Application For 60D CILA Support Services Form & Instructions; & Revised Alternative Day Program Request Form

Helping Families. Supporting Communities. Empowering Individuals.

Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.11.012

Revised: Application for 60D CILA Support Services Form & Instructions, and Request for Alternative Day Program Form
Date:  7/1/2011

Purpose

This Information Bulletin alerts community provider agencies about the updated Application for CILA Services Form and Instructions (IL462-4425), and the Alternative Day Program Request form (IL462-0285).

  1. Application for 60D CILA Support Services Form and Instructions (IL462-4425)

    The Application for 60D CILA Support Services has been significantly revised from the previous version contained in the 2002 CILA User Guide.

    Formerly, there were two separate CILA application forms: 1) 24-Hour and Foster Care/Host Family Supports, and; 2) Intermittent and Family CILA supports. These two forms have been combined into one form to cover all CILA support services.

    The new version of the Application for 60D CILA Support Services (IL462-4425) is to be used for all requests for CILA services.  Updated Instructions for the Application for CILA Services form are also available on the Division of Developmental Disabilities forms list. Please refer to the revised instructions when filling out the CILA Application.

    The last page of the CILA application has a check list of required documentation. In order for CILA funding requests to be reviewed and processed in a timely manner, the Division is mandating that the required documents be submitted in a SPECIFIC ORDER. The specific order is located on the Application for 60D CILA Support Services form.

    Submitted applications for CILA services that are missing required documentation or with documentation that is not in the proper order will be returned as incomplete to the local PAS/ISC/ISSA agency who will return the Application for 60D CILA Support Services to the CILA agency submitting the request.

    The Application for 60D CILA Support Services must now be filled out online, printed, and submitted with required supporting documentation to the local Pre-Admission Screening/Individual Service Coordination/Individual Support and Service Advocacy (PAS/ISC/ISSA) agency, forwards the completed application to the appropriate Network Facilitator.

  2. Request for Alternative Day Program Form (IL462-0285)

    The Request for Alternative Day Program Form (IL462-0285) has been modified to include requests to authorize an individual for:

    1. At-Home Day Services (Program code 37U)
    2. Adult Day Care (Program code 35U)
    3. Supported Employment (Program code 36U, 39U, 36G, 39G)
    4. Regular Work/Sheltered Employment (Program code 38U)
    5. Other Day Program (Program code 30U)

    The Request for Alternative Day Program form is available to be filled out online, printed, and submitted to the PAS/ISSA/ISC Agent who will in turn forward it to the Network Facilitator.

    Certain alternative day programs require additional documentation:

    1. Supported Employment (36U, 36G, 39U, 39G)
    2. At Home Day Services (37U)
    3. Regular Work/Sheltered Employment (38U)
    4. Other Day Program (30U)

    Requests for alternative day programs that are missing any required documentation upon submission will be returned as incomplete to the local PAS/ISC/ISSA agency who will return the request to the agency submitting the request.

Effective Date

These revised forms may be used effective immediately with the release of this Information Bulletin; however, these form versions must be used beginning January 1, 2012.

Note: Earlier versions of these forms, submitted to the Department on or after January 1, 2012, will not be accepted or processed, and will be returned.