Independent Service Coordination (ISC) Manual

ISC Manual- Version 2, Updated December 30, 2024

Table of Contents

  1. Section 1: Introduction
  2. Section 2: General Information
    1. 2.1 Dictionary
    2. 2.2 Geographic Responsibility
    3. 2.3 Qualifications of Individual Service Coordinators
    4. 2.4 Mandated Reporting
  3. Section 3: PUNS for Persons with Developmental Disabilities
    1. 3.1 PUNS Categories
    2. 3.2 Individual Assurances
    3. 3.3 Educating
    4. 3.4 Screening
    5. 3.5 For Whom to Complete a PUNS Form
    6. 3.6 For Whom NOT to Complete a PUNS Form
    7. 3.7 Special Form Completion Circumstances
    8. 3.8 Guidelines for Completing the PUNS Process
    9. 3.9 Instructions for Completing the PUNS Form
    10. 3.10 Updating, Changing and Closing PUNS Records
    11. 3.11 Maintaining Local PUNS Records
    12. 3.12 Dependents of Military Service Members
  4. Section 4: Pre-Admission Screening (PAS) for DD Services
  5. Section 5: Pre-Admission Screening and Resident Review (PASRR)
    1. 5.1 PASRR Authority
    2. 5.2 PASRR Level I Screen
    3. 5.3 DD PASRR Level II Assessment
    4. 5.4 DD PASRR Level II Outcome
    5. 5.5 Follow Up Visits
    6. 5.6 Resident Reviews
    7. 5.7 Community Service Recommendations
  6. Section 6: Annual Americans with Disabilities Act (ADA)/Olmstead Outreach to an Individual in an Institutional Setting
  7. Section 7: General Service Coordination
  8. Section 8: Person Centered Planning
    1. 8.1 The Person Centered Planning process
    2. 8.2 The Discovery Process
    3. 8.3 Personal Plan
    4. 8.4 Implementation Strategies
  9. Section 9: Individual Service and Support Advocacy
    1. 9.1 Annual Review and Update of the Plan
    2. 9.2 ISSA Monitoring Activities
    3. 9.3 Medicaid Benefit Enrollment and Medical Renewal Process
    4. 9.4 Level of Care Redeterminations (Clinical)
    5. 9.5 Rights and Advocacy
    6. 9.6 Critical Incident Reporting and Analysis System (CIRAS)
  10. Section 10: Bogard Consent Decree
    1. 10.1 Bogard Class Members
    2. 10.2 Bogard Class Members Residing in an ICF/DD
    3. 10.3 Bogard Class Members Residing in Other Non-Waiver Settings
    4. 10.4 Bogard Class Members Residing in a Medicaid Waiver Setting
  11. Section 11: Housing Navigation
    1. 11.1 Eligible Individuals
    2. 11.2 Housing Navigation Program
    3. 11.3 Housing Navigators
  12. Section 12: Screenings for the Supported Living Program
    1. 12.1 SLP Services
    2. 12.2 SLP Initial Screen Submission
    3. 12.3 DD SLP Comprehensive Assessment
    4. 12.4 SLP Determination of Disability
    5. 12.5 SLP Assessment of Individual Needs and Risks
    6. 12.6 Outcomes of the SLP Assessment
  13. Section 13: DDD Service Requests
    1. 13.1 Waiver services
    2. 13.2 Institutional Services
    3. 13.3 Grant Services
    4. 13.4 Support Services Teams (SSTs)
    5. 13.5 Crisis Criteria
    6. 13.6 Waiver Service Transitions
    7. 13.7 Young Adults Aging Out
    8. 13.8 ICF/DD or MC/DD Downsizing
  14. Section 14: Addressing and Resolving Issues or Concerns
    1. 14.1 Principles of the Resolution Process
    2. 14.2 Protocol for Resolving Issues or Concerns
    3. 14.3 Time Frames
    4. 14.4 Documentation
  15. Section 15: Referral for Monitoring and Technical Assistance
  16. Section 16: Service Terminations and Bedhold Request
    1. 16.1 Service Termination Approval Request
    2. 16.2 Bed Hold Request
  17. Section 17: Appeal Process
  18. Section 18: Administrative Requirements
    1. 18.1 ISC General Administrative Requirements:
    2. 18.2 Data Collection
    3. 18.3 Reporting and Billing
    4. 18.4 Payment and Reimbursement
    5. 18.5 Maintenance of ISC Records
  19. Section 19: Monitoring of Independent Service Coordination Agencies
    1. 19.1 Monitoring and Medicaid Waiver Compliance
    2. 19.2 BQM Unannounced Visits and Interviews
  20. Section 20: Appendix

Section 1:  Introduction

Independent Service Coordination (ISC) agencies contract with the Illinois Department of Human Services, Division of Developmental Disabilities (IDHS, DDD) to perform their duties under the authority of, and in compliance with, all applicable federal and state laws, rules and regulations, including but not limited to Illinois Administrative Codes and Rules, DDD Waivers Home and Community Based Services Waiver Programs | HFS (illinois.gov), Uniform Grant Agreement and related Attachments, Developmental Disabilities Manuals, Person Centered Planning Policy and Guidelines for DD Waiver Services, and Division of Developmental Disabilities Information Bulletins.

ISC agencies are Conflict of Interest free (42 CFR 441.301(c)(1)(vi)) case management entities meaning that their functions are separate from service delivery and cannot be done by a relative of the person served, a direct provider of service, someone who has a financial interest in a provider or who is employed by a provider.

The ISC's role includes, but is not limited to:

  • Maintaining the PUNS database.
  • Conducting Pre-Admission Screens.
  • Providing Individual Service and Support Advocacy.
  • Providing service coordination to Bogard class members.
  • Conducting outreach.
  • Serving as the front line for information and assistance to help individuals and families navigate the system.
  • Ensuring informed choice of services and service providers.
  • Developing and monitoring a person's Plan.
  • Linking individuals to services.
  • Addressing problems related to outcomes and quality including mandated reporting and reporting critical incidents.
  • Providing accurate individual information for statewide planning.
  • Collaborating with service providers to ensure individual's health, safety, welfare, well-being, and satisfaction with services funded by DDD.
  • Encouraging individuals and families to make informed decisions, exercise choice, and have maximum control over their lives.
  • Serving as the primary connection between individuals (and guardians) who are seeking or receiving developmental disability services and the IDHS/DDD.

ISC agencies are essential to the Illinois Developmental Disability service system. The purpose of this manual is to outline the policies and procedures to be followed by ISC agencies when performing their duties on the behalf of the IDHS/DDD.

Section 2: General Information

All ISC duties must be carried out in a culturally sensitive manner. This includes respecting differences related to ethnicity, race, religion, age, gender, sexual orientation, abilities, and communication preferences. Where needed or requested, ISC agencies should secure interpreter services to promote the full inclusion of persons seeking or receiving services, their legal guardian, and their family members.

ISC agencies are available 24 hours a day, 365 days of the year for individuals in crisis.

2.1 Dictionary

Note: For definitions and descriptions of DD services, please refer to the Developmental Disabilities Program Manual and the Developmental Disabilities Waiver Manual, both are available on the DHS website.

TERM DEFINITION/DESCRIPTION
Adult Protective Service (APS) A program within the Illinois Department on Aging that investigates abuse, neglect, or financial exploitation of adults age 60 or older and adults age 18-59 with disabilities living in the community.
All Kids Illinois' comprehensive health insurance program for children. The program covers doctor visits, hospital stays, prescription drugs, vision care, dental care, eyeglasses, regular check-ups and immunizations (shots). All Kids also covers special services like medical equipment, speech therapy, and physical therapy for children who need them.
AssessmentPro (APro) A web-based system used to record, store, transport, and track Pre-Admission Screen and Resident Review (PASRR), Supported Living Program (SLP) and Specialized Mental Health Facility (SMHRF) referrals throughout the State. APro is a shared system used by HFS, DHS, Dept. on Aging, Nursing Homes, Hospitals and Maximus.
Centers for Medicare and Medicaid Services (CMS) The federal agency within the Department of Health and Human Services, which reviews, approves and monitors State Medicaid Waiver plans.
Community Reporting System (CRS) The PC-based system designed to be used for collecting and submitting required data to the Department of Human Services (DHS) by those community providers who have contracted with the Department to provide services for individuals.
Department of Children and Family Services (DCFS) State agency that is responsible for protecting children who are reported to be abused or neglected. DCFS also works to increase families' capacity to safely care for their children; provide for the well-being of children in their care; provide appropriate, permanent families as quickly as possible for those children who cannot safely return home; support early intervention and child abuse prevention activities.
Department of Human Services (DHS) State agency that community health and prevention programs, oversees interactive provider networks that treat persons with developmental disabilities, mental health and substance abuse challenges and provides rehabilitation services. This agency also aids eligible, low-income individuals and families with essential financial support, locating training and employment opportunities and obtaining child care in addition to other family services.
Department on Aging (DoA) State agency responsible for helping older adults live independently in their own homes and communities.
Developmental Disability (DD) An intellectual disability or related condition.
Discovery Tool The first component of the DD Person Centered Planning process. The Tool is used to gather information about a person's preferences, interests, abilities, preferred environments, activities, and supports needed.
Division of Developmental Disabilities (DDD) A Division within the Department of Human Services that provides services and supports for individuals with developmental disabilities and their families.
Division of Mental Health (DMH) A Division within the Department of Human Services that serves at the State's Mental Health Authority. This Division is responsible for assuring those children, adolescents and adult, throughout Illinois, have the availability of and access to public-funded mental health services for those who are diagnosed with a mental illness or emotional disturbance and who have an impaired level of functioning based on a mental health assessment.
Division of Rehabilitation Services (DRS) A Division within the Department of Human Services that serves as the state's lead entity responsible for assisting individuals with disabilities to prepare for, locate and maintain employment. This Division also ensures that people with disabilities make informed choices to achieve full community participation through employment, education, and independent living opportunities.
Family and Community Resource Center (FCRC) The local office (under the Department of Human Services/Division of Family & Community Services) that process Medicaid Benefits applications such as Cash, SNAP and/or medical assistance.
Governor's Office of Management and Budget (GOMB) The Governor's Office of Management and Budget prepares the Governor's annual State budget and advises the Governor on the availability of revenues and the allocation of those resources to agency programs.
Grant Accountability and Transparency Unit (GATU) A unit of the Governor's Office of Management and Budget that is tasked with administering the Grant Accountability and Transparency Act.
Healthcare and Family Services, Illinois (HFS) The single Illinois state Medicaid agency that oversees Waiver programs. This agency is responsible for providing healthcare coverage for adults and children who qualify for Medicaid, and for providing child support services to help ensure that Illinois children receive financial support from both parents.
Home and Community Based Services (HCBS) Waivers Services that prevent or delay a person from living in a long-term care facility or institution. The Division of DD operates three HCBS Waivers for people with developmental disabilities: The Adult Waiver, the Children's Residential Waiver and the Children's Support Waiver.
Independent Service Coordination (ISC) Entities contracted with the Division of Developmental Disabilities that provide case management/service coordination which includes maintaining the Division's waiting list, determining clinical eligibility, assisting with identifying providers of choice, developing the Personal Plan and monitoring the Plan. ISC agencies serve as the front line for information and assistance to help individuals and families make informed choices and to navigate the system.
Integrated Eligibility System (IES) Eligibility system for Medicaid, SNAP and Cash Assistance shared between DHS and HFS. The IES has two main components, ABE (the public facing application process) and the worker portal, in which eligibility decisions are made and maintained.
Intellectual Disability (ID) A condition with onset during the developmental period (before the individual reaches age 22), that includes both intellectual and adaptive deficits in conceptual, social, and practical domains. Deficits in intellectual functioning are confirmed by both clinical assessment and individualized, standardized intelligence testing (generally indicated with an IQ score of about 70 or below).
Inventory for Client and Agency Planning (ICAP) An instrument that assesses adaptive and maladaptive behavior and gathers additional information to determine the type and amount of special assistance that people with disabilities may need. Created to be used for determining eligibility, planning services, evaluating, reporting progress, and for use in funding reports.
Individual Service and Support Advocacy (ISSA) Service coordination or case management to persons who are receiving a DD Home and Community Based Service Waiver service and to Bogard class members who live in an ICF/DD. Through the provision of ISSA, the ISC monitors whether services are being provided as outlined in the person's Plan as well as monitors the person's welfare, health and safety.
Individual Support Plan (ISP) A document that prioritizes and structures the delivery of all services (including generic and Medicaid State Plan) and supports across environments. The document should include relevant and timely assessment information, including individual preferences, abilities and needs. The Plan must be based on principles of community inclusion and self-determination and includes functional goals and methods to measure progress toward those goals. ISPs are developed for individuals in ICFs/DD and other non-waiver settings.
Medical Management Unit (MMU) An entity within the Department of Human Services/Division of Family & Community Services that was created to streamline the maintenance of medical only cases and more effectively manage the redeterminations. This office was created out of 2 existing Family and Community Resource Centers and replaces the services formerly provided by the Illinois Medicaid Redetermination Project.
Office of Inspector General (OIG) The Office of the Inspector General, within the Department of Human Services, investigates all reports of abuse, neglect and exploitation, to foster humane, competent, respectful and caring treatment of individuals with physical, developmental and/or mental disabilities. It also assists State agencies and facilities in prevention efforts.
Office of State Guardian (OSG) A state entity that handles the personal, financial, and legal affairs of people with developmental disabilities, mental illness and elderly persons with disabilities.
Omnibus Reconciliation Act (OBRA) A bill, first enacted in 1987, to improve the quality of care in nursing homes for the health and safety of nursing home residents. This legislation significantly strengthened federal standards, inspections and enforcement of nursing home quality.
Personal Plan
  • The single, comprehensive personal vision for a person's life. This document is developed through a person-centered process and focuses on the individual's strengths, preferences, needs and desires. This Plan is developed by ISC agencies in conjunction with the individual, guardian, family, and providers. The Personal Plan contains desired outcomes, documents choices of qualified providers, reflects what is important to the person regarding delivery of services in a manner which ensures personal preferences, health and welfare. It must also include risk factors and plans to minimize them.
  • Personal Plan is required for all individuals in a DD Waiver program.
Person Centered Planning (PCP) The process through which each waiver participant's needs, goals and preferences are identified and strategies are developed to address those needs, goals and preferences. It is the process through which the people in a waiver exercises choice and control over services and supports and through which risks are assessed and planned for.
Pre-Admission Screen (PAS) A process used to determine whether an individual has a developmental disability, whether they require active treatment and the type of DD services the individual is eligible for.
Pre-Admission Screen and Resident Review (PASRR) A process used to determine whether an individual is appropriate for admission to a Medicaid certified nursing facility and in need of long-term Nursing Facility care.
PUNS Division of Developmental Disabilities statewide database that registers individuals who want or need DDD Waiver services. As funding becomes available, this database is used to invite individuals to apply for DDD Waiver services.
Qualified Intellectually Disability Professional (QIDP) A professional staff that who is responsible for a variety of duties such as integrating, coordinating, and monitoring services for individuals with developmental disabilities. QIDP must possesses the qualifications according to the 42 CFR 483.430
Related Condition (RC) A severe, chronic disability that is found to be similar in effect to an intellectual disability because this condition results in impairment of adaptive behavior similar to that of someone with an intellectual disability and requires treatment or supports similar to those required for these people. A related condition is manifested before the individual reaches age 22, is likely to continue indefinitely. Impairment of adaptive behaviors are due to the related condition and not due to other, separately diagnosable and treatable conditions, such as medical illness, substance abuse, mental illness, or personality disturbances. It also results in substantial functional limitations in three or more of the following areas: Self-care, Language, Learning, Mobility, Self-direction, and Capacity for independent living.
Redetermination (REDE) The process, usually every 12 months, of reassessing a person's eligibility for Medicaid benefits. Also referred to as Medicaid Renewals.
Reporting of Community Services (ROCS) A computer-based system within the Community Reporting System that collects and processes service reporting data to DHS. This data is used by DHS to monitor services, supports and funding.

2.2 Geographic Responsibility

Each Independent Service Coordination (ISC) agency is responsible for a specific geographic area of the State. The ISC agency located in the geographic area in which the individual resides is the designated ISC agency for that individual. If an individual is receiving day program services from a provider agency located outside the ISC agency's area, the ISC agency in the geographic area in which the individual's resides will still be the responsible entity. An ISC agency cannot decline an individual residing in their designated area. The Independent Service Coordination Agency Map, pdf is useful in identifying geographic areas and the corresponding ISC Agency.

2.3 Qualifications of Individual Service Coordinators

Individual Service Coordinators must possess the Qualified Intellectual Disability Professional (QIDP) credentials as defined in Federal regulations. This requirement applies regardless of whether they provide services full-time or part-time.

  1. Service coordinators/QIDPs must update their job skills and knowledge by earning 12 Continuing Education Units annually in job-related training.
  2. Service Coordinators should possess the ability to:
    1. Coordinate all elements of the Person-Centered Planning process, including conducting formal and informal assessments, developing outcomes, producing a Plan, reassessment and revision of the service plan.
    2. Work within a team process, including such skill areas as facilitating meetings and providing follow up.
    3. Facilitate communication, including the ability to interpret non-verbal communication, especially as presented by persons with developmental disabilities; the ability to empathize with others' points of view, and the ability to assist others in expressing their own viewpoints and opinions.
    4. Assist with conflict resolution, including the abilities to facilitate communication, to develop alternative strategies and to help restore normalcy.
    5. Present information succinctly, both verbally and in writing, without bias, that addresses the level of interests of its intended audience. This includes the ability to interpret technical information to persons inexperienced in the use of technical language.
    6. Identify, utilize and develop resources that are important for the developmental disability service planning process and for developmental disability service delivery.
    7. Utilize professional assessments and service reports in the determination of eligibility for services, especially services provided through the Home and Community-Based Waiver.
    8. Organize one's professional activities so that deadlines are met, appointments are kept and non-productive time (travel and personnel reports) is minimized.
    9. Maintain a professional demeanor that presents a positive approach to service issues.

2.4 Mandated Reporting

Individual Service Coordinators will report any allegations or observations of suspected abuse, neglect and financial exploitation directly to:

  • Office of the Inspector General (OIG) at 1-800-368-1463 for individuals residing in a Community Integrated Living Arrangement (CILA) or incidents that occur at Community Day Services (CDS).
  • Adult Protective Services (APS) at 1-866-800-1409 for adults age 18 and over, who reside in their own home or family's home.
  • Department of Children and Family Services at 1-800-252-2873 (Voice), 1-800-358-5117 (TTY) for children under the age of 18 or for anyone residing in a Child Group Home or Child Care Institution
  • Department of Public Health at 1-800-252-4343 email at DPH.CCR@Illinois.gov for individuals residing in a Community Living Facility (CLF).
  1. Office of the Inspector General, Abuse, Neglect and Exploitation Observations and Reporting
    1. Independent service coordinators are considered "required reporters" under The Illinois Administrative Code Title 59, Part 50 (Rule 50 or OIG Rule) and must report all or suspected cases of abuse, neglect, exploitation or other incidents specifically included in this Rule.
    2. When the ISC makes a report to OIG, he/she is considered the "complainant". As necessary, the ISC should inform the DDD Region staff and keep them apprised of the situation.
    3. Rule 50 establishes specific guidelines to follow from the initial reporting of abuse, neglect and exploitation through final action which would result from any subsequent investigation.
    4. The Illinois Administrative Codes, Title 59 Part 115 (for Community-Integrated Living Arrangements) and Part 119 (for Community Day Services) also contain language requiring reporting to OIG.
    5. OIG is responsible for such investigations in all DDD Waiver settings, except Community Living Facilities, which are licensed by the Department of Public Health.
  2. Adult Protective Services
    1. When the ISC is made aware of an Adult Protective Services (APS) investigation, they will contact the identified APS staff or supervisor and offer assistance and information.
    2. The ISC must not intervene in the investigation.
    3. When the ISC is made aware of an Adult Protective Services (APS) substantiated and verified case, the ISC will work with the APS to resolve issues related to this case.
      1. In these situations, the ISC will receive a Substantiation Decision Summary and a Report of Substantiated Decision.
      2. For those who are not already in DDD Waiver services, the ISC should determine if the person is eligible for DDD Waiver services and if they meet the crisis criteria or should be placed on the PUNs. For those who are already enrolled in DDD Waiver services, the ISC must determine if the person needs additional services.
      3. In some cases, it may be necessary for the ISC to develop a safety plan until permanent arrangements have been made.
      4. The ISC must keep the Division informed of their course of action.

Section 3: PUNS for Persons with Developmental Disabilities

PUNS is a database that registers individuals who want or need DDD Waiver services. People that are interested in receiving services through an ICF/DD should work with the ISC agency to explore potential ICF/DD providers. Individuals can still seek placement on PUNS while exploring ICF/DDs. At the time of enrollment into the database, the ISC must explain all service options available to the person.

ISCs will use the Illinois PUNS Enrollment Tool Form, pdf to collect individual information. If any data entry field or explanation is not clear or if ISCs have questions about what should be reported, they may contact the Division of Developmental Disabilities' Program Development Unit at (217) 785-6171 for clarification.

3.1 PUNS Categories

PUNS consist of two categories: Seeking Services and Planning for Services; both are defined below. PUNS selections are based on an individual's length of time in the Seeking Services category. This means that those who have been on the list the longest, in the Seeking Services category, will be selected first.

  1. Seeking Services
    1. The Seeking Services category is for individuals with a developmental disability who currently need or want supports and are in situations (including but not limited to) the following:
      1. Individuals who have (or will shortly) graduate from school and will need day supports (i.e., there are no other employment, day or natural support options available/planned).
      2. The Individual is dissatisfied with current living arrangement and would like to live in his/her own home (with supports) or have DD residential services.
      3. The Individual currently lives in an out-of-home residential setting that is not funded by the Division of DD and wishes to return to their family home (and family concurs). The family is capable of providing care but would like support to return this individual to the home.
    2. For the scenarios below, the ISC will assess each individual and their current circumstances to determine if a crisis (homelessness, abuse, or neglect) exist. If the individual is in crisis, the ISC should continue to assess and process all situations that rise to the Crisis level, without placing the individual on PUNS. Individuals who do not meet the crisis criteria, and are in the following situations, should be placed on PUNS in the Seeking Services category.
      1. An individual whose caregiver is progressing toward being unable to provide care for any number of reasons (age of the caregiver, physical/psychological/health condition of caregiver, health or other situation of the individual). The individual and/or family are coping for now but supports are, and will be, needed.
      2. The individual has a deteriorating living situation or natural support system, which requires supports from an outside entity or agency.
      3. Cases where, although the individual has not been directly affected, a death in the family (especially of a care giver's spouse or other family member who may have assisted in providing care) or other circumstance, has affected the individual's situation requiring a need for additional support.
      4. Situations where the caregiver(s) must work to provide income to pay the rent, etc. If services are not provided, the caregiver(s) would have to remain at home to provide support to the individual, and effectively be unable to continue working.
  2. Planning for Services. The Planning for Services category is for individuals who:
    1. Do not currently want or need supports but may in the future. It is helpful to know about these situations even though the individual/family is not anticipating the need for services.
    2. Are not currently seeking services but will be seeking if something happens to the caregiver (e.g. caregiver becomes ill or passes away) or other family circumstances change.
    3. Currently receive funding or services through entities other than DD, and whose eligibility will eventually terminate due to the age of the individual. This individual is not in crisis and does not have a current need or desire for DD services. This might include, but is not limited to, individuals who are funded through:
      1. Early, Periodic Screening, Diagnosis and Treatment (EPSDT) program.
      2. Medically Fragile/Technology Dependent Children's Waiver.
      3. Individual Care Grant supports through the mental health system.
      4. Illinois State Board of Education or public-school system.
  3. Additional information about PUNS Categories:
    1. Children or Adults enrolling on PUNS can be enrolled directly into the Seeking Services category, given they meet the criteria described in the description of Seeking Services described above.
    2. An individual's time on the PUNS begins once they enter the Seeking Services category. A person does not accumulate time while in the Planning for Service Category.
    3. PUNS selections are only made from the Seeking Services category, as funding is available. PUNS selections are not made from the Planning for Services category.
    4. In order to move from one PUNS category to the other, individuals and/or their guardian, if applicable, must notify their ISC. Movement from one category to the other is not automatic. This includes:
      1. An individual who is turning or who has just turned 18 years old and who wants to enroll as an adult must notify their ISC. Changing categories at age 18 is not automatic.
      2. An individual currently in the Planning for Services category and now wants to move to the Seeking Services category must notify their ISC. Changing categories is not automatic.
      3. An individual who is currently in the Seeking services category and is no longer wanting or needing DD Waiver services, for whatever reason, and choses to move to the Planning for Services category must notify their ISC. Changing categories is not automatic.

3.2 Individual Assurances

  1. The ISC agency must ensure people with developmental disabilities and their guardians/caregivers understand that completion of the PUNS form and the inclusion of the information in the IDHS database does not guarantee the individual is eligible or will receive services.
  2. The information collected through the PUNS form is confidential. The individual, guardian, family and/or caregiver(s) are to be advised of the form's confidentiality and that person-specific information or other personally identifying data will not be released.
  3. Note: Summary data will be made available via the Department of Human Services' (IDHS) website and upon request. These data will be aggregated and will not disclose information that could be tied to a specific individual.

