Introduction

The Illinois Department of Human Services (DHS), Division of Developmental Disabilities' Program Manual is a guide to information about Illinois' developmental disabilities service system. In addition, this document provides supplementary contractual requirements for disability service providers under contract with DHS.

The Division of Developmental Disabilities (Division) has oversight for the Illinois system of programs and services specifically designed for individuals with developmental disabilities. DHS provides direct services to individuals with developmental disabilities and funds community services provided by local agencies.

The Division works as a partner with many local entities statewide to offer an extensive array of services which enable persons with developmental disabilities to reside with their families or in other community living situations, and to develop functional and occupational skills. DHS funds over 340 of these community service providers in every part of Illinois.

A system of comprehensive community service networks is in place to manage, by geographic area, state funds budgeted for developmental disabilities services. Network facilitators manage financial contracts and agreements with private Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/DDs) and coordinate community services with state-operated developmental centers. The Division develops policy and provides technical assistance and support to the networks.

The Division has administrative oversight and funds over 300 private Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/DD's) and Skilled Nursing Facilities for Pediatrics (SNF/Ped's). These residential settings in the community provide a continuous program of specialized and generic training, treatment, health services and related services that is directed toward the acquisition of the behaviors necessary for the individual to function with as much self determination and independence as possible and the prevention or deceleration of regression or loss of current optimal functional status (also known as active treatment). ICF/DD's may also offer nursing care and highly-structured programs.

The Division also manages the operations of residential services to individuals with developmental disabilities who reside in state-operated developmental centers (SODC's). These developmental centers generally provide residential services to persons with developmental disabilities who have a higher level of need, or to individuals in crisis. In addition, the SODC's provide an array of services and supports to assist individuals to reside in community living environments.

Definitions

Only individuals determined to have a developmental disability are eligible for services within the service system. A person is determined to have a developmental disability if the person has Mental Retardation or a Related Condition.

Mental Retardation refers to significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested before the age of 18 years. Significantly subaverage is defined as an intelligence quotient (IQ) of 70 or below on standardized measures of intelligence. This upper limit could be extended upward depending on the reliability of the intelligence test used.

A person with a Related Condition means an individual who has a severe, chronic disability that meets all of the following conditions:

  1. It is attributable to--
    • Cerebral palsy or epilepsy; or
    • Any other condition, other than mental illness, found to be closely related to mental retardation because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with mental retardation and requires treatment or services similar to those required for these persons.
  2. It is manifested before the person reaches age 22.
  3. It is likely to continue indefinitely.
  4. It results in substantial functional limitations in three or more of the areas following of major life activity:
    • Self-care
    • Understanding and use of language
    • Learning
    • Mobility
    • Self-direction
    • Capacity for independent living

In addition, some programs require individuals to be eligible for federal matching funds under one of the Medicaid Home and Community-Based Services Waivers (HCBS Waivers). Criteria for HCBS Waiver eligibility are contained in the Home and Community-Based Services Waiver Provider Manual (Waiver Manual).


To determine Medicaid Home and Community-Based Services waiver eligibility, a Pre-Admission Screening (PAS) assessment by an Independent Service Coordination agency is required for all individuals with developmental disabilities seeking covered services. The Provider shall not enroll individuals into Medicaid waiver services until completion of an assessment by PAS, issuance of a Department Award Memorandum, and completion of Medicaid enrollment.

Residential providers are required to remain operational year-round. The Department will fund those individuals being served by the Provider or for whom bed-hold funding is requested, consistent with the bed-hold policies established by the Department. The Provider shall comply with bed-hold policies and stipulations as issued by the Department. Payment will not be made for individuals receiving waiver services on dates when the individual is not enrolled in Medicaid unless the Division grants prior approval.

Overview of Services

Pre-Admission Screening (PAS) services are provided by agencies that act as the "front door" for entry into the developmental disabilities system. The role of the PAS process is to ensure compliance with applicable Federal and State laws, arrange for and conduct assessments, make necessary determinations regarding eligibility for services, educate individuals and families, and make referrals and provide linkage to appropriate and needed services. The PAS process prevents inappropriate admissions to long term care facilities (nursing facilities and Intermediate Care Facilities for persons with Developmental Disabilities [ICF/DDs]) and inappropriate enrollments in waiver programs.

The Individual Service and Support Advocacy (ISSA) program represents the Department's interests in determining whether program services are being provided in the interest of and to the satisfaction of individuals receiving services; alerts the Division when monitoring and technical assistance are necessary; and provides support to individuals, guardians and providers in working through a variety of service issues, including those requiring conflict resolution, increased communication, and possible changes in support levels.

Independent Service Coordination (ISC) promotes service accessibility and continuity of care, and seeks to maximize an individual's potential for independence, productivity and community integration. An independent service coordinator collects information on individuals seeking developmental disabilities services and enters the information on the Prioritization of Urgency of Need for Services (PUNS) database. An independent service coordinator ensures the completion of comprehensive assessments, development and implementation of an individual's service plan, linkages to support services, and provision of on-going service monitoring and advocacy. Additional information can be found in Section IV, Program Descriptions.

Community Residential Services are provided in Intermediate Care Facilities for persons with developmental disabilities (ICF/DD's), Specialized Living Centers (SLC's), Skilled Nursing Facility-Pediatrics (SNF-Ped's), Supported Living Arrangements (SLA's), Special Home Placements [SHP's], Home Individual Programs [HIP's]), Community Living Facilities,(CLF's), Children's Group Homes (CGH), Child Care Institutions (CCI's), and Community-Integrated Living Arrangements (CILA's).

Day and Vocational Services include developmental training, regular work/sheltered employment, supported employment, adult day care, at home day services, and other day programs. These services are provided by community-based agencies and organizations to individuals throughout Illinois. These services are designed to enhance a person's skill levels in the major life areas, work-related activities, and employment skills.

Individual and Family Support Services enable people with developmental disabilities to continue to reside in their own or family homes while receiving needed Department-funded support services, such as Respite, Family Assistance Program, Home-Based Support Services, and other in-home support services.

State Operated Developmental Centers (SODC's) provide intensive services that presently cannot be provided in family homes or in community-based residential programs for people with developmental disabilities, primarily mental retardation. Emphasis on assisting people to achieve their personal goals of living where and with whom they choose, coupled with the development of community resources over the past several years, has resulted in census reduction at the SODC's. In particular, the number of children and adolescents living in SODC's has been declining. These changes are consistent with national trends in residential services where focus has shifted to helping people remain in their homes or community-based residential programs.