worker Registry: (http://www.idph.state.il.us/nar/) The Provider shall not employ an individual in any capacity until the Provider has inquired of and received results from the Illinois Department of Public Health's Health Care Worker Registry concerning the individual. Such inquiry shall not occur more than 30 days prior to the first day of employment. If the Registry reflects the existence or contains information that substantiates a finding of physical or sexual abuse or egregious neglect against an applicant or a disqualifying criminal conviction for which there is no waiver by the Illinois Department of Public Health, the Provider shall not employ him or her in any capacity. For each employee, the Provider shall, in addition, inquire of the Registry annually thereafter during employment. At the time of the annual check, if a current employee's name has been placed on the Registry, the employee must be terminated unless there is a waiver by the Illinois Department of Public Health. For purposes of annual checks, Providers must establish a schedule that results in completion of checks annually (approximately every 365 days). That may be accomplished by: 1) repeating the check on the anniversary of the employee's hire; 2) repeating the check at the time of the employee's annual performance evaluation; or 3) creating a specific schedule of checks that results in timely completion.
    2. DCFS State Central Register/Child Abuse and Neglect Tracking System (CANTS): Providers shall not employ an individual in any capacity until the Provider has inquired of the Department of Children and Family Services as to information in the DCFS State Central Register concerning the individual. Such inquiry shall not occur more than 30 days prior to the first day of employment. If the Register reflects the existence of or contains information that indicates a disqualifying conviction or disqualifying substantiated case of abuse or neglect for which there is no waiver by the Department of Human Services, the Provider shall not employ him or her in any capacity. Disqualifying convictions or disqualifying substantiated cases of abuse or neglect are defined for the DCFS Central Register by the Department of Children and Family Services' standards for background checks in Part 385 of Title 89 of the Illinois Administrative Code. For each employee, the Provider shall, in addition, inquire of the Register annually thereafter during employment. At the time of the annual check, if a current employee's name has been placed on the Register, the employee must be terminated unless there is a waiver by the Illinois Department of Human Services. For purposes of annual checks, Providers must establish a schedule that results in completion of checks annually (approximately every 365 days). That may be accomplished by: 1) repeating the check on the anniversary of the employee's hire; 2) repeating the check at the time of the employee's annual performance evaluation; or 3) creating a specific schedule of checks that results in timely completion.
    3. Illinois Sex Offender Registry: (http://www.isp.state.il.us/sor/) Providers shall not employ an individual in any capacity until the Provider has inquired of and received the results from the Illinois Sex Offender Registry concerning the individual. Such inquiry shall not occur more than 30 days prior to the first day of employment. If the Registry reflects the existence or contains information that indicates a finding, the Provider shall not employ him or her in any capacity. For each employee, the Provider shall, in addition, inquire of the Registry annually thereafter during employment. At the time of the annual check, if a current employee's name has been placed on the Registry, the employee must be terminated. For purposes of annual checks, Providers must establish a schedule that results in completion of checks annually (approximately every 365 days). That may be accomplished by: 1) repeating the check on the anniversary of the employee's hire; 2) repeating the check at the time of the employee's annual performance evaluation; or 3) creating a specific schedule of checks that results in timely completion.
    4. Health Care Worker Background Check Act and the Abused and Neglected Child Reporting Act
      • The Provider will comply with all requirements and regulations issued pursuant to the Health Care Worker Background Check Act (225 ILCS 46) and the Abused and Neglected Child Reporting Act (325 ILCS 5/1).
    5. Illinois Department of Healthcare and Family Services (HFS) Sanctions List
      • Prior to employment of an individual or utilization of a subcontractor or licensed practitioner, the Provider shall confirm that the individual or entity is not on the sanctions list of terminated or suspended providers and barred entities and individuals on the Illinois Department of Healthcare and Family Services. Such inquiry shall not occur more than 30 days prior to the first day of employment. This list is maintained on the HFS OIG Website at:  http://www.state.il.us/agency/oig/sanctionlist.asp
      • This sanctions list contains the names of providers and individuals who are currently terminated, suspended, barred, voluntarily withdrawn or otherwise excluded from participation in the Illinois Medical Assistance Program. If an individual or entity is found to be on the sanctions list, the Provider shall confirm eligibility with HFS' OIG as per HFS guidelines.

