Developmental Disabilities Program Manual

Helping Families. Supporting Communities. Empowering Individuals.
  1. Introduction
  2. Definitions
  3. Overview of Services
  4. Policies and Procedures
  5. Program Descriptions
  6. Deliverables/Costs/Payment
  7. Provider Responsibilities
  8. Department Responsibilities
  9. Support Services
  10. Community Services Structure
  11. Billing Instructions
  12. Program Monitoring
  13. Program Budget
  14. Appendix - State Authoritative Sources
  15. Contact Information
  16. Authority
  1. 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 regions is in place to manage, by geographic area, state funds budgeted for developmental disabilities services. Region facilitators manage financial contracts and agreements with private Intermediate Care Facilities for Individuals with Developmental Disabilities (ICFs/DD) 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 (ICFs/DD) and Skilled Nursing Facilities for Pediatrics (SNF/Peds). 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). ICFs/DD 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 (SODCs). 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 SODCs provide an array of services and supports to assist individuals to reside in community living environments. 

  2. 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 Intellectual Disabilities or a Related Condition.

    Developmental disabilities refers to significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested before the age of 18 years. Significantly sub-average 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:

    It is attributable to:

    • Cerebral palsy or epilepsy; or
    • Any other condition, other than mental illness, found to be closely related to intellectual disabilities because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with intellectual disabilities and requires treatment or services similar to those required for these persons.
    • It is manifested before the person reaches age 22.
    • It is likely to continue indefinitely.
    • 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 Manual.

    To determine Medicaid Home and Community-Based Services waiver eligibility, a Pre-Admission Screening (PAS) assessment by an Independent Service Coordination (ISC) 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 ISC, 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. 

  3. 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 [ICFs/DD]) 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 ongoing 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 (ICFs/DD), Specialized Living Centers (SLCs), Skilled Nursing Facility-Pediatrics (SNF-Peds), Supported Living Arrangements (SLAs), Special Home Placements (SHPs), Home Individual Programs HIPs), 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 (SODCs) provide intensive services that presently cannot be provided in family homes or in community-based residential programs for people with developmental disabilities, primarily intellectual disabilities. 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 SODCs. In particular, the number of children and adolescents living in SODCs 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.

  4. Policies and Procedures

    The Department's policies and procedures for service providers may be found within the Developmental Disabilities Manuals.

    In addition, procedural information is contained within:

Contract

The DHS Community Services Agreement (CSA) between the Department and the Provider is generally referred to as the Agreement and consists of several parts:

  • DHS Community Services Agreement containing the standard contract language used for all Department agreements.
  • Contract Attachment "A" containing specific agreement requirements related to programs funded by the Division. In particular, Section II "Applicable Rules and Guidelines," provides a listing of the Federal and State laws, rules, policies and procedures.
  • Contract Exhibits showing the contract information, the type of services, the method of payment, the method of reconciliation, and contract deliverables.

The Department will initiate the Agreement, make it available for the Provider for review and signature, obtain the Secretary's signature and return a copy of the executed agreement to the Provider. The Agreement is not effective until signed by the Secretary.

Amendment Process

The Department will initiate a two-party signed amendment to the contract when:

  • The Department adds services to the Provider's program that are beyond the scope shown in Attachment "A".

The Department will modify the contract by letter notification when:

  • The Department revises the scope of services shown in the Exhibits to the Community Service Agreement; and/or
  • The Department increases or decreases a fixed/maximum funding amount. For example: grant-funded programs, respite or Program 65H, (fee-for-service intermittent CILA) or adds program services.
  1. Program Descriptions

    1. Screening, Advocacy & Service Coordination

      Pre-Admission Screening

      Individual Service and Support Advocacy

      Independent Service Coordination

      Bogard Service Coordination

    2. Residential Services

      Intermediate Care Facilities / Developmental Disabilities

      State-Operated Developmental Centers

      Supported Living Arrangement

      Special Home Placement

      Home Individual Placement

      Children's Group Home

      Child Care Institution

      Community Living Facility

      Community-Integrated Living Arrangement 

    3. Day Services

      Developmental Training

      Regular Work/Sheltered Employment

      Supported Employment

      Other Day Program, Adult Day Care, At Home Day Program 

    4. Other Services

      In-Home Respite, Residential Respite, Group Respite

      Family Assistance Program 

      Home-Based Support Services 

      Therapies: Behavior Intervention and Treatment; Behavior Counseling-Individual and Group; Behavior Therapy-Individual and Group; Waiver Physical Therapy, Waiver Occupational Therapy, Waiver Speech Therapy 

      Bogard Specialized Services 

      Demonstration/Special Project 

      Dental Services 

      Epilepsy 

      Related Support 

      Adaptive Equipment, Assistive Technology, Home Accessibility Modifications, Temporary Intensive Staffing, Vehicle Modifications, CILA Startup, Crisis Services

  2. Deliverables/Costs/Payment

    Deliverables

    All services are expected to have functional and measurable data concerning services provided by funds awarded. The Provider must submit any and all data required by rule or by the Department. The deliverables and their definitions are detailed in the Division's, Attachment "A" and this Program Manual.