3.3 Educating

  1. Among its roles, the ISC agency is to educate individuals of all ages and families who present themselves by informing them of and explaining all the services and support options available.
    1. By doing so during the screening process, the ISC agency ensures all individuals and families make informed decisions about their need for services or supports.
    2. This educational role is particularly important when individuals or families do not initially foresee a need for services or supports within the next five years.
  2. If after fully exploring the service and support options, the individual and family state their need for any services or supports is more than five years away, the ISC should enroll this person in the Planning for Services category. Although PUNS selections will not occur from this category, the Division needs to be aware of these individuals for planning and budgeting purposes.

3.4 Screening

  1. The ISC agency is to use the guidelines from the Level I Pre-Admission Screen (PAS) process to ensure there is a reasonable basis to believe the person has a developmental disability. A reasonable basis would include, but is not limited to, the person has a diagnosis of an intellectual disability or a related condition.
  2. The ISC agency is not expected to routinely complete a Level II PAS for all individuals who request enrollment on PUNS. However, if the ISC agency finds it is necessary to proceed with a Level II PAS before enrolling certain individuals on PUNS, then the screening must be treated as a full Level II PAS and the individual/guardian must be informed of the results.
  3. If the Level II PAS determines an individual would not be eligible for services, the individual must be informed about his/her appeal rights and should be referred to alternative services, if appropriate (e.g., aging, mental health).

3.5 For Whom to Complete a PUNS Form

  1. Both children and adults, for whom there is a reasonable basis to believe they have a developmental disability, can enroll on PUNS.
  2. The ISC agency should only complete a PUNS form for individuals within the ISC agency service area. This includes:
    1. Adults, age 18 and over, who desire DDD Waiver services (this may include individuals who currently reside in ICF/DDs) and do not meet the descriptions outlined in the next section.
    2. Children, age 2.5 years or older, who desire DDD Waiver services and do not meet the descriptions outlined in the next section. PUNS is not a database for Early Intervention (EI) services.
    3. Dependents of military service members who are absent from the State due to the member's military service.
      1. Upon request, the person can be enrolled in PUNS to indicate the need for services upon return to the State.
      2. These persons should not meet the criteria outlined in the next section.
  3. Both children and adults can enroll on PUNS. The selection for Children and Adult services occurs separately.
  4. Children on PUNS:
    1. Children can be enrolled on PUNS beginning at 2.5 years old and up through age 18.
    2. Children can enroll on PUNS to request Children's Home-Based Services.
    3. If funding is identified to do a PUNS selection for the children's Home-Based Services, selection will be based on a child's cumulative length of time on PUNS prior to age 18.
  5. Adults on PUNS
    1. People 18 and over can enroll on PUNS for DD Adult waiver services.
    2. Adults must be in the Seeking Services category to accumulate time toward the PUNS selection.
    3. Time spent on PUNS, while under the age of 18, does not count toward selection for Adult DD Waiver Services.

3.6 For Whom NOT to Complete a PUNS Form

The ISC agency should not complete a PUNS form on individuals:

  1. For whom there is no reasonable basis to believe the presence of a developmental disability.
  2. Who are already receiving services funded through a DDD Waiver. This includes individuals who are receiving DDD Waiver funding for CDS only or HBS and who might want to increase their supports in the future.
  3. Who do not want DDD Waiver services now or in the future.
  4. Who, upon assessment, the ISC determines meet the Crisis Criteria as described above.
  5. Who are transitioning from State-Operated Developmental Centers into a DDD Waiver service.
  6. Who are transitioning from State-Operated Mental Health Centers and found to be appropriate for DDD Waiver services.
  7. Who are transitioning from the Department of Children and Family Services into a DDD Waiver service.
  8. Who are part of an ICF/DD Downsizing agreement with DDD and have chosen to go into a DDD Waiver service.

3.7 Special Form Completion Circumstances

  1. Out of State Guardian/Family: For individuals whose guardian/family lives out of state or outside the ISC agency's assigned geographic area, schedule completion of the PUNS form when the guardian/family visits the individual. If no visit is likely to occur before a PUNS form is necessary, complete the PUNS form with the individual with developmental disabilities with the participation of the guardian/family by telephone.
  2. Individuals who are Wards of the Office of State Guardian: For individuals who are wards of the Office of State Guardian, schedule completion of the PUNS form to coincide with scheduled visits by the OSG representative or work with the OSG representative to schedule his/her visit at the same time the ISC agency completes the PUNS form if it can be arranged and is timely. If a coordinated face-to-face interview cannot be arranged in a timely fashion, the OSG representative may participate by telephone. A copy of the completed PUNS form can then be sent to the OSG representative for confirmation and signature.
  3. Children and Adolescents: Individuals ages 12 and older should be encouraged to participate in the PUNS completion meeting.

3.8 Guidelines for Completing the PUNS Process

  1. The completion of the PUNS form is to occur when the person first contacts the ISC agency, at any time the individual's needs change significantly after enrolling on PUNS, and annually to make sure the individual's information is current.
  2. Whenever the PUNS form is completed, it should be completed as a result of a conversation between the individual, his/her guardian(s), and ISC agency staff.
    1. Other individuals, as desired by the person with the developmental disability and/or guardian may also be involved.
  3. The PUNS form should be completed in its entirety.
  4. Anyone who participates in completing the PUNS form should sign the form.
  5. The ISC must conduct a face-to-face interview with the person, guardian, and family (as applicable) when completing the initial PUNS form.
    1. The initial PUNS form should never be sent to an individual, guardian, caregiver, family member, or others for him/her to fill out.
    2. The ISC must schedule and reschedule, if necessary, the PUNS meeting to a time and date that will accommodate attendance by the individual and guardian, as well as family members and primary caregivers.
    3. The face-to-face meeting must be held at the location of the individual's or guardian's choosing.
  6. ISC agency staff should remind those involved in completing the PUNS form, the individual, guardians, parents and/or caregiver(s) that it is important to bring all relevant and supporting documentation of the individual's medical condition(s) and living situation to the interview.
    1. This information will help to ensure that the person's needs and/or desires for services and supports is determined accurately.
  7. The PUNS form and database entry must be closed when an individual becomes enrolled in a DDD Waiver service or when an individual withdraws from the database.

3.9 Instructions for Completing the PUNS Form

  1. Individual Data. In this section, record basic information such as the reason for completing the form, the name of the individual requiring services, the service coordinator, caregiver, provider, guardian, etc. Please do not leave any blank fields. If information is not applicable to the individual or is unknown, indicate this by entering NA or UNK as applicable.
    1. Effective Date - Enter the eight-digit (8) date (MM/DD/YYYY) that the initial or updated form was completed. This entry is important because it is used to trigger the 30-day notice to ISC agencies when the annual update is due as well as the priority order in which the person will be enrolled into the database.
    2. Person's name - Enter the first name, middle initial, and last name of the person requesting services.
    3. Social Security Number - Enter the social security number of the individual being enrolled on PUNS. Please be sure it is entered correctly as the number will be used for tracking purposes over time.
    4. Reason for PUNS or PUNS Update - Check one and only one reason for completing the form.
    5. Primary Caregiver - Enter the name, date of birth and address of the family member with whom the person with developmental disabilities is living and who serves as the primary caregiver. If there is not a primary caregiver or if the person is in a residential placement, enter "NA." Paid staff members are not primary caregivers for the purposes of this question.
    6. Secondary Caregiver - Enter the date of birth of the family member with whom the person with developmental disabilities is living and who serves as the secondary caregiver. This would be the case, for example, for someone living with both parents and one parent is the primary caregiver and the other is the secondary caregiver. If there is not a secondary caregiver or if the person is in a residential placement, enter "NA." Paid staff members are not secondary caregivers for the purposes of this question.
    7. Is the individual in school? Select yes or no. If yes, enter the projected graduation date.
    8. Be sure to read the paragraph regarding confidentiality and eligibility to the individual and/or his/her family.
    9. Signatures - The names of the service coordinator, individual, family member and/or guardian should be printed legibly, and their signatures obtained.
  2. Client Case Registration and Client Developmental Disability Information. The data fields that will be completed in this section of the PUNS form are taken directly from the IDHS Community Reporting System (CRS) manual Reporting of Community Services (ROCS) screens.
    1. These screens contain demographic and clinical information. If the data have been previously entered through the ROCS system by the ISC agencies, and if it is still current and accurate, it need not be reentered. Service coordinators should make sure the individual's data displayed in the ROCS system is current at the time of the interview.
    2. The demographic field descriptions are available through the IDHS CRS manual. It is recommended that ISC agencies access this manual through the IDHS website periodically to ensure that field descriptions have not changed.
  3. PUNS Categories. On the PUNS Form/Screens, the ISC must select only one of the two categories below:
    1. Seeking Services (people who currently need, or desire supports)
    2. Planning for Services (people who do not currently want or need supports but may in the future).
  4. Supports Needed. On the PUNS Form/Screens, the ISC is to check supports identified by the individual or family as needed by the individual. All needed supports identified should be checked. If the person does not need a particular support as identified below, this option should be left blank.
INDIVIDUAL SUPPORTS Check (Y) if applicable
Personal Support (include habilitation, personal care, intermittent respite)
Respite Supports (24 hours or more)
Behavioral Supports (includes behavioral intervention, therapy, counseling)
Physical Therapy
Occupational Therapy
Speech Therapy
Assistive Technology [or Adaptive Equipment]
Adaptations [modifications] to Home or Vehicle
Nursing Services in the Home, provided intermittently
Other Individual Supports
VOCATIONAL OR OTHER STRUCTURED SUPPORTS Check (Y) if applicable
Support to work at home (e.g., self-employment or earnings at home) 
Support to work in the community
Support to engage in work/activity in a disability setting
Attendance at activity center for seniors
RESIDENTIAL SUPPORTS Check (Y) if applicable
Out-of-home residential services with less than 24-hour supports 
Out-of-home residential services with 24-hour supports

3.10 Updating, Changing and Closing PUNS Records

The ISC agency is responsible for updating, changing and closing PUNS records as described below to ensure the information in the database accurately reflects the person's need and/or desire.

  1. The Process of Annually Updating PUNS Records.  The ISC agency is required to update PUNS records at least annually to ensure the individual and/or guardian is still interested in DDD Waiver services and to assess whether their situation has changed from one category to the other.
    1. ISCs should remind all persons involved in the annual update to provide documentation of the individual's medical condition and living situation.
    2. The ISC must also remember to give everyone who signed the updated PUNS form a copy of the signed form. Failure to update the PUNS form annually will result in the individual's information being identified as "Closed" in the database.
      1. Before the individual's information is identified as "Closed" in the database, the ISC will document completion of the steps outlined in the "Closing PUNS Records" section.
    3. When the ISC conducts the annual PUNS update with individuals who are 17 years old, the ISC will have a conversation with the individual and/or their guardian, if applicable, to ensure they clearly explain the PUNS categories, time waiting and how selection occurs.
      1. The ISC must inquire whether the individual wants to move from Planning for Services to Seeking Services at age 18. Moving to the Seeking Services category at age 18 means the individual will begin to accumulate time on the list and determine when they will be selected from PUNS for adult waiver services.
      2. For people who choose to move from Planning for Services to Seeking Services at age 18, the ISC will take the necessary steps to ensure this occurs on or before their 18th birthday.
      3. The ISC must document (and make available for review/audit) that they conducted the above conversation, the individual/guardian's choice of category and the follow up actions, if any. The ISC agency should give everyone who signed the updated PUNS form a copy of the signed form.
    4. The ISC is primarily responsible for PUNS updates, but this is a shared responsibility with the individual, guardian, family members and/or primary caregivers (as applicable). All parties should be knowledgeable of the process and take appropriate action to ensure annual updates are completed timely.
  2. Annual updates to the PUNS Information:
    1. Can be conducted by phone for persons in either category as long as the opportunity for a face-to-face discussion was offered.
    2. Requires a face-to-face discussion if an ISC starts an update by phone and determines a change to the category exists. In these cases, the PUNS update should stop and must be completed at a face-to-face meeting.
    3. Requires a face-to-face discussion if requested by the individual and/or guardian.  When no changes to the current information are to be reported, the service coordinators should check the Annual Update box, complete the form by marking the same items as the previous PUNS Form, and send a copy of the "Annual Update" PUNS Form to the individual/guardian for signature.
    4. For those updates completed over the phone, the ISC will send the individual or guardian a written or electronic copy of the updated enrollment. The date of the update will be the date the phone interview occurred. The signatures may not pre-date the phone call. The individual or guardian (or parent in the case of an individual aged 18 or younger) must sign and return a copy of the form to the ISC agency.
    5. The ISC agency will be notified at least 90 days before the date the annual update is due for all PUNS-enrolled individuals it serves.
      1. At the end of each month, the IDHS Community Reporting System will generate a listing for the ISC agency that will identify each individual whose annual update is due in the next 90-120 days.
      2. The names on the listing will be based on the date entered in the "Date Form Completed and Signed by All Parties" on the most recent PUNS form recorded in the database.
      3. Letters will also be generated simultaneously to the individual and guardian of record to alert them to prepare for the annual update of the PUNS record.
      4. These notifications are intended to assist the individuals, guardians, and ISC providers; however, the annual update requirement is the joint responsibility of the individual, guardian, and ISC provider.
    6. When practical and if applicable, the ISC agency should coordinate the completion of annual updates with regularly scheduled visits by OSG representatives.
  3. Changes to PUNS Records (outside of the annual update).  ISC agencies are required to update PUNS records whenever an individual's situation changes significantly from what was reported by the previous PUNS form.
    1. This can be whether the previous PUNS form was an initial one, an annual update or one that also reported a previous significant change.
    2. The ISC agency should complete an update within 30 days of becoming aware of the change in the individual's situation and remember to give everyone who signed the updated PUNS form a copy of the signed form.
    3. Signature by the individual or guardian is not required in circumstances of moved to another state, deceased, or unable to locate.
  4. Closing PUNS Records.  In order to ensure everyone has fair and equal access to Medicaid Waiver services, and that the Department has accurate information for planning and budgeting purposes, PUNS records must be kept current. To that end, the following steps will be taken if annual updates are not completed timely.
    1. Families will be notified by the Department 90 days before the date the annual update is due.
    2. The ISC agency will be aware of the due date through the monthly reports discussed under "Annual Updates to PUNS Records".
    3. The ISC must then contact the individual or guardian to complete the annual update. If the individual or guardian does not respond to the notice or contact, the ISC agency must take the following steps prior to closing the PUNS record.
      1. The ISC completes a first phone call or text to the individual or guardian 60 days prior to the PUNS annual update due date.
      2. If there is no response and an update session is not scheduled, the ISC completes a second phone call or text one to two weeks following the first phone call, varying day and time of the call.
      3. If there is still no response or plan for updating the PUNS record, the ISC completes and sends the first letter or e-mail to the individual or guardian 45 days prior to the PUNS annual update due date stating that the person's record will be closed if there is no response within 30 days.
      4. If there is no response, the ISC completes and sends a second letter or e-mail two weeks after the previous letter stating the enrollment will be closed if there is no response by the date specified in the two letters.
      5. If there is no response after two weeks following the second letter, the ISC will close the PUNS enrollment record.
  5. Time Frames
    1. Note: Days and time periods referenced in this section represent calendar days.
    2. An example of time frames for the above actions would be as follows for an annual PUNS update due on June 1st:
      1. April 1, first phone call or text.
      2. April 7 through 14, second phone call or text.
      3. April 15, first letter or e-mail indicating the PUNS enrollment will be closed if the individual/guardian does not respond by May 15.
      4. May 1, second letter or e-mail indicating the PUNS enrollment will be closed if the individual/guardian does not respond by May 15.
      5. June 1, PUNS enrollment is closed.
  6. Once the ISC closes the PUNS record and electronically reports the closure to the Department, the Department will send a notice of the closure to the individual or guardian at the last known address reported by the ISC.

3.11 Maintaining Local PUNS Records

Copies of all completed PUNS forms (initial, changes, annual updates) are to be maintained by the ISC agency in the individual's file.

Whenever a PUNS form is completed or updated, the ISC is to give a copy of the signed PUNS form to the individual and any other person who signed the PUNS form (i.e., guardian, primary caregivers, etc.) for their information and records. Exception: If a guardian or primary caregiver who lives with the individual specifically requests not to receive a separate copy of the PUNS form, the service coordinator should note that request on the agency's copy of the PUNS form.

3.12 Dependents of Military Service Members

People who are dependents of military service members, absent from the State due to the member's military service and who have been selected from the PUNS database to receive services will have 6 months, from the date of the selection notification, to apply for services. This person then has another 6 months to commence using such services. Once this person begins receiving DD waiver services, they no longer need to be on PUNS.

Section 4: Pre-Admission Screening (PAS) for DD Services

The Pre-Admission Screening (PAS) Manual provides the policies and procedures ISCs must follow to conduct PAS for DD Services. The role of the ISC agency 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 services. The PAS process prevents inappropriate admissions to Intermediate Care Facilities for individuals with Developmental Disabilities (ICFs/DD) and inappropriate enrollments in DDD waivers.

Section 5: Pre-Admission Screening and Resident Review (PASRR)

Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care.

5.1 PASRR Authority

  1. The Code of Federal Regulations (CFR) governing Preadmission Screening and Resident Review is found primarily at 42 eCFR 483.100-138 (Electronic Code of Federal Regulations).
    1. PASRR requires that Medicaid-certified nursing facilities:
      1. Evaluate all applicants for serious mental illness (SMI) and/or intellectual disability (ID).
      2. Offer all applicants the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings).
      3. Provide all applicants the services they need in those settings.
    2. PASRR is to comply with the Supreme Court decision, Olmstead vs L.C. (1999), under the Americans with Disabilities Act, individuals with disabilities cannot be required to be institutionalized to receive public benefits that could be furnished in community-based settings. PASRR can also advance person-centered care planning by assuring that psychological, psychiatric, and functional needs are considered along with personal goals and preferences in planning long-term care.
    3. In brief, the PASRR process requires that all applicants to Medicaid-certified nursing facilities be given a preliminary assessment to determine whether they might have a Serious Mental Illness (SMI) or a Developmental Disability. This is called a "Level I screen." The results of this evaluation result in a determination of need, determination of appropriate setting, and a set of recommendations for services to inform the individual's plan of care.
  2. The Illinois Department of Healthcare and Family Services (HFS) is the lead State agency for all PASRR functions.
    1. HFS contracted with Maximus who developed and oversees the AssessmentPro database, conducts all PASRR Level I screenings, and conducts Level II assessments for individuals with a Serious Mental Illness (SMI). The Maximus- Illinois Help Desk is available to assist and can be reached through the following:
      1. General PASRR questions: ILPASRR@maximus.com
      2. Phone: (833) 727-7745
      3. Web: Illinois Tools and Resources
      4. PASRR Follow Up Visits-related questions: ILFollowUpVisits@maximus.com

5.2 PASRR Level I Screen

Independent Service Coordination (ISC) agencies, in addition to other AssessmentPro users, will complete an Illinois Level I Form in AssessmentPro for individuals who need or desire Nursing Facility (NF) admission. Once the form is submitted Maximus will conduct a Level I PASRR Screen.

  1. Exemptions, Categoricals, and Exclusions.  Maximus receives and reviews all Level I identification screens and performs clinical reviews as for any triggered screens. During that review, Maximus verifies if any available Exemptions, Categoricals, or Exclusions apply and issues outcomes accordingly.
    1. Exemptions -30-day Exempted hospital discharge
    2. Categoricals -60-day convalescent, serious physical illness, terminal illness
      1. Convalescent care (60 days or less) - Provides for NF services for convalescent care from an acute physical illness which required hospitalization and does not meet all the criteria for an exempt hospital discharge.
      2. Serious Physical Illness - Documented severe physical illness which results in a level of impairment so severe that the individual could not be expected to benefit from Specialized Services. For example: coma, brain stem only functioning, progressed ALS or Huntington's, etc. (42 CFR 483.130 (c)(3)).
      3. Terminal Illness - Provides for Terminal illness as defined for hospice purposes in Sec. 418.3: A life expectancy of six (6) months or less if the illness runs its normal course.
    3. Exclusions -dementia primary and progressed with non-primary Serious Mental Illness.
  2. Dual Diagnosis (MI+ DD).  A Level I which indicates a known or suspected dual condition are routed to DDD/ISCs for a Level II assessment and also to Maximus for a level II Mental Health assessment, when available categorical or exemptions do not apply. DDD/ISCs report the disposition of the Level II DD in AssessmentPro as outlined in later sections.
  3. Children.  PASRR referrals for those under 18 with a known or suspected DD or a dual diagnosis (Mental Illness and DD) can be accepted and should be referred to the ISC. The ISC should assess, triage and take any necessary action, all as needed.
  4. Out of State.  If it is determined that a Level II PASRR is required for a person who is out of state with a known or suspected DD or dual condition, ISC will triage and take any needed action regarding the DD Level II referral. As appropriate, the ISC should conduct a desk-based review and not a face-to-face assessment.  The AssessmentPro record, communicator box, should note the person's out of state status.

5.3 DD PASRR Level II Assessment

When the Level I Screen indicates the suspicion of a Developmental Disability (DD), a Level II referral will be sent to the ISC agency in the geographic area the person resides.

  1. The ISCs must conduct a DD PASRR Level II Assessment [42 CFR 483.128] for people who are seeking admission to a Medicaid certified nursing facility, has had a Level I assessment through AssessmentPro and for whom there is reason to suspect a developmental disability.
    1. The DD PASRR Level II Assessment is not the same as the PAS Level II used to assess appropriateness for DD Waivers and ICF/DD.
    2. A DD PASRR Level II Assessment will be used to evaluate and determine whether:
      1. The person has or is likely to have a developmental disability;
      2. A NF is the most appropriate setting, and
      3. The person needs specialized services while in the NF;.
    3. This assessment can only be performed by an ISC QIDP or by the Department.
    4. The DD PASRR Level II Assessment process requires interdisciplinary coordination, as necessary; this may include personnel from Nursing Facilities, the Division of Rehabilitation Services, Dept. on Aging Care Coordination Unit (CCU), Maximus and others.
    5. The DD PASRR Level II Assessment must be completed and entered into AssessmentPro in 72 hours or less from the referral.
    6. On occasion, the ISC will encounter individuals, family or guardians who want NF admissions.
    7. All persons seeking admission to a Medicaid certified NF must be entered in AssessmentPro and allow the algorithm to take place as indicated in Section I. PASRR Level I Screen.
    8. As with all entry's, Maximus will conduct a level I screen.
    9. If necessary, the referral will be sent for a DD Level II PASRR Assessment.
  2. Assess whether the individual has a Developmental Disability
    1. The ISC must assess whether the person has a developmental disability: an intellectual disability or related condition, the age of onset occurred before 22, and if the person would benefit from active treatment.
    2. For some referrals, the information provided/obtained will substantiate the person has a developmental disability. The ISC will document that the person has a developmental disability and document the sources of information.
    3. If the information provided/obtained indicates a developmental disability (may not have the appropriate documentation but indicated by sources, even secondary or tertiary sources) the ISC should document that it is likely that this person has a developmental disability and document the sources of information.
    4. If the sources of information do not support a diagnosis of developmental disability (the person does not have an intellectual disability or a related condition; the ISC cannot verify, even verbally, the age of onset; or the individual does not need active treatment).  In such cases:
      1. The ISC should document that the person does not have a developmental disability and the assessment ends here.
      2. There is no need to assess whether a NF is appropriate or if the person requires specialized services.
      3. The ISC should document that the person does not have a developmental disability and the sources of information used to make this determination.
      4. This determination is not appealable in PASRR.
    5. Note: The PASRR Level I screen generates a PASRR Level II referral for anyone who is suspected to have a "developmental condition or diagnosis" that affects either intellectual and/or adaptive functioning, this includes a wide range of diagnosis, some of which are not a developmental disability (i.e. person has learning disability, ADHD, congenital blindness - with no ID or related condition).
      1. These referrals are sent to ISCs because the PASRR Level I screen (screening phase) is not the level at which a decision is made that an Individual "does have intellectual or developmental disabilities,"- this has to be assessed during the PASRR Level II assessment.
      2. When a PASRR Level I screen is submitted in AssessmentPro, the algorithm first looks to answer the question "is the Individual not in PASRR population (SMI or DD)?"
      3. If the algorithm, based on the answers provided, cannot make this decision, the PASRR Level I screen then goes to a Clinical Review by a Maximus Nurse, this role asks the same question, "Is this Individual not in PASRR population?" If there are answers within the screen or supporting documentation that would not allow the Maximus Nurse, to "rule out" the Individual from PASRR population, then the screen has to move to a Level II Assessment.
  3. Assess whether a Nursing Facility (NF) is the most appropriate setting [42 CFR 483.132] for the individual.
    1. Determination of Need. While the ISC is conducting the DD PASRR assessment, the Dept. on Aging, CCUs will be completing the Determination of Need (DON).
      1. The DON assesses whether a person meets the NF Level of Care (LOC) by looking a person's abilities in daily living areas such as eating, bathing, grooming, dressing, transferring, continence, money management, telephone, preparing meals, laundry, housework, health (routine and special), outside home, and being alone.
      2. The DON score is the ultimate determination of whether a person can enter a NF.
      3. A DON Score of 29 or more indicates the person meets NF LOC. The CCU might reach out to the ISC for input on the DON.
      4. If contacted, the ISC should work cooperatively with the CCU; this might include providing assessments and information already obtained by the ISC.
    2. Is the NF the most appropriate/least restrictive setting?  The ISC's role is to assess whether a NF is the most appropriate/the least restrictive setting for the individual.
      1. Even if a person meets the minimum criteria for admission, as determined by the DON score, the nursing facility may not be the least-restrictive setting for that person.
      2. The DON only considers if people are eligible for a nursing facility; it does not mean they should go to a NF.
      3. The PASRR should offer less-restrictive alternatives to nursing facility placement, if appropriate, even if someone meets level of care criteria.
    3. If eligible for a NF, a person may choose to be admitted.
    4. The ISC must review all available information and make recommendations as to the appropriate setting and services for the person. The ISC must consider:
      1. Is a NF medically necessary; does the person require 24-hour nursing care?
      2. Is a NF the best place for the person?
      3. If 24-hour nursing care is appropriate and desired but the NF is not the appropriate setting for meeting the individual's needs is another setting, such as an ICF/DD, an appropriate institutional setting for meeting those needs?
      4. Can their needs be met in a less restrictive environment?
      5. Can the individual's needs be met in an appropriate community setting?
      6. Do they need a more restrictive environment? Is the person a danger to self or others?
    5. Nursing facilities should be a "last resort" for an individual with a developmental disability. Because of this perspective, ISC notes or summary should mention why less restrictive settings were not appropriate.
    6. Length of stay
      1. If someone meets NF criteria but the nursing facility is not the least restrictive setting, the summary of findings should indicate a short-term/time limited approval noting that the person's needs can be met in the community.
      2. Time limited stays must specify the length of time.
      3. Use short-term approvals to prompt a second look-especially when someone could transition to the community after a short NF stay. Typically, this means they are expected to have their medical milestones met in the NF within 6 months or less.
      4. Be advised that the longer someone is in a NF, the greater the chance they will lose skill and/or deplete their resources and ability to move back into the community.
      5. Short-term approvals also encourage NFs to plan for discharge, and they hold NFs accountable. When an approval expires, to remain compliant, the NF must submit a new Level I assessment for the person to stay in the facility before the short-term approval expires, which will result in referral for another Level II assessment (i.e., a Resident Review).
      6. It is best practice not to issue back-to-back (i.e., more than one) short term stay approvals; therefore, take careful consideration when recommending a length of stay.
  4. Assess the need for Specialized Services [42 CFR 483.120].
    1. If the ISC determines the person has or is likely to have DD and NF is the most appropriate setting to meet the person's needs, the ISC must then review the individual's comprehensive information, including the history and physical examination and make a qualitative judgment on the extent to which the person's status reflects the need for specialized services.
    2. Specialized services, which is also known as active treatment [42 CFR 483.120 and 483.440], includes:
      1. Psychotherapy/Counseling
      2. Physical Therapy
      3. Occupational Therapy
      4. Speech/Communication Therapy
      5. Case Management
      6. Other (specify)
    3. If it is determined the person does not have/not likely to have DD, or is not appropriate for NF care, the ISC should not assess the need for specialized services.
    4. Note: The DD eligibility determination (for ICF/DD and Waiver services) decides if a person can benefit from active treatment. The assessment for Specialized Services determines what active treatment needs the person has and list them so the institution can provide them. The ISC must document what services/supports are needed.
  5. Illinois does not require a new Level II (or a Level I) in the following situations:
    1. Transfers from a NF to a NF; this is considered the same level of care
    2. Transfers from a NF to a Supportive Living Program (SLP); this is considered the same level of care
    3. Transfers from a SLP to a NF; this is considered the same level of care
    4. Return to a NF from a hospital setting for medical treatment for current NF residents. Exception: If the person discharged to a lower level of care in the interim, such as the community, then a new Level I is needed. The NF may still need to submit a Resident Review (RR) if the person has experienced a change in status, however this does not need to occur before the person's return to the NF.
    5. Return to a NF from a hospital setting for psychiatric treatment for current NF residents. Exception: If the person discharged to a lower level of care in the interim, such as the community, then a new Level I is needed. The NF may still need to submit a Resident Review (RR) if the person has experienced a change in status, however this does not need to occur before the person's return to the NF.

