Developmental Disabilities CSA Attachment A

Introduction

Applicable Statutes, Rules and Guidelines

Program Services

Program Plan and Deliverables

Payment

Eligibility Criteria

Reporting Requirements

Special Conditions

I. Introduction

This document serves as an attachment to the Illinois Department of Human Services (DHS) Uniform Grant Agreement (UGA), standalone contracts which sets forth supplemental contractual obligations between the Provider and DHS. The attachment provides contractual requirements beyond and in addition to those in the UGA, Community Services Agreement, established contractual obligations and IMPACT enrolled providers. It is intended to address the programmatic areas of the Division of Developmental Disabilities (the Division).

II. Applicable Statutes, Rules and Guidelines

If a Public Act increases the wages for persons working in positions that provide services to individuals with developmental disabilities, the Provider agrees to apply the funding increase to its employees in the manner prescribed in the legislation. Failure to comply with this paragraph may result in recovery of the funds, by the Division or other sanctions, as determined by the Division. Such sanctions include, but are not limited to payment hold, hold on enrollment, or termination of the underlying contractual agreement.

In addition, the Provider must comply with all applicable federal, state, and local regulations and statutes; as well as Departmental directives, including, but not limited to, the following:

A. Federal

Federally Approved Waiver for Adults With DD (pdf) for IL
Federally Approved Children's Support Waiver (pdf) for IL
Federally Approved Children's Residential Waiver (pdf) for IL
Medicaid Waiver, Section 1915(c) of the Social Security Act, Title 42 of USC 1396;
General Medicaid, Title XIX, 42 USC 1396; OBRA1987, PL100-203 and OBRA1990, PL101-508 and accompanying regulations 42 CFR 405, 42 CFR 431, 42 CFR 433, 42 CFR 483;
Medicaid ICF/MR, 42 CFR 440, 42 CFR 483.pdf
42 CFR 441.301 - Contents of request for a waiver

B. State Statutes

Health Facilities and Regulation: Community-Integrated Living Arrangements Licensure and Certification Act (210 ILCS 135/);
Health Facilities and Regulations: Community Living Facilities Licensing Act (210 ILCS 35/)
Mental Health and Developmental Disabilities Code (405 ILCS 5);
Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110);
Community Services Act (405 ILCS 30);
Abused and Neglected Child Reporting Act (325 ILCS 5/1)
Abused and Neglected Long Term Care Facility Residents Reporting Act (210 ILCS 30);
Adult Protective Services Act (30 ILCS 20)
Illinois Nursing and Advanced Practice Nursing Act (225 ILCS 65);
State Finance Act (30 ILCS 105/9.05);
Illinois Grant Funds Recovery Act (30 ILCS 705);
Mental Health and Developmental Disabilities Administrative Act (20 ILCS 1705);
Health Care Worker Background Check Act (225 ILCS 46)
Elder Abuse and Neglect Act (320 ILCS 20/7.5)
Department of Human Services Administrative Act (20 ILCS 1305).
Grant Accountability and Transparency Act (GATA) (30 ILCS 708/)

C. State Rules

59 Ill. Adm. Code 50, Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities;
59 Ill. Adm. Code 103, Grants;
59 Ill. Adm. Code 115, Standards and Licensure Requirements for Community Integrated Living Arrangements;
59 Ill. Adm. Code 116, Administration of Medication in Community Settings;
59 Ill. Adm. Code 117, Family Assistance and Home-Based Support Programs for Persons with Mental Disabilities;
59 Ill. Adm. Code 119, Minimum Standards for Certification of Developmental Training Programs;
59 Ill. Adm. Code 120, Medicaid Home and Community Based Waiver Program for Individuals with Developmental Disabilities;
59 Ill. Adm. Code 125, Recipient Discharge/Linkage/Aftercare
77 Ill. Adm. Code 370, Minimum Standards for Licensure of Community Living Facilities;
89 Ill. Adm. Code 331 - Unusual Incidents;
89 Ill. Adm. Code 384 - Behavior Treatment in Residential Child Care Facilities;
89 Ill. Adm. Code 385 - Background Checks;
89 Ill. Adm. Code 401 - Licensing Standards for Child Welfare Agencies;
89 Ill. Adm. Code 403 - Licensing Standards for Group Homes;
89 Ill. Adm. Code 507 - Audit Requirements of DHS;
89 Ill. Adm. Code 509 - Fiscal/Administrative Recordkeeping and Requirements;
89 Ill. Adm. Code 511- Grants and Grant Funds Recovery;
89 Ill. Adm. Code 140 - Medical Payment;
89 Ill. Adm. Code 144 - Developmental Disabilities Services.
89 Ill. Adm. Code 270, Subpart E - Adult Protective Service Registry

D. Guidelines

III. Program Services

A. Program Requirements for Community-Integrated Living Arrangement (CILA) Providers

CILA services are provided in compliance with 59 Ill. Adm. Code 115 (Standards and Licensure Requirements for Community-Integrated Living Arrangements), 59 Ill. Adm. Code 116 (Administration of Medications in Community Settings) and 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Program for Individuals with Developmental Disabilities), 59 Ill. Adm. Code 50 (Office of the Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities). The Provider of CILA Services agrees to provide services to persons with developmental disabilities pursuant to these rules and shall comply with the Division's Information Bulletins and/or Official Correspondence, the Division's Quality Review Tools, Waiver Manual, Community Integrated Living Arrangement Individual Rate Determination Model User Guide, Cost Center Definitions, and Allowance Levels, and the Interpretative Guidelines to Rule 115, which are incorporated herein and are made a part hereof by this reference.
The Provider shall design a procedure to evaluate the degree to which there is movement toward the outcomes which are documented in the individual's Personal Plan. Providers must develop service implementation strategies, in accordance with Division guidelines, that are based upon and consistent with the Personal Plans developed by the ISC agencies for all Medicaid Waiver participants. Service providers must modify implementation strategies when such strategies are not resulting in movement toward the individual's desired outcomes.
The Division authorizes individual CILA capacity via a CILA Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Division via the CILA Award Memorandum or CILA Pre-Award Letter prior to initiation of CILA services to the individual.
For the initial 12 months subsequent to a new CILA provider entering into a Service Agreement with the Division, the Division may consider approval of no more than eight individuals.
CILA payments during the initial 12 months of CILA services rendered by a new CILA provider will be initiated upon approval of each individual's service implementation strategy by the Division of Developmental Disabilities, and effective the date of actual placement but no sooner than the date of the Department's Award Memorandum or Pre-Award Letter.
The provider will assume responsibility for providing directly, or by arrangement with other agencies or professionals, all necessary services for all individuals accepted for service.
The Provider is required to notify its assigned Independent Service Coordination (ISC) agency of all CILA terminations within five (5) business days of anticipated terminations. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) IL462-2028 form.
Payments for CILA services are initiated effective the later of:
1. the date of actual placement,
2. date of the Department's Award Memorandum,
3. date of the Pre-Award Letter,
4. the date the ISC Provider completes the Pre-Admission Screening (PAS) assessment,
5. the date the individual is enrolled in Medicaid,
6. or date individual is terminated from a conflicting DD program or other waiver.
CILA payments are terminated effective the actual date the individual permanently departs the Community-Integrated Living Arrangement. Upon termination of services with a CILA provider, the provider will make available all personal belongings, identification cards, financial benefit information, and spending money held by the provider to the individual, his/her guardian, or the new provider (if applicable).
The Department will not double pay for capacity when an individual transfers to another residential provider.
Providers of CILA services shall ensure individuals enrolled in CILA are not enrolled in other 1915c Waiver programs, with the exception of those individuals grandfathered in through prior approval from the Division.
Provider shall enter timely and accurate vacancy data into the DHS Capacity Management Application on an on-going basis but not less than monthly.
Provider is required to comply with reporting requirements cited in the Critical Incident Reporting and Analysis System (CIRAS) Manual for waiver participants.

