Illinois Department of Human Services
Division of Developmental Disabilities
This information Bulletin is to provide guidance on the remote provision of Individual Service and Support Advocacy (ISSA) monitoring activities authorized in the Emergency Preparedness and Response Appendix K.
Independent Service Coordination (ISC) Agencies are required to provide ISSA monitoring activities to individuals who are enrolled in a DD Medicaid Waiver program. Monitoring activities are provided to ensure the health, safety and welfare of each participant as well as to facilitate the Person Centered Planning process. Activities are categorized as 1) minimum required annual visits, 2) additional monitoring visits, and 3) other ISSA monitoring activities.
ISC agency staff conduct two minimum required visits per each fiscal year: one visit to update the Discovery Tool and Personal Plan and another to assess the individual's satisfaction with the outcomes and services as well as to monitor their wellbeing. Separate from the minimum required visits, the ISC conducts additional monitoring visits any time there are significant issues or emergencies with the person receiving waiver services. Prior to the Public Health Emergency and initial shelter in place order, the above mentioned visits were required to be face to face.
The ISC agency can also perform other ISSA monitoring activities, as needed. This 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.
In March of this year, the Division suspended all ISC in-home visits due to COVID-19 and the shelter in place order. Through the Emergency Preparedness and Response Appendix (Appendix K) the Division was able to allow ISCs to provide monitoring, as well as the creation of the Discovery and Personal Planning process, remotely. This Information Bulletin seeks to clarify the remote provision of these activities.
It is expected that ISCs continue to monitor the health, safety and welfare of individuals as well as provide timely and updated Personal Plans during the pandemic.
- The number of ISSA monitoring activities should continue to be conducted based on the person's needs.
- It is preferred that ISCs conduct all monitoring activities through video-teleconference Use of video-teleconference software can include Microsoft's Skype, Adobe's Connect, Google's Hangout or Classroom, WebEx, Go-to-Meeting, Zoom, etc.
- If the use of video-teleconference poses a significant issue for an individual, family or provider, monitoring can be completed through phone calls and as a last resort, other forms of electronic communications.
- Provider agencies are responsible for supporting the individual to participate in video-teleconference communication by providing privacy, as needed or requested, and the necessary equipment in each home. When this is not available in a residential agency or private home, phones or other electronic devices should be made available to the person.
- Until instructed otherwise, ISCs must continue to conduct the minimum required ISSA contacts: one to update the Discovery Tool/Personal Plan and the other to assess the individual and guardian's wellbeing and satisfaction with services. These must be completed in the required time frames and documented as outlined in Section 9.2 of the ISC Manual.
- If there are significant issues or emergencies with the person receiving waiver services the ISC must still ensure the health and safety of the individual. Significant issues or emergencies include, but are not limited to:
- Police involvement [with or without court action]
- Investigative findings of egregious neglect, abuse, and/or exploitation
- Status after a hospitalization
- Significant life changes/transitions
- Significant behavioral issues/concerns that could change the individual's Personal Plan or Implementation Strategy
- Significant medical issues/concerns
- Death of family or close supports that have a potential to adversely affect the individual's services and/or supports
- Changes in level of care needs within the Waiver
- Guardian's interests conflict with the person's desires that adversely affect the individual's services and/or supports
- Unresolved individual/guardian issues and concerns that adversely affect the individual's services and/or supports
- Other situations which create concerns related to health, well-being, and service provision
- Danger of losing current placement
- Involvement of Service and Support Teams (SST), Short-term Stabilization Homes (SSH), and/or Clinical and Administrative Review Team (CART)
Documentation of these situations should include confirmation that the events related to the circumstance no longer present a risk to the individual.
- In some occasions, the ISC may need to conduct an in-person visit with the person served, especially if it is related to a resolved or unresolved significant issue as defined above. In-person visits should be used only when necessary and may include situations where the ISC suspects abuse or neglect, or where a health and welfare check is needed. It may also be warranted in situations where an individual, family or provider refuses a video engagement and the ISC believes they must see the individual. When an in-person visit is necessary, the ISC should take the following precautions:
- ISCs must wear face masks any time they are meeting face to face with individuals served, their family/guardians or residential/day program staff per the Governor's Restore Illinois Plan.
- If appropriate to the situation, visits should be made outside of the person's home/residential setting. The ISC should agree to meet the individual in the community (i.e. park, outdoor restaurant, person's yard, etc.).
- If the ISC must visit a person in their home (residential setting or private residence), the ISC must participate in a COVID screening if required by the family or provider agency. A screen is a series of questions designed to determine a person's risk for illness.
- ISCs should not visit a home (residential setting or private residence) where there are individuals who are COVID-19 positive.
ISC agency staff should use the ISC Individual Monitoring and Interview Notes [IL462-4465] to document most monitoring activities. All sections of the Monitoring Note may not be relevant when conducting monitoring activities. The updated Discovery Tool and Personal Plan will continue to serve as documentation for one of the minimum required contacts, ISCs are not required to complete a Monitoring Note also. All monitoring activities must be conducted within the time frames outlined in the Independent Service Coordination Manual, 9.2 ISSA Monitoring Activities.