B. Mandatory Meetings & Training

The Division may designate any meeting or training it deems necessary as mandatory for Provider attendance. The Provider shall ensure that appropriate staff attend all mandatory training. Providers will be given adequate notice of such training.

C. Representative Payee Status

The Provider shall assist an individual receiving DHS-funded services when he or she demonstrates persistent failure to meet financial obligations in respect to his/her basic needs. This assistance is defined as identifying a person, entity, or process to serve as representative payee for the individual or assuming responsibility for representative payee services when no other appropriate person or entity is available. Pre-Admission Screening (PAS) and Individual Service and Support Advocacy (ISSA) agencies may not serve as the representative payee for the individual.

D. Monitoring

The Provider shall allow the Department access to its facilities, records, and employees for the purposes of monitoring this Agreement. Providers agree to participate actively in periodic announced and/or unannounced reviews of all funded programs by Department staff.

The Department will monitor compliance with the conditions specified herein. Monitoring will be conducted by staff within various offices of the Department, including but not limited to, the Division; the OCAPS Bureau of Accreditation, Licensure, and Certification; Inspector General and the Office of Contract Administration.

Monitoring may consist of, but is not limited to, the following:

  1. Reviews of all required licenses and certifications.
  2. Reviews of all provider service and funding plans.
  3. Reviews of direct service provision.
  4. Reviews of alleged and substantiated cases of abuse and neglect.
  5. Reviews of individual records, personnel files, agency and program policies and procedures, and financial records.
  6. On-site observations and interviews of individuals, guardians, and agency staff (including, but not limited to, program, supervisory and direct care staff).
  7. Reviews of electronic data submissions and verification of data submissions or data accepted in lieu of electronic submission.
  8. Reviews of utilization patterns.
  9. Reviews of staff training records.

Any findings arising from the monitoring activities of the Division of Developmental Disabilities will be shared with the Provider by that entity for review and corrective action. Upon request, the Provider shall submit acceptable corrective action plans to the Division. Acceptance of the plan is subject to the approval of the Division. The Provider shall comply with plans of correction approved or imposed by the Division.

In addition, the Department of Healthcare and Family Services will review, on a sample basis, agencies that are enrolled as Providers under the Home and Community-Based Services Waivers for individuals with developmental disabilities (Adult DD Waiver, Children's Support Waiver, and Children's Residential Waiver).

E. Sanctions

The Division of Developmental Disabilities may impose sanctions on Providers which fail to comply with conditions stipulated herein. Sanctions include, but are not limited to, payment suspension, loss of payment, and enrollment limitations, or other actions up to and including contract termination. The Division of Developmental Disabilities may post sanctions imposed on Providers on its website.

F. Provider Responsibility Upon Termination of Services

A Provider that ceases operation due to the termination of an Illinois Department of Human Services (DHS) contract, or DHS notice that it will not continue the contract beyond the end of the contract period, or for other reasons shall:

  1. Confirm the Division listing of all individuals currently involved and receiving services in each of the Division funded programs.
  2. Indicate which of the individuals will continue to be served by the agency if some, but not all, programs are terminating.
  3. Provide the Division access to all records and files of individuals enrolled in the Division funded programs.
  4. Ensure transition of the individual to an appropriate provider agency selected by the client or designated by the Division.
  5. Participate in the individual's transition process with the Division and the successor provider until such time that the individuals have successfully transitioned to the new service provider.

G. Utilization Management

The Provider shall have a formal, written utilization management procedure, designed to capture information about discrete supports and services being provided to individuals in relation to assessed needs and goals and outcomes achieved that are attributable to the provision of services. Information collected shall be available in a format that can be shared with the Division.