B. Program Requirements for Independent Service Coordination (ISC) Agencies

The Provider agrees to take full responsibility for the activities of its subcontractors engaged pursuant to this agreement. The Provider will ensure the subcontractor meets all provisions in applicable sections of this contract.
The Provider shall enforce conflict of interest procedures that include, at a minimum, the following provisions:
1. The Board of Directors shall not include individuals who work for or are on the Board of Directors of entities that provide direct services, such as, but not limited to, residential, vocational, respite, day program, supported employment or family support services.
2. The Provider or provider's staff may not provide direct services, such as, but not limited to, residential, vocational, respite, day program, supported employment, self-directed assistant or family support services
The provider shall ensure the timely development of the Discovery Tool and Personal Plan with the individual and their guardian for all individuals entering or enrolled in Medicaid Waiver services.
The Provider ensures 24-hour per day, 365 days per year accessibility in times of crisis for individuals. The Provider shall ensure its contact information, and specifically its telephone number for crisis access, is accurate and current as posted on the Division's website.
The Provider shall, as requested by the Division, initiate face-to-face contact to inquire as to the need for services, provide follow-up, conduct PAS, and perform other advocacy functions for individuals referred by the Division as part of the State's compliance with the Adult Protective Services Act.
The Provider shall, as requested by the Division, conduct face-to-face screenings of individuals in crisis who present to local hospitals or emergency rooms.
The Provider shall ensure individuals enrolled in any DDD Waiver program are not also enrolled in other 1915c Waiver programs, with the exception of those individuals grandfathered in through prior approval from the Division. The Provider shall ensure that Medicaid Redeterminations are completed and submitted in a timely manner.
The Provider shall pursue activities to become the Approved Representative for DDD Waiver program participants enrolled in the Adult or Children's Home-Based Service and Children's Residential Waiver. This process ensures that the Provider can act on behalf of the participant with the Department of Healthcare and Family Services or the Department of Human Services for Cash, SNAP, Medicaid benefits and resolution of Medicaid eligibility issues.
The Provider agrees that all contracted activities must be conducted with direct involvement by the individual to be served and his or her guardian. The individual must be presented with realistic choices to the maximum extent possible within regulations and funding constraints. These choices shall include all potential residential and support categories of service.
The Provider agrees to report in a timely fashion through the designated computerized reporting system(s) all data required by the Division to monitor contracted activities.
The Provider shall participate in all State Operated Developmental Centers (SODC) transition activities as directed by the Division.
The Provider shall submit funding request packets, STAR Terminations, and individual changes through the designated computerized reporting system(s) to the Division for individuals in accordance with the Division's approved criteria (e.g. Community Crisis Criteria - Adult and Community Crisis Criteria - Children) in response to PUNS selections, or in accordance with special funds (e.g. SODC discharges, DCFS transfers).
Provider is required to comply with reporting requirements cited in the Critical Incident Reporting and Analysis System (CIRAS) Manual for waiver participants.

C. Program Requirements for Children's Group Home (CGH) Providers

Children's Group Home (CGH) services are provided in compliance with Abused and Neglected Child Reporting Act (325 ILCS 5/1), 89 Ill. Adm. Code 384 (Behavior Treatment in Residential Child Care Facilities), 89 Ill. Adm. Code 401 (Licensing Standards for Child Welfare Agencies), 89 Ill. Adm. Code 403 (Licensing Standards for Group Homes), 59 Ill. Adm. Code 116 (Administration of Medications in Community Settings) and 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Programs for Individuals with Developmental Disabilities). The Provider, as a Children's Group Home provider, agrees to provide services to persons with developmental disabilities pursuant to these rules, the Division's Information Bulletins and/or Official Correspondence, the Division's Quality Review Tools, and the Waiver Manual, which are incorporated herein and are made a part hereof by this reference.
The Provider shall design a procedure to evaluate the degree to which there is movement toward the outcomes which are documented in the Personal Plan. The provider shall develop service implementation strategies, in accordance with Department guidelines, that are based upon and consistent with the Personal Plans developed by the ISC agencies for all Medicaid Waiver participants. Service providers must modify implementation strategies when such strategies are not resulting in movement toward the individual's desired outcomes.
The Department authorizes individual CGH capacity via a CGH Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the CGH Award Memorandum or Pre-Award Letter prior to initiation of CGH services to the individual.
For the initial 12 months subsequent to a new CGH provider entering into a Service Agreement with the Division of Developmental Disabilities, the Department may consider approval of no more than 10 individuals.
CGH payments during the initial twelve (12) months of CGH services rendered by a new CGH provider will be initiated upon approval of each individual's service implementation strategy by the Division of Developmental Disabilities, and effective the date of actual placement but no sooner than the date of the Department's Award Memorandum.
The Provider shall send a copy of each final report of Child Welfare Agency or CGH licensure survey conducted by DCFS staff to the Division's Bureau of Quality Management within 30 calendar days of receiving the report.
The Provider shall send a copy of each final report by DCFS's OIG of substantiated abuse/neglect investigations involving individuals whose services are funded by the Division and employees or contractors of the provider.
The Provider is to notify its assigned ISC agency of all terminations within five (5) business days of anticipated terminations. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) form.
Payments for CGH services are initiated effective the later of:
1. the date of actual placement,
2. date of the Department's Award Memorandum,
3. date of the Pre-Award Letter,
4. the date the ISC Provider completes the Pre-Admission Screening (PAS) assessment,
5. the date the individual is enrolled in Medicaid
6. the date individual is terminated from a conflicting DD program or other waiver.
CGH payments are terminated effective the actual date the person permanently departs the Children's Group Home.
Upon termination of services with a CGH provider, the provider will make available all personal belongings, identification cards, financial benefit information, and spending money held by the provider to the individual, his/her guardian, or the new provider (if applicable).
The Division will not double pay for capacity when an individual transfers to another residential provider.
Provider is required to comply with reporting requirements cited in the Critical Incident Reporting and Analysis System (CIRAS) Manual for waiver participants.

D. Program Requirements for Community Living Facility Providers (CLF)

A CLF is a residential setting licensed by the Department of Public Health that serves individuals with developmental disabilities in skill training programs that provide guidance, supervision, training and other assistance, with the goal of eventually assisting these individuals in moving to independent living.
Individuals are required to participate in day activities, such as vocational training, sheltered workshops or regular employment.
A CLF shall not be a nursing or medical facility and shall house no more than 20 residents, excluding staff, except as provided for in Section 18 of the Community Living Facilities Licensing Act [210 ILCS 35/18]. (Reference: 77 Ill. Adm. Code 370.240) The Department continues to support these programs and vacancies are filled.
The Department authorizes individual CLF capacity via an Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department prior to initiation of services to the individual.
Individuals must be screened for eligibility and offered an informed choice by a DHS-designated Independent Service Coordination (ISC) agency prior to receiving services. Individuals must be enrolled in the adult Medicaid waiver if placement will occur in an in-state, CLF that serves 16 or fewer individuals (i.e. a waiver CLF site).
The provider will assume responsibility for providing directly, or by arrangement with other agencies or professionals, all necessary services for all individuals accepted for service.
The Provider is to notify its assigned Independent Service Coordination (ISC) agency of all CLF terminations within five (5) business days of anticipated terminations. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) IL462-2028 form.
Payments for CLF services are initiated effective:
1. the later of the date of actual placement,
2. but no sooner than the date of the Department's Award Memorandum, Pre-Award Letter,
3. the date the ISC Provider completes the Pre-Admission Screening (PAS) assessment,
4. or the date the individual is enrolled in Medicaid
5. or is terminated from a conflicting DD program, DD provider or other waiver.
CLF payments are terminated effective the actual date the individual permanently departs the Community Living Facility.
The Provider shall ensure individuals enrolled in any DDD Waiver program are not also enrolled in other 1915c Waiver programs, with the exception of those individuals grandfathered in through prior approval from the Division.
Provider is required to comply with reporting requirements cited in the Critical Incident Reporting and Analysis System (CIRAS) Manual for waiver participants

E. Program Requirements for Providers Providing Personal Support

Personal Support services are provided in compliance with 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Programs for Individuals with Developmental Disabilities). The Provider, as a Personal Support provider, agrees to provide services to persons with developmental disabilities pursuant to this rule, the Division's Information Bulletins and/or Official Correspondence, and the Waiver Manual, which are incorporated herein and are made a part hereof by this reference.
Restrictive interventions to modify behavior must be reviewed and approved in writing by the Behavior Intervention Committee, and the Human Rights Committee.
The Department authorizes individual capacity via an HBS Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the HBS Award Memorandum or Pre-Award Letter prior to the initiation of services to the individual.
Payments for Personal Support services are initiated the later of:
1. the date of actual placement,
2. the date of the Department's Award Memorandum,
3. date of Pre-Award Letter,
4. date the ISC Provider completes the Pre-Admission Screening (PAS) assessment,
5. date the individual is enrolled in Medicaid,
6. or date individual is terminated from a conflicting DD program, DD provider or other waiver.
The Provider shall ensure individuals enrolled in any DDD Waiver program are not also enrolled in other 1915c Waiver programs, with the exception of those individuals grandfathered in through prior approval from the Division.
The Provider shall ensure services are delivered in accordance with the individual's service plan. Service Billing may not exceed the quantity of services as specified in the individual's personal plan and applicable Service Agreement.