5.4 DD PASRR Level II Outcome

  1. Documenting Outcomes
  • The outcome of the DD PASRR Level II assessment must correspond to the person's current functional status as documented in medical and social history records.
  • Once the DD Level II Assessment is complete, the ISC must log into AssessmentPro and select one of the outcomes in the chart below.

SS= Specialized Services; ST= Short Term/time limited stay

AssessmentPro Outcome: What this means: What to record in the PASRR Outcome Explanation Notice (page 2)
Level II Approved, No SS-ST

Level II approved: Person has DD or is likely to have DD; appropriate for NF LOC (DON score of 29 or more) and NF is the most appropriate setting (as determined by the DD Level II Assessment).

No specialized services are needed

Approved Short Term/time limited stay of ______ based on medical needs/conditions expected:

  • 30 days
  • 60 days
  • 90 days
  • 120 days
  • 180 days

ISCs should not recommend convalescent care (i.e., "120 days of convalescent care") because Maximus will determine all Categoricals, which includes convalescent stay, during the Level I screen. Recommending 120 days, if based on medical information, might be appropriate.

You are appropriate for Nursing Facility level of care but do not require specialized services.

This Means, based on our assessment:

  • You have a developmental disability/are likely to have a developmental disability.
  • You received a Determination of Need (DON) score of ___ which indicates you meet NF level of care. It was also determined that a Nursing Facility is the most appropriate setting to meet your needs at this time.
  • You do not need Specialized services.
  • An approved time limited stay of ______ is needed based on medical needs/conditions:

Also, you received a Determination of Need (DON) score of ___. This indicates that you meet the Level of Care for Nursing Facility admission.
Level II Approved, No SS

Level II approved: Person has a DD or is likely to have a DD. Person is appropriate for NF LOC (DON score of 29 or more) and NF is the most appropriate setting (as determined by the DD Level II Assessment).

No specialized services needed

Long-term stay

You are appropriate for NF level of care but do not require specialized services.

This Means, based on our assessment:

  • You have a developmental disability/are likely to have a developmental disability.
  • A Nursing Facility is the most appropriate setting to meet your needs at this time.
  • You do not need Specialized services.
  • A Short-term stay is not indicated.

Also, you received a Determination of Need (DON) score of ___. This indicates that you meet the Level of Care for Nursing Facility admission.
Level II Approved, with SS-ST

Level II approved: Person has or is likely to have a DD. Person appropriate for NF (DON score of 29 or more) and NF is the most appropriate setting (as determined by the DD Level II Assessment)

Specialized services needed

Approved short term/time limited stay of (must specify the length) ______ based on medical needs/conditions expected:

  • 30 days
  • 60 days
  • 90 days
  • 120 days
  • 180 days

You are appropriate for Nursing Facility level of care and require specialized services.

This Means, based on our assessment:

  • You have a developmental disability/are likely to have a developmental disability.
  • A Nursing Facility is the most appropriate setting to meet your needs at this time.
  • Specialized services are needed.
  • Approved time limited stay of ______ based on medical milestones expected:

Also, you received a Determination of Need (DON) score of ___. This indicates that you meet the Level of Care for Nursing Facility admission.
Level II Approved, with SS

Level II approved: Person has a DD or is likely to have a DD. Person appropriate for NF (DON score of 29 or more) and NF is the most appropriate setting (as determined by the DD Level II Assessment)

Specialized services needed

Long-term stay

You are appropriate for Nursing Facility level of care and require specialized services.

This Means, based on our assessment:

  • You have a developmental disability/are likely to have a developmental disability.
  • A Nursing Facility is the most appropriate setting to meet your needs at this time.
  • The following specialized services are recommended: ______

Also, you received a Determination of Need (DON) score of ___. This indicates that you meet the Level of Care for Nursing Facility admission.
Level II- Denied- NF not Appropriate

NF admission is not appropriate based on medical needs/condition; medical necessity is not met (DON <29); a denial must be issued indicating NF level of care was not met.

If the DON says they are appropriate, but the DD Level II outcome indicates a less restrictive setting is the appropriate setting, the person can choose to enter the NF OR pursue the less restrictive setting(s).

Individual/guardian must be given the right to appeal either determination. Refer to C. Appeal Rights for more information.

After assessment, it was determined that you do not meet the Level of Care standard, as determined by the Determination of Need (DON), required for Nursing Facility Admission. Your DON score is ____ and is required to be 29 or higher.

OR

After assessment, it was determined that although you meet the Level of Care standard, as determined by the Determination of Need (DON score= __), your needs may be met in a less restrictive environment. You can choose NF admission (based on the DON score) or you can pursue the less restrictive option(s).

You have the right to appeal this determination. If you choose to appeal the above determination, please refer to the Notice of Appeal Rights for further instructions.
Level II Denied-NF not Appropriate-Needs Exceed NF Care

NF admission is not appropriate because it was determined that the person requires a level of service that is more than a NF can provide (person is a danger to self or others; person's needs cannot be safely met in a NF, etc.).

Even if the ISC makes this determination and per the DON, the person meets the NF LOC standard, the person can be admitted to the NF based on the DON score.

Individual/guardian must be given the right to appeal this determination. See Appeal Rights.

After assessment, it was determined that your needs cannot be met in a Nursing Facility.

Your needs might be more appropriately met in a ___________. Please contact: __________at: ___ if you choose to pursue this option.

You have the right to appeal this determination. If you choose to appeal the above determination, please refer to the Notice of Appeal Rights for further instructions.
Level II-Excluded from PASRR-No Diagnosis After assessment, it was determined that the person does not appear to have a developmental disability; since the person does not have a PASRR condition, a decision is not required regarding NF admission appropriateness or the need for specialized services. After assessment, it was determined that you do not have a developmental disability. Since you do not have a developmental disability, a decision is not required regarding NF appropriateness or the need for specialized services.
Cancelled

Level II assessment is no longer needed

Ex: Individual has left the hospital and does not want NF.

 Outcome Notice not required.
  1. In the event the DD PASRR Level II outcome and the SMI PASRR Level II outcome are contrary (one says NF is appropriate and the other says not appropriate) for individuals who are dually diagnosed, the ISC must contact the DDD liaison prior to entering an outcome in AssessmentPro or sending a Notice of Outcome letter.
    1. DDD and the ISC will review information and discuss findings.
    2. If the discrepancy still exists, DDD will contact Maximus to discuss and resolve the discrepancy.
    3. The ISC's selection of Outcome in AssessmentPro will reflect the resolution between Maximus and DDD.
  2. Outcome Notice.  In addition to recording the outcome in AssessmentPro, the outcome must also be provided in writing, per the PASRR Outcome Explanation Notice (Attachment A).
    1. The Notice must be sent to the individual/guardian, perspective NF, and the discharging hospital if the individual is seeking NF admission from a hospital.
    2. The ISC should use the information from the chart above (What to record in the PASRR Outcome Explanation Notice column) to inform the appropriate parties of the outcome and any subsequent actions (i.e., The right to appeal).
  3. Appeal Rights. When appropriate, as indicated below, the ISC must provide the individual/guardian the right to appeal an adverse determination [42 CFR 483.204 (a)(2)].
    1. Appeal rights must be provided in writing using the format provided by the Division.
    2. The appeal will include an informal review and the right to a Fair Hearing.
    3. The Informal Review will be a review of information between the ISC and the Division of DD and should include any new information that has become available.
    4. ISCs will discuss the information with the Division of DD and come to agreement on an outcome.
    5. If the person is still denied NF appropriateness or the need for specialized services, even after the Informal Review, the appeal will be sent to HFS for a Fair Hearing
    6. If the ISC/Division reverses the original outcome, there is no need for the appeal process to continue. The ISC should change the outcome in AssessmentPro and re-issue the Notice of Outcome letter.
    7. When a person is appealing the DON score, DDD will accept the appeal and send directly to HFS without conducting an Informal Review.
  4. Adverse or appealable determinations include the following:
Determination What does this mean?
Level II- Denied- NF Appropriateness NF admission is not appropriate based on medical needs/condition; medical necessity is not met (DON less than 29) OR NF is not the least restrictive setting.
Level II-Denied-NF Appropriateness-Needs Exceed NF Care NF admission is not appropriate because it was determined that the person requires the level of services that is more than a NF can provide (person is a danger to self or others; person's needs cannot be safely met in a NF, etc.).
No SS Person does not need specialized services.


5.5 Follow Up Visits

When an individual has been determined to need a brief, time limited stay in a NF the ISC must visit the individual and monitor the individual's situation in at least 30 days, but not more than 60 days, after the date of the completed DD Level II Assessment.

  1. The purpose of this visit is to provide a one-time, face-to-face visit to:
    1. Verify the person's preferences for receiving care,
    2. Meet with the Discharge Planner and individual to verify the status of the individual's discharge planning,
    3. Follow up on receipt of specialized services, if recommended, and to
    4. Determine if the individual is connected to community resources.
  2. If the individual is recovering and will return to their residence within the recommended time limit:
    1. No further assessment is needed.
    2. The ISC should communicate the person's status and plan to return to their home with the family, guardian and/or residential provider agency, as applicable.
  3. If the individual is not recovering, will remain in the NF longer, or will not return to his or her permanent residence:
    1. The NF must enter a new episode/case in AssessmentPro prior to the conclusion of any time limited/short term stay. This entry will produce a referral for a new Level II assessment; see Resident Review for more information.
    2. AssessmentPro will automatically track and cue the NF when Follow-Up Visits are due.

5.6 Resident Reviews

The Nursing Facility (NF) must initiate a Resident Review (RR) in AssessmentPro when a resident's condition changes, or a resident's short-term approval is ending soon.

  1. The NF must enter the individual's information into AssessmentPro as a Resident Review- this will result in a Level I screen.
  2. As appropriate, the Level I screen will generate a DD Level II referral.
    1. ISCs will again evaluate whether a NF is the most appropriate setting, whether a continued NF stay is appropriate, whether to approve the person for a non-time limited stay, or a short-term stay with a suggested return to the community.
  3. ISCs should not issue LOC denials for Resident Reviews and instead use the admitting DON as the prevailing determination.

5.7 Community Service Recommendations

The ISC should make recommendations for community services or referrals to other agencies for all individuals assessed in the event they are not admitted to, or if they are discharged from a NF (except when the person is ruled out of PASRR population/found not to have a developmental disability).

  1. Community Services or referral options to consider include:
    1. Housing (permanent supportive housing, rentals, phone services, etc.)
    2. Vocational Supports/Day Program (competitive integrated employment, DRS or DDD supported employment, DD day services, etc.)
    3. Mental Health Services
    4. Home health supports
    5. Substance Use (outpatient, day treatment, detox, residential, etc.)
    6. Natural supports (food pantries, financial literacy, libraries, support groups, spiritual/faith-based involvement, etc.)
    7. Public supports (transit, food stamps, SSA, SSI/SSDI, language resources, etc.)
    8. Other (specify)

Section 6: Annual Americans with Disabilities Act (ADA)/Olmstead Outreach to an Individual in an Institutional Setting

The Division has responsibility under the Americans with Disabilities Act (ADA), and specifically the Olmstead vs. L.C. U.S. Supreme Court decision, that all individuals who reside in ICF/DDs and SODCs should be aware of community-based services and other living options and the process for getting access to those services to make informed decisions about their services.

  1. The ISC will visit the ICF/DD and/or SODC on an annual basis to engage with the individual residents and their guardian if applicable.
  2. The ISC should confirm with the ICF/DD and/or SODC prior to each visit to ensure they have accurate contact information for legal guardians of the facility's residents.
  3. The ISC should arrange the onsite date(s) and time(s) with the facility to make sure individuals will be present and any family members, legal guardians, or other identified supports can also be present to provide support.
  4. If the individual is not interested in learning more about the availability of different services at that time, the ISC should document the decision.
    1. If the decision is in writing, the ISC should keep a copy for the file.
    2. If an individual has a legal guardian, the ISC will send a letter to the individual's legal guardian notifying them of the outreach and with the following information:
      1. Information on Developmental Disability (DD) services available to the individual, including home and community-based services (HCBS).
      2. Date(s) and time(s) the ISC will be onsite at the facility.
      3. Offer to register the individual on PUNS if interested in HCBS and living in an ICF/DD. Offer to contact DDD's Bureau of Transition Services (BTS) if interested in HCBS and living in an SODC.
  5. The ISC should provide alternate dates(s) and time(s) for in-person, virtual or telephonic meetings to discuss service options with an individual and their guardian if applicable if they are unable to attend the ISC's regular scheduled visit to the facility.
  6. During the meeting, the ISC should share information on DD services available to the individual and their guardian if applicable, including HCBS.
  7. If the individual and/or guardian indicates they entered the ICF/DD during a crisis and they are interested in transitioning to HCBS, the ISC should review the individual's records to see if there is documentation that reflects this.
    1. If there is documentation and/or an ISC staff can confirm the situation, the ISC can offer the person the option to move directly to the community without joining the PUNs list.
    2. If there is no documentation and/or ISC staff who cannot confirm the situation, the ISC should add the individual to the PUNs list in order to access HCBS.
  8. During the meeting, the ISC will complete the Outreach Visit Form (PDF) (IL462-5525) or Outreach Visit Form Spanish (PDF) (IL462-5525S).
  9. The ISC will complete the PUNS registration if requested by individuals residing in ICF/DDs and their guardian if applicable or contact the Bureau of Transition Services for individuals residing in an SODC.
  10. In the event the individual living in an ICF/DD is enrolled on PUNS, the ISC should follow the PUNS process for follow-up and the individual will be removed from the ADA/Olmstead outreach process.
  11. In the event the individual living in an SODC and the guardian where applicable would like waiver funded services, the BTS, the SODC interdisciplinary team, and the ISC should begin working on the transition process with the individual. The individual should be removed from the ADA/Olmstead outreach process as long as they are working on community placement.
  12. ISCs will encourage all guardians to take the Guardianship and Advocacy Commission online training.
    1. ISCs will recommend the guardian review information on guardianship, especially as it pertains to the power to place and the requirement that an individual with I/DD be informed of all options for services and supports.
    2. If the guardian and individual disagree about being registered on the PUNS list (ICF/DD only) or placed on the transition list in an SODC, then the ISC should document the response.
      1. If the response is in writing, the ISC should keep a copy for the file.
      2. The ISC should also notify DDD of the disagreement.
  13. If there is a disagreement between the individual and guardian on how to proceed and the individual lives in a private ICF/DD, the following should occur:
    1. The ISC should meet with individual and guardian and perform conflict resolution to identify areas of disagreement and barriers from the guardian's perspective to transiting to the community.
    2. The ISC should meet with ICF/DD or SODC facility staff to get an understanding of the individual's desires.
    3. If the conflict cannot be resolved by the ISC, they should refer the person to the following:
      1. Equip for Equality is the Illinois protection and advocacy agency for persons with disabilities.
      2. Legal Advocacy Service (LAS) which was created so that eligible children and adults, who have a disability, could obtain legal advice and representation to protect and enforce their rights guaranteed by Illinois' mental health laws.
    4. The ISC also should document the response and notify DDD of the disagreement and keep a copy of the file. The ISC should return the following year for ADA/Olmstead Outreach.
  14. If there is a disagreement between the individual and guardian on how to proceed and the individual lives in a SODC, the following should occur:
    1. The ISC should meet with individual and guardian and perform conflict resolution to identify areas of disagreement and barriers from the guardian's perspective to transiting to the community.
    2. The ISC should meet with ICF/DD or SODC facility staff to get an understanding of the individual's desires.
    3. The ISC should document the response and refer the issue to the SODC case management and BTS staff for conflict resolution steps.

Section 7: General Service Coordination

  1. ISC agencies provide general service coordination for children and adults with developmental disabilities who are not in a DDD Waiver funded service and who are not a part of the Bogard Class.
  2. General service coordination includes:
    1. Intake
    2. Education
    3. Referral and linkage to both generic and specialized services
    4. Transportation to facilitate referrals and linkage
    5. Planning (only in those instances where not otherwise provided by other programs)
    6. Crisis intervention
    7. Participation in planning efforts for adolescents aging out of the public school system.
    8. Completion and update of PUNS information, as outlined in Section 3 of this Manual, for all individuals in the assigned geographic area who seek inclusion in the database.
    9. Initial eligibility (OBRA 1) and linkage. The Independent Service Coordination agency, upon request from an individual or guardian, shall complete initial eligibility and linkage as described in Section 4.8.

Section 8: Person Centered Planning

Person Centered Planning addresses the balance between what is important to a person and what is important for a person in service planning. The process focuses on outcomes that are identified by the person in collaboration with their guardian and family.

  • The ISC will document desired outcomes, assist in identifying the barriers that currently prevent the outcomes, and assist the individual/family to locate and select agencies that are willing and qualified to provide the needed supports.
  • Person Centered Planning is required for individuals who are or will be funded through a DDD Waiver.
  • Person Centered Planning does not mandate goals in independence in daily living, economic self-sufficiency, community integration or self-administration of medication.

8.1 The Person Centered Planning process

  1. The Person Centered Planning process, as describe at 42 CFR 441.301(c)(1), must:

    1. Be driven by the person.
    2. Ensure services are delivered in a manner that reflects personal preferences and choices.
    3. Include evidence that setting is chosen by the individual.
    4. Assist to achieve personally defined outcomes in the most integrated setting.
    5. Contribute to the assurance of health and welfare of the person receiving services.
    6. Include opportunities to seek employment and work in competitive integrated settings.
    7. Include opportunities to engage in community life, control personal resources, and receive services in the community to the same degree of access as those not receiving Medicaid Home and Community Based Services.
    8. Include risk factors and measures to minimize risk.
    9. Be written in plain language that can be understood by the person who receives services and their guardian.
    10. Reflect cultural considerations.
    11. Include strategies for solving disagreements.
  2. The Person Centered Planning process includes three main documents: the Discovery Tool, the Personal Plan and Implementation Strategies (IS) Form (state.il.us), PDF, each of these are described in detail below.
    1. In most cases, the initial Person Centered Planning documents will be completed prior to a person entering DD Waiver services.
    2. Once a person has begun receiving services, these documents must be updated at least annually.

8.2 The Discovery Process

  1. The Discovery process is the first component of Person Centered Planning. The Discovery process:
    1. Is designed to gather information about a person's preferences, interests, abilities, preferred environments, activities, and supports needed. The ISC agencies will be responsible for facilitating the Discovery process and documenting what they gather in the Discovery Tool.
    2. Is not a one-time event or meeting, but a series of information gathering activities. The ISC will gather information through discussions (face-to-face, phone, and electronic), observations, and record reviews (evaluations, assessments, case notes).
    3. Note: If the information gathering is face-to-face, this will count as one of the required ISSA (Section 9) visits.
    4. Should begin with the individual and then include the guardian, advocate or family, and others chosen by the individual. It must also include current providers.
    5. Captures information used to develop the Personal Plan which summarizes key and critical areas of the person's life.
  2. Independent Service Coordinator (ISC) Responsibilities
    1. The ISC is responsible for the completion of the Discovery process and Tool. This must be done in conjunction with the person and his/her guardian.
    2. The ISC must complete the initial Discovery process for children and adults newly transitioning to a DDD Waiver, including Ligas Class members.
    3. The Discovery process must be completed after the person has been determined eligible but prior to developing the Plan or searching for a provider. This does not include individuals in Crisis.
    4. The ISC must continue to complete and submit the Crisis Transition Plan and Funding Request form for individuals who are considered to be in Crisis (homeless, abuse or neglect).
    5. The ISC then has 30 calendar days after the date the person begins DDD Waiver services to complete the Discovery process and develop the Personal Plan.
    6. The ISC should not complete the Discovery Tool/process for individuals who are Bogard class members living in an Intermediate Care Facility for individuals with Developmental Disabilities (ICF/DD). These individuals are not involved in the Person Centered Planning process and will continue to have an Individual Service Plan developed by the ICF/DD provider.
  3. The Process
    1. In preparing for the Discovery process, the service coordinator must consider the individual's desired preference for the manner, location(s) and time(s) to gather the information.
    2. The ISC must facilitate the Discovery process and complete the Discovery Tool.
    3. The ISC should ask the individual who they want to participate in the initial discussions. The person should consider inviting people who know, support, and respect them.
    4. If possible, the Discovery process should include a face-to-face discussion with the individual/guardian (if applicable). In situations where the guardian is unable to be present, the ISC must document how information was received from the guardian.
    5. The ISC must obtain information from provider agencies currently serving the individual (if applicable). The provider can attend a Person Centered Planning discussion if invited by the individual/guardian, but the ISC should always gather written information.
    6. The ISC can also obtain information from family members, Personal Support Workers, teachers, therapists, friends, childcare providers, and others who know the person well.
    7. The Discovery process is fluid and should be conducted over a period of time instead of in a single meeting.
    8. The completion date of the Discovery Tool cannot be more than six (6) months from the date of the Personal Plan.
    9. For those who become enrolled in a DDD Waiver, the Discovery Tool should be updated at least annually.
  4. Sources of Information
    1. The questions in the Discovery Tool are meant to guide conversations. It is not necessary to ask every question in each section, but it is necessary to address each section of the Tool.
    2. Prior to talking to the individual, the ISC should consider what supports may be needed to promote the person's full participation (visual aids such as graphics/pictures to understand concepts, pen, paper, sign language interpreter, etc.).
    3. The ISC can obtain information in various ways: conversations (face-to-face, phone, e-mails), record reviews, assessments/evaluations, provider agency notes and summaries.
    4. If the individual is currently enrolled in other services (e.g. residential service funded by a local school district), the ISC agency must obtain information, such as assessments, case notes, monthly reports, nursing notes, etc., from the current provider agency(s).
      1. If information will be obtained face-to-face, the ISC staff must ensure agency staff has the appropriate authorization to leave their work responsibilities to participate.
      2. Agency staff should not participate in Discovery discussions without consulting with or informing the appropriate provider agency management.
    5. When addressing risk, the ISC must gather information from a variety of sources including the individual, guardian, family, staff, record review, and observation. Then, they must use the information gathered to document why the concern currently presents a risk or when the concern has presented significant risk in the past.
    6. A separate risk assessment is not required but if an ISC chooses to use one, it must include the following domains: health/medical; safety in the home, in the community and in the workplace; finances and behavioral supports.
  5. Guiding Conversations
    1. When gathering information:
      1. Speak with the person using first person language and open-ended questions, such as "What do you…"
      2. Communicate with the individual/family using words that are easy to understand. Refrain from canned language and acronyms.
      3. If conducting a discussion with multiple people, ask the individual for input before asking others present to respond.
      4. Allow sufficient time for the individual to formulate thoughts and answer.
      5. Encourage/support multiple styles of communicating thoughts and ideas (pictures, drawing, symbols and words).
    2. The ISC should consider having a separate discussion with the individual prior to gathering information from other sources.
    3. If the individual is unable to communicate in a way for the ISC to understand, ISCs will communicate with those who know the person best to complete the Discovery process. You may also rely upon caregivers when conducting the Discovery process with young children.
  6. Documenting the Information
    1. The ISC must document what is gathered in the Discovery Tool, preferably with the use of bullet points. Information obtained should not be simply copied and pasted from other documents but should accurately reflect discussions had during this process.
    2. The Tool must be completed by the ISC staff and therefore will not be written in first person.
    3. The ISC should provide a copy of the Discovery Tool to the individual/guardian once the Tool is considered complete (each section addressed and with the ISC signature).
    4. The most recent copy of the Discovery Tool should be kept on file with the ISC.
    5. The ISC should provide a copy of the Discovery Tool and Plan, as a part of the complete referral packet, to the provider agency selected by the individual/guardian. This should occur after the person has selected the provider(s) and given consent to make a detailed referral for services.
    6. The ISC must update the Discovery Tool at least annually but can do so more often if the preferences, abilities or needs of the person changes.
    7. The completed Discovery Tool will not require a review/approval from the Division of Developmental Disabilities.