    Costs

    Funding for each program is based upon a Department-approved level for services detailed in the Program Manual and/or the Division's, Attachment "A". The funding level for each program is shown in the Exhibits to the Community Service Agreement. The Department is not liable for costs incurred by the provider that are not approved. Except as otherwise stated, or provided for in the Exhibits to the Community Service Agreement, no payment for extra charges, supplies or expenses will be made without prior written approval from the Department.

    Payment

    Provider services will be paid under the following terms and conditions, depending on the type of service covered under the Agreement. Service types are as follows:

    • Fee-for-Service programs receive payment at a Department-approved rate subsequent to delivery of services. A specific description of this funding mechanism can be found in Attachment "A".  Some Fee-for-Service programs receive payment at a negotiated rate. An example includes HBS Personal Support (55D) services.
    • Grant programs receive all or part of the program funding in advance of the actual delivery of services in prospective monthly payments except where otherwise noted in the provider agreement. A specific description of this funding mechanism can be found in Attachment "A".

    Payment for Fee-for-Service and grant programs is contingent upon funds being made available by the General Assembly and Governor.

  3. Provider Responsibilities

    Funded providers are expected to be in full compliance with all laws, rules, policies procedures and mandates specified in the Community Services Agreement, Attachment "A", other Administrative Rules and all other referenced documents. It is the responsibility of the Provider to notify the Division of any difficulty in meeting these contractual obligations.

  4. Department Responsibilities

    Department of Human Services, Division of Developmental Disabilities has the following responsibilities: 

    • Division Region staff shall act as the liaison between the contracting parties.
    • Division staff shall assist in the monitoring, evaluating, or auditing of provider services.
    • The Division shall provide ongoing monitoring of provider services and funding. 
    • The Division shall inform provider agencies of any new DHS (or Division) policies, procedures and guidelines. 
    • The Division shall develop and facilitate the dissemination of new Division policies, procedures, and guidelines. 
    • The Division will develop and provide training opportunities as it deems necessary. 
    • The Division will establish levels of reimbursement for programs covered under the Community Service Agreement, Division Attachment "A".
  5. Support Services

    Providers may request technical assistance by contacting the Division's Bureau of Community Services for their area. 

  6. Community Services Structure 

    The Illinois developmental disabilities service system is divided into seven regions. This system provides a structure for communication, implementation and coordination of developmental disabilities programs. State staff are assigned to each region, and service providers are also assigned based on their geographic service area.

    Please see this List of Community Services Staff, with contact information. Counties serviced by each Region are also identified.

  7. Billing Instructions 



    For technical software/computer issues, requests for assistance can be e-mailed to: Dhs.Rocs@Illinois.gov

  8. Program Monitoring

    The Provider will make available to the Secretary of the Department of Human Services or the Secretary's designee, access to data, records and all facilities in which service or administrative operations are performed to ensure compliance with the terms and conditions of the Agreement. The Department will monitor compliance with the conditions specified in the Agreement or herein. Monitoring will be conducted by staff within various offices of the Department, including but not limited to, the Division, the Bureau of Accreditation, Licensure and Certification; Office of Inspector General; and the Office of Contracts Administration. In addition, the Department of Healthcare and Family Services may monitor on a sample basis some agencies that are enrolled as providers under one of the Home and Community-Based Services Waivers for Persons with Developmental Disabilities.

    The Division will share with the Provider any findings arising from the monitoring activities by the Division for review and corrective action. The Provider shall submit corrective action plans to the Division as requested, and shall comply with plans of correction approved or imposed by the Division. Monitoring may consist of, but is not limited to, the following:

    • Reviews of all required licenses and certifications
    • Reviews of all provider service and funding plans
    • Reviews of direct service provision
    • Reviews of alleged and substantiated cases of abuse and neglect
    • Reviews of provider quality assurance, records and activities including provider reviews of medication error
    • On-site reviews of client records, personnel files, agency and program policies and procedures, and financial records
    • On-site observations and interviews of clients, guardians, and agency staff (including, but not limited to, program supervisory and direct care staff)
    • Reviews of electronic data submissions and verification of data submissions or data accepted in lieu of electronic submission
    • Reviews of utilization patterns
    • Review training records
    • Review of follow up to CART recommendations, if applicable 
  9. Program Budget

    Please Note:

    All Providers are expected to have a board-approved budget on file as part of standard operating procedures. Agency Plans are required as described in Section IV of Attachment "A". 

  10. Appendix - State Authoritative Sources

    As the Provider, in addition to State and Federal rules and regulations governing the programs you deliver you are responsible for complying with all of the State sources below, if applicable:


Additional information regarding the developmental disabilities service system may be accessed via the Internet: Division of Developmental Disabilities.

Contact Information

You may also contact the Division of Developmental Disabilities by phone at:

  • Toll Free:  (800) 843-6154
  • Springfield Office:  (217) 524-7065
  • TTY:  (800) 447-6404

Authority

Implementing Section 3 of the Community Services Act [405 ILCS 30/3], the Community Integrated Living Arrangements Licensure and Certification Act [210 ILCS 135], and Sections 15 and 15.2 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15 and 15.2] and authorized by Section 9 of the Community Integrated Living Arrangement Licensure and Certification Act [210 ILCS 135/9], Section 5-104 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-104].