F. Program Requirements for Providers Providing Supported Employment

Supported Employment services are provided in compliance with 59 Ill. Adm. Code 120 (Medicaid Home and Community-Based Waiver Programs for Individuals with Developmental Disabilities). The Provider, as a Supported Employment Provider, agrees to provide services to persons with developmental disabilities pursuant to this rule, the Division's Information Bulletin and/or Official Correspondence, the Division's Quality Review Tools, and the Waiver Manual, which are incorporated herein and are made a part hereof by this reference.
The Provider shall design a procedure to evaluate the degree to which there is movement toward the outcomes which are documented in the individual's Personal Plan. Providers must develop service implementation strategies, in accordance with Department guidelines, that are based upon and consistent with the Personal Plans developed by the ISC agencies for all Medicaid Waiver participants. Service providers must modify implementation strategies when such strategies are not resulting in movement toward the individual's desired outcomes.
The Provider agrees to provide flexible hours of service to permit full or partial shift work, work on weekends, and work at night or evenings based on the preferences of the individual and the individual's work schedule.
Supported Employment services shall be delivered in integrated work settings. There must be interaction with co-workers without disabilities and the public. The amount of integration should be the same as that for individuals without disabilities in comparable jobs.
The Provider shall submit to its assigned ISC agency notice of all terminations within five (5) business days of anticipated terminations. Notification of terminations must be in writing on the Service Termination Approval Request (STAR) form.
Payments for SEP services are initiated the later of:
1. the date of actual placement,
2. the date of the Department's Award Memorandum,
3. date of Pre-Award Letter,
4. date the ISC Provider completes the Pre-Admission Screening (PAS) assessment,
5. date the individual is enrolled in Medicaid,
6. or date individual is terminated from a conflicting DD program, DD provider or other waiver. Payments for SEP services are terminated effective the actual date the person permanently departs or is last served in SEP.
Payments for SEP services are terminated effective the actual date the person permanently departs or is last served in SEP.
The Provider shall ensure individuals enrolled in any DDD Waiver program are not also enrolled in other 1915c Waiver programs, with the exception of those individuals grandfathered in through prior approval from the Division.
Provider is required to comply with reporting requirements cited in the Critical Incident Reporting and Analysis System (CIRAS) Manual for waiver participants.

G. Program Requirements for Providers Providing Community Day Services (CDS) (Formerly Developmental Training (DT))

Community Day Services are provided in compliance with 59 Ill. Adm. Code 119 (Minimum Standards for Certification of Community Day Services formally known as Developmental Training Programs), and 59 Ill. Adm. Code 120 (Medicaid Home and Community Based Waiver Program for Individuals with Developmental Disabilities Rule), 59 Ill. Adm. Code 50 (Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities). The Provider as a Community Day Service Provider agrees to provide services to persons with developmental disabilities pursuant to these rules and shall comply with the DHS Division's Information Bulletin and/or Official Correspondence, the Division's Quality Review Tools, Waiver Manual, and the Interpretative Guidelines to Rule 119, which are incorporated herein and are made a part hereof by this reference.

Providers providing CDS services to residents of long-term care settings that are certified for participation in the Medicaid program as Intermediate Care Facilities for individuals with Intellectual Disabilities (ICF/IID) must comply with the federal regulations governing ICF/IID facilities (42 CFR 440 and 42 CFR 483). Authorization and termination of ICF/IID residents is the responsibility of the ICF/IID provider with the Department. The ICF/IID provider contracts with the CDS provider for services and payment for CDS/DT services for its residents.

The Department authorizes individual with CDS capacity via a CDS POS, HBS, or CILA Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the Award Memorandum prior to the initiation of DT services to the individual.

For persons funded through waiver home-based services, Service Billing may not exceed the quantity of services as specified in the individual's personal plan and applicable Service Agreement.

The Provider shall submit to its assigned ISC agency notice of all terminations within five (5) business days of anticipated terminations. Notification of terminations or anticipated terminations must be in writing on the Service Termination Approval Request (STAR) form.

Payments for CDS services are initiated effective:

Community Day Services are provided in compliance with 59 Ill. Adm. Code 119 (Minimum Standards for Certification of Community Day Services formally known as Developmental Training Programs), and 59 Ill. Adm. Code 120 (Medicaid Home and Community Based Waiver Program for Individuals with Developmental Disabilities Rule), 59 Ill. Adm. Code 50 (Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities). The Provider as a Community Day Service Provider agrees to provide services to persons with developmental disabilities pursuant to these rules and shall comply with the DHS Division's Information Bulletin and/or Official Correspondence, the Division's Quality Review Tools, Waiver Manual, and the Interpretative Guidelines to Rule 119, which are incorporated herein and are made a part hereof by this reference.
Providers providing CDS services to residents of long-term care settings that are certified for participation in the Medicaid program as Intermediate Care Facilities for individuals with Intellectual Disabilities (ICF/IID) must comply with the federal regulations governing ICF/IID facilities (42 CFR 440 and 42 CFR 483). Authorization and termination of ICF/IID residents is the responsibility of the ICF/IID provider with the Department. The ICF/IID provider contracts with the CDS provider for services and payment for CDS/DT services for its residents.
The Department authorizes individual with CDS capacity via a CDS POS, HBS, or CILA Award Memorandum. Capacity for an individual must be authorized and approved in writing by the Department via the Award Memorandum prior to the initiation of DT services to the individual.
For persons funded through waiver home-based services, Service Billing may not exceed the quantity of services as specified in the individual's personal plan and applicable Service Agreement.
The Provider shall submit to its assigned ISC agency notice of all terminations within five (5) business days of anticipated terminations. Notification of terminations or anticipated terminations must be in writing on the Service Termination Approval Request (STAR) form.
Payments for CDS services are initiated the later of:
1. the date of actual placement,
2. the date of the Department's Award Memorandum,
3. date of Pre-Award Letter,
4. date the ISC Provider completes the Pre-Admission Screening (PAS) assessment,
5. date the individual is enrolled in Medicaid,
6. or date individual is terminated from a conflicting DD program, DD provider or other waiver.
Payments for CDS services are terminated effective the actual date the person permanently departs or is last served in CSD.
The Provider shall ensure individuals enrolled in any DDD Waiver program are not also enrolled in other 1915c Waiver programs, with the exception of those individuals grandfathered in through prior approval from the Division.
The Provider shall design a procedure to evaluate the degree to which there is movement toward the outcomes which are documented in the Personal Plan. The provider shall develop service implementation strategies, in accordance with Department guidelines, that are based upon and consistent with the Personal Plans developed by the ISC agencies for all Medicaid Waiver participants. Service providers must modify implementation strategies when such strategies are not resulting in movement toward the individual's desired outcomes.
Provider is required to comply with reporting requirements cited in the Critical Incident Reporting and Analysis System (CIRAS) Manual for waiver participants.

H. Self-Direction Assistance (SDA)

SDA is an optional service offered to assist the participant, family or representative in arranging for, directing and managing services. Practical skills training is offered to enable families and participants to independently direct and manage waiver services. This service may provide the following activities to address the individual/family's needs in the Personal Plan.

The Provider may provide skills training to enable families and participants to independently direct and manage self-directed services.
The Provider may provide information on and assistance in recruiting, hiring, and managing Personal Support Workers.
The Provider may provide assistance with budgeting and funding allocation management.
The Provider may provide assistance with communication and problem-solving strategies with Personal Support workers.
The Provider may provide skills training and assistance with completion of timekeeping and other employer-related tasks required to interface with the Fiscal Management Agency.
The Provider may provide assistance with securing information necessary for a participant or family to request Adaptive Equipment, Assistive Technology, Minor Home or Vehicle Modifications.
Service Billing may not exceed the quantity of services as specified in the individual's personal plan and applicable Service Agreement.
Provider is required to comply with reporting requirements cited in the Critical Incident Reporting and Analysis System (CIRAS) Manual for waiver participants .

I. Program Roster

The following is a listing of service programs funded by the Division covered by an agreement to which this attachment is a part. The program name is followed by program code and method of payment (GIA = Grant in Aid, FFS = Fee for service). Program descriptions can be found in the Division Program Manual.