8.3 Personal Plan

  1. The Personal Plan is the single, comprehensive personal vision for a person's life.
    1. The Personal Plan:
      1. Focuses on the individual's strengths, preferences, needs and desires. The ISC agencies will be responsible for developing the Personal Plan in conjunction with the individual, guardian, family, and providers.
      2. Not only contain the outcomes the person requires in their life, but also documents choices of qualified providers, reflect what is important to the person regarding delivery of services in a manner which ensures personal preferences, health and welfare.
      3. Must also include risk factors and plans to minimize them.
      4. Is developed through a person centered process and serves as a mechanism for sharing this information with others who are or will be involved in supporting the person to achieve his/her desired life.
      5. Provides the basis for receiving services, service monitoring and quality evaluation. The Plan should be completed based on what was learned during the Discovery process and can only be developed after the Discovery process is complete. The Plan must be completed prior to searching for a provider agency and initiating DDD Waiver services (except for individuals who are in crisis).
  2. Developing the Plan. The ISC is responsible for developing the outcomes and ensuring the completion of the Plan.
    1. The Personal Plan is based on information gathered during the Discovery process.
    2. The ISC must develop the Personal Plan for children and adults newly transitioning to a DDD Waiver. This must be completed prior to initiating DDD Waiver services, except for Crisis cases.
    3. For individuals who are considered to be in Crisis (homeless, abuse, or neglect), the ISC must complete the Crisis Transition Plan and Funding Request form. The ISC then has 30 calendar days after the date the person begins DD Waiver services to conduct the Discovery process and develop the Personal Plan.
    4. The ISC will use the Personal Plan form as the official Plan. If needed, the ISC should also make the plan available in additional formats, such as braille, pictures, or other languages, and provide it to the individual/guardian as needed.
    5. The contents of the Plan must reflect the key aspects of a person's life as outlined on the form. If there is no outcome listed in a section, the ISC should still complete the remaining statements/questions of that particular section as appropriate.
    6. It should be recognized that some individuals will have multiple desired outcomes, all of which may not be addressed at this time. In such cases, the ISC should assist the person to prioritize outcomes and select providers that meet the "top" priorities. The ISC should document the outcome(s) that are currently on hold and the reason why.
    7. The ISC must ensure the Plan accurately reflects the outcomes, preferences, strengths and support needs of the individual.
    8. The Plan must also discuss risk and strategies to minimize these risks.
    9. The Personal Plan is considered complete when the individual and guardian approve the services, identified outcomes and supporting information in the Plan. The individual, guardian (if applicable) and ISC must sign the Personal Plan. The last signature date of these three parties becomes the annual renewal date for the Personal Plan.
    10. If the individual is unable or unwilling to sign the Personal Plan, the ISC must document the reason why and the date the ISC reviewed the Plan with the person.
    11. If the guardian:
      1. Is unable to sign the Plan, the ISC must obtain verbal approval from the guardian and document the method and date the approval was received.
      2. Is unwilling to approve and sign the Plan, the ISC must first work to resolve any disagreement(s) and document in the Plan how the disagreement(s) was addressed. If the guardian is still unwilling to approve and sign the Plan, the ISC must document the reasonable measures taken to obtain their approval/signature.
      3. Is unresponsive to requests for their approval and signature, the ISC must document the reasonable measures taken to obtain this information and that the individual's guardian has failed to respond.
      4. Does not sign and date the Personal Plan, the last signature date of the individual or ISC becomes the annual renewal date for the Personal Plan.
    12. The completed Plan shall become a part of the individual's record.
  3. Dissemination of the Plan and Provider Selection
    1. The individual/guardian directs the ISC to disseminate the Personal Plan to provider organizations that he/she is considering as a possible service provider for the purpose of determining organizations' ability to meet the desired outcomes and/or provide services identified in the Plan.
    2. Provider agencies that believe they can meet outcomes and/or provide services identified in the Plan can request additional information from the ISC (i.e. Discovery Tool, medical and social histories, psychological evaluation(s), etc.) and work with the ISC who will facilitate the provider selection process.
    3. Provider agencies that believe they cannot meet outcomes and/or provide services identified in the Plan should not sign a Provider Signature Page.
      1. The ISC should assist the individual to locate other qualified and willing providers.
      2. Until a qualified and willing provider(s) is located, the ISC should document progress toward finding an appropriate service provider and document the outcome(s) currently on hold and the reason(s) why.
    4. It is crucial for all stakeholders to understand the outcomes listed in the Personal Plan are those expressed by the individual through the Discovery process. Service providers who are aware of the need to change the Plan should notify the ISC of the person's need or desire to change their Plan.
  4. Outcomes
    1. It is expected that each individual in DD Waiver services has at least 1 outcome. This may reflect something the individual desires that is not currently present or it may reflect something that is already present, and they want to maintain. When developing outcomes in the Personal Plan, remember that outcomes:
      1. Can only be developed after identifying what is important to the person.
      2. Should include what is important for the person. The outcome statement should reflect "in order to" or "so that". See examples below.
      3. May have to be prioritized.
      4. Are not services and supports or something that is routinely offered (such as: having breakfast every morning). Outcomes must be related to the individual and not to the provider or staff. See examples below.
      5. Should make sense for a person without an intellectual/developmental disability.
      6. Must be written in present tense and plain language.
      7. Should not be written in first person.
      8. Do not have to be present in each section of the Plan. Outcomes should only be identified for sections that the individual expressed a desire or preference.
    2. Examples of Outcomes Statements:
      1. Mary volunteers at a day care center so she gets to spend time with children and knows she is needed.
      2. Bernice sings with the choir on Sundays so she stays active.
      3. Ron selects music to listen to while bathing so he can relax and feel refreshed.
      4. Bree watches Animal Planet when she is assisted to stretch so she feels safe and relaxed during her exercise time.
      5. John delivers mail at the hospital in order to gain job skills.
  5. Back Up Plan
    1. A Back Up Plan is a contingency plan put in place to ensure that needed services and supports will be provided in the event the regular services and supports in the individual's Personal Plan are temporarily unavailable.
    2. The Back Up Plan:
      1. Is only required for individuals who are funded in the Home-Based Support Services Program.
      2. Should address contingencies and emergencies, including the failure of a support worker to appear when scheduled to provide necessary services and the absence of the service presents a risk to the individual's health and welfare.
      3. Must be specific to the individual's needs and preferences. A sufficient Back Up Plan is not just to rely on calling 911, but rather one that utilizes other formal social service agencies, as well as family, neighbors, friends, assistive technology devices, etc.
      4. Once complete, will be kept with the Personal Plan, provided to any providers identified to provide services in the Back Up Plan, and provided to the individual.
      5. Must be documented using the Individualized Back Up Plan form.pdf.
  6. Risk.  When documenting risk in the Personal Plan:
    1. Provide narrative information (including brief overview of current skills as well as potential and known risks) sufficient to guide a provider.
    2. Consideration should be given to both the risks associated with current activities of the individual as well as potential risks which inhibit the individual from pursuing his/her goals and fully participating in integrated settings.
    3. All supports, education and training necessary to mitigate identified risks should be included.
    4. Discuss with the individual/guardian, if applicable, if they are willing to accept some situations with risks to facilitate choice, independence, and community integration.
    5. Identify safeguards that are already in place to minimize identified risks and outline additional needed actions to reduce other risks which pose a real or potential threat to the individual's health, safety and/or welfare.
    6. Identify who will be responsible for each of the needed safeguards and actions.
  7. Conflict. If conflict arises during Personal Plan development, the ISC should:
    1. Determine what needs to change or what needs to remain the same for the person.
    2. Consider what makes sense or what is working in the individual's life?
    3. Consider what doesn't make sense or what is not working in the individual's life?
    4. Allow each person to contribute his/her perspective.
    5. Use the information gathered as the basis of thought for the development of an outcome.
  8. Summary of Services & Supports Page
    1. The Summary of Services & Supports page of the Personal Plan is to be completed by the ISC agency.
    2. The ISC must document all services, as applicable to each individual, on this page in the Plan under the column titled Service/Support.
    3. ISC agencies must ensure that all Medicaid Waiver services to be provided to an individual (including the services' scope, amount, frequency and duration) must be listed in the individual's Personal Plan.
      1. This should include Individual Service & Support Advocacy.
      2. Billings and claims for any Medicaid Waiver service found during an audit not to be included in the Plan will be voided. It is not necessary for ISCs agencies to document the details of the services that will be provided (i.e. provide assistance with meal preparation) on this page.
    4. Provider agencies who are aware of the need to change services (i.e. add Supported Employment), should notify the ISC to ensure this service is requested by the individual/guardian and included in the Personal Plan.
  9. Provider Signature Page
    1. The Provider Signature Page of the Personal Plan should only be completed and signed by provider agencies that will render services or work toward outcomes listed on Summary of Services & Supports page of the Personal Plan.
    2. The Summary of Services & Supports page will not be completed or signed by families, guardians or those serving as the HBS Employer of Record. Prior to delivering any services through the Medicaid Waivers, provider agencies should ensure they have a copy of the final and completed Plan.
    3. The Summary of Services & Supports page of the Plan must contain the service(s) the provider will deliver.
    4. All paid services that are applicable to the individual must be identified on this page.
    5. Billings and claims for any Medicaid Waiver service found during an audit not to be included in the Plan will be voided.
    6. After receipt of a Personal Plan, provider agencies that will support any of the services or outcomes listed on the Plan should document the particular service(s) and outcomes they will address on the Provider Signature Page of the Personal Plan. It is not necessary for provider agencies to document the details of these services (i.e. providing assistance with hygiene) on this page. The details of how the service will be provided should be outlined in an Implementation Strategy.
    7. A provider agency must not change the services or outcomes contained in the Plan. Provider agencies who are aware of the need to revise or edit the Plan, should notify the ISC.
    8. Provider agencies have 10 calendar days to complete, sign and return the Provider Signature Page. The completed and signed page becomes a part of the individual's Personal Plan.

8.4 Implementation Strategies

  1. The information identified in the Personal Plan must be addressed and accounted for in the Implementation Strategy.
    1. An Implementation Strategy must detail the supports and services that will be provided on a day-to-day basis.
    2. Implementation Strategies are developed by provider agencies that have agreed to provide services and/or by the Home-Based Services (HBS) Employer of Record.
    3. Implementation Strategies will be evaluated to assure consistency between the stated desires and activities/support.
  2. Implementation Strategies developed by Provider Agencies
    1. After the provider agency's signature on the Provider Signature Page of the Personal Plan, the provider agency will complete the Implementation Strategies (IS) Form (state.il.us), PDF which includes the details of how the service(s) will be provided.
    2. Prior to delivering any services through the Medicaid Waivers, the ISC must provide provider agencies a copy of the final and completed Personal Plan. Billings and claims for any Medicaid Waiver service found during an audit not to be included in the Plan will be voided.
    3. When an individual is using the same provider agency for both CILA and CDS services, a provider agency is not required to develop 2 different Strategies.
      1. If the strategies for CILA and CDS are significantly different, and the provider determines that separate Implementation Strategy documents would be more "user friendly" for the staff, the use of separate documents is acceptable.
      2. Regardless of whether the provider opts to use separate or combined strategies, each Implementation Strategy document must contain all the necessary components described above.
      3. The provider should keep a copy in both locations so staff are aware of the supports and services they are to provide.
    4. All Implementation Strategies should include the justification and documentation for any restriction(s) and/or modifications that limit the individual's choice, access, or otherwise conflict with HCBS Settings Rule.
    5. The Implementation Strategy should be completed within 20 calendar days of the provider's dated signature on the Provider Signature Page.
    6. The Implementation Strategy must be approved by the individual receiving services before it can be implemented. Plans should then be sent to the guardian, if applicable, for approval.
  3. Employer of Record Implementation Strategy
    1. Individual's, family, and others who act as the Employer of Record in HBS, must develop an Implementation Strategy when they will arrange any service (i.e. hiring PSWs or purchasing Self Direction Assistance (SDA)) or work on any outcome from the Personal Plan. It is the responsibility of the ISC agency to notify the individual, family guardian of this and to direct them to the form.
    2. The Employer of Record will complete the Employer of Record Implementation Strategy form [IL462-1240] and use the Instructions for Completing the Employer of Record Implementation Strategy [IL462-1241].
    3. If the Employer of Record wants or needs help completing the form, they can purchase SDA. The ISC agency should help individuals and families locate an agency that provides SDA.
    4. The Employer of Record's Implementation Strategy must:
      1. Be completed using the Employer of Record Implementation Strategy form according to the instructions provided.
      2. Be completed by the HBS Employer of Record for the person receiving DD Waiver services or a SDA hired by the individual, family or guardian.
      3. Be completed when the individual or family has chosen to arrange or oversee services and/or outcomes from the Personal Plan. This might include when services are being delivered by a family member, Personal Support Workers (PSW) privately hired, Special Recreation Association programs, private day programs, or professionals/therapists who do not accept Medicaid. When an individual or family has chosen agency-based services only (i.e. Community Day Access, agency based Personal Support Workers), it is not necessary to complete this form.
      4. Contain all the outcomes from the Personal Plan the individual, family or guardian has agreed to work on or arrange.
      5. Contain any of the services the individual, family or guardian has or will arrange. This includes: PSWs hired directly by the individual, family or guardian; Adaptive Equipment, Assistive Technology, Home Modifications, Non-Medical Transportation, Self-Direction Assistant and Vehicle Modifications.
      6. Be updated at least every year. It can be updated more often if the individual/guardian's needs or desires change.
    5. The Employer of Record Implementation Strategy does not replace the Home-Based Support Service Agreement.
    6. The Employer of Record must keep the completed Strategy on hand and provide a copy to their Independent Service Coordination (ISC) agency and SDA if they have hired one. It should be available to the DDD staff as requested.
    7. The Employer of Record must ensure all services and supports are provided and/or billed according to your HBS Service Agreements, Service Authorizations and Implementation Strategy.

Section 9: Individual Service and Support Advocacy

Individual Service and Support Advocacy (ISSA) is service coordination or case management to persons who are receiving a DDD HCBS Waiver service. This will include some individuals who are:

  • Living at home and are receiving intermittent support services through Community Integrated Living Arrangement (CILA) or Home-Based Services.
  • In a variety of community-based residential settings, including CILA, Community Living Facilities (CLF) and Child Group Homes (CGH).
  • Receiving Community Day Services (CDS).
  • State funded and receiving a DDD HCBS Waiver service.

ISSA is also provided to Bogard class members who live in an ICF/DD. Through the provision of ISSA, the ISC represents the Department's interests in determining whether program services are being provided as outlined in the Personal Plan as well as monitoring the person's welfare, health and safety.

  • Individuals, families, and guardians are required to participate in ISSA, once the individual becomes enrolled in a DDD HCBS Waiver service.
  • ISSA includes, but is not limited to visits (in-person or other), meetings for Discovery Tool and Personal Plan, and obtaining necessary approvals and signatures, etc.

9.1 Annual Review and Update of the Plan

For individuals enrolled in a DDD Waiver, the Discovery Tool and Personal Plan must be updated annually to ensure they continue to reflect the person's preferences and support needs.

  1. The Plan must be updated within 365 calendar days of the previous Plan.
    1. This includes obtaining the individuals/guardian's signatures.
    2. The Personal Plan should always align with the information obtained through the Discovery process.
    3. The ISC must provide a copy of updated Discovery Tool and Plan to current provider agencies serving the individual.
  2. For annual reviews and updates to the Plan, the ISC agency must obtain information from the current provider agency(s).
    1. Provider agencies must send the ISC requested information/documents within 14 calendar days of receiving a request.
    2. ISCs should request information from or coordinate discussions through provider's management staff.
    3. If the individual/guardian has identified a specific provider staff (i.e., a direct care staff) to be involved, the ISC should make management at the provider agency aware of the request.
    4. Agency staff should not participate in Discovery discussions without consulting with or informing the appropriate provider management staff.
  3. The Personal Plan can be revised or edited more often than annually if the person's desires or needs change. Individuals, guardians, families, or service providers who are aware of the need to revise or edit a Plan should notify the ISC.
  4. Revisions to the Personal Plan:
    1. If the individual's preferences, desires, abilities or support needs change, prompting a change in the Plan, the ISC must review and revise the Discovery Tool and Personal Plan to ensure these documents accurately reflect the current preferences, desires, abilities, and support needs of the individual.
    2. On page 1 of the Personal Plan, under Check type of Plan, the ISC must select Revision.
    3. A Revision requires new signatures (and dates) from the individual, guardian(s) and ISC.
    4. The latest signature date of the individual, guardian(s) and ISC becomes the annual renewal date for the Personal Plan.
    5. A new Provider Signature Page(s) should be completed along with a new Implementation Strategy.
    6. Example 1: Waiver Service Transitions or DHS Aging Out.
    7. Example 2: Individual in CILA is hospitalized, then released home with hospice. (In this scenario, one would expect the person's total needs and desires to be different. This would require a change to the Discovery Tool also.)
  5. Edits to the Personal Plan:
    1. When the ISC becomes aware of the individual's desire to add, remove or change an outcome; change a service provider(s); or add/remove a service(s), this constitutes an Edit to the Personal Plan.
    2. In such situations, the ISC should check Edit on the Personal Plan IL462-4457-DYN (state.il.us), pdf
    3. The Discovery Tool should be reviewed and updated as needed (if discrepancies are identified).
    4. It is not necessary to obtain new signatures from the individual, guardian(s) or ISC when the Plan is edited.
    5. An edit to the Plan does not reset the annual renewal date.
    6. Example 1: An individual in HBS is currently purchasing CDS from a provider. The individual wants to add a second CDS program/provider. The individual already indicated the desire to participate in CDS, so in this case, there is no need to update the Discovery Tool.
    7. Example 2: An individual receiving CILA services was hospitalized and then moved to a nursing facility for a short term stay of 90 days. This is an "Edit" if person will return to CILA w/no change to level of support needed.
    8. Example 3: Individual in HBS purchasing PSW services. The individual needs to add physical therapy because of a torn ACL. The need for PT is temporary and does not change other factors in the Plan.

9.2 ISSA Monitoring Activities

As the case management entity, the ISC agency is responsible for monitoring the implementation of the Plan as well as monitoring the health, welfare and safety of the individual receiving DD services. The following guidance should be used when conducting monitoring visits and other monitoring activities.