The Provider agrees that the optimal outcomes for individuals receiving services in vocational, developmental training, and supported employment programs are: a) that the individual becomes a worker who is compensated commensurately with the task either with or without a job coach; and b) is engaged in work that occurs in an integrated work setting in which non-disabled workers are also employed. The performance goal of the Provider is the movement of individuals into settings that fall within those parameters. The Provider agrees that the need for the job coach is inherent in learning a new job, but may also be needed for support after the technical aspects of the job have been mastered and at times of transition. A satisfactory outcome might also include enrollment in a community senior center, becoming a volunteer, or having a part time job. The Provider shall establish outcome measures with consideration of agency-specific factors, including local economy, preferences of individuals being served, and skill levels.

Performance outcome measures are also required of residential programs. The Provider must implement a procedure to evaluate the degree to which there is movement toward the goals established by and with individuals and documented in the Individual Service Plan.

H. Compliance with Life/Safety Standards and Requirements

The Provider shall comply with applicable state licensure requirements and local ordinances including but not limited to fire, building, zoning, sanitation, health, and safety requirements for each program facility.

I. Professional Service Requirements

  1. A licensed physician (MD or DO) shall assume medical and legal responsibility for medical services offered in any program, including prescription of medications.
  2. All professional services such as, but not limited to, nursing, physical therapy, occupational therapy, speech therapy, counseling, etc., must be provided by individuals licensed or certified to provide those services by the Illinois Department of Financial and Professional Regulations in accordance with the applicable practice acts. Professional behavioral services may also be provided by individuals certified or approved to provide those services in accordance with provider standards published by the Division.
  3. All Qualified Intellectual Disabilities Professionals (QIDPs) employed by the Provider must receive 40 hours of basic training in a DHS-approved course if employed as a QIDP after October 1, 1999. The training program must be completed within six months of assuming responsibilities of a QIDP. Once training starts, the 40-hour QIDP training program cannot be completed in less than 21 calendar days, but must be completed within 120 calendar days, unless the approved training program is conducted by a community college or other educational institution on a term, semester or trimester schedule.
  4. All QIDPs employed by the Provider must receive 12 hours of DHS approved continuing education units each State of Illinois fiscal year (July 1- June 30) beginning in the state fiscal year following the one in which the initial 40-hour basic QIDP training is completed. (See Training Requirements Manual for details concerning continuing education requirements).
  5. All QIDPs employed by the Provider must submit the QIDP Job and Educational Requirements Checklist A, along with a resume and education transcripts to the Division for review and approval. Upon review by the Division, all QIDP applicants meeting state and federal guidelines will be placed on the Division's QIDP database. It is the Provider's responsibility to assure that all QIDPs receive the 40-hour DHS-approved QIDP training course within the required timeframe and the 12 hours of continuing education units each fiscal year. The Provider is required to maintain all training records for QIDPs who complete the 40 hour training program and continuing education units at the Provider's administrative office. This includes the QIDP Orientation Training Competency Area Checklist, the sign-in sheets verifying attendance in the classroom training and documentation of 12 hours of continuing education each fiscal year for each QIDP. The continuing education requirement excludes the state fiscal year in which the QIDP completed the initial 40 hours of training. QIDPs having a gap in service of less than two years will not need to repeat QIDP training as long as they have met the annual continuing education requirements during their gap in service. Providers will be responsible for assessing the competency level of QIDPs with a gap in service of two or more years and provide and document retraining in identified skill gap areas.
  6. All Direct Support Person (DSPs) employed by the Provider (with the exception of respite workers, job coaches, secretaries and other support staff) must successfully complete 120 hours of training (40 hours classroom and 80 hours on-the-job) in a DHS-approved course within 120 calendar days of starting to work as a DSP. DSP training records must be submitted to as specified in the DSP Illinois Health Care Worker Registry Packet Instruction Manual within 30 calendar days of successfully completing DSP training. Training information will be scanned and electronically transferred to the Illinois Department of Public Health (IDPH) so the DSP training record can be added to the Health Care Worker Registry. This transfer will occur within 30 calendar days of submitting DSP training records. Important: It is the responsibility of each Provider to check the Health Care Worker Registry after DSP training is reported to ensure that its trained DSPs are designated as a "DD Aide" under "Programs" on the Health Care Worker Registry. DSPs cannot work alone to support persons with Developmental Disabilities until they are designated as a "DD Aide" on the Health Care Worker Registry. If the "DD Aide" designation does not appear on the Health Care Worker Registry within 30 calendar days of submitting DSP training records, it is the responsibility of the Provider to work directly with IDPH's Health Care Worker Registry staff to determine the reason(s) why the employee's name is not appearing on Registry and provide the necessary information or documentation to IDPH to allow for the posting of the "DD Aide" designation for the employee in question.