PRE-ADMISSION SCREENING Program 780, GIA
INDIVIDUAL SERVICE AND SUPPORT ADVOCACY Program 50D, FFS
INDEPENDENT SERVICE COORDINATION Program 500, GIA
BOGARD SERVICE COORDINATION Program 781, GIA
SUPPORTED LIVING ARRANGEMENT Program 42D, FFS
SPECIAL HOME PLACEMENT Program 41D, FFS
CHILDREN'S GROUP HOME Program 17D, FFS
CHILD CARE INSTITUTION RESIDENTIAL SCHOOL Program 19D, FFS
COMMUNITY LIVING FACILITY Programs 67D, 67E and 67O FFS
COMMUNITY-INTEGRATED LIVING ARRANGEMENT Program 60D FFS
COMMUNITY-INTEGRATED LIVING ARRANGEMENT (INTERMITTENT), Program 65H, FFS
COMMUNITY DAY SERVICES PROGRAMS 31U & 31C, FFS
DEVELOPMENTAL TRAINING, SODC, Program 31S, FFS
REGULAR WORK/SHELTERED EMPLOYMENT Program 38U, FFS
SUPPORTED EMPLOYMENT-GROUP Program 39G, FFS
SUPPORTED EMPLOYMENT-INDIVIDUAL Program 39U, FFS
OTHER DAY Program 30U, FFS
ADULT DAY CARE Program 35U, FFS
AT HOME DAY Program 37U, FFS
Self-Direction Assistance Program 55A, FFS
PERSONAL SUPPORT (AGENCY-PROVIDED) Program 55D, FFS
RELATED SUPPORT - ADULT (73D) FFS
IN-HOME RESPITE Program 87D, FFS
RESIDENTIAL RESPITE Program 89D, FFS
GROUP RESPITE Program 880, GIA
VOUCHER RESPITE 450-0010, GIA
DEMONSTRATION/SPECIAL PROJECTS Program 450, GIA
EPILEPSY Program 250, GIA
DENTAL SERVICES Program 400, GIA

IV. Program Plan and Deliverables

A. Agency Program Report/Narrative

The Provider of grant funded services agrees to execute Agency Report/Narrative provided by the Department and submit to the Division when requested. These documents need to be submitted within time frames specified by the Division. The Provider must have an approved Agency Program Report/Narrative on file with the Division and is required to comply with all conditions and provisions therein.

V. Payment

A. Types of Funding

1. Grant Programs (GIA)

Grant funded programs may receive all or part of the funding in advance of the actual delivery of services in accordance with Administrative Code (Title 44, Subtitle F, Chapter I, Part 7000.120) This includes prorated prospective payments and payments made by the Department on an estimated basis or any other basis when the Department does not know the actual amount earned by the Provider. This does not include advance payments made under the authority of Section 9.05 of the State Finance Act (30 ILCS 105/9.05).

Reimbursement. Reimbursement is the preferred method. When the reimbursement method is used, the State awarding agency or pass-through entity must make payment within 30 calendar days after receipt of the billing, unless the State awarding agency or pass-through entity reasonably believes the request to be improper. However, in Fiscal Year 2020 if the awardee requests to receive advance and reconcile payments the payments will be authorized, unless the State awarding agency sets a specific condition per UR section 200.207 (Specific conditions).
1. Advance payments must be limited to the minimum amounts needed and be timed to be in accordance with the actual, immediate cash requirements of the awardee in carrying out the purpose of the approved program or project. The timing and amount of advance payments must be as close as is administratively feasible to the actual disbursements by the awardee for direct program or project costs and the proportionate share of any allowable indirect costs. The awardee entity must make timely payment to contractors in accordance with the contract provisions.
2. The awardee must submit a yearly spending plan to the Department prior to the first payment of the grant. The yearly spending plan must be based on known expenses or historical spending patterns. The Department will make the initial advance payment based on the amount projected in the spending plan. Subsequent payments will be issued based on the previous month's expenditures documented in the Expenditure Documentation Forms (EDFs) provided by the Department. Subsequent payments may need to be adjusted to account for shortages/overages from the initial projection.
3. The final payment from the Department under this Agreement shall be made upon the Department's determination that all requirements under this Agreement have been completed, which determination shall not be unreasonably withheld. Such final payment will be subject to adjustment after the completion of a review of the Provider's records as provided in the Agreement.

In future fiscal years, the awardee may be required to meet the requirements in subsection (b)(1) of 2 CFR 200 to qualify for advance and reconcile payments. When implemented awardees will be required to provide and maintain documentation that demonstrates their willingness to maintain both:

1. written procedures that minimize the time elapsing between the transfer of funds and disbursement by the awardee; and
2. financial management systems that meet the standards for fund control and accountability as established in UR section 200.302.
Working Capital Advances. If the awardee entity cannot meet the criteria for advance payments as stated in subsection (b)(1) and the State awarding agency or pass-through entity has determined that reimbursement is not feasible because the awardee lacks sufficient working capital, the State awarding agency or pass-through entity may provide cash on a working capital advance basis. Under a working capital advance, the State awarding agency or pass-through entity must advance cash payments to the awardee to cover its estimated disbursement needs for an initial period, generally geared to the awardee's disbursing cycle. This would include initial start-up cost and normal monthly grant expense not to exceed two months of monthly grant expenses. Thereafter, the State awarding agency or pass-through entity must reimburse the awardee for its actual cash disbursements.
1. A working capital advance requires the State awarding agency or pass-through entity to provide timely advance payments to awardees to meet the awardee's actual cash disbursements.
2. A working capital advance must not be used if the reason for the working capital advance is the unwillingness or inability of the State awarding agency or pass-through entity to provide timely advance payments to the awardee to meet the awardee's actual cash disbursements.
3. State agencies must implement written policies and procedures for each grant payment method utilized by the agency: advance payments, reimbursements and working capital advances. The policies and procedures must be approved by State agency staff responsible for federal and State cash drawdowns and reporting.
4. Standards governing the use of banks and other institutions as depositories of advance payments under awards are as follows:
  1. Advance payments of federal funds must be deposited and maintained in insured accounts whenever possible.
  2. The awardee must maintain advance payments of federal awards in interest-bearing accounts, unless the following apply:
    1. The awardee receives less than $120,000 in federal awards per year.
    2. The best reasonably available interest-bearing account would not be expected to earn interest more than $500 per year.
Parameters Regarding Interest Earned
1. Interest earned by the awardee up to $500 per year may be retained by the awardee for administrative expense.
2. Interest earned by the awardee more than $500 per year on federal advance payments deposited in interest-bearing accounts must be returned to the State awarding agency in accordance with UR section 200.305(9).
Payment Withholding
1. Unless otherwise required by State statute, payments for allowable costs shall not be withheld at any time during the period of performance unless the conditions of Section 7000.80 apply, the awardee is determined to be "not qualified" in accordance with Section 7000.320, or one or more of the following conditions exists:
  1. The awardee has failed to comply with the project objectives, State statutes or regulations, or the Grant Agreement; or
  2. The awardee is delinquent in a debt to the State of Illinois (see the Illinois State Collection Act of 1986).
2. Under these conditions, the agency may, upon reasonable notice, inform the awardee that the awardee shall not make payments for obligations incurred after a specified date until the delinquency is corrected or the indebtedness to the State is liquidated.
3. If the grant is suspended and payment is withheld because of the awardee's failure to comply with the Grant Agreement, payment must be released to the awardee upon subsequent compliance. Refer to Section 7000.80 for the Grantee Compliance Enforcement System and the Illinois Stop Payment List.
4. Payments will not be made to an awardee for amounts to be paid to contractors that the awardee retains to assure satisfactory completion of work. Payments will be made when the awardee disburses the withheld funds to the contractors or to escrow accounts established to assure satisfactory completion of work.

All funds paid as a grant are subject to the Illinois Grant Funds Recovery Act (30 ILCS 705). All funds disbursed by the Department on a grant basis are subject to reconciliation and the recovery of lapsed funds. Any funds remaining after reconciliation are subject to the Illinois Grant Funds Recovery Act. Payment is made contingent upon funds being made available by the Illinois General Assembly and the Governor.

2. Fee-For-Service (FFS)

Fee-for-service programs receive payment at a Department-approved rate subsequent to delivery of services. Fee-for-service program providers receive payments that are made on the basis of a rate, unit cost, or allowable costs incurred, and are based on a statement or bill as required by the Department. Payment is contingent upon funds being made available by the Illinois General Assembly and the Governor.

Billings are submitted by the Provider in Reporting of Community Services (Rocs) upon delivery of services and must include the complete and correct name, social security number, and Recipient Identification Number (if one has been assigned), for all individuals. The Provider shall be paid for services at a specified rate(s) as authorized by the Department. Submission of provider enrollments, individual service authorizations, and billings must be timely and accurate. The Provider shall maintain adequate substantiating documentation of services provided.

The Provider agrees that it will not assess the individual nor his/her family a fee or any other type of financial obligation that supplements the rate established by the Department for the individual. The Provider understands that individuals enrolled in some funded services do contribute a specified portion of earned income or entitlement benefits toward the cost of care in accordance with the formula established by the Department for each service.

The Provider may be issued an advance that will be deducted from billings before the end of the contract period.