  1. Quarterly Visits
    1. The ISC agency will conduct a minimum of four face-to-face ISSA visits per year (one per quarter) to each person in a DDD Waiver program.
    2. ISC Quarterly Visits are based on the State Fiscal Year and defined as follows:
      1. Quarter 1: July 1 through September 30
      2. Quarter 2: October 1 through December 31
      3. Quarter 3: January 1 through March 31
      4. Quarter 4: April 1 through June 30
    3. The quarterly visits will consist of the following:
      1. At least one face-to-face visit must be conducted to complete the Discovery Process/Personal Plan. This visit will count as the face-to-face visit for that quarter. The ISC can conduct additional visits to complete the Plan if necessary.
      2. Three additional face-to-face monitoring visits are to be spaced throughout the following 3 quarters. The ISC Monitoring Visit Notes will serve as documentation for these visits.
    4. If the ISC met with the individual multiple times to complete the Discovery/Personal Plan, then the ISC should identify and record one of the face-to-face dates that they are using to calculate future monitoring visits occurring in the following 3 quarters.
    5. Prior to conducting the required monitoring visits, the ISC should contact the individual (as appropriate), guardian, family member or friend (if allowed by the individual) to:
      1. Formally schedule the visit if occurring in the family home or other pre-determined location (as opposed to a drop-in visit at a day program).
      2. Inquire if there are issues or concerns, or information that needs to be collected prior to the forthcoming visit.
    6. The ISC must consider and plan for the amount of time needed to make contact with the guardian prior to a visit and begin the process as early as necessary. At a minimum, the ISC's effort to contact the guardian, family member and/or friend should consist of at least the following efforts:
      1. One telephone call
      2. One written communication (text, e-mail, or letter)
    7. Location of Monitoring visits
      1. Residence: A minimum of two face-to-face monitoring visits must be conducted at the individual's residence to assess the individual's satisfaction with the outcomes and services as well as to monitor their health, safety, and welfare. The monitoring visits should occur in the person's home/residence; this includes licensed settings (i.e., CILAs, CLFs, CGHs) as well as non-licensed settings (individual's own or family homes).
      2. For individuals who have an approved Live In Caregiver exemption for Electronic Visit Verification (EVV), the ISC will verify the living arrangement of the PSW and individual meets one of the definitions for the exemption during one of the monitoring visits to the individual's residence.
      3. Day Program (as applicable): If the individual attends a day program, one face-to-face monitoring visit must be conducted at the site (Community Day Service, Enhanced Residential Habilitation/37U, Adult Day Service, or other day service setting) to assess the individual's satisfaction with the outcomes and services as well as to monitor their health, safety, and welfare.
      4. No Day Program: If the individual does not attend a day program, the 3rd face-to-face monitoring visit should occur in the location of the individual's choosing.
      5. Privately funded day program and schools: The ISC should also consider visiting privately funded day program sites if the individual spends a considerable portion of their time each week at this setting. The ISC also has the ability to do the visit at the individual's school as appropriate and warranted.
      6. Competitive integrated employment: A visit to an individual's competitive integrated employment or small group employment site is not required.
  2. Additional Monitoring visits
    1. Separate from the minimum required monitoring visits and the visit(s) for the Discovery Process/Personal Plan, the ISC should conduct additional monitoring visits (face-to-face) any time there are significant issues or emergencies with the person receiving waiver services.
      1. The number of additional monitoring visits should be conducted based on the person's needs.
      2. Additional monitoring visits can occur in the person's residence or in other locations. The location (i.e., day program site, hospital, home) should be based on the situation or reason for monitoring.
      3. In most cases, the ISC should conduct Additional Monitoring visits within 30 calendar days of becoming aware of an issue
      4. The exact timing of the visit should be based on the urgency of the situation and the potential risks to the person receiving services.
    2. The following are a list of circumstances which may require at least one additional face-to-face visit:
      1. Police involvement [with or without court action]
      2. IDHS Office of the Inspector General investigative findings of egregious neglect, abuse, and/or financial exploitation
      3. Status after a hospitalization
      4. Significant life changes/transitions
      5. Significant behavioral issues/concerns that could change the individual's Personal Plan or Implementation Strategy
      6. Significant medical issues/concerns
      7. Death of family or close supports that have a potential to adversely affect the individual's services and/or supports.
      8. Changes in level of care needs within the waiver.
      9. Guardian's interests' conflict with the person's desires that adversely affect the person's services and/or supports.
      10. Unresolved individual/guardian issues and concerns that adversely affect the individual's services and/or supports.
      11. Situations which create concerns related to health, well-being, and service provision.
      12. Danger of losing current placement
      13. Involvement of Service and Support Teams (SST) or Stabilization Homes (SH).
  3. Visits to Private Homes
    1. The State has the responsibility to ensure the general health and well-being for persons in the waiver, including individuals in their own homes; therefore, individuals who choose to participate in waiver programs, including Intermittent CILA, host family settings, and HBS, must provide access to their homes for on-site visits.
    2. For individuals requesting waiver-funded services, ISC Agencies must inform families prior to enrollment that ISC visits will take place in the family homes. Families are more likely to be receptive and cooperative if this necessity is explained to them from the beginning.
    3. At least two annual monitoring visits by service coordinators will be made to the individual's home. These visits should typically occur during evening and weekend hours (i.e., not during the individual's day program or working hours).
    4. For visits to individuals residing in private homes, the ISC must take into consideration cultural and economic factors that may affect individual's environment. Standards that apply in provider-supported residential settings may not be appropriate standards when visiting a person's own home.
      1. For example, in evaluating whether the setting is clean, the ISC should recognize that individuals and families vary from day to day in their interest and capacity to adhere to any one set of standards for what is considered "clean." When the ISC has questions in this area, the ISC should address whether the individual's health, safety and well-being are supported by the setting. Another consideration relates to fairness.
      2. The ISC should consider whether everyone within the home shares the same standards for cleanliness, or whether a double standard exists, so that the individual being visited does not benefit equally from standards existing elsewhere in the home.
      3. Considerations like the above should be utilized when determining if, "The individual appears to be well groomed and appropriately dressed."
      4. For individuals who have an approved Live in Caregiver exemption for Electronic Visit Verification (EVV), the ISC will verify the living arrangement of the PSW and individual.
  4. Guidelines for Completing the Individual Monitoring and Interview Notes
    1. The ISC Individual Monitoring and Interview Notes and the Interpretive Guidelines [IL462-4465] assist the service coordinators in accurately and consistently recording information gathered during a monitoring visit to individuals receiving DDD Waiver services.  The priority is to address issues of health, safety, and welfare of the individual, as well as services being provided according to the Personal Plan and Implementation Strategy.
    2. ISCs are required to complete a Monitoring Note for the minimum required monitoring visits.
      1. In addition, the Monitoring Notes can be used to document any additional monitoring visits.
      2. In situations where a revised Discovery Tool and Personal Plan are required, service coordinators are not required to complete a Monitoring Note also.
    3. ISCs are not required to send Monitoring Notes to the Division on a routine basis; however, ISC agencies will forward their Monitoring Notes when submitting the Referral to the Department of Human Services for Monitoring and/or Technical Assistance form (see Section 12) to DDD, or upon request from the Division.
    4. Copies of completed Monitoring Notes must be shared with the individual and/or the guardian and the waiver service providers within 10 calendar days following the completion of the monitoring visit. All Monitoring Notes must be typed or printed and must be legible.
    5. The following guidance is provided to assist service coordinators in completing sections of the form.
      1. General Information: This section contains basic information about the person receiving Waiver services, the provider agency, the parent/guardian and the ISC agency.
      2. Purpose of visit: Document that this is a "Quarterly Monitoring Visit" or an "Additional Monitoring visit to address…" (see B. Additional Monitoring Visits).
      3. Location of visit: See Section 10.2 of this manual for requirements on location of quarterly visits. Additional monitoring visits can occur in the person's residence or in other locations based on the situation or reason for monitoring.
      4. Residential Program Type: Example responses include, but are not limited to, 24 Hour Community Integrated Living Arrangement (CILA), Host Family CILA, Child Group Home. If the person is authorized for day program only or HBS, indicate "own home" or "family home".
      5. Provider Agency Name: List the primary provider. If the person:
        • Is in DDD residential services, this agency is the primary provider.
        • Is enrolled in a day program only, the day program agency is the primary provider.
        • Is enrolled in HBS with agency-based services, any of the agencies can serve as the primary provider.
        • Is enrolled in HBS and does not have any agency involved, enter "self-directed".
      6. Sources of Information Used During Visit: In this section, use the grid to document the sources of information that were used for the monitoring visit. Although the primary source of information will come from face-to-face interviews, the ISC can gather additional information through observations, telephone interview, etc. Regardless of the source, record the information in this section.
      7. Interests of Guardian, Family, Friends: Provide a brief narrative of any interests, concerns, or issues expressed by the guardian prior to or during this visit. In cases where there is no guardian, provide a brief narrative of any interests, concerns, or issues expressed by significant family or friends if the individual has given permission for those persons to be contacted.
      8. Key Elements of Accomplishment/Attainment: In addition to the Monitoring Notes, the Interpretive Guidelines should be used when conducting the individual interviews. These are probing questions and are provided as a guide to prompt conversation and encourage dialogue.
        • Use as many or as few questions as needed for each key element. The ISC must be sure to be sensitive to the communication style for each person they will interview.
        • Take time to seek support from someone who knows the person best when communication styles differ from your own. Ensure the person has whatever communication supports (for example: interpreter, communication device, visual supports) that are used in their daily life available to them at the time of the interview.
        • For each statement/question in the Key Elements of Accomplishment/Attainment section, mark yes, no, or not applicable. A narrative must be completed for each question. The Narrative section should reflect presence or absence of evidence to support each key element.
        • For Example, Key Element #1: ISC has received all Implementation Strategies for this person. 
          • If the response is YES: The Narrative(s) should address the presence of evidence to support this key element. The Narrative might read: John has three implementation strategies, and all received within the required time frame.
          • If the response is NO, the Narrative(s) should address the absence of evidence to support this key element. The Narrative might read: Two of three implementation strategies are present at time of review, follow up needed.
      9. General Observations, Comments, Unusual Circumstances. In this section, ISCs will record:
        • Their overall impressions and summary information.
        • Whether the individual appears to be well groomed and appropriately dressed.
        • Any concerns or issues specific to the person receiving Waiver services.
        • Whether previous issues have been addressed and if the person is satisfied with the solution or result.
        • Any special efforts or achievements by the person being visited, providers or other entities that might be commended.
      10. Suggested Follow-Up: The ISC must determine if follow-up action is needed based on what they found during the interview process.
        • If follow-up action is needed, the ISC must complete each item in this section (Issue, Suggested Action, By Whom, Suggested Target Date and Follow-up Actions Response).
        • Follow-up Action may include suggestions to providers, modification of the Personal Plan or Implementation Strategies, securing additional assessments or other action needed by persons other than the ISC.
        • The service coordinator will not always be the person responsible for completing the Suggested Action; it might be the individual, family/guardian, and/or the provider. In cases where there is no follow-up action needed, then there is no need to complete this section.
      11. The service coordinator must sign and date the monitoring note when completed.
  5. Other ISSA Monitoring Activities
    1. The ISC shall perform additional monitoring activities as needed to ensure the health, welfare, safety, satisfaction, and continued Waiver eligibility of the individual.
    2. Other ISSA monitoring activities could include telephone calls, face-to-face discussions or electronic communications with families, guardians, or provider agencies; this also includes reviews of records and other documentation.
    3. The ISC must determine if the activity is considered significant thereby requiring a Monitoring Note.
    4. If the activity is not significant, documentation can be completed with a case note.
  6. Visits to Bogard Class Members Living in an Intermediate Care Facility for persons with Developmental Disabilities
    1. ISC agencies conduct ISSA activities for Bogard class members who live in ICF/DDs, per the Bogard Consent Decree.
    2. For Bogard class members, the ISC must conduct a minimum of 4 quarterly visits a year.
    3. ISC agencies must record their visits using the Individual Service and Support Advocacy (ISSA) Visiting Notes; the ISSA Visiting Notes Interpretive Guidelines should be used for guidance.
    4. ISC agencies will not develop a Personal Plan for Bogard class members who live in ICF/DDs; the provider will continue developing an Individual Service Plan (ISP).

9.3 Medicaid Benefit Enrollment and Medical Renewal Process

As the case management entity, the ISC agency plays an important role in the Medicaid Benefit and Medical Renewal Process for Medical, Cash and SNAP. This includes assisting individuals and families who will be entering a DDD Waiver to apply for Medicaid Benefits. It also includes assisting the individual/family who is already in a DDD Waiver with their annual redetermination process.

  1. Approved Representatives
    1. In order for the ISC to receive Medicaid Benefit information on behalf of someone enrolled in a DDD Waiver, the individual/guardian must first designate the ISC as an Approved Representative. 
      1. ISCs are not required to be an Approved Representative, however, being designated as such allows an ISC to act on a person's behalf with the Department of Healthcare and Family Services or the Department of Human Services for Cash, SNAP and Medical benefits.
      2. An approved representative is a person who has been given permission by a client to apply for benefits and receive notices; it is not the same as a Representative Payee.
    2. A person can designate more than one approved representative if they desire.
    3. The ISC enrolling as the Approved Representative:
      1. Is particularly beneficial when serving people in a DDD Waiver who do not have a service provider as it ensures the ISC will receive all correspondence from DHS and HFS.
      2. Allows the ISC to represent the person in a DDD Waiver at a local DHS office/FCRC, over the phone or by e-mail.
      3. Must be involved in the enrollment process along with the individual/guardian.
    4. Enrollment can be done:
      1. Online by accessing Manage My Case or
      2. By completing and submitting the Approved Representative Form [IL444-2998] PDF .
    5. The ISC is still responsible for ensuring people who are enrolled in a DD Waiver service maintain financial eligibility for Medicaid even if the ISC is not designated as an Approved Representative.
  2. Medicaid Benefit Enrollment for Children Authorized for a DDD Children's Waiver
    1. Children who are determined DD clinically eligible, who have been given an Award Letter for the Children's Support Waiver or the Children's Residential Waiver and who are under the age of 19 can apply for Medicaid under special eligibility rules.
    2. The special eligibility rules can waive family income for families who would not otherwise qualify for Medicaid benefits for their child because of the parent's income.
    3. When children meet the criteria above, the ISC agency will follow the procedures below to help the family apply for Medicaid benefits and to ensure the child's Medicaid application is prioritized. The ISC will send the Child's Medicaid application to the Illinois Department of Healthcare and Family Services (HFS) All Kids Unit which is responsible for processing medical applications for persons under the age of 18 years old.
    4. When sending an application to All Kids, please write: DD WAIVER in red on the envelope and on the first page of the application.
    5. The Illinois Department of Human Services Family and Community Resource Center (FCRC) Medical applications sent to the All Kids Unit must include:
      1. A cover letter;
      2. The DD Waiver service award letter;
      3. Proof of parent's income (Proof of income is still required despite being waived), and;
      4. all other required verifications.
    6. For Children already receiving Medicaid medical benefits please send a copy of the DD Waiver service award letter with a cover letter to the All Kids Unit attention Beth Riley at Beth.Riley@Illinois.gov.
  3. Expedited Medicaid Benefit Process
    1. The ISC will send Medicaid applications directly to HFS for persons who are enrolled or planning to be enrolled in a DDD Waiver in order to expedite Medicaid enrollment or to resolve a lapse in benefits. This assistance is provided to:
      1. Children entering a DDD Waiver; as described in part B.
      2. Young adults who are turning 19 (transitioning to adult Medicaid).
      3. Any individual selected from the PUNS list who is not enrolled in Medicaid or whose case has lapsed more than 90 days.
    2. These cases will be sent to Matt Gurney at Matthew.r.Gurney@illinois.gov.
  4. Redetermination of Medicaid Benefits, Medical Renewal
    1. An individual, guardian or approved representative is responsible for maintaining uninterrupted eligibility for Medicaid benefits to continue receiving DDD Waiver services. As such, a Redetermination occurs every year for each individual receiving benefits.
    2. The term "Redetermination" is a generic term used to describe two separate redetermination processes for individuals enrolled in a DDD HCBS Waiver. In this Section, a Medicaid redetermination refers to continued eligibility for Medicaid Benefits and Medical Renewal Process for Medical, Cash and SNAP.
    3. The individual, guardian or approved representative will receive two (2) Illinois Medical, Cash and SNAP Redetermination Notices in the mail every year.
    4. The notices contain a return address from the Illinois Department of Human Services (IDHS), Family and Community Resource Center (commonly known as FCRC or local office) or the Illinois Department of Healthcare and Family Services (HFS). These are the two (2) Illinois entities which handle Redeterminations.
    5. It is crucial the individual, guardian (if applicable) or approved representative complete and return the Medical, Cash and SNAP Redetermination Notice within the specified time frames in order to avoid interruption or loss of Medicaid status and Waiver services.
      1. The form used for this process is titled "Medical, Cash and SNAP Redetermination Notice" [IL444-1893].
      2. The first mailing from HFS is a notice the redetermination date is approaching and the Illinois Medical, Cash and SNAP Redetermination Notice will arrive in approximately two (2) weeks.
      3. The second mailing from HFS contains the actual Illinois Medical, Cash and SNAP Redetermination Notice. This form will already contain the individual's name and date of birth; it will also contain a barcode in the upper right-hand corner.
    6. To complete the redetermination process, the individual, guardian (if applicable) or approved representative must:
      1. Complete the preprinted Illinois Medical, Cash and SNAP Redetermination Notice.
      2. Attach any verifications and/or documentation requested.
      3. Sign the form.
      4. Return the form and any verifications and/or documentation by the date indicated on page 3, #11 of the form.
    7. When necessary, the ISC should assist persons enrolled in a DDD Waiver with the Illinois Medical, Cash and SNAP Redetermination Notice as to avoid any interruption in eligibility or coverage. For everyone enrolled in a DDD Medicaid Waiver service, the ISC should:
      1. Remind the individual, guardian or approved representative, as well as any residential provider of the annual redetermination date if known.
      2. Remind the individual, guardian or approved representative, as well as any residential provider that they will (or inquire if they already have) receive an Illinois Medical, Cash and SNAP Redetermination Notice as described above.
      3. Help resolve cancelled Medicaid cases. Any time the ISC becomes aware the individual is not eligible or the Medicaid case has been cancelled, the ISC must take the following steps:
        • Identify the reason for cancellation.
        • If the case is cancelled and the redetermination has been sent in, contact the FCRC/local office liaison identified by DDD.
        • If the case is cancelled and the redetermination has not been sent in, the ISC must contact the FCRC/local office liaison identified by DDD to request a new Illinois Medical, Cash and SNAP Redetermination Notice is issued.
        • If there is no resolution to the Medicaid Medical, Cash or SNAP redetermination issues, contact the identified Medicaid benefits liaison within the DDD.
      4. If the individual, guardian or approved representative is unable to successfully complete the Illinois Medical, Cash and SNAP Redetermination Notice, the ISC should assist as needed. A provider agency can also assist the individual, guardian or authorized representative in completing and returning the form.
  5. Spenddown
    1. The Notice of DHS Community-Based Services form/HFS 2653 (commonly known as the Spenddown form) must be completed by a provider agency or the Home-Based Services Employer of Record.
    2. The Estimated Monthly Cost to be filled in on this form can be found on the DHS/DDD Rate sheets, which is the second page of the DDD Award Letter.
    3. The provider must forward a copy of the form to the ISC agency.
    4. It is the ISC agency's responsibility to provide assistance and information as needed to the provider agency or the Home-Based Services Employer of Record.
    5. The ISC is not required to send this form into DHS but should maintain the Notice of DHS Community-Based Services form/HFS 2653 in the individual's file.
  6. Medicaid Benefit Contacts:
    1. State Agency Contacts
      1. HFS Contact for processing Medicaid All Kids applications: Matt Gurney at Matthew.r.Gurney@illinois.gov.
      2. DHS FCS Contact for processing DDD waiver participant applications: DHS.FCS.DDWaiver@illinois.gov.
      3. DDD Contact for Medicaid benefit assistance: Jay Bohn, (217) 558-1361 or at Jay.Bohn@Illinois.gov.
    2. For Medical only cases, a more streamlined contact process between the FCRC staff of the local offices and the staff at the Medical Management Unit (MMU) has been created. The MMU, Office 155, can now be contacted via email at DHS.MMU@Illinois.gov
      1. Medical Management Unit (Formerly Homewood IMRP): 1055 W. 175th Street Suite 201, Homewood, IL 60430; Phone (708) 957-8352
      2. Medical Management Unit (Formerly Hunter IMRP): 527 S. Wells, Chicago, IL 60607; Phone (312) 793-2152, Fax (312) 814-1651

9.4 Level of Care Redeterminations (Clinical)

At least annually, a service coordinator will conduct a level of care/Waiver eligibility redetermination. In this Section, a redetermination refers to the clinical level of care and is conducted for continuing eligibility of services to everyone in the DDD Waivers. This redetermination is for waiver claiming and is summarized and documented on the Redetermination of Medicaid DD Waiver Eligibility form [IL462-0952].

  1. The annual level of care redetermination can be performed during the time of the annual review of the Personal Plan; however, the redetermination may never be allowed to expire.
    1. If the redetermination and the Personal Plan process cannot be scheduled during the same time, the ISC must perform the redetermination on or before its next due date, regardless of the timing of the Personal Plan process.
    2. The timeliness of the redetermination is of critical importance, as it will be monitored by the federal government: Centers for Medicare & Medicaid Services (CMS), and state government: The Illinois Department of Healthcare and Family Services (HFS) and The Illinois Department of Human Services (DHS) Division of Developmental Disabilities (DDD).
    3. No redetermination may be allowed to become out of date, it must be completed within 365 days of the date on the most recent Determination of Intellectual Disability or Related Condition & Associated Treatment Needs (DDPAS-5) form [IL462-4428] or the Redetermination of Medicaid DD Waiver Eligibility form [IL462-0952], documenting the need for an ICF/DD level of service (sometimes referred to as active treatment for developmental disability).
  2. The IL462-4428 or IL462-0952 must be maintained in the individual record.
  3. Not only will the ISC complete and document the Level of Care Redetermination, the ISC must also report the annual redeterminations in the Reporting of Community Services (ROCS) system.
  4. The criteria for continuing waiver eligibility are the same as the criteria for initial waiver eligibility. The following assessments and programmatic information must be completed or reviewed in re-determining the level of care:
    1. Inventory for Client and Agency Planning (ICAP): An existing ICAP may be used if it is not more than 1 year old.
      1. The redetermination date may be adjusted as needed to coordinate with the previous ICAP that was completed as long as the 365-day time limit is met.
      2. The ISC is responsible for ensuring the ICAP is updated in a timely manner.
      3. The completion of the ICAP is the responsibility of a QIDP at the ISC agency and can be shared with provider agencies.
    2. Other documentation: Individual redeterminations should also be based on a review of the Personal Plan, other formal and informal assessments, all available case notes, individual progress reports, medical information and the individual's status.
    3. Release of Information: The Release of Information form [IL462-1214] is needed to continue sharing the individual's information for Medicaid waiver purposes. This form must also be maintained in the individual record and completed annually.

9.5 Rights and Advocacy

  1. Rights
    1. People with intellectual and development disabilities receiving Medicaid HCBS waiver funded services have important rights that should be shared with them on an annual basis, or more often as needed. The list of rights is informed by Illinois Mental Health and Developmental Disabilities Code, the Federal Settings Rule language (42 CFR 441.301(c)(4)) and other federal and state laws.
    2. The Division has put together the Rights of Individuals in Medicaid Home and Community-Based Services Developmental Disabilities Waiver document (pdf).  A plain language version of this document (pdf) for people receiving services is also available.
    3. The ISC agency must inform individuals (or the guardian of the individual, if applicable) of rights under the Waiver using the Rights of Individuals form [IL462-1201] annually and upon request or when changes in services occur.
    4. The ISC must also provide the individual/guardian with a copy of the form. This form must be filed in the individual's clinical record.
  2. Advocacy
    1. Independent Service Coordination (ISC) agencies act as advocates on behalf of individuals with disabilities.
    2. As an advocate, ISC agencies conduct Mandated Reporting, Address and Resolve Issues or Concerns, and Refer for Monitoring and Technical Assistance. In addition, ISCs also:
      1. Assist the individual in self-advocacy with providers of waiver services and will assist with conflict resolution.
      2. Conduct necessary problem-solving activities as issues arise regarding implementation of the Plan, coordination of services, or general health and well-being.
      3. Work cooperatively with service providers to implement improvements in the responsiveness and appropriateness of the services received by the individual according to the individual's Personal Plan.
      4. Refer any recurring, unresolved issues or serious problems affecting the individual's health and welfare to DDD so the Division can monitor or provide technical assistance as needed.
      5. Conduct necessary evaluations and assessments of individual service needs.
      6. Assist individuals with linkage and applications for any non-Waiver services; provide any necessary coordination of services. This may include working with Managed Care Organizations (MCOs) when coordinating State Plan services.
      7. Assemble and submit any necessary applications for changes in DDD Waiver services, including those that require prior approval.
      8. Assist individuals with appeals resulting from discharges, suspension, or terminations of DDD Waiver services as outlined in Section 14 of this Manual.
      9. Inform individuals of all willing and qualified providers.
      10. Explain and provide information to individuals about reporting allegations of abuse, neglect, and exploitation, as well as filing other complaints and grievances.
    3. The following entities are also available to individuals and guardians for advocacy services:
      • Equip for Equality. Individuals/guardian can access Equip for Equality online or by reaching out to one of the following offices:
Office Address Phone & Fax
Main/Chicago Office 20 N. Michigan, Suite 300, Chicago, Illinois 60602

Phone: (312) 341-0022 or (800) 537-2632

TTY: (800) 610-2779, Fax: (312) 341-0295
Central Illinois 1 West Old Capitol Plaza, Suite 816, Springfield, IL 62701

Phone: (217) 544-0464 or (800) 758-0559

TTY: (800) 610-2779

Fax: (217) 523-0720
Northwestern Illinois 1515 Fifth Avenue, Suite 420, P.O. Box 276, Moline, IL 61265

Phone: (309) 786-6868 or (800) 758-0464

TTY: (800) 610-2779

Fax: (309) 797-8710
Southern Illinois 300 E. Main Street, Suite 18, Carbondale, IL 62901

Phone: (618) 457-7930 or (800) 758-6869

TTY: (800) 610-2779

Fax: (618) 457-7985
  • Illinois Guardianship and Advocacy Commission (Regional offices are located throughout the state)
Office Address Phone & Fax

Chicago Regional Office

*Includes Legal Advocacy Service

 160 N. La Salle Street, Suite S500, Chicago, IL 60601

Phone: (312) 793-5900

Fax: (312) 793-4311

TTY: (866)-333-3362
East Central Regional Office 2125 S. First Street, Champaign, IL 61820

Phone: (217) 278-5577

Fax: (217) 278-5588 T

TY: (866)-333-3362
Egyptian Regional Office #7 Cottage Drive, Anna, Illinois 62906-1669

Phone: (618) 833-4897

Fax: (618) 833-5219

TTY: (866)-333-3362
Metro East Regional Office 4500 College Avenue, Suite 100, Alton, IL 62002

Phone: (618) 474-5503

Fax: (618) 474-5517

TTY: (866)-333-3362
North Suburban Regional Office 9511 Harrison Street, Room 335, Des Plaines, Illinois 60016

Phone: (847) 294-4264

Fax: (847) 294-4263

TTY: (866)-333-3362
Peoria Regional Office 401 N. Main Street, Suite, 620, Peoria, IL 61602

Phone: (309) 671-3030

Fax: (309) 671-3060

TTY: (866)-333-3362
Rockford Regional Office 4302 N. Main Street, Suite 108, Rockford, IL 61103

Phone: (815) 987-7657

Fax: (815) 987-7227

TTY: (866)-333-3362

Springfield Regional Office

*Includes Office of State Guardianship

 521 Stratton Building, 401 S. Spring Street, Springfield, IL 62706

Phone: (217) 785-1540

Fax: (217) 524-0088

TTY: (866)-333-3362
West Suburban Regional Office

Madden Mental Health Center

1200 S. First Street, P.O. Box 7009, Hines, IL 60141

Phone: (708) 338-7500

Fax: (708) 338-7505

TTY: (866)-333-3362

Note: Geographic areas of the State may offer specific county and local resources and providers of advocacy services.

9.6 Critical Incident Reporting and Analysis System (CIRAS)

The Division of Developmental Disabilities (DDD) has developed the Critical Incident Reporting and Analysis System (CIRAS) to capture electronic reports from ISC agencies, as well as providers, of certain incidents involving participants in the State's Medicaid Waiver programs for individuals with developmental disabilities. The types of incidents to be reported are listed and defined in the CIRAS Manual which is available on the DHS website.

  1. The DDD will use the information reported through CIRAS to:
    1. Inform ISC agencies of potential issues involving the participants whose general health and well-being the ISCs are monitoring,
    2. Ensure incidents are addressed appropriately, and
    3. Analyze potential systemic issues and take steps to enhance overall system quality.
  2. CIRAS is not a reporting system for alleged incidents of abuse, neglect, or exploitation. Alleged cases of abuse, neglect or exploitation should continue to be reported to the Department of Human Services' Office of the Inspector General (OIG), Department of Children and Family Services (DCFS), Department on Aging / Adult Protective Services (APS), and/or Department of Public Health as appropriate and required in accordance with the type of service involved.
  3. As ISCs are informed of critical incidents, they will be the primary responder, will perform the appropriate follow-up and will notify the Division of its findings.
    1. The ISC agencies are also CIRAS incident reporters. Being a reporter will allow ISC agencies to enter the incident in CIRAS, making the report complete and keeping the Division aware of all CIRAS incidents.
    2. ISCs should refer to the CIRAS Manual for guidelines on enrolling, reporting and follow-up.

Section 10: Bogard Consent Decree

The Department of Human Services is required to follow the Bogard Modified Consent Decree signed July 25, 2000, for individuals identified as a Bogard class member. ISC agency staff serve as the service coordinators for Bogard class members and are required to be a Qualified Intellectual Disabilities Professional (QIDP).