    The DSP training program must be presented in a minimum time frame of 21 calendar days, but cannot exceed 120 calendar days from the date of hire as a DSP, unless the approved training program is conducted by a community college or other educational institution on a term, semester, or trimester schedule. The Provider is required to maintain all training records for DSPs who complete the 120-hour training program at the Provider's administrative office. This includes the DSP Training Program Competency Area Checklist, sign-in sheets verifying attendance in the classroom training, and all On-the-Job Training Activities (OJTs) and Competency-Based Training Assessments (CBTAs). The original Test of Adult Basic Education (TABE) test score sheet (or other recognized test of functional literacy, such as the Adult Basic Literacy Examination (ABLE) or Comprehensive Adult Student Assessment System (CASAS), test score sheet) is required to be maintained in the personnel records of DSPs who are administering medications. The original TABE, ABLE or CASAS test score sheet must be properly completed and document that the DSP has a reading score at least at the eighth grade level. If the online TABE is used, the Department accepts TABE reading level scores printed off the McGraw-Hill website if accompanied by a signed statement from the person proctoring the online test attesting that the testee was verified to be the person who actually completed the online test for whom the test score is printed. The signed statement should also identify the Procter's position in the organization from which the testee is employed, if any, or the Procter's relationship to the organization, such as private contractor, etc.

  7. Direct Support Persons (DSPs) employed by the Provider who are to be authorized to administer medications in settings of 16 or fewer individuals that are funded or licensed by the Department of Human Services must have successfully completed all required Basic Health and Safety components of DSP training before starting any medication training classes. 

    To become authorized to administer medications, a DSP must successfully complete a medication administration training program specified by the DHS and taught by an RN Nurse-Trainer (a registered professional nurse or advanced practice nurse who has successfully completed the Department's RN Nurse-Trainer medication administration training program). This DSP training must consist of at least 8 hours of classroom training and completion of Competency-Based Training that assures the ability of the authorized DSP to safely administer medications under the supervision of the RN Nurse Trainer. The Provider is required to maintain dated training records for all authorized DSPs who complete this medication administration training program. Records must be maintained at the Provider's administrative office, be readily available and include: sign in/sign out class roster with DSP's signatures verifying all necessary pre authorization classroom training and Competency-Based Training Assessments (CBTAs), and all annual and as necessary training and retraining to assure competency in medication administration for every individual to whom she/he is to administer medications.

  8. Following the initial training, DSPs must maintain CPR and First Aid Certification or hold current certification as an Emergency Medical Technician (EMT) in order to work unsupervised or administer medications.

J. Behavior Management and Human Rights Review

The Provider (excluding PAS/ISSA/ISC providers) shall establish or ensure a process for the periodic review of behavior intervention and human rights issues involved in the individual's treatment and/or habilitation. Agencies required to have behavior intervention and human rights review policies and procedures under licensure or certification standards shall continue to comply with those standards.

K. Provider Responsibility for Individual Service and Support Advocacy

The Provider (excluding PAS/ISC/ISSA providers) shall allow Individual Service and Support Advocacy (ISSA) Agencies (under contract with the Department) and their staff access to sites and records and individuals served. The ISSA staff is a member of the community support team (CST) for a specific individual. The Provider shall include the ISSA staff in service planning meetings and other significant service planning activities. ISSA staff shall interview and observe individuals, guardians, and Provider staff on-site and review records pertaining to individuals and their service delivery.