Some fee-for-service programs are paid through an "advance and reconcile" payment mechanism that advances fee-for-service payments that are then reconciled against actual fee-for-service bills submitted by the Provider.

B. Debt Service Deduction

If the Provider is approved by the Department for a debt service deduction contract to participate in a pooled loan program or other loan program where the debt service deduction will be performed by the Department, the Provider hereby authorizes the Department to deduct Provider's debt service payments from the Provider's award and forward payment directly to the trustee bank or other designated party. The Provider agrees to execute a Debt Service Deduction contract in a form provided by the Department if so participating.

The Provider agrees to provide 90 calendar days written notice to the Department of its intention to enter into pooled-loan financing, or any other financing transaction that would require the use of a debt-service deduction mechanism by the Department. If the Provider fails to provide such notice, the Department shall not execute any debt-service deduction contracts until the Department has had 90 calendar days for project review. The Department retains the right to accept or decline to participate through debt service deduction in any financed projects. Additionally, providers specifically acknowledge that if they enter into a debt service deduction contract with the Department to secure a loan based on fee-for-service funding, such funding is based upon individual recipients, each authorized for placement by the Department, at rates set by the Department. Accordingly, if and when funding for a particular recipient terminates, the Department does not guarantee replacement of equivalent funding. Therefore, any such debt service deduction contract will be honored only to the extent of currently supported fee-for-service funding at the time of any required debt service deduction.

The Provider shall supply to the Department an estimated debt-service deduction payment schedule thirty (30) calendar days before closing of the loan transaction.

VI. Eligibility Criteria

A. Individual Eligibility

General eligibility and specific program eligibility can be found in the Division Program Manual. The Division of Developmental Disabilities reserves the right to review and reverse any PAS determination.

B. Eligibility Residential Programs

All individuals accepted in adult residential programs and Children's Group Homes must be determined to be eligible for Home and Community-Based Services Waiver funding. Exceptions to this requirement can only be approved by written notification by the Director of the Division of Developmental Disabilities or designee.

C. Selection Criteria and Priority Populations

Authorizations for Fee-for-service programs are subject to appropriation levels and applicable maximum capacities for programs (e.g., Waiver capacity). Individuals potentially in need of these services are enrolled in the Division's Prioritization of Urgency of Need for Services (PUNS) database by one of the ISC agencies serving as access points. This database records demographic and clinical information regarding the individual and his/her circumstances, services currently received, and services needed. New individuals are selected from the PUNS database.

D. Adult Residential

As appropriations are available, individuals are selected for authorization via an automated process that focuses on the individual's needs and the family's circumstances (where applicable). Entrance to the waiver for adults with developmental disabilities or otherwise eligible applicants is deferred via this process until capacity becomes available as a result of turnover or the appropriation of additional funding by the legislature. Authorizations for adult residential services are established in accordance with the criteria set by the division including:

Individuals who are in crisis situations (e.g., including, but not limited to, participants who have lost their caregivers, participants who are in abusive or neglectful situations),
Individuals who are wards of the Department of Children and Family Services and are approaching the age of 18 and individuals who are aging out of children's residential services funded by the Division of Developmental Disabilities,
Individuals who reside in State-Operated Developmental Centers (SODCs),
Bogard class members- (i.e. certain individuals with developmental disabilities who currently reside or previously resided in a nursing facility),
Individuals with developmental disabilities who reside in State-Operated Mental Hospitals,
Individuals who are selected from Puns.

E. Children's Residential Services

The selection criteria will provide for selection of individuals on several bases, including urgency of need, length of time on the database, and randomness. As appropriations are available, children are selected for authorization via an automated process that focuses on the child's needs and the family's circumstances. Entrance to the Children's Residential Waiver of otherwise eligible applicants is deferred via this process until capacity becomes available as a result of turnover or the appropriation of additional funding by the legislature.

F. Adult Support Services

As appropriations are available, individuals are selected for authorization that focuses on the individual's needs and the family's circumstances (where applicable). The State gives service priority to eligible persons who have been identified as individuals who are currently not receiving any support services from the Division or the Division of Rehabilitation Services (except vocational rehabilitation services). Within this population, if requests exceed available capacity, the State will prioritize:

Individuals who are in crisis situations (e.g., including, but not limited to, participants who have lost their caregivers, participants who are in abusive or neglectful situations),
Individuals who are wards of the Department of Children and Family Services and are approaching the age of 18 and individuals who are aging out of children's residential services funded by the Division of Developmental Disabilities,
Individuals who reside in State-Operated Developmental Centers (SODCs),
Bogard class members- (i.e. certain individuals with developmental disabilities who currently reside or previously resided in a nursing facility),
Individuals with developmental disabilities who reside in State-Operated Mental Hospitals,
Individuals who are selected from PUNS.

G. Children's Support Services

As appropriations are available, children are selected for authorization that focuses on the child's needs and the family's circumstances. The number of individuals served each year will be based on available appropriations. New enrollees will be selected from the Prioritization of Urgency of Need for Services (PUNS) database, a database maintained by the Division of Developmental Disabilities of individuals potentially in need of state-funded DD services within the next five years. Entrance to the Children's Support Waiver of otherwise eligible applicants is deferred via this process until capacity becomes available as a result of turnover or the appropriation of additional funding by the legislature. The selection criteria will provide for selection of individuals on several bases, including urgency of need, length of time on the database, and randomness

VII. Reporting Requirements

A. Centralized Repository Vault (CRV)

The Centralized Repository Vault (CRV) is a system used by the Office of Contract Administration (OCA) to gather reports and documents from all providers who do business with the State of Illinois. All Providers are required to register in CRV using the CRV invitation key (pdf) to provide a point of contact information for their agency. Providers need to ensure that the information is accurate and must be updated as that information changes. It is necessary for providers to use this information to upload all year-end financial documents, including but not limited to admin/agency forms, audits and consolidated financial Reports (CFR's), regarding Impact waiver Services, Uniform Grant Agreements or Community Service Agreements as required by (OCA).

B. Service Reporting for Grant Programs

The Provider must submit complete and submit accurate service reports 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 sixty (30) calendar days following the end of the service month.

C. Data

The Provider must submit any and all data required by rule or requested by the Department concerning the operation of its funded programs. The Provider must submit data in a timely manner in a format prescribed by the Department. The Provider shall complete and transmit service reporting accurately and timely in accordance with 59 Ill. Adm. Code 103, Section 103.170(b)(1).

When reporting or billing for services in Reporting of Community Services (ROCS), the complete name, social security number, and Recipient Identification Number (if one has been assigned), are required for all individuals.

D. Financial Reporting Requirements

Annual Financial Statement Audits: This paragraph applies only to providers of Developmental Disabilities Medicaid Waiver services that are subject to this Attachment A through the Medicaid Provider Enrollment Agreement and that do not have a Uniform Grant Agreement (UGA) with the Division of Developmental Disabilities. Financial reporting requirements are addressed in the main section of the Uniform Grant Agreement for all other providers subject to Attachment A. Providers of Developmental Disabilities Medicaid Waiver services covered by this paragraph, which receive between $500,000 and $749,999 through the Division of Developmental Disabilities (DDD), must have a financial statement audit conducted in accordance with Generally Accepted Auditing Standards (GAAS). Providers which receive over $750,000 through the Division of Developmental Disabilities, must have a financial statement audit conducted in accordance with Generally Accepted Government Auditing Standards (GAGAS). Providers shall submit these financial statement audit reports to the Department either within 30 calendar days after receipt of the auditor's report(s) or 180 calendar days after the end of the audit period, whichever is earlier.

Consolidated Financial Report (CFR): This is a five-schedule report prepared by all DDD Providers and select Executive Ethics Commission (EEC) contracted vendors which consist of the following five schedules.

Program Costs (Expenditures)
Program Revenues
Program Service Units
Personnel
Contractual/Consultants

All DDD Providers and EEC vendors who are subject to the audit requirements mentioned above must also have their external auditor complete an In Relation to Opinion on the CFR. CFR's are to be prepared on the DDD Providers/Vendors fiscal year.

In some situations, DDD Providers and EEC Vendors are also IDHS grantees and will also be required to complete a GATA Consolidated Year-end Financial Report (CYEFR) in the GATA Portal along with a separate auditor's opinion on this CYEFR if subject to an audit requirement.

E. Provider Contact Information

The Provider must ensure the Division has the accurate mailing address, telephone number, and email address for the provider, as well as the name and contact information for the current executive director. This information is to be submitted to the Department via the Provider / Agency / Payee Information Update Form (IL462-0723) and must be updated as that information changes.