10.1 Bogard Class Members

  1. Bogard class members are defined in the modified Bogard Consent Decree, Page 1, Section A., as "all persons 18 years of age or older, with developmental disabilities, who, on or after March 23, 1986, resided in an Intermediate Care Facility or Skilled Nursing Facility in Illinois as a Medicaid recipient for a period of more than 120 days in the aggregate.
    1. No person first admitted to an Intermediate Care Facility or a Skilled Nursing Facility on or after April 1, 1994, can be a member of the class."
    2. Bogard class members are designated by the Department of Human Services/Division of Developmental Disabilities.
  2. Class members receive a specific form of case coordination directly related to their residential setting. These class members live in nursing facilities, nontraditional DD settings such as State Operated Mental Health Centers, shelter care homes, their own or family homes, apartments without DD services, and State Operated Developmental Centers.
  3. Bogard class members who are receiving waiver services, such as Community Integrated Living Arrangements (CILA), Community Day Services (CDS) or Home-Based Support Services (HBS), as well as class members living in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD), not including State-Operated Developmental Centers, receive Individual Service and Support Advocacy.
  4. It is expected that Bogard class members develop new skills and maintain existing ones through specialized services or active treatment, receive adaptive equipment as appropriate, live in appropriate community-based residential settings if they so choose, and receive case coordination on a regular basis.

10.2 Bogard Class Members Residing in an ICF/DD

  1. Bogard class members residing in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD) will be provided all Individual Service and Support Advocacy (ISSA) activities except for:
    1. The level of care redetermination and
    2. The Person Centered Planning process.
  2. For Bogard class members residing in an ICF/DD:
    1. The level of care redetermination and Person Centered Planning are not required.
    2. The ISC agency will provide assistance to both individuals and their providers to enhance the delivery and effectiveness of services.
    3. The ISC will:
      1. Attend interdisciplinary team meetings to provide input into the ISP.
      2. Ensure individuals have adequate and appropriate assessments and reassessments of needs and abilities.
      3. Complete a minimum of four monitoring visits per year (approximately one per quarter), first informing the guardian (if applicable) and according to the following guidelines. All visits must occur when the individual is present at the site.
        • One visit for participation in the development of the Individual Service Plan (ISP). The person's ISP will provide documentation for this visit.
        • One visit either to the individual's residence or day program (if the individual participates in a day program). The ISSA Visiting Note will provide documentation for this visit.
        • One visit each to the individual's residence and day program (if the individual participates in a day program). The ISSA Visiting Notes will provide documentation for this visit.
        • One or two visits to the location of the individual's choice. The ISSA Visiting Notes will provide documentation for this visit.
      4. Complete additional visits beyond what is outlined above, if necessary, to resolve issues or in times of crisis. The ISC must document in the record the reason for the additional visit(s). For example, additional visits may be needed for a class member who is unable to communicate with spoken words, when the guardian does not participate, if there are serious medical or behavior issues and/or there is suspected abuse.
      5. Prior to each visit, contact the guardian to determine if there are issues or concerns they have for consideration during the visit. At a minimum, the ISCs effort to contact the guardian should consist of at least the following, unless successful before the next step:
        • One telephone call during daytime hours
        • One telephone call during non-business hours
        • One email or letter
      6. Ensure facilitation and collaboration with service providers, of conflict resolution for matters of concern to the individual and/or guardian and provider, including satisfaction, health, safety, well-being, and the development and implementation of the ISP.
      7. Recommend to the provider that an interdisciplinary team meeting be convened if service planning and implementation do not appear to be adequate.
      8. Work cooperatively with service providers to implement improvements in the responsiveness and appropriateness of services received by the individual according to the individual's satisfaction, preferences and unique perspectives.
      9. Refer any reoccurring, unresolved or serious issues affecting the individual's health and welfare to DHS/DDD for possible technical assistance and/or monitoring, as needed.
      10. Screen for and report any allegation or observation of suspected abuse and neglect to the Department of Public Health at 800-252-4343.

10.3 Bogard Class Members Residing in Other Non-Waiver Settings

  1. Bogard class members residing in the following type of non-waiver settings will receive Bogard Service Coordination from the ISC agency:
    1. Nursing Facility.
    2. State Operated Mental Health Center, Shelter Care Home, their own or family home and apartment without DD services.
    3. State Operated Developmental Center.
  2. Under Bogard Service Coordination, the ISC will:
    1. Ensure completion of adequate and appropriate assessments and reassessments of needs and abilities.
    2. Coordinate the Individual Service Plan (ISP) development.
    3. Ensure the individual and guardian provided input in the ISP.
    4. Facilitate and broker Specialized Services for persons in nursing facilities.
    5. Advocate for the development of natural supports.
    6. Conduct activities to maintain or improve availability, accessibility, and quality of services.
    7. Assist with the procurement of adaptive equipment through the Department of Healthcare and Family Services.
    8. Complete, at a minimum, one monthly service coordination monitoring visits with the individual.
    9. Monitor the implementation of the ISP, as well as the individual's health, safety and well-being, through site visits to residential and day programs.
    10. Utilize problem-solving procedures to achieve conflict resolution.
    11. Provide crisis intervention supports, as needed.
    12. Ensure the provision of transportation to facilitate the selection of employment and residential services among other options.
    13. Advocate for individuals in securing services, exercising rights and identifying their choice.

10.4 Bogard Class Members Residing in a Medicaid Waiver Setting

Bogard class members residing in a Community Integrated Living Arrangement (CILA), Community Living Facility (16 beds or less) or receiving Community Day Services through the Medicaid waiver program, will receive ISSA. ISSA activities are outlined in Section 9 of this Manual.

Section 11: Housing Navigation

Housing Navigation was created to expand residential options where individuals with DD can receive services. It provides individuals a choice in where and how they live.

11.1 Eligible Individuals

Individual who are eligible for the Housing Navigation Program:

  1. Have a developmental disability,
  2. Would like to live in their own apartment or home,
  3. Are receiving services via home-based supports, CILA, I-CILA, ICF/DD, or SODC, or
  4. Are selected from the PUNS list.
  5. Receive Medicaid Home and Community Based Waiver (HCBS) services.

11.2 Housing Navigation Program

The Housing Navigation Program supports individuals with DD who want to live integrated in the community.

  1. Individuals may desire to live alone or with a roommate of choice, who may or may not have a disability.
  2. ISC Housing Navigators are identifying housing options that are landlord-based where individuals will have a lease.
    1. There may be multiple co-signers on the Apartment or home lease, where everyone has tenant protections as well as responsibilities for maintaining the lease.
    2. All dwellings must be zoned property and have a self-contained unit access to a bathroom, living space, and kitchen, and have adequate health and safety features such as exits, functioning windows, electrical, plumbing, etc.
  3. People who have apartments or homes for rent to individuals with disabilities might reach out to the Housing Navigator to add to their inventory.
  4. Housing Navigators do not link individuals to shared homes for individual room rental opportunities.
  5. Housing Navigation does not provide rent or purchase assistance. Please note, the Medicaid waivers cannot pay for housing.

11.3 Housing Navigators

Housing Navigators are a part of an ISC agency and:

  1. Help find available housing units.
  2. Help find housing that individuals can afford.
  3. Help people apply for rental units.
  4. Help find housing that is accessible.
  5. Find a Provider Agency that will support an individual in their home and give the services they need.

Section 12: Screenings for the Supported Living Program

The Supportive Living Program (SLP) is an assisted living model made possible through a federally approved HCBS waiver (1915c) and is overseen by the Department of Healthcare and Family Services (Illinois Administrative Code, at 89 Ill. Admin. Code, Part 146, Subpart B). The goal of the program is to preserve privacy and autonomy while emphasizing health and wellness for persons who would otherwise need NF care.

The Department of Healthcare and Family Services has contracted with Maximus to create and a statewide database of individuals who desire admission to a SLP as well as to conduct all initial screens as described below.

12.1 SLP Services

  1. Admission into a SLP offers an alternative to Nursing Facility (NF) placement for older adults (age 65 and up) and individuals with physical disabilities (age 22 and up).
  2. Eligible individuals must meet NF level of care, among other requirements, as assessed by a Care Coordination Unit (CCU) or the Division of Rehabilitative Services (DRS) using the Determination of Need (DON) tool.
  3. Supportive Living Program (SLP) services include:
    1. Routine nursing assessments and follow up care.
    2. Teaching by a licensed nurse for new health conditions (ex. newly diagnosed diabetic who needs to learn how to check their blood sugar).
    3. Medication ordering, set up, reminders and medication administration.
    4. Assistance with activities of daily living (ADL) including but not limited to bathing, eating, dressing, personal hygiene, grooming, toileting, ambulation and transferring.
    5. Three meals per day and snacks.
    6. Housekeeping, laundry and maintenance.
    7. Social and health promotion activities.
    8. Assistance with scheduling medical appointments and scheduling. transportation to medical appointments.
    9. Assistance with shopping when resident is unable to do so.
    10. Emergency call system.
    11. Daily well-being check (3 times per day for individuals in a SLP dementia care setting).
    12. Staff available to assist residents 24 hours/day.
      1. Individuals usually have a private apartment, although some providers offer double occupancy apartments.
      2. Although staff is available, individuals are often in their apartments without staff present.

12.2 SLP Initial Screen Submission

  1. When an individual is seeking admission to a SLP, the ISC, or other entity as appropriate (i.e., DRS staff, nursing facility staff) will enter the individual's information into AssessmentPro; this process is outlined at Illinois Tools and Resources Page.
  2. From AssessmentPro, Maximus will conduct an Initial SLP screen. The Initial SLP Screen is the first step in determining an individual's appropriateness for an SLP setting.
  3. If during the initial screen, there is a reasonable basis to suspect a Developmental Disability (DD), a request for a DD SLP Comprehensive Assessment will be sent through AssessmentPro to the ISC agency in the geographic area the individual resides.
  4. ISCs must check their AssessmentPro Que frequently to obtain DD SLP referrals.
  5. In addition to the initial screen by Maximus, each SLP referral will receive a DON score conducted by a CCU or DRS and an assessment conducted by the SLP provider.

12.3 DD SLP Comprehensive Assessment

ISCs must complete a SLP Comprehensive Assessment for individuals who are referred through AssessmentPro.

  1. The SLP Comprehensive Assessment must be completed in 3 business days of receiving the request.
  2. The ISC should obtain as much information as possible on each individual referred. The information can be obtained by discussion (face-to-face, virtually, by telephone) and based on review of documents.
  3. DD SLP Comprehensive Assessments do not require the ISC to obtain a new psychological or other evaluation on an individual.
  4. As much as possible, ISCs will receive referrals based on where the individual resides. It is also possible for ISCs to receive referrals outside of the geographic region, when this occurs, the receiving ISC should complete the assessment for the referral received.
  5. The DD SLP Comprehensive Assessment includes both a determination of a developmental disability and an assessment of needs/risk - both are outlined below.
  6. After reviewing all information, the ISC must then determine an outcome (identified below) and enter it into AssessmentPro.

12.4 SLP Determination of Disability

  1. The ISC will assess whether the individual has a developmental disability.
    1. The presence of a developmental disability does not automatically preclude admission to the SLP. Admission is precluded when the individual's needs are beyond the scope of the Program.
    2. If the individual's needs are beyond the scope of the SLP, the individual should be considered for other services not available through the SLP.
  2. When assessing whether the individual has a developmental disability, the ISC must determine one of the following:
    1. The individual has an intellectual disability or a related condition, the age of onset has been verified, and the individual requires active treatment. This outcome is based on current knowledge and/or information on the individual. In such situations there is no need to obtain any further information; the current information continues to be valid.
    2. Based on the information provided, it is likely that this individual has a developmental disability. This is appropriate when the information reviewed indicates an intellectual disability or a related condition, indicates the age of onset is prior to age 22, and indicates there is a need for active treatment. Although the ISC has not performed a thorough Level II DDD Pre-Admission Screen for DD Services, enough information is present to believe the individual is likely to have DD.
      1. Example 1: The individual is someone new to the ISC but based on conversations and limited documentation there is a reasonable degree of certainty the individual has an intellectual disability or related condition. Maybe a family member has indicated the individual was diagnosed with DD as a child and current information supports.
      2. Example 2: The ISC has been provided documentation supporting the age of onset but does not have all of the current assessments (i.e.: current psychological evaluation).
    3. The individual does not have a developmental disability, or the information does not indicate a developmental disability. In these cases, the assessment ends here; there is no need to further assess if a SLP is appropriate.
      1. Example 1: The individual referred does not have an intellectual disability or a related condition diagnosis (individual has learning disability, ADHD, congenital blindness - with no ID or related condition).
      2. Example 2: The documentation does not identify the age of onset; ISC cannot verify the age of onset even with interviews.
      3. Example 3: Individual does not need active treatment.
  3. Note: The SLP initial screen in AssessmentPro will generate a DD SLP Comprehensive Assessment referral for anyone who is suspected to have a "developmental condition or diagnosis that affects either/both intellectual and/or adaptive functioning". This will include a wide range of diagnosis which are not all a developmental disability. The ISC should assess each individual, as described above.
  4. If the ISC determines the individual does not have or is unlikely to have a developmental disability, the assessment ends here, and the outcome is "Not Appropriate" as identified below.

12.5 SLP Assessment of Individual Needs and Risks

From the information gathered, the ISC should determine if the individual's needs can be met in the Supportive Living Program at large, and if their risk are appropriate for the program. Each SLP provider will later determine if their specific facility can serve the individual.

Reminder: If the individual does not have a DD, there is no reason to assess the Needs or Risk.

  1. The identification of needs and risk should be considered in, but not limited to, the following areas:
    1. Health/Medical - chronic medical conditions, compliance with physician recommendations, dietary needs, swallowing difficulties, medication and side effects, mobility/reposition self to reduce likelihood of pressure ulcers), sensory impairments, frequent falls, and other similar issues.
    2. Home - environmental hazards, individual safety, awareness of hazards, others in the home, emergency response, cooking, water temperatures, chemicals, cleaning products, and other similar issues.
    3. Community - community access, traffic, strangers, navigation, supervision, and other similar issues.
    4. School/Workplace - conflict resolution with others, use of tools and equipment on the job, avoidance of dangers associated with tasks, dangers posed by other persons at the school or worksite, and other similar issues.
    5. Finances - financial exploitation, income loss, insurance/benefit loss, and other similar issues.
    6. Behavioral - display of inappropriate/maladaptive behaviors and interventions (including risks to self and risks to others), inappropriate sexual behaviors, elopement.
    7. Supports - presence and involvement of natural supports (family and friends, interpersonal skills, communication of needs (ability to ask for help), and other similar issues.
  2. The individual's needs cannot be met in a SLP if the following criteria are met. The individual:
    1. Is not able to make known their needs known to people who do not know them. Totally incontinent, cannot identify when they have been incontinent and cannot assist with managing incontinence or associated hygiene.
    2. Can perform ADLs when supervised but is unable to perform them without continuous reminders.
    3. Lacks understanding regarding the need for activities of daily living and their proper location, timing, and/or performance.
    4. Experiences seizures frequently during the day (e.g., once a week or more) and his/her post seizure condition lasts for several hours and severely limits his/her ability to perform ADLs, communicate receptively and/or expressively -so the individual requires someone to sit with them for extended time or if they require 100% assistance with ADLs during this time.
    5. Has deficits in expressive communication with others and is difficult to understand.
      1. If using an adaptive device, the process of communicating back and forth is exceedingly slow and difficult, often resulting in errors of understanding.
      2. People who work and live closely with the individual have an easier time understanding him/her, but strangers usually must ask the individual to repeat.
      3. The individual often has some difficulty with receptive communication.
    6. Not be able to understand basic communication from a stranger-for example, a police officer directing foot traffic around an accident, a store clerk giving directions for finding a sale item, or a bus driver indicating what time the next bus will leave.
    7. Even with extra time and appropriate assistive technology (especially for communication), the individual does not demonstrate the capacity to make independent, age-appropriate reasoned decisions in important areas of the individual's life (e.g., vocational, social, financial, legal, spiritual, familial, etc).
    8. Not able to make known his/her needs to people who do not know the individual. Totally incontinent, cannot identify when they have been incontinent and cannot assist with managing incontinence or associated hygiene.
    9. Can perform ADLs when supervised but is unable to perform them without continuous reminders.
  3. The individual's risks cannot be safely addressed in a SLP if the following are present:
    1. Behaviors that would result is a danger to self or others.
    2. Swallowing risk coupled with being unable to understand/follow MD orders for this condition, such as a thickened liquid diet. For example, the individual would need to be able to understand they could not drink a glass of water in their apartment.
    3. Lack of basic safety awareness: for example, it is not safe to walk into the street; you cannot put metal objects in the microwave, inability to regulate bathing water temperature.

12.6 Outcomes of the SLP Assessment

  1. The outcome of a DD SLP Comprehensive Assessment referral will be one of the following:
    1. Appropriate. This means:
      1.  The individual has a developmental disability or is likely to have a developmental disability, 
      2. The individual's needs can be met in a SLP, AND 
      3. The individual's risk/behaviors can be met in a SLP.
    2. Not Appropriate.  This means:
      1. The individual's support needs cannot be met in an SLP OR 
      2. The individual's risk/behaviors cannot be addressed in a SLP.
    3. Withdrawn.  This means the submitter has indicated the assessment is no longer needed.
    4. Excluded - no developmental disability diagnosis. This means the individual does not have a developmental disability or is not likely to have a developmental disability.
  2. The outcome of the assessment must be entered into AssessmentPro. The ISC should also upload any documents that support their determination.
  3. The appropriate CCU will conduct a DON on the individual and the prospective SLP provider will assess the individual to see if they are an appropriate admission for the specific site.
  4. If the individual is transitioning from a DD Waiver to a SLP,
    1. The ISC must send the SLP provider a complete packet of clinical information and assist, as needed, the individual or guardian in notifying their DD provider(s) of the transition.
    2. The ISC must ensure the individual is closed out of DD services with a Service Termination Approval Request (IL462-2028).
    3. The SLP program is a HCBS Waiver program and individuals should not receive or be authorized for any other HCBS Waiver program at the time SLP services are being delivered.

Section 13: DDD Service Requests

ISCs assist individuals, families, and guardians to navigate the DD system; this includes providing information on service and provider options. When individuals want or need DD services, the ISC will:

  • Check to ensure the individual is both Medically (Medicaid benefits for medical, cash and SNAP) and clinically (as determined through a Pre-Admission Screen for DD services) eligible and,
  • When necessary, prepare and submits request for services.

A complete description of all DDD services can be found in the Developmental Disabilities Program Manual. Services can be requested for individuals who are new to DD services, those who are already receiving services and need additional or a different type of support, or for those who are already receiving services and desire to transition to a different provider agency.

13.1 Waiver services

  1. Waiver service enrollment criteria.  DDD operates 3 Home and Community Based Waivers: The Adults with Developmental Disabilities Waiver, the Children and Young Adults with Developmental Disabilities - Support Waiver and the Children and Young Adults with Developmental Disabilities - Residential Waiver.
  2. In addition to being Medically and clinically eligible for DD services, individuals needing or desiring a DDD Waiver service must meet one of the following criteria:
    1. Crisis situations.
    2. Illinois Department of Children and Family Services youth in care who are approaching the age of 22 or residing as an adult in child group homes.
    3. State-Operated Developmental Centers (SODCs) transitions.
    4. Bogard class members.
    5. Individuals with developmental disabilities who are transitioning from State-Operated Mental Health Centers (SOMH).
    6. PUNS selection.
    7. Individuals who are a part of a DHS Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD) Downsizing Agreement.
  3. Individuals who are already enrolled in a DDD Waiver and need or desire additional services, must meet one of the following criteria:
    1. DDD Aging Out
    2. Waiver service transitions
  4. Submitting Request for Waiver Services
    1. DDD service/funding request must be submitted to the Division electronically through Birdseye. In addition, service/funding request must contain all required documents and accurate information.
    2. The Division reserves the right to solicit additional information to assist in fully understanding the situation and/or eligibility of the individual being presented for funding.
    3. The ISC should reference the Developmental Disabilities Waiver Manual and Home and Community Based Services Waiver Programs | HFS (illinois.gov) for additional information on DD Waiver Services.
    4. When services require prior approval by the Division, as indicated in the chart below, individuals should not begin services without written authorization in the form of a Pre-Award Letter or an Award Letter. Once the award letter is received, the ISC should assist the individual in transitioning to the authorized service.
    5. The chart below provides guidance on submitting a Waiver service request. In addition to the chart, ISCs should also consider the following:
      1. For services requiring Prior Approval, the request must be submitted to DDD for approval and authorization prior to the provider billing.
      2. Individuals age 17.5 can request CILA services if they meet the "Reason for Authorization" as indicated below. The CILA provider must request an Age Waiver as outlined in Rule 115, Section 115.210.
  5. Stabilization Homes (SH)
    1. SH are a type of CILA and specified in the DD Adult Waiver as 24-Hour Stabilization Services.
    2. SH services are for individuals who are experiencing behavior challenges that can't be resolved in their current setting.
    3. Individuals, in conjunction with their guardian, may participate in a SH when the desires and/or needs of the individual, as reflected in their Personal Plan, would be better met in this setting. SH requires prior approval from the Division.
    4. If an individual, their guardian, if applicable, or family caregivers, in conjunction with the ISC, provider and Stabilization Home clinical staff, believe the individual's desires and/or needs, as reflected in their Personal Plan, would be better served in an alternate setting, those opportunities shall be discussed as they are identified.
    5. The request may be made at any point during the period specified in (a)(1) or at the conclusion of that period, when assessing whether continued participation in the program would be appropriate for the individual.
Service Program Code Requires Prior Approval by the DDD Reason for Authorization Required Application (*other information may be required as indicated on the application or otherwise)
Adaptive Equipment, Assistive Technology, Vehicle Modification, Home Accessibility Modification and Remote Support 53E, 53T, 53H, 53V and 53E Yes Must be enrolled in Waiver; based on need. Adaptive Equipment/Assistive Technology/Remote Support/Home & Vehicle Modification Request Cover Sheet, pdf
Adult Day Care 35U Yes Based on need. Alternative Day Program Request Form (IL462-0285), pdf
Behavior Intervention and Treatment 56U Yes Must be enrolled in Waiver; Prior authorization not required. N/A
Children's Group Homes (CGH) 17D Yes Crisis, PUNS Application for Individual Service Authorization (pdf)
Community Day Services (non-site based) 31C Yes Crisis, PUNS, DDD Aging Out, DCFS Aging Out, SODC Transition, ICF/DD, Downsizing, SOMH Transition Application for Individual Service Authorization (pdf)
Community Day Services (Site Based) 31U Yes Crisis, PUNS, DDD Aging Out, DCFS Aging Out, SODC Transition, ICF/DD, Downsizing, SOMH Transition Application for Individual Service Authorization (pdf)
Community Integrated Living Arrangement (CILA, 24 Hr., Int. & Host Fam.) 60D Yes Crisis, PUNS, DDD Aging Out, DCFS Aging Out, SODC Transition, ICF/DD Downsizing, SOMH Transition CILA Individual Rate Determination Model
Community Living Facility (CLF)- less than 16 beds 67D Yes Funded capacity Application for Individual Service Authorization (pdf)
Counseling (Individual and Group) 57U, 57G No Must be enrolled in Adult Waiver; Prior authorization not required. N/A
Enhanced Residential Day Program 37U Yes Based on need or desire Alternative Day Program Request Form (IL462-0285), pdf
Home-Based Support- Adult None Yes Crisis, PUNS, DDD Aging Out, DCFS Aging Out, SODC Transition, ICF/DD Downsizing, SOMH Transition Application for Individual Service Authorization (pdf)
Home-Based Support- Children None Yes Crisis, PUNS Application for Individual Service Authorization (pdf)
Physical, Occupational and Speech Therapy 52P, 52O and 52S Yes Based on need Medicaid Waiver Therapy Prior Approval Request (pdf) (IL462-1302)
Psychotherapy (Individual and Group) 58U, 58G No Must be enrolled in Adult Waiver; Prior authorization not required N/A
Supported Employment Program (funded by the DDD) 36U, 36G & 33G Yes Crisis, PUNS, DDD Aging Out, DCFS Aging Out, SODC Transition, ICF/DD Downsizing, SOMH Transition Alternative Day Program Request Supported Employment - Initial and Revalidation Questionnaire, pdf
Temporary Intensive Staffing - Residential (CILA/60D only) and Day (CDS only) 53R, 53D Yes Based on need Additional Staff Support Request, pdf
Virtual Day Program 31V Yes Based on need or desire Alternative Day Program Request Form (IL462-0285), pdf

13.2 Institutional Services

Institutional services are residential facilities that assume total care, including room and board, of the individuals who are admitted.