L. Support Services Teams

The Division may contract with qualified vendors for Support Services Teams. These vendors are charged with assembling interdisciplinary teams of behavioral, medical, and other professionals within the developmental disabilities field that will be required to deliver, upon referral from the Division, coordinated services and supports. These services will be provided to individuals with developmental disabilities who are experiencing acute behavioral and/or medical conditions that result in chronic distress, despite previous attempts to address issues, which without intervention, could lead to displacement from current living environments. The Provider must work collaboratively with these teams to ensure the best outcomes for the individuals served. The Provider must be responsive to contacts and requests from the teams, actively participate in their consultation activities, and stand receptive to their recommendations and services.

M. Abuse, Neglect, and Death Reporting and Investigation

  1. The Provider shall develop and implement a written policy and process for handling and reporting incidents of alleged abuse, alleged neglect, recipient death and certain other incidents to the DHS Office of the Inspector General (OIG), DHS, DPH, and DCFS in accordance with DHS Rule 59 Ill. Adm. Code 50, DCFS Rule 89 Ill. Adm. Code 331, and other applicable standards, rules and laws. The policy shall include definitions of abuse and neglect, screening prohibition, timeframes for reporting, preservation of evidence, and notification of parents and guardians. The Provider shall fully cooperate in investigations of alleged abuse or neglect or death conducted in accordance with applicable standards, rules, and laws. Each provider shall ensure that all staff is trained to recognize possible abuse and neglect of individuals and to report to the appropriate investigatory authority and respond to allegations of abuse and neglect.
  2. The Provider shall have a formalized, ongoing systemic review process at least quarterly for evaluating all injuries, including those not definable as abuse and neglect, deaths and other adverse events within the agency. The review processes shall include, but are not limited to:
    1. Examining the circumstances and data to determine how and why the injury or other adverse event occurred, including determining all related processes and systems;
    2. Identifying risk points and their potential contribution to the event, such as evaluating the appropriateness of the individual's service plan and level of supervision;
    3. Identifying, communicating, documenting, implementing, and evaluating improvements in processes, systems, or treatment to prevent future such injury or other adverse event, including specifying;
      1. The staff responsible for implementation;
      2. When the actions will be implemented; and
      3. How the effectiveness of the action will be evaluated.

N. Abuse and Neglect Training

The Provider shall ensure that all employees successfully complete DHS OIG approved 59 Ill. Adm. Code 50 training at the time of hire (before the employee assumes any regular duties or responsibilities of the position) and a biennial (every two years) refresher training course approved by DHS OIG pursuant to Rule 50.20 d) 2).

O. Reporting to the Illinois Department of Financial and Professional Regulation and the National Practitioners Data Bank

  1. It is the policy of the Division that all requirements pertaining to the reporting of licensed health care practitioners to the Illinois Department of Financial and Professional Regulation (DFPR) and the National Practitioners Data Bank be followed. Provider shall make such reports when and to the extent required by law.
  2. Provider shall endeavor to reinforce the responsibility of health care practitioners to report appropriate matters to DFPR by such actions as it deems reasonably necessary, including posting notice that individual practitioners shall comply with applicable licensing and reporting requirements.

P. Critical Incident Reporting

Using electronic reporting mechanisms specified by the Division, the provider shall report critical incidents as defined by the Division within the time frames required by the Division. The reports will include complete and accurate information such as the type of incident, description of the incident, date and time of the incident, participants involved, staff involved, and actions taken by the provider.

Q. Participation of Individuals with Developmental Disabilities and Their Families

The Provider shall have policies and practices that reflect formal mechanisms which ensure the participation of individuals with developmental disabilities and their families in the planning, development, delivery, and evaluation of services.

R. Funding Reserve

Reductions in Amounts Payable: The amount(s) payable, or estimated amount(s) payable, to vendor/provider under the agreement and this attachment may be subject to a reduction as necessary or advisable, based upon actual or projected budgetary considerations, at the sole discretion of the Illinois Department of Human Services.