VIII. Special Conditions

A. Registry and Criminal Background Checks

Providers serving adults and/or children must comply with all statutes and administrative rules referenced in this section, check all of the following registries and adhere to the employment restrictions based on the results of these checks. Provider must maintain documentation of the checks in each individual's personnel file.

1. Health Care Worker Registry

The provider shall not utilize a staff person, contractor, or volunteer in any capacity until the provider has inquired of and received results from the Illinois Department of Public Health's Health Care Worker Registry concerning the individual. Such inquiry shall not occur more than 30 calendar days prior to the first day of employment. If the Registry reflects the existence or contains information that substantiates an administrative finding of physical or sexual abuse or egregious neglect against an applicant or a disqualifying criminal conviction for which there is no waiver by the Illinois Department of Public Health, the Provider shall not employ him or her in any capacity. For each employee, the Provider shall, in addition, inquire of the Registry annually thereafter during employment. At the time of the annual check, if a current employee's name has been placed on the Registry, the employee must be terminated unless there is a waiver by the Illinois Department of Public Health. For purposes of annual checks, Providers must establish a schedule that results in completion of checks annually (approximately every 365 calendar days).

That may be accomplished by

repeating the check on the anniversary of the employee's hire;
repeating the check at the time the employee's annual performance evaluation is due; or
creating a specific schedule of checks that results in timely completion.

2. Adult Protective Services Registry

The provider shall not utilize a staff person, contractor, or volunteer in any capacity until the provider has inquired of and received results from the Illinois Department on Aging's APS registry. Such inquiry shall not occur more than 30 calendar days prior to the first day of employment and no later than the first day the employee is in paid status. Placement on the APS Registry prevents that individual from providing direct care if the position is regulated or paid with public funds. 320 ILCS 20/7.5 and Title 89, Illinois Administrative Code 270, Subpart E. For each employee, the Provider shall, in addition, inquire of the Registry annually thereafter during employment. At the time of the annual check, if a current employee's name has been placed on the Registry, the employee must be terminated. If the individual is appealing the decision they cannot work until they provide the division with the final administrative decision showing name removal. For purposes of annual checks, Providers must establish a schedule that results in completion of checks annually (approximately every 365 calendar days).

That may be accomplished by:

repeating the check on the anniversary of the employee's hire;
repeating the check at the time the employee's annual performance evaluation is due; or
creating a specific schedule of checks that results in timely completion.

3. DCFS State Central Register/Child Abuse and Neglect Tracking System (CANTS)

The provider shall not utilize a staff person, contractor, or volunteer in any capacity until the Provider has inquired of the Department of Children and Family Services as to information in the DCFS State Central Register concerning the individual. Such inquiry shall not occur more than 30 calendar days prior to the first day of employment. If the Register reflects the existence of or contains information that indicates a disqualifying conviction or disqualifying substantiated case of abuse or neglect for which there is no waiver by the Department of Human Services, the Provider shall not employ him or her in any capacity. Disqualifying convictions or disqualifying substantiated cases of abuse or neglect are defined for the DCFS Central Register by the Department of Children and Family Services' standards for background checks in Part 385 of Title 89 of the Illinois Administrative Code. For each employee, the Provider shall, in addition, inquire of the Register annually thereafter during employment. At the time of the annual check, if a current employee's name has been placed on the Register, the employee must be terminated unless there is a waiver by the Illinois Department of Human Services. For purposes of annual checks, Providers must establish a schedule that results in completion of checks annually (approximately every 365 days).

That may be accomplished by:

repeating the check on the anniversary of the employee's hire;
repeating the check at the time the employee's annual performance evaluation is due; or
creating a specific schedule of checks that results in timely completion.

4. Illinois Sex Offender Registry

The provider shall not utilize a staff person, contractor, or volunteer in any capacity until the Provider has inquired of and received the results from the Illinois Sex Offender Registry concerning the individual. Such inquiry shall not occur more than 30 calendar days prior to the first day of employment. If the Registry reflects the existence or contains information that indicates a finding, the Provider shall not employ him or her in any capacity. For each employee, the Provider shall, in addition, inquire of the Registry annually thereafter during employment. At the time of the annual check, if a current employee's name has been placed on the Registry, the employee must be terminated. For purposes of annual checks, Providers must establish a schedule that results in completion of checks annually (approximately every 365 calendar days).

That may be accomplished by:

repeating the check on the anniversary of the employee's hire;
repeating the check at the time the employee's annual performance evaluation is due; or
creating a specific schedule of checks that results in timely completion.

5. Health Care Worker Background Check Act and the Abused and Neglected Child Reporting Act

The Provider will comply with all requirements and regulations issued pursuant to the Health Care Worker Background Check Act (225 ILCS 46) and the Abused and Neglected Child Reporting Act (325 ILCS 5/1).

6. Illinois Department of Healthcare and Family Services (HFS) Sanctions List

Prior to employment of an individuals or utilization of a subcontractor or licensed practitioner, the Provider shall confirm that the individual or entity is not on the sanctions list of terminated or suspended providers and barred entities and individuals on the Illinois Department of Healthcare and Family Services Sanctions List. Such inquiry shall not occur more than 30 calendar days prior to the first day of employment. This list is maintained on the HFS OIG web site.
The sanctions list contains the names of providers and individuals who are currently terminated, suspended, barred, voluntarily withdrawn or otherwise excluded from participation in the Illinois Medical Assistance Program. In an individual or entity is found to be on the sanctions list, the Provider shall confirm eligibility with HFS' OIG and per HFS guidelines.

B. Mandatory Meetings & Training

The Division may designate any meeting or training it deems necessary as mandatory for Provider attendance. The Provider shall ensure that appropriate staff attend all mandatory training. Providers will be given adequate notice of such training.

C. Representative Payee Status

The Provider shall assist an individual receiving DHS-funded services when he or she demonstrates persistent failure to meet financial obligations in respect to his/her basic needs. This assistance is defined as identifying a person, entity, or process to serve as representative payee for the individual or assuming responsibility for representative payee services when no other appropriate person or entity is available. ISC Providers may not serve as the representative payee for the individual. Any person or entity which serves as a Representative Payee has responsibilities as outlined by the Social Security Administration (SSA). Additional information from the SSA can be found in the "A Guide for Representative Payees" at: https://www.ssa.gov/pubs/EN-05-10076.pdf

D. Monitoring

The Provider shall allow the Department access to its facilities, records, and employees for the purposes of monitoring this Agreement. Providers agree to participate actively in periodic announced and/or unannounced reviews of all funded programs by Department staff.

The Department will monitor compliance with the conditions specified herein. Monitoring will be conducted by staff within various offices of the Department, including but not limited to, the Division; the OCAPS Bureau of Accreditation, Licensure, and Certification; Inspector General and the Office of Contract Administration.

Monitoring may consist of, but is not limited to, the following:

Reviews of all required licenses and certifications.
Reviews of all provider service and funding plans.
Reviews of direct service provision.
Reviews of alleged and substantiated cases of abuse and neglect.
Reviews of individual records, personnel files, Provider and program policies and procedures, and financial records.
On-site observations and interviews of individuals, guardians, and Provider staff (including, but not limited to, program, supervisory and direct care staff).
Reviews of electronic data submissions and verification of data submissions or data accepted in lieu of electronic submission.
Reviews of utilization patterns.
Reviews of staff training records.

Any findings arising from the monitoring activities of the Division of Developmental Disabilities will be shared with the Provider by that entity for review and corrective action. Upon request, the Provider shall submit acceptable corrective action plans to the Division. Acceptance of the plan is subject to the approval of the Division. The Provider shall comply with plans of correction approved or imposed by the Division.

E. Sanctions

The Division of Developmental Disabilities may impose sanctions on Providers which fail to comply with conditions stipulated herein. Sanctions include, but are not limited to, payment suspension, loss of payment, and enrollment limitations, or other actions up to and including contract termination. The Division of Developmental Disabilities may post sanctions imposed on Providers on its web site.

F. Provider Responsibility Upon Termination of Services

If a Provider ceases all or partial operations, the Provider must:

Confirm with the Division a listing of all individuals currently involved and receiving services in each of the Division-funded programs.
Indicate which of the individuals will continue to be served by the Provider if some, but not all, programs are terminating.
Provide the Division access to all records and files of individuals enrolled in the Division-funded programs.
Ensure transition of the individual to an appropriate provider selected by the individual or designated by the Division.
Participate in the individual's transition process with the Division and the successor provider until such time that the individuals have successfully transitioned to the new service provider.
Terminations must be in writing on the Service Termination Approval Request (STAR) IL462-2028 form.

G. Utilization Management

The Provider shall have a formal, written utilization management procedure, designed to capture information about discrete supports and services being provided to individuals in relation to assessed needs and goals and outcomes achieved that are attributable to the provision of services. Information collected shall be available in a format that can be shared with the Division.