  1. Institutional services include:
    1. Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/DD),
    2. Medically Complex facilities for Individuals with Developmental Disabilities (MC/DD),
    3. Child Care Institutions (CCI)/program code 19D,
    4. Community Living Facilities (CLF), greater than 16 beds or out of State,
    5. Nursing Facilities (not a DDD service); and
    6. State Operated Developmental Centers (SODC)
  2. Clinical eligibility must be determined through a PAS (for ICF/DD, MC/DD, CCI, CLF and SODC) or PASRR (for Nursing Facilities) and established prior to admission.
  3. ICF/DD and MC/DD admissions:
    1. ICF/DD and MC/DD are entitlement programs which means anyone who is eligible can be admitted. Individuals do not have to meet other criteria such as crisis or be on PUNS to be admitted.
    2. The ISC will gather necessary items for the request and work directly with the facility for an admission.
    3. The ISC should not submit a request for funding to the Division for these services.
  4. CCI admissions:
    1. Individual seeking admission to a CCI must meet the Crisis Criteria.
    2. If clinically eligible, the ISC should discuss and present all appropriate provider options to the individual, family and guardian.
    3. Once the person and guardian has selected a service, the ISC should proceed with a referral to the provider(s). The ISC should also facilitate visits to providers.
    4. Once a provider has been selected, the ISC should submit a complete funding request packet to the DDD - as a crisis request.
  5. Nursing Facilities, although not a DDD service, are also institutional services. Request for Nursing Facility admission is outlined in the PASRR Section of this Manual.
  6. State Operated Developmental Centers (SODC). 
    1. Admission to a State Operated Developmental Center (SODC) must be facilitated as described in 405 ILCS 5/Mental Health and Developmental Disabilities Code (ilga.gov) and in conjunction with DDD Region and SODC staff.
    2. SODC Transition Support (as applicable). ISCs receive funding for SODC transition staff based on their location and the SODC transition need. For those ISCs that receive this funding, they are responsible for working in conjunction with the SODC interdisciplinary team (IDT), the SODC transition staff, and the Bureau of Transition Services (BTS) to ensure individuals in SODCs are educated and supported in their transition to HCBS waiver services and that waiver services are identified for them.
    3. Transition plannings begin when an individual enters an SODC.
    4. ISC activities include the following:
      1. Participate in the SODC transition process of individuals being placed into the community setting, working with the IDT, BTS, SODC case managers and others. This includes:
        • With consent, participating, as a part of the IDT, in the process of informing the individual and the guardian of choices for community living.
        • Specifically supporting the education of options for community services and supports for interested individuals.
        • When notified by IDT, responding within 10 business days and no later than 15 business days to contact with individuals and families who have expressed interest in wanting to transition (consistent with the SODC Transition Manual).
      2. Send updated referral packets individually to service providers chosen by the individual, through an informed choice process, presenting all available service options.
        • The initial referral packet should include but not limited to updated Individual Support Plan (ISP), notes from Special Team Meetings since ISP, Behavioral Support Plan (BSP) with any addendum, 6 months BSP data, updated ICAP and HRST.
        • Information should be communicated to BTS weekly about interested providers and the contacts and follow up made by the ISCs.
      3. Conduct the Discovery Process and develop a Personal Plan.
      4. Submit completed service and funding requests to DDD.
      5. Work with IDT, BTS, and SODC case managers, facilitate transition and follow up with ISSA activities after individuals have transitioned to the waiver.
      6. Complete, a minimum of four visits with the individual post-transition, for one year following transition into Waiver-funded settings.
    5. SODC transition staff can support transition needs across regions as needed.
    6. A detail of activities, processes and responsibilities of all parties are present in the SODC Transition Manual.
  7. Institutional Services Authorization and Documentation
Service Program Code Must submit request to DDD for approval and authorization Reason for Authorization Required Application/ documentation
Child Care Institutions (CCI) 19D Yes Crisis Criteria Application for Individual Service Authorization (pdf)
Community Living Facility (CLF) greater than 16 beds 67E No N/A - Entitlement Clinical documents as desired by facility
Community Living Facility (CLF) Out-Of-State 67O N/A No new authorizations. N/A
Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD) N/A No N/A -Entitlement PAS forms and Clinical information as desired by facility
Medically Complex facilities for Individuals with Developmental Disabilities (MC/DD) N/A No N/A -Entitlement PAS forms and Clinical documents as desired by facility
State Operated Developmental Center (SODC) N/A Yes As described in 405 ILCS 5/ Mental Health and Developmental Disabilities Code. (ilga.gov) Application as described in 405 ILCS 5/ Mental Health and Developmental Disabilities Code. (ilga.gov)
Nursing Facility N/A No See PASRR Section. See PASRR Section

13.3 Grant Services

  1. Individuals wanting or needing DD services can access grant services, for example: In-Home Respite, as available.
  2. Grant services:
    1. Are not a part of a DDD HCBS Waiver program.
    2. Do not require a request to be sent to the Division.
    3. Can be requested by contacting the provider directly. The ISC should identify providers in the desired geographic area and link the individual, family and guardian to the provider.
    4. Are not always available in the desired geographic area.
    5. Do not require the ISC to determine clinical eligibility.
  3. The DHS website contains a variety of helpful information on grant programs including IDHS: Contracts (state.il.us) which contains Developmental Disabilities CSA Attachment A and Developmental Disabilities Program Manual for the appropriate fiscal year.

13.4 Support Services Teams (SSTs)

  1. SSTs provide an interdisciplinary technical assistance and training response to individuals with a developmental disability in a medical or behavioral situation that challenges their ability to live and thrive in the community.
  2. The SSTs :
    1. Will observe, assess, evaluate, consult with family members and provider agencies working to support the individual and provide training as necessary.
    2. Will have nurses, Qualified Intellectual Disability Professionals (QIDPs), psychologists, and Board Certified Behavior Analysts (BCBAs) on staff and have ready access to other needed specialty providers, such as psychiatrists.
    3. Are not a substitute for emergency medical and psychiatric services and hospitalization.
    4. Are not investigators and will not replace the DDD and ISC processes.
  3. Additional information is available at IDHS: Support Services Teams (SSTs) (state.il.us), including the referral process and referral form.

13.5 Crisis Criteria

Ensuring safety and providing services to individuals who are in crisis (i.e. homeless, abuse and neglect) are the highest priorities for the Division. To substantiate a crisis, the ISC will take careful consideration of an individual's situation to determine if the individual meets the crisis criteria.

  1. Crisis categories
  2. Homeless includes, but is not limited to, the following:
    1. Individuals who do not have a permanent residence or are staying at a shelter; individual/caregiver has received an official eviction notice.
    2. Situations where the authorities, such as the Office of the Inspector General (OIG), Adult Protective Services (APS), the Department of Children and Family Services (DCFS) or Illinois Department of Public Health (IDPH) are currently involved due to abandonment and/or lock out.
    3. The individual lost his/her home due to the primary caregiver's death or admission into long term care facility (i.e. hospice, nursing facility, assisted living, senior living, etc.).
    4. The ISC must also consider who is supporting or caring for the individual now and what caused the homeless situation.
  3. Abuse includes, but is not limited to, the following:
    1. Harm done to the individual with a developmental disability.
    2. Maladaptive/aggressive behaviors the individual is displaying that result in the crisis. For these situations, the ISC must:
      1. Provide the frequency, intensity, duration and severity of the aggressive behavior(s)
      2. Consider the circumstances surrounding the abuse, the relationship of the alleged abuser to the individual, whether the abuse has been reported to or investigated by the appropriate authorities such as local police, OIG, IDPH, APS, etc.
      3. Consider recent changes in the individual's life that may have increased or caused the abusive behaviors, hospitalizations, ER visits, involvement by medical care, mental health, and/or behavior therapy professionals as related to the current crisis situation.
      4. Assess whether the proposed service will resolve the current crisis situation.
  4. Neglect. In determining neglectful situations, the ISC will consider:
    1. What the individual cannot do for himself/herself that is causing the crisis situation.
    2. The adverse outcomes of these unmet needs and recent changes in the individual/family household that is prompting the crisis.
    3. The availability of others who can meet the identified needs of the individual, services the individual is currently receiving, if the individual has a legal guardian, the type of guardianship and what the guardian is unable to do for the individual.
    4. How is the family/caregiver unable to meet the individual's needs (i.e. ADLs, medical, physical, psychiatric, adequate food, water, heat, electricity, functional bathrooms and adequate sleep arrangements in the home, etc.).
    5. The ISC must also consider if the neglect has been reported to the appropriate investigative authorities such as local police, OIG, IDPH, APS, etc. and the outcome of the investigation, if one has occurred.
  5. NOTE: As a mandated reporter, the ISC must report any/all suspected abuse and/or neglect to the proper investigative authority.
  6. Individuals who are in a crisis and found eligible for DD services must be offered the choice of DD Waiver services or Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD).  The ISC will assist with making referrals to DD Waiver agencies and/or ICF/DD agencies as indicated in other parts of this section.
  7. Approved crisis services must have the potential to alleviate the presenting crisis situation.
  8. For individuals who are in crisis and choose DD Waiver services:
    1. The ISC must submit the Crisis Transition Plan and Funding Request [IL462-0140] form, pdf and upload it to Birdseye or complete the Crisis Request form contained within the Birdseye. Either format must include a safety plan.
    2. The ISC must ensure a safety plan is in place to keep the individual safe from the crisis situation until services begin.
    3. If an individual need for services is more immediate, the Division may issue a Pre-Award Letter to allow the individual to enter into services that day.
    4. If the individual is awarded waiver funded services, they must begin services within 72 hours of the Division producing a funding award notice. After the individual enters DD Waiver services, the ISC agency in the geographic area where the individual will reside will then provide Individual Service and Support Advocacy (ISSA).
  9. Individuals who do not meet crisis but are financially and clinically eligible can choose ICF/DD services or choose to be placed on the PUNS list.
  10. Individuals can enter an ICF/DD and be on PUNS (to be selected for DD Waiver services).
  11. Individuals who do not meet the crisis criteria and/or who are not clinically eligible also have the right to appeal these determinations as outlined in the Notice of Individual's Right to Appeal Medicaid Waiver Determinations form [IL462-1202], pdf.

13.6 Waiver Service Transitions

  1. Waiver Service Transitions are for individuals who are currently receiving a DD Adult Waiver service and are seeking a different Adult DD Waiver service based on a change in their needs or preferences or based on the outcomes identified in their Personal Plan.
  2. Waiver Service Transitions are transitions from:
    1. Community Day Services to Adult Home-Based Services
    2. Community Day Services to Community Integrated Living Arrangement (any model)
    3. Adult Home-Based Services to Community Integrated Living Arrangement (any model)
    4. Intermittent CILA to 24-Hour or Host Family CILA
  3. It is not necessary for individuals in a DD Waiver service to be enrolled in or selected from the PUNS to participate in a Waiver Service Transition, nor do they have to meet the Crisis Criteria.
  4. Waiver service transitions pertain to the DD Adult Waiver only. Individuals currently in the Children's Support Waiver and want or need Children's Residential Waiver must meet the Crisis Criteria.
  5. The Waiver Service Transition process requires an individual to demonstrate:
    1. The Waiver Service Transition is necessary to meet their needs, preferences, or outcomes identified in their Personal Plan.
    2. All options within the individual's current waiver services have been exhausted and continue to be unable to meet the identified needs, preferences, or outcomes. Exhausting all options ensures a person has accessed or attempted to access supports already available, which could include natural supports, State Plan services or supports available through their current authorized waiver service.
  6. Waiver Service Transitions, including updates to the Plan, can occur any time the individual's desires or needs change; this is not limited to the annual update of the Plan.
  7. Individuals, families, guardians, as applicable, or providers who are aware of the need or desire to request an alternative waiver service should notify the individual's ISC agency.
  8. To request the waiver service change, the ISC agency submits a service request packet for a Waiver Service Transition to the assigned Community Services Region Representative within the Division.
  9. The request must:
    1. Clearly state the current and proposed DD Waiver Service.
    2. Include a narrative explaining why the individual is requesting the change in service, the needs/desires that are not currently being met and how the person is being affected.
    3. Describe how the current services have been changed and/or exhausted to meet the individual's needs or preferences as well as how the new services will help the individual meet the outcomes in their Personal Plan.
    4. Contain a copy of the current Personal Plan with the appropriate signatures. The proposed service type must be indicated on the first page of the Plan and supported by the contents of the Plan.
    5. Identify a proposed provider agency, except in the case of Home-Based Services.
    6. Include the required applications and supporting documents for each type of service and clearly state the current and proposed DD waiver service.
  10. DDD will review each request and determine that:
    1. According to what is included in the Personal Plan, the request for a Waiver Service Transition is appropriate, at which point the packet is processed for an award letter based on appropriation authority.
      1. In the event the DDD does not have appropriation authority to process the award letter, the DDD will communicate a timeline for approval.
    2. A decision on a Waiver Service Transition cannot be made due to insufficient information.
      1. The request will be returned to the ISC agency with questions and/or a request for additional information; or
      2. The need or preference for a new waiver service has not been established or the new service is not supported in the Personal Plan.

13.7 Young Adults Aging Out

The DDD funds three services for eligible children and young adults (age 18-21) with developmental disabilities: a Child Group Home (CGH, 17D), a Child Care Institution (CCI, 19D) and Children's Home-based Support (CHBS).

  1. Young adults aging out of a CGH, CCI or CHBS services can transition to DDD Adult services as follows:
    1. Child Group Home/17D to Community Integrated Living Arrangement (any model) or Adult Home-Based Services
    2. Child Care Institution/19D to Community Integrated Living Arrangement (any model) or Adult Home-Based Services
    3. Children's Home-based Support (CHBS) to Adult Home-Based Services
  2. Young adults aging out of a Child Group Home (CGH) and Child Care Institutions (CCI) are given priority status for Adult Developmental Disabilities Waiver Services. If an individual is ineligible for the Adult DD Waiver, assistance is provided to access an ICF/DD, State Plan services, or other services as appropriate.
  3. Young adults may transfer to the Adult DD Waiver at age 18, however, they can stay in the CGH or CCI through the age of 21.
    1. This four-year transition period (from age 18 up to the 22nd birthday) is designed to enable children a smooth transition to other services.
    2. Most individuals will choose to transition as they exit the special education system.
    3. The ISC is responsible for the successful transition from children's services to adult services as appropriate.
  4. To facilitate the transition, the ISC must:
    1. Determine eligibility, as outlined in the PAS for DD Services Section, for both CCI and CGH.
    2. Begin working on a transition plan with the individual starting at age 18 to ensure transition by the age of 22.
    3. Initiate the process, for those already being funded by DDD, by contacting the young adult, family and guardian, if applicable, to set a date and time to discuss the steps in the transition process. The ISC should also contact the current residential provider to inform them of the transition process.
    4. Begin the transition process for those funded by DCFS, ISBE or HFS once these entities contact the ISC to initiate the process.
    5. Assist the participant and family by informing the participant and family about adult service and provider options, ensuring necessary eligibility screenings are completed (if they haven't already been completed), developing or updating the Personal Plan, if appropriate, and submitting a funding request to the Division when applicable.
  5. The ISC must follow, at a minimum, the steps below when the individual in a CGH or CCI turns 18:
    1. If not already completed, the ISC must determine eligibility for Adult DD services through a Level II PAS assessment (PAS for DD services).
    2. If clinically eligible, the ISC should discuss and present all appropriate service and provider options to the individual, family and guardian, if applicable.
    3. Once the person and guardian, if applicable, has selected a service, the ISC should proceed with a referral to the provider(s). The ISC should also facilitate visits to providers.
    4. Young adults transitioning from DD residential services who want or need DD Adult services do not have to be enrolled on PUNS or meet the crisis criteria for DD Waiver services.
    5. If the individual will enter a DD Waiver program, the ISC should develop or update the Discovery Tool and Personal Plan to be included in the referral packet. A referral packet should also include:
      1. Clinical information such as psychological and psychiatric evaluations,
      2. Medical history, including current and past medication,
      3. Social history.
    6. Once a provider has been selected, the ISC should submit a complete funding request packet to the DDD if DD Waiver services have been chosen.
    7. Once the award letter is received, the ISC should assist the person and guardian in arranging the transition from the current residential provider to the alternative service/provider.
  6. For young adults transitioning from a CGH or CCI to the Adult Waiver, the process outlined above should begin at age 17 in case the individual intends to transition to adult services shortly after age 18.
    1. Sometime around the 17th birthday (could be the annual PUNS update or the Personal Plan update), the ISC should facilitate a discussion to discuss transitioning from children's services. ISC should give general information on eligibility, service options and the transition process.
    2. When necessary, per the PAS process, a Level II PAS must be completed within 90 days of the initial request/referral.
      1. The level II goes deeper into service options.
      2. If no level II is required, the ISC needs to have the deeper discussion about service options and providers.
    3. Within 90 days of the intent to transition to adult services, the family explores options, visits providers, and possibly makes a decision.
    4. When a decision has been made, the ISC works with the chosen provider to develop a packet and do Discovery/Personal Plan, as necessary.
  7. If transitioning to adult services at age 18, the Division needs the complete service request no later than the 18th birthday (the packet can be sent as early as 4 weeks prior to turning 18). It's ok if the individual receives their award letter and moves after their 18th birthday.
  8. If the individual isn't going to transition immediately upon their 18th birthday, the ISC must communicate with the individual, guardian (if applicable), and residential provider to maintain and update the Personal Plan so it's ready when the individual is ready to transition to Adult Services.
  9. The children's residential provider should assist in the transition by:
    1. Participating in conversations with the ISC and any potential providers, ensuring that a release of information has been completed.
    2. Providing current clinical, behavioral, and other relevant service information to the ISC and receiving provider.
  10. Note: If a young adult ages out of the Children's Residential Waiver but remains in a CGH, the provider may no longer continue to receive payment for services.
    1. The CGH provider will have to request to continue to receive payment by providing proof to the Division of attempts they have made to secure proper placement for the individual who is still residing in their home.
    2. Approval for continued payment will be considered on a case-by-case basis.
  11. When an individual leaves CGH services, the provider must submit a Service Termination Approval Request (STAR) form (IL462-2028), pdf through the ISC as described in the Developmental Disabilities Waiver Manual.
  12. Young Adults Aging Out of Non-DDD Services

    1. Children and young adults with Intellectual/Developmental Disabilities who are funded by the Illinois State Board of Education (ISBE) or Healthcare and Family Services (HFS) will be referred from these entities to their ISC if they are seeking adult services through the Adults with Developmental Disabilities waiver.

      1. Young adults funded through ISBE or HFS enter adult waiver services through the normal PUNS process or by meeting crisis criteria.
    2. The Division has a transition agreement with the Department of Children and Family Services (DCFS) regarding DCFS youth in care who are approaching the age of 22 or residing as an adult in child group homes. These young adults will enter adult waiver services as follows:
      1. DCFS will initiate the process with the ISC Agency. 
      2. Individuals do not have to meet the crisis criteria or be on PUNS.
      3. The ISC will conduct a PAS for DD services.

13.8 ICF/DD or MC/DD Downsizing

  1. ICF/DD or MC/DD provider agencies that wish to convert their current facilities to CILA(s) can request an ICF/DD Downsizing Agreement with the DHS/DDD.
  2. If the Downsizing Agreement is approved, the individuals who are residing in the ICF/DD at the time of the agreement, are offered choice of DD Services, including HCBS Waiver services considering they are both clinically and financially eligible.
    1. In such cases, the individuals do not have to be selected from PUNS or meet the crisis criteria.
    2. In addition, the ISC is not required to conduct a full Level II PAS assessment.
  3. When an individual is transferring from an ICF/DD or MC/DD to a DD Waiver program, it is presumed the individual would have been previously determined to need the level of care required for the HCBS Waiver.
    1. To confirm eligibility, the ISC agency must obtain from the ICF/DD or MC/DD written documentation that the individual needs ICF/DD level of care (also known as active treatment), such as a statement within the individual's service plan at the facility or a form completed by the ICF/DD or MC/DD certifying continuing need for ICF/DD level of care.
    2. The DDPAS 10, pdf is also required (see PAS for DD Services). The signature date on the DDPAS 10 should be used in reporting determinations to the Division.
    3. The ISC agency must also complete the Home and Community-Based Services for Individuals with Developmental Disabilities Choice of Services and Supports form (IL462-1238), pdf and any other enrollment forms specific to the Waiver (e.g., the individual rights form) at the appropriate time.
  4. The ICF/DD or MC/DD must send a letter to the individuals who reside in the facility and their guardian, if applicable, informing them of their right to an informed choice and of the process for choice determination as described in the PAS for DD Services process (Presentation and Selection of Service Options).
    1. The ISC will receive a copy of the letter as well.
    2. The letter should designate the ISC agency as the contact for individuals residing in the ICF/DD or MC/DD.
    3. Division Region staff will be available to assist individuals in resolving issues, the coordination of CILA rates packets and determining CILA rates.
    4. ISC agencies must work with the ICF/DD or MC/DD and the Division to ensure a seamless transition of services for the individual. This might include:
      1. Notices to the local Family Community Resource Center (FCRC) of changes in the individual's enrollment,
      2. Ensuring prospective provider agencies receive complete packets of information on the individual (medical records/physician's orders, documents that outline the need for care and level of functioning, the Service Plan, etc.) and
      3. Ensuring funding request packets are sent to the Division.

Section 14: Addressing and Resolving Issues or Concerns

In the course of their work with individuals and providers, ISC agencies will become aware of issues and concerns. The Division has developed a process to address these, with time frames that comply with expectations from the Centers for Medicare and Medicaid Services.

14.1 Principles of the Resolution Process

This resolution protocol is based on five foundational principles. These principles include:

  1. Issues or concerns are best resolved at the level where they originate and should be elevated to higher levels of an organization only when they resist a concerted effort at initial level resolution.
  2. Direct, problem-solving communication must occur between those directly involved with the problem.
  3. Evaluation of the problem to higher levels of organizations should not allow those initially involved with the problem to avoid responsibility for either the problem or resolution.
  4. Creative, collaborative solutions should not be allowed to compromise the quality of supports provided to individuals served by provider agencies.
  5. Communication and problem-solving activities should work to resolve the problem and help build relationships, respect, and trust.

14.2 Protocol for Resolving Issues or Concerns

  1. ISCs are to ensure an initial response to complaints or otherwise identified problems within two business days. Time frames to resolve the identified issues involved are outlined below.
    1. ISC agencies are also to ensure that services continue while resolution of the issues is pending. See four levels listed below:
    2. Initial Level Resolution: Worker to Worker
      1. Issues or concerns identified during any ISC contact with individuals, guardians, family members, provider agencies, or other advocates, will initially be addressed with the individual responsible for oversight of daily program implementation (provider agency QIDP, house lead, ISC worker, etc.). The ISC and the agency staff will develop an action plan, acceptable to both, for addressing the issues or concerns.
      2. If there is a medical or safety need, then appropriate, prompt action is required of the ISC. Likewise, problems that require reporting to OIG or some other regulatory body must first be handled per those requirements, and then, if appropriate, submitted to the Resolution of Issues or Concerns process. If the identified issues or concerns are perceived to be significantly serious, then the ISC will immediately utilize the second or third level.
      3. If no action plan is developed after 30 days, the issue shall be moved to the second level.
    3. Second Level Resolution: Worker to Worker and Supervisor to Supervisor
      1. If seriousness warrants, the matter is not resolved per the action plan, or if the parties fail to create a mutually acceptable action plan, the ISC and/or the agency staff will immediately contact his/her supervisor to inform the supervisor of the unresolved issue or concern.
      2. Additional efforts at resolving the issue or concern will be promptly undertaken using the following guidelines:
        • Both the ISC and the provider agency program level staff individual must provide a written statement of the issue or concern, as each sees it, and their recommended solution. These written statements will be shared with the other party prior to any additional problem solving discussions.
        • Continuing problem solving discussions will include all four participants (ISC and supervisor, agency program level staff individual and agency program director).
        • Copies of resolution plans will be forwarded to the agency Executive Director and the ISC Executive Director. If no action plan is reached within 14 days, the issue shall move to the third level.
    4. Third Level Resolution - Worker to Worker, Supervisor to Supervisor, and Executive Director to Executive Director
      1. If the matter remains unresolved, then the Executive Director of the ISC agency and the Executive Director of the agency will be brought into the problem-solving discussions (discussions will now have six participants).
      2. If resolution cannot be reached within 7 days, the issue shall move to level four.
    5. Fourth Level Resolution: Involvement of the Division of Developmental Disabilities
      1. If the matter is not resolved under Levels 1 through 3, the ISC Executive Director will contact the Division of Developmental Disabilities within 2 business days following completion of Level 3 via the Referral for Monitoring and Technical Assistance Tool.
        • Please also see: Instructions for Completing Referral Form regarding completion and submission.
        • The Division will collect all available information regarding those involved and will work with the parties to bring about a final resolution to the problem.
      2. In the event the parties are unable to reach agreement, then the Division will issue a final and binding decision.

14.3 Time Frames

  1. The time frames specified above are to be considered maximum time frames.
  2. If it becomes clear, for example, on day five that resolution cannot be reached under Level 1, then the parties should proceed immediately to Level 2.
  3. Individuals served may contact the Division directly at any time during the process if they so choose.

14.4 Documentation

  1. Documentation of the conflict resolution process will be maintained in the individual's ISC record.
  2. The ISC agency will document that it has provided the individual and guardian with the status and progress of the resolution process.
  3. This documentation (that the information was provided to the individual and guardian) and the status/progress of the process must be maintained in the individual's ISC record.

