CILA/DT Provider Instructions

New Agency - Request For A DHS Community Service Agreement To Provide Conmunity-Integrated Living Arrangement (CILA) or Developmental Training (DT)

New providers seeking a DHS Community Service Agreement to provide Division of Developmental Disabilities funded Community-Integrated Living Arrangement (CILA) or Developmental Training (DT) must submit a letter on agency letterhead requesting a contract. The letter must contain the following information and all the required attachments:

• The agency's legal name, address, FEIN, telephone and FAX numbers, name and address of both the executive director and the Board President, and a contact e-mail address.
• The programs to be covered by the Agreement (CILA and/or DT).
• The letter must be signed by the Executive Director or Board President.

Required Attachments:

• Copy of the CILA license and/or DT certification
• Articles of Incorporation issued by the Illinois Secretary of State
• Letter from the IRS assigning a Federal Employer Identification Number (FEIN) to the agency
• Identification, including both name and Social Security Number, of the Qualified Mental Retardation Professional(s) who will be providing case management services
• Providers must have an approved Direct Support Person (DSP) training program in place, or submit one for approval by the Department, or have access to an approved program through another entity to ensure that Personal Support workers in their employ meet the DSP training requirements set forth by the State and have their names added to the Illinois Health Care Worker registry.
• Written request for ROCS software, including legal name and FEIN of the agency
• Completed Forms:
  • Provider Information Form (Part I) (IL462-1246) (pdf)
  • Request for Taxpayer Identification and Certification (IRS W-9) (pdf)
  • Community Provider FTP Registration Request (pdf) (for FTP)
  • Community Provider User ID and System Access Request (pdf) (for FTP and Mobius reports)
  • Waiver Provider Agreement Medical Program (HFS 1413A) (pdf)
  • Provider Enrollment Application (HFS 2243) (pdf)

Submit letter and attachments to:

For downstate Illinois:

Illinois Department of Human Services
Division of Developmental Disabilities
319 E. Madison, Suite 2M
Springfield, IL 62701

Contacts for downstate Illinois

For Metro Chicago:

Illinois Department of Human Services
Division of Developmental Disabilities
100 West Randolph Street, Suite 6-400
Chicago, IL 60601

Contacts for Metro Chicago

The Division of Developmental Disabilities will review the materials submitted and determine whether or not to enter into a contractual relationship with the agency. Submission of required information does not guarantee issuance of a contract.