The Provider agrees that the optimal outcomes for individuals receiving services in vocational, developmental training, and supported employment programs are: a) that the individual becomes a worker who is compensated commensurately with the task either with or without a job coach; and b) is engaged in work that occurs in an integrated work setting in which non-disabled workers are also employed. The performance goal of the Provider is the movement of individuals into settings that fall within those parameters. The Provider agrees that the need for the job coach is inherent in learning a new job but may also be needed for support after the technical aspects of the job have been mastered and at times of transition. A satisfactory outcome might also include enrollment in a community senior center, becoming a volunteer, or having a part time job. The Provider shall establish outcome measures with consideration of Provider-specific factors, including local economy, preferences of individuals being served, and skill levels.

Performance outcome measures are also required of residential programs. The Provider must implement a procedure to evaluate the degree to which there is movement toward the goals established by and with individuals and documented in the Individual Service Plan.

H. Compliance with Life/Safety Standards and Requirements

The Provider shall comply with applicable state licensure requirements and local ordinances including but not limited to fire, building, zoning, sanitation, health, and safety requirements for each program facility.

I. Professional Service Requirements

A licensed physician (MD or DO) shall assume medical and legal responsibility for medical services offered in any program, including prescription of medications.
All professional services such as, but not limited to, nursing, physical therapy, occupational therapy, speech therapy, counseling, etc., must be provided by individuals licensed or certified to provide those services by the Illinois Department of Financial and Professional Regulations in accordance with the applicable practice acts. Professional behavioral services may also be provided by individuals certified or approved to provide those services in accordance with provider standards published by the Division.
All Qualified Intellectual Disabilities Professionals (QIDPs) employed by the Provider must receive 40 hours of basic training in a DHS-approved course if employed as a QIDP after October 1, 1999. The training program must be completed within six months of assuming responsibilities of a QIDP. Once training starts, the 40-hour QIDP training program cannot be completed in less than 21 calendar days, but must be completed within 120 calendar days, unless the approved training program is conducted by a community college or other educational institution on a term, semester or trimester schedule. Completing the Core Competency Area Checklist (CCAC) is considered part of the training.
All QIDPs employed by the Provider must receive 12 hours of DHS approved continuing education units each State of Illinois fiscal year (July 1- June 30) beginning in the state fiscal year following the one in which the initial 40-hour basic QIDP training is completed. (See Training Requirements Manual for details concerning continuing education requirements).
All QIDPs employed by the Provider must submit the QIDP Job and Educational Requirements Checklist A, along with a resume and education transcripts to the Division for review and approval. Upon review by the Division, all QIDP applicants meeting state and federal guidelines will be placed on the Division's QIDP database. It is the Provider's responsibility to ensure that all QIDPs receive the 40-hour DHS-approved QIDP training course within the required timeframe and the 12 hours of continuing education units each fiscal year. The Provider is required to maintain all training records for QIDPs who complete the 40-hour training program and continuing education units at the Provider's administrative office. This includes the QIDP Orientation Training Competency Area Checklist, the sign-in sheets verifying attendance in the classroom training and documentation of 12 hours of continuing education each fiscal year for each QIDP. The continuing education requirement excludes the state fiscal year in which the QIDP completed the initial 40 hours of training. Providers will be responsible for assessing the competency level of QIDPs with a gap in service of two or more years and provide and document retraining in identified skill gap areas, through the use of the Core Competency Area Checklist (CCAC).
All Direct Support Persons (DSPs) employed by the Provider (with the exception of respite workers, job coaches, secretaries and other support staff) must successfully complete 120 hours of training (40 hours classroom and 80 hours on-the-job) in a DHS-approved course within 120 calendar days of starting to work as a DSP. DSP training records must be submitted to as specified in the DSP Illinois Health Care Worker Registry Packet Instruction Manual within 30 calendar days of successfully completing DSP training. Training information will be scanned and electronically transferred to the Illinois Department of Public Health (IDPH) so the DSP training record can be added to the Health Care Worker Registry. This transfer will occur within 30 calendar days of submitting DSP training records. Important: It is the responsibility of each Provider to check the Health Care Worker Registry after DSP training is reported to ensure that its trained DSPs are designated as a "DD Aide" under "Programs" on the Health Care Worker Registry. DSPs cannot work alone to support persons with Developmental Disabilities until they are designated as a "DD Aide" on the Health Care Worker Registry. If the "DD Aide" designation does not appear on the Health Care Worker Registry within 30 calendar days of submitting DSP training records, it is the responsibility of the Provider to work directly with IDPH's Health Care Worker Registry staff to determine the reason(s) why the employee's name is not appearing on Registry and provide the necessary information or documentation to IDPH to allow for the posting of the "DD Aide" designation for the employee in question.
The DSP training program must be presented in a minimum time frame of 21 calendar days but cannot exceed 120 calendar days from the date of hire as a DSP, unless the approved training program is conducted by a community college or other educational institution on a term, semester, or trimester schedule. The Provider is required to maintain all training records for DSPs who complete the 120-hour training program at the Provider's administrative office. This includes the DSP Training Program Competency Area Checklist, sign-in sheets verifying attendance in the classroom training, and all On-the-Job Training Activities (OJTs) and Competency-Based Training Assessments (CBTAs). The original Test of Adult Basic Education (TABE) test score sheet (or other recognized test of functional literacy, such as the Adult Basic Literacy Examination (ABLE) or Comprehensive Adult Student Assessment System (CASAS), test score sheet) is required to be maintained in the personnel records of DSPs who are administering medications. The original TABE, ABLE or CASAS test score sheet must be properly completed and document that the DSP has a reading score at least at the eighth-grade level. If the online TABE is used, the Department accepts TABE reading level scores printed off the McGraw-Hill website if accompanied by a signed statement from the person proctoring the online test attesting that the testee was verified to be the person who actually completed the online test for whom the test score is printed. The signed statement should also identify the Procter's position in the organization from which the testee is employed, if any, or the Procter's relationship to the organization, such as private contractor, etc.
Direct Support Persons (DSPs) employed by the Provider who are to be authorized to administer medications in settings of 16 or fewer individuals that are funded or licensed by the Department of Human Services must have successfully completed all required Basic Health and Safety components of DSP training before starting any medication training classes.
1. To become authorized to administer medications, a DSP must successfully complete a medication administration training program specified by the DHS and taught by an RN Nurse-Trainer (a registered professional nurse or advanced practice nurse who has successfully completed the Department's RN Nurse-Trainer medication administration training program). This DSP training must consist of at least 8 hours of classroom training and completion of Competency-Based Training that assures the ability of the authorized DSP to safely administer medications under the supervision of the RN Nurse Trainer. The Provider is required to maintain dated training records for all authorized DSPs who complete this medication administration training program. Records must be maintained at the Provider's administrative office, be readily available and include: sign in/sign out class roster with DSP's signatures verifying all necessary pre-authorization classroom training and Competency-Based Training Assessments (CBTAs), and all annual and as necessary training and retraining to assure competency in medication administration for every individual to whom she/he is to administer medications.
2. To become authorized to inject insulin via an insulin pen, as delegated by a RN-Trainer, an ADSP must complete the Diabetes and Insulin Advanced Training Curriculum furnished by DHS and taught by a RN-Trainer. This ADSP advanced training must consist of classroom and On-the-Job training, successful completion of a written exam furnished by DHS with a score of 80% or above and demonstration of 100% competency under the direct observation and supervision of the RN-Trainer, as documented by Competency Based Training Assessment(CBTA) specific to administering insulin injections via insulin pen.
3. To become authorized to care for and use Enteral Tubes, as delegated by a RN-Trainer, an ADSP must complete the Advanced Enteral Tubes Advanced Training Curriculum furnished by DHS and taught by a RN-Trainer. This ADSP advanced training must consist of classroom and On-the-Job training, successful completion of written exam furnished by DHS with a score of 80% or above and demonstration of 100% competency under the direct observation and supervision of the RN-Trainer, as documented by Competency Based Training Assessments (CBTAs) specific to the care and maintenance of enteral tubes and administering nutrition and/or medication via enteral tubes.
Following the initial training, DSPs must maintain CPR and First Aid Certification or hold current certification as an Emergency Medical Technician (EMT) in order to work unsupervised or administer medications.

J. Behavior Management and Human Rights Review

The Provider (excluding ISC providers) shall establish or ensure a process for the periodic review of behavior intervention and human rights issues involved in the individual's treatment and/or habilitation. Providers required to have behavior intervention and human rights review policies and procedures under licensure or certification standards shall continue to comply with those standards.