Section 15: Referral for Monitoring and Technical Assistance

  1. When ISCs are unable to resolve service issues at the local level, they can request the assistance of the Division by using the Referral for Monitoring and Technical Assistance Tool.
  2. The formal Referral for Monitoring and Technical Assistance Tool is sent to the Division for consideration of technical assistance and/or additional monitoring. For assistance in completing the form, refer to the Instructions for Completing Referral Form.
  3. Note: This form is not used for suspected cases of abuse, neglect, or financial exploitation which are reported immediately to the appropriate investigative body.
  4. Upon receipt, the referral will be assigned to the appropriate Bureau within the Division for appropriate follow up.
  5. The assigned Bureau Chief is responsible for ensuring appropriate and timely follow up.
  6. Depending on the nature of the concern being raised by the ISC:
  7. The Division may involve additional resources, such as the Support Service Team (SST) and the Bureau of Accreditation, Licensure and Certification (BALC).
  8. The ISC should Revise or Edit and individual's Personal Plan if additional services or supports are required.
  9. The Division maintains a database to capture information about service issue referrals so routine reports may be produced for monitoring and management purposes. Reports are also shared with the Department of Healthcare Services (HFS).

Section 16: Service Terminations and Bedhold Request

The ISC agency will ensure that Service Termination Approval Request (STAR) and Bed Hold Extension Request forms are complete and submitted to the Division as outlined below.

16.1 Service Termination Approval Request

  1. The Service Termination Approval Request (STAR) form (IL462-2028), pdf is applicable to HCBS Waiver and POS services funded through the Division of Developmental Disabilities. STAR forms are not required for ICF/DD, MC/DD or grant programs.
  2. The provider agency is responsible for initiating the STAR form. The provider should complete applicable sections and forward the form, through Birdseye, to the appropriate ISC agency no later than five (5) business days after the individual leaves or ceases receiving services from the service provider.
  3. The ISC agency should review the STAR form to ensure it is complete. The ISC agency must sign the STAR form and forward it to the appropriate Region staff within the DDD.
  4. If the ISC agency receives a STAR form for an individual and the individual, guardian or individual's representative has informed the ISC of their intent to appeal a termination of HCBS Waiver services, the ISC should return the STAR form to the service provider. In the case of an appeal, the individual can only be terminated as outlined in Part 120 (Rule 120 - Medicaid Home and Community-Based Services Waiver Program for Individuals with Developmental Disabilities) Section 120.110 or the appeal has been withdrawn.
  5. Upon the DDD's processing and data entry of a STAR form, the termination date will not be changed to a later date unless there was an error on the part of the DDD or ISC agency.
  6. The Division reserves the right to modify any date reported on the STAR form when it does not match official service reporting by the service provider or information obtained through the IDHFS.

16.2 Bed Hold Request

  1. When an individual is absent from a residential setting, the residential provider may be able to secure payment in recognition of ongoing costs during the absence of the amount they would traditionally receive to support the individual. The payments are referred to as bed hold payments.
  2. Bed Hold is applicable to individuals in the following residential programs:
    1. Children's Group Home (CGH/17D),
    2. Child Care Institution (CCI/19D),
    3. Special Home Placement (SHP/41D),
    4. Supported Living Arrangement (SLA/42D),
    5. Community Living Facility (CLF/67D and 67E).
  3. Note: The Bed Hold request process does not apply to individuals residing in CILA/60D (any type); CILA contains an Occupancy Factor and medical payments.
  4. A total of 60 CUMULATIVE Bed Hold days per state fiscal year are allowed for an individual served.
    1. The Division shall consider requests for approval over 60 cumulative days of bed hold for an individual when a completed Bed Hold Extension Request (IL462-2027) form and supporting documentation is submitted by the CGH, CCI, SHP, SLA, or CLF residential service provider to the applicable ISC agency.
    2. The ISC agency will forward the Bed Hold request through Birdseye to DDD region staff.
  5. Bed Hold request submitted to the Division should be documented in the individual's record (Personal Plan for individual in a DDD Medicaid Waiver or Service Plan for individuals in non-Waiver POS programs).
  6. Service options should be discussed with the individual, guardian and provider and documented for periods requiring extensive Bed Hold.

Section 17: Appeal Process

  1. Any individual requesting or receiving Medicaid waiver-funded services, the individual's guardian or representative, has the right to appeal the following certain actions including the following:
    1. A denial of services or a determination of ineligibility for services from an ISC agency or the Division;
    2. A termination, suspension, or reduction of waiver-funded services by a provider agency or by the Division.
    3. See Rule 120, Section 120.110 Appeals and fair hearings, for more information on appeals.
  2. The ISC, DDD or provider agency, whichever entity took the above-mentioned action, must provide the individual and/or guardian a written notice of the action taken and the process to appeal. The notice must include:
    1. The action to be taken,
    2. Whether or not services will continue, and
    3. A copy of the Notice of Individual's Right to Appeal Medicaid Waiver Determinations form [IL462-1202], pdf.
  3. If the individual and/or guardian decide to appeal the action, they must communicate this to the ISC within 10 working days after the date they receive the notice of action. The communication must be followed by a written request to appeal signed by the individual, guardian or individual's representative.
  4. the individual and/or guardian decide to appeal the action, the ISC agency is responsible for gathering and submitting:
    1. A complete appeal checklist.
    2. The written request to appeal signed by the individual, guardian, or individual's representative.
    3. A completed Documentation for Medicaid Waiver Appeals form [IL444-0171].
    4. An appeal packet of documentation/information that will be used in the informal review process for a determination regarding the specifics of the appeal case.
    5. Documents from the provider agency, if applicable, to support its decision to suspend, terminate, or reduce services.
    6. Any additional documentation relevant to the appeal.
  5. The appeal packet must include a signed written request to appeal by the individual and/or guardian.
  6. The appeal packet must be submitted within 45 calendar days of the notice received of the actions listed above. The 45-calendar day limitation does not apply if the DD provider agency, the ISC, DDD, whichever entity or agency took the action, fails to notify the individual in writing of the action or the time limit.
  7. The Division has 30 working days to complete an informal review of the appeal case.
    1. The DDD must then notify the individual and/or guardian of the informal review decision within 10 working days of that determination.
    2. Should the individual and/or guardian disagree with the determination by the DDD, they have the option of requesting within 10 days, an administrative hearing with the Department of Healthcare and Family Services (HFS) to review the DDD's informal review decision.
  8. Details of the grounds for appeal, notification requirements and appeal process are contained in the Administrative Rule: Medicaid Home and Community-Based Services Waiver Program for Individuals with Developmental Disabilities, Section 120.110 Appeals and Fair Hearings (59 Ill. Adm. Code 120.110).

Section 18: Administrative Requirements

Independent Service Coordination agencies must follow contractual requirements as outlined by the Department, the Developmental Disabilities Program Manual, the Community Services Agreement and Attachment A.

18.1 ISC General Administrative Requirements:

  1. ISC agencies will:
    1. Participate in webinars, trainings, outreach, pilot projects and/or initiatives as directed by the Division.
    2. Ensure each ISC representative completes all required training, both initial and continuing education.
    3. Comply with any formal requests for desk reviews and audits, by the Division and other entities.
    4. Respond to all general inquiries and requests for information by the Department of Human Services.
    5. Comply with Medicaid Waiver qualifications, as delineated in the federally approved Waiver. The Waiver can be found by accessing Home and Community Based Services Waiver Programs | HFS (illinois.gov).
    6. Be conflict of interest free and not provide any direct services.
    7. Provide prompt notice to the Division, including plans to remediate issues, when issues arise that may jeopardize eligibility.
    8. Be available, minimally by phone, 24-hours per day, 365 days per year for individuals in times of crisis.
    9. Enter into a Corrective Action Plan with the Division to remediate issues and achieve compliance if the Department determines the ISC agency is out of compliance. Determinations will be based on the Division's review tools published on the DHS website under Quality Review and Related Documents.

18.2 Data Collection

  1. ISC agencies are required to document service provision and maintain accurate, comprehensive service records for all individuals seeking or receiving services in the assigned service area(s).
  2. ISC agencies will provide quarterly periodic reports to the Division to demonstrate compliance with all performance measures as well as provide ad hoc reports as requested by the Division.
  3. Quarterly reporting will be completed utilizing the Periodic Performance Report (GOMBGATU-4001) and Periodic Financial Report (GOMBGATU-4002) including all deliverables noted in Exhibit B of the Uniform Grant Agreement. Quarterly reports will be submitted no later than 15 days after end of each period.
    1. 1st Quarter Reports are due by October 15th, without a pre-approved extension.
    2. 2nd Quarter Reports are due by January 15th, without a pre-approved extension.
    3. 3rd Quarter Reports are due by April 15th, without a pre-approved extension.
    4. 4th Quarter Reports are due by July 15th, without a pre-approved extension.
  4. Under the terms of the Grant Funds Recovery Act (30ILCS 705/4.1), "Grantor agencies may withhold or suspend the distribution of grant funds for failure to file required reports."
    1. If the report is more than 30 calendar days delinquent, without any approved written explanation by the grantee, the entity will be placed on the Illinois Stop Payment List.
    2. Refer to the Grantee Compliance Enforcement System for details about the Illinois Stop Payment List. Additional information can be found on the Grant Accountability and Transparency Act webpage.
    3. The ISC agency is required to meet compliance reporting status to comply with consent decrees, compliance reporting and other legal requests to the appropriate parties (i.e. Ligas compliance reporting status to the Ligas Court Monitor.)
    4. Monthly service delivery reporting through the ROCS database or alternative systems as determined by the Division is required.
    5. ISC agencies must submit complete and accurate service reports (the Periodic Performance Report (PPR), Periodic Financial Report (PFR), Monthly Invoices for reimbursement, and the year-end Performance Close-Out Report) 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 thirty (30) calendar days following the end of the service month.
  5. In addition, the ISC agency must submit all data required by rule or requested by the Department concerning the operation of its funded programs.
    1. The ISC must submit data in a timely manner in a format prescribed by the Department.
    2. The ISC shall complete and transmit service reporting accurately and timely in accordance with Title 59, Ill. Adm. Code Part 103.

18.3 Reporting and Billing

  1. When reporting or billing for services, the complete name, Social Security Number, RIN (Medicaid Recipient Identification Number), age, gender identity, ethnicity, and county in which they reside, are required for each individual.
  2. Billing Individual Service and Support Advocacy (ISSA)/Program 51A - 51L
    1. The ISC agency will bill ISSA as a fee for service program in ROCS. Each ISC agency will bill the service code that is appropriate for their geographic area: Area A (51A), Area B (51B), Area C (51C), Area D (51D), Area E (51E), Area F (51F), Area G (51G), Area I (51I), Area J (51J), Area K (51K) or Area L (51L).
    2. Billing procedures should be followed using the Community Reporting System (CRS) as outlined in the Developmental Disabilities Waiver Manual. Specific instructions are listed, including proper forms to utilize along with a timeline for completion.
    3. Billable ISSA hours consist of time spent on behalf of the individual waiver recipient and include:
      1. Conducting necessary evaluations and assessments (i.e., Inventory for Client and Agency Planning, risk assessment).
      2. Completing Vocational Rehabilitation (VR) referrals for individuals who have documented such services and supports in their Personal Plan.
      3. Reviewing/Updating the Discovery Tool and Personal Plan.
      4. Conducting monitoring visits for individuals served through the DD Waiver programs; including travel time involving ISC visits and documentation time to support ISSA billings.
      5. Conducting other monitoring activities for individuals served through the DD Waiver programs.
      6. Reviewing, verifying and submitting service requests to the Division.
      7. Reporting allegations of abuse, neglect, and exploitation per Division guidelines and regulations and Administrative Rules.
      8. Completing annual level of care redeterminations.
      9. Reporting and providing follow up on critical incidents for waiver participants in the CIRAS system.
      10. Informing individuals, at the initiation of services and annually thereafter, of their rights as a waiver participant.
      11. Ensuring the appeals process for individuals receiving waiver services is followed as appropriate, including serving as a representative for the Division when attending the hearings.
      12. Ensuring the health, safety, and welfare of individuals involved with Adult Protective Services (APS).
      13. Assisting HBS participants with finding alternative personal support if DDD requires agency-based services.
      14. Coordinating the transition between and within DDD Waivers.
      15. Identifying issues concerning rejected billings related to Medicaid benefits and level of care re-evaluations. Work with other entities to resolve as necessary.
      16. Participating in consultations and providing follow-up as necessary related to individuals including but not limited to: Support Services Team (SST), Stabilization Home (SH), State Operated Developmental Center (SODC), and State Operated Mental Health Hospital (SOMH).
      17. Responding to general and/or emergency inquiries and complaints from sources such as: hospitals, emergency rooms, jail, other state and community agencies specific to individuals receiving waiver services.
      18. Ensuring STAR (Service Termination Approval Request) and Bedhold request forms are completed and submitted to the Division.
      19. Providing service coordination to Bogard class members residing in a Community Integrated Living Arrangement (CILA), Host Family or Community Living Facility (67D).
    4. Note: ISSA will be reimbursed at an hourly rate established by DHS.
      1. The agency will have a pool of hours, as identified in the ISC contract, per year per individual receiving ISSA.
      2. The ISC agency will have the flexibility to manage these hours to ensure individuals receive the appropriate level of support.
      3. The ISC is not allowed to exceed the total amount of hours awarded in the pool unless they receive written authorization from the Division.
  3. General Service Coordination (PUNS, Initial Eligibility and Linkage) - Program 500
    1. ISC agencies must report grant activities under program 500.
    2. Guidance on the types of activities to be conducted and reported as part of this programs include the following:
      1. Completing the OBRA 1 screening.
      2. Providing information and linkage to the Department on Aging, Division of Mental Health, and the Division of Rehabilitation Services.
      3. Reviewing service options, including Medicaid entitlements (ICF/DD, CLFs that are larger than 16 beds, etc.) and Home and Community Based waiver services (HCBS).
      4. Completing the PUNS database forms/enrollment.
      5. Completing annual update of PUNS information.
      6. Making appropriate referrals for interim services (e.g. DRS, Respite), for individuals with a developmental disability who opt to go on PUNS.
  4. Pre-Admission Screening - Program 780
    1. ISC agencies must report activities under grant program 780 (PAS). Guidance on the types of activities to be conducted and reported as part of this program include:
      1. Conducting a PAS Level II Screen and providing notice of Screening results.
      2. Educating individuals, guardians, and families about service options.
      3. Making referrals to all service providers and presenting all available service options.
      4. Conducting the Discovery process and develop a Personal Plan.
      5. Submitting initial service/funding requests, for individuals not enrolled in a DD service, to the Division or other appropriate entity.
      6. Monitoring the transition of the individual (for four weeks) following initiation of waiver services.
      7. Securing a service provider and completing a safety plan for individuals who are in a crisis.
      8. Complying with Ligas Consent Decree requirements.
  5. Bogard Service Coordination - Program 781
    1. ISC agencies must report activities under program 781 (Bogard). Activities to be conducted and reported as part of this program include:
    2. Providing assistance to enhance the delivery and effectiveness of service provision.
    3. Completing service coordination monitoring visits.
    4. Ensuring collaborative facilitation of conflict resolution for matters of concern to the individual and/or guardian and provider.
    5. Completing referrals to the DDD Regional staff for monitoring and/or technical assistance.
    6. Providing Service Coordination to Bogard class members residing in other non-waiver settings:
      1. Ensuring completion of assessments and reassessments of needs and goals.
      2. Coordinating the Individual Service Plan (ISP) development.
      3. Facilitating and brokering Specialized Services for individuals in nursing facilities.
      4. Advocating for the development of natural supports.
      5. Conducting activities to maintain or improve availability, accessibility, and quality of services.
      6. Assisting with the procurement of adaptive equipment.
      7. Completing monthly service coordination monitoring visits with the individual.
      8. Monitoring the implementation of the ISP, as well as the individual's health, safety, and well-being, through site visits.
      9. Utilizing problem-solving procedures to achieve conflict resolution.
      10. Providing crisis intervention supports.
      11. Providing transportation to facilitate the selection of employment and residential services.
      12. Ensuring the Bogard choice process.

18.4 Payment and Reimbursement

  1. Payments will be made in accordance with the CSA Attachment A.
  2. Under the terms of the Grant Funds Recovery Act (30ILCS 705/4.1), Grantor agencies may withhold or suspend the distribution of grant funds for failure to file required reports.
    1. If the report is more than 30 calendar days delinquent, without any approved written explanation by the grantee, the entity will be placed on the Illinois Stop Payment List.
    2. Refer to the Grant Accountability and Transparency Act webpage for details about the Illinois Stop Payment List.
  3. Payment methodologies:
    1. Advance Payment Method (Advance and Reconcile)
      1. An initial payment will be processed in an amount equal to the first two months' cash requirements as reflected in the Advance Payment Requirements Forecast (Cash Budget) Form submitted with the Grantee's application. The initial payment will be processed upon execution of the grantee's Uniform Grant Agreement.
      2. Grantees must submit monthly invoices in the format and method prescribed in the Grantee's executed Uniform Grant Agreement. Invoices must be submitted no later than 15 days following the end of any respective monthly invoice period, or as indicated in their UGA Exhibit F - Payments. Invoices must include only allowable incurred costs that have been paid by the Grantee. For programs that have Grantee matching requirements, allowable costs are only reimbursable when matching costs have also been incurred.
      3. Subsequent monthly payments will be based on each monthly invoice submitted to the grant program, and will be adjusted up or down, based on a comparison of actual cumulative expenditures to cumulative advance payments, to date.
      4. Grantees that do not expend all advance payment amounts by the end of the grant term or that are unable to demonstrate that all incurred costs were necessary, reasonable, allowable, or allocable as approved in their respective grant budget, must return the funds or be subject to grant funds recovery.
      5. Grantees may be required to submit supporting documentation for their requests at the request of and in a manner prescribed by the Grantor.
      6. Failure to abide by advance payment governance requirements may result in grantee losing their right to advance payments.
    2. Reimbursement Method
      1. IDHS will disburse payments to Grantee based on actual allowable costs incurred as reported in the monthly financial invoice submitted for the respective month, as described below.
      2. Grantees must submit monthly invoices in a format prescribed by Grantor. Invoices must include all allowable incurred costs for the first and each subsequent month of operations until the end of the Award term. Invoices must be submitted no later than 15 days following the end of any respective monthly invoice period, or as indicated in their UGA Exhibit F - Payments. As practicable, Grantor shall process payment within 30 calendar days after receipt of the invoice, unless the State awarding agency reasonably believes the request to be improper.
      3. Grantees may be required to submit supporting documentation for their requests at the request of and in a manner prescribed by the Grantor.
    3. Working Capital Advance Method
      1. IDHS Grant Program Managers will advance working capital payments to the grantee to cover their estimated disbursement needs for an initial period not to exceed two months of grant expenses. Startup costs may be approved if determined by IDHS Grant Program Managers to be allowable.
      2. Grantees must submit monthly invoices for each of the one or two months covered by the Working Capital Advance in the format and method prescribed by the Grantor.
        • Invoices must be submitted no later than 15 days following the end of any respective monthly invoice period, or as indicated in their UGA Exhibit F - Payments.
        • Invoices must include only allowable incurred costs that have been paid by the grantee.
        • For grant programs that have grantee matching requirements, allowable costs are only reimbursable when matching costs have also been incurred.
      3. Grantees may be required to submit supporting documentation for their requests at the request of and in a manner prescribed by the Grantor.
      4. Working Capital Advance Payments are limited to a single occurrence per grant term.
      5. Following the initial working capital advance payment, grantees will be paid via reimbursement method unless an IDHS Advance Payment Request Cash Budget Template is submitted for Advanced Payment Method.
  4. Grantees will automatically be paid via Reimbursement Method unless a request for Advance Payment Method or Working Capital Advance Method is made using the IDHS Advance Payment Request Cash Budget Template (Cash Budget).

18.5 Maintenance of ISC Records

  1. Independent Service Coordination (ISC) agency records are subject for review by monitoring entities to include HFS, DHS and DDD. ISC agency records should include:
    1. Documentation of DDD payments to the ISC agency.
    2. Audit report and consolidated year-end financial report.
  2. For individuals receiving DDD Waiver services, ISCs must maintain ISSA records which must include, but are not limited to, the following information:
    1. Completed and updated Discovery Tool and Personal Plan.
    2. Documentation to support the annual level of care redetermination.
    3. The completed Individual Monitoring and Individual Interview Note(s) to support the minimum monitoring requirement.
    4. Documentation to support additional monitoring activities to the individual.
    5. Correspondence with provider agencies regarding issues related to the individual.
    6. Evaluation and reevaluation forms are kept on-site at each Independent Service Coordination (ISC) office under contract with the OA.
      1. Files are kept by the ISC five years. After five years, the files may be disposed of if the customer is no longer receiving waiver services and all audits have been completed and no litigation is pending or anticipated.
      2. If the customer remains enrolled in the waiver, all files will remain in storage either onsite at the ISC office or at a secure location near where the ISC is located.

Section 19: Monitoring of Independent Service Coordination Agencies

19.1 Monitoring and Medicaid Waiver Compliance

  1. ISC agencies are monitored by the Division of Developmental Disabilities to ensure compliance with the Uniform Grant Agreement (performance measures, performance standards, and deliverables identified), the Administrative Code Part 7000 Grant Accountability and Transparency Act and contractual requirements.
  2. In addition, ISC agencies are monitored to carry out established standards to include PAS, ISSA, Bogard Service Coordination, PUNS and Person-Centered Planning.
  3. The Division will also assess ISC agency staff's qualifications/training and 24-hour accessibility for emergencies.
  4. The Division's Medicaid Waiver Unit will also conduct periodic reviews of Medicaid Waiver compliance. These Mobius based reviews will determine if service coordinators completed timely Level of Care redeterminations (Clinical).

19.2 BQM Unannounced Visits and Interviews

  1. At least annually, the DDD's Bureau of Quality Management (BQM) will conduct an unannounced visit to each ISC agency.
  2. During the annual unannounced visit, BQM will review a sample of individual records to determine:
    1. Completion of PUNS records including annual updates.
    2. Accuracy of PAS determinations.
    3. Timeliness of the annual Level of Care redetermination.
    4. Quality and accuracy of Discovery Tools and Personal Plans.
    5. Completion of the Rights of Individuals form [IL462-1201].
    6. Accuracy and timeliness of monitoring visits and documentation.
  3. The DDD's BQM annual visit will be a part of DDD's waiver compliance review.
    1. ISC agencies will be notified in writing of any deficiencies and if they're required to submit a plan of correction, including time frames for completion. Division staff will review the plan of correction and remediations, and if acceptable, approve the corrective action plan.
    2. When the performance of an ISC agency is found to be less than adequate or they fail to comply with applicable regulations, IDHS may terminate contracts, reduce the scope of contracts, or impose administrative sanctions.
    3. The Division will provide additional monitoring and technical assistance as needed.
  4. BQM will also conduct face-to-face and phone interviews with individuals receiving DDD Waiver services.
    1. The purpose of the Interview is to assess their satisfaction with service delivery, as documented by the National Core Indicator survey data.
    2. Although the ISC does not play a direct role in the interviews, their service delivery will be measured by the information collected.

Section 20: Appendix

A

Adult Protective Services (APS), Hotline: 1-866-800-1409, 1-888-206-1327 (TTY)

Approved Representative Form [IL444-2998] PDF

B

Bed Hold Extension Request Form [IL462-2027], pdf

Bed Hold Request Process

C

Certificate of Understanding and Acknowledgment for the Critical Incident Reporting and Analysis System, pdf

Community Provider/External User I.D. And System Access Request [IL444-2022], pdf

Crisis Transition Plan and Funding Request form [IL462-0140], pdf

Critical Incident Reporting and Analysis System (CIRAS) Manual

D

DDD Medicaid Application Training Webinar, April 27, 2017, pdf

DDPAS Forms (see OBRA 1 for Initial Screen)

Department of Children and Family Services (DCFS) Hotline 800-252-2873, 1-800-358-5117 TTY

Developmental Disabilities Program Manual

Developmental Disabilities Waiver Manual

Discovery Tool and Instructions for completing the Tool [IL462-4455], pdf

Documentation for Medicaid Waiver Appeals [IL444-0171], pdf

E

Employer of Record Implementation Strategy [IL462-1240], pdf

H

Health Care and Family Services (HFS), Illinois Department of

I

Illinois Administrative Code, Title 59, Chapter I:

Illinois PUNS Enrollment Tool Form, pdf

Implementation Strategies (IS) Form (state.il.us), pdf

Instructions for Completing the Referral for Monitoring and Technical Assistance Form, pdf

Independent Service Coordination Individual Monitoring and Interview Notes and Interpretive Guidelines [IL462-4465], pdf (for individuals enrolled in DD Waivers)

Individual Service and Support Advocacy (ISSA) Visiting Notes (doc) (Bogard)

Individual Service and Support Advocacy (ISSA) Visiting Notes Interpretive Guidelines (Bogard)

N

Notice of Individual's Right to Appeal Medicaid Waiver Determinations form [IL462-1202] pdf

Notice of DHS Community-Based Services form [HFS 2653] (pdf), (also known as the Spenddown form)

O

OBRA 1: Initial Screen [IL462-4437], pdf

Office of the Inspector General (OIG)

P

Person Plan and Instructions for completing the form [IL462-4457], pdf

Personal Plan and Instructions for completing the form, Spanish [IL462-4457 S], pdf

Public Health, Department of

R

Redetermination of Medicaid DD Waiver Eligibility form [IL462-0952], pdf

Referral for Monitoring and Technical Assistance Tool

Release of Information form [IL462-1214], pdf

Request for MIS Hardware, Software and Services [IL444-4144], pdf

Rights of Individuals form [IL462-1201], pdf

Rule 50, 115, 119, 120 -see Illinois Administrative Code

S

Service Termination Approval Request (STAR) form [IL462-2028], pdf