Service providers are required to obtain approval for any Restrictive interventions by the Behavior Intervention Committee and the Human Rights Committee prior to implementation of such interventions and/or restrictions.

K. Provider Responsibility with regard to Independent Service Coordination

The Provider (excluding ISC providers) shall allow ISC Providers (under contract with the Department) and their staff access to sites and records and individuals served. ISC staff shall interview and observe individuals, guardians, and Provider staff on site and review records pertaining to individuals and their outcomes.

L. Support Services Teams (SST) and Short-Term Stabilization Home Vendors (SSH)

The Division may contract with qualified vendors for Support Services Teams. These vendors are charged with assembling interdisciplinary teams of behavioral, medical, and other professionals within the developmental disabilities field that will be required to deliver, upon referral from the Division, coordinated services and supports. These services will be provided to individuals with developmental disabilities who are experiencing acute behavioral and/or medical conditions that result in chronic distress, despite previous attempts to address issues, which without intervention, could lead to displacement from current living environments. The ISC and Provider must work collaboratively with these teams to ensure the best outcomes for the individuals served. The ISC and Provider must be responsive to contacts and requests from the teams, actively participate in their consultation activities, and stand receptive to their recommendations and services.

In addition, the Division may contract with qualified vendors for Short-Term Stabilization Homes. These homes will provide 24-hour supports to individuals with extraordinary behavioral needs who require stabilization services outside of their current living arrangement. The ISC and provider must work collaboratively with the vendors of SSH services to ensure the best outcomes for the individuals served. The ISC and Provider must be responsive to contacts and requests from the homes, actively participate in their consultation and planning activities, and stand receptive to SSH recommendations and services with the goal of individuals returning to their previous living arrangements whenever possible or successfully transitioning to alternative services if necessary.

M. Abuse, Neglect, Exploitation, and Death Reporting and Investigation

The Provider shall develop and implement a written policy and process for handling and reporting incidents of alleged abuse, alleged neglect, alleged exploitation, recipient death and certain other incidents to the DHS Office of the Inspector General (OIG), DHS, DPH, Department on Aging (DOA Adult Protective Services Act), and DCFS in accordance with DHS Rule 59 Ill. Adm. Code 50, DCFS Rule 89 Ill. Adm. Code 331, and Department on Aging Rule 30 Ill. Adm. Code 20, and other applicable standards, rules and laws. The policy shall include definitions of abuse and neglect, screening prohibition, timeframes for reporting, preservation of evidence, and notification of parents and guardians. The Provider shall fully cooperate in investigations of alleged abuse or neglect or death conducted in accordance with applicable standards, rules, and laws. Each provider shall ensure that all staff is trained to recognize possible abuse and neglect of individuals and to report to the appropriate investigatory authority and respond to allegations of abuse and neglect.

N. Abuse, Neglect and Exploitation Training

The Provider shall ensure employees are trained in the area of abuse, neglect, and exploitation as follows:

The Provider, if serving adults ages 18 and older in Division-funded or licensed/certified residential and day program services, shall ensure that all employees successfully complete DHS OIG approved 59 Ill. Adm. Code 50 training at the time of hire (before the employee assumes any regular duties or responsibilities of the position) and a biennial (every two years) refresher training course approved by DHS OIG pursuant to Rule 50.20 (d)(2).
The Provider, if serving children and adolescents in Child Group Homes, Child Care Institutions, and the Children's Home-Based Support Program, must ensure all employees are trained at the time of hire (before the employee assumes any regular duties or responsibilities of the position) and biennially (every two years) about reporting requirements for DCFS.
The Provider, if serving adults ages 18 and older who live in non-licensed/certified domestic settings (e.g., an individual's family home) must ensure all employees are trained at the time of hire (before the employee assume any regular duties or responsibilities of the position) and biennially (every two years) regarding Adult Protective Services as referenced in M. above.
ISC Providers must ensure all employees successfully complete DHS OIG approved 59 Ill. Adm. Code 50 training at the time of hire (before the employee assumes any regular duties or responsibilities of the position) and a biennial (every two years) refresher training course approved by DHS OIG pursuant to Rule 50.20 (d)(2); are trained at the time of hire (before the employee assumes any regular duties or responsibilities of the position) and biennially (every two years) about reporting requirements for DCFS; and are trained at the time of hire (before the employee assumes any regular duties or responsibilities of the position) and biennially (every two years) regarding Adult Protective Services as reference in M. above.

O. Reporting to the Illinois Department of Financial and Professional Regulation and the National Practitioners Data Bank

It is the policy of the Division that all requirements pertaining to the reporting of licensed health care practitioners to the Illinois Department of Financial and Professional Regulation (DFPR) and the National Practitioners Data Bank be followed. Provider shall make such reports when and to the extent required by law.
Provider shall endeavor to reinforce the responsibility of health care practitioners to report appropriate matters to DFPR by such actions as it deems reasonably necessary, including posting notice that individual practitioners shall comply with applicable licensing and reporting requirements.

P. Critical Incident Reporting

Using electronic reporting mechanisms specified by the Division, the provider must report critical incidents as defined by the Division within the time frames required by the Division. The reports will include complete and accurate information such as the type of incident, description of the incident, date and time of the incident, participants involved, staff involved, and actions taken by the provider.

The Provider must have a formalized ongoing systemic review process at least quarterly for evaluating all injuries, including those not definable as abuse and neglect, deaths and other adverse events within the Provider. The review processes shall include, but are not limited to:

Examining the circumstances and data to determine how and why the injury or other adverse event occurred, including determining all related processes and systems;
Identifying risk points and their potential contribution to the event, such as evaluating the appropriateness of the individual's service plan and level of supervision;
Identifying, communicating, documenting, implementing and evaluating improvements in processes, systems, or treatment to prevent future such injury or other adverse events, including specifying:
1. The staff responsible for implementation;
2. When the actions will be implemented; and
3. How the effectiveness of the action will be evaluated.

Q. Participation of Individuals with Developmental Disabilities and Their Families

The Provider shall have policies and practices that reflect formal mechanisms which ensure the participation of individuals with developmental disabilities and their families in the planning, development, delivery, and evaluation of services.

Developmental Disabilities CSA Attachment A

Table of Contents

I. Introduction

II. Applicable Statutes, Rules and Guidelines

A. Federal

B. State Statutes

C. State Rules

D. Guidelines

III. Program Services

A. Program Requirements for Community-Integrated Living Arrangement (CILA) Providers

B. Program Requirements for Independent Service Coordination (ISC) Agencies

C. Program Requirements for Children's Group Home (CGH) Providers

D. Program Requirements for Community Living Facility Providers (CLF)

E. Program Requirements for Providers Providing Personal Support

F. Program Requirements for Providers Providing Supported Employment

G. Program Requirements for Providers Providing Community Day Services (CDS) (Formerly Developmental Training (DT))

H. Self-Direction Assistance (SDA)

I. Program Roster

IV. Program Plan and Deliverables

A. Agency Program Report/Narrative

V. Payment

A. Types of Funding

1. Grant Programs (GIA)

2. Fee-For-Service (FFS)

B. Debt Service Deduction

VI. Eligibility Criteria

A. Individual Eligibility

B. Eligibility Residential Programs

C. Selection Criteria and Priority Populations

D. Adult Residential

E. Children's Residential Services

F. Adult Support Services

G. Children's Support Services

VII. Reporting Requirements

A. Centralized Repository Vault (CRV)

B. Service Reporting for Grant Programs

C. Data

D. Financial Reporting Requirements

E. Provider Contact Information

VIII. Special Conditions

A. Registry and Criminal Background Checks

1. Health Care Worker Registry

2. Adult Protective Services Registry

3. DCFS State Central Register/Child Abuse and Neglect Tracking System (CANTS)

4. Illinois Sex Offender Registry

5. Health Care Worker Background Check Act and the Abused and Neglected Child Reporting Act

6. Illinois Department of Healthcare and Family Services (HFS) Sanctions List

B. Mandatory Meetings & Training

C. Representative Payee Status

D. Monitoring

E. Sanctions

F. Provider Responsibility Upon Termination of Services

G. Utilization Management

H. Compliance with Life/Safety Standards and Requirements

I. Professional Service Requirements

J. Behavior Management and Human Rights Review

K. Provider Responsibility with regard to Independent Service Coordination

L. Support Services Teams (SST) and Short-Term Stabilization Home Vendors (SSH)

M. Abuse, Neglect, Exploitation, and Death Reporting and Investigation

N. Abuse, Neglect and Exploitation Training

O. Reporting to the Illinois Department of Financial and Professional Regulation and the National Practitioners Data Bank

P. Critical Incident Reporting

Q. Participation of Individuals with Developmental Disabilities and Their Families