Draft Rule 119 5.17.21

Word Version (docx)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 119

MINIMUM STANDARDS FOR CERTIFICATION OF

DAY PROGRAMS

SUBPART A: GENERAL PROVISIONS

Section

  1. 100 Purpose
  2. 110 Incorporation by reference
  3. 120 Definitions

SUBPART B: PROGRAM REQUIREMENTS FOR CERTIFIED DAY PROGRAMS

Section

  1. 200 General requirements
  2. 205 Criteria for participation
  3. 210 Exclusion, suspension or discharge of an individual (Repealed)
  4. 215 Program staff
  5. 220 Interdisciplinary team (team) (Repealed)
  6. 225 Assessment of individuals (Repealed)
  7. 230 Individual services plan (plan) (Repealed)
  8. 232 Work activities (Repealed)
  9. 235 Individual rights and confidentiality
  10. 240 Positive behavior supports
  11. 245 Committees
  12. 250 Medications and medical care
  13. 255 Environmental management
  14. 260 Administrative requirements
  15. 261 Application for waiver of the prohibition against employment
  16. 270 Accreditation (Repealed)

SUBPART C: CERTIFICATION REQUIREMENTS

Section

  1. 300 Issuing a certificate and period of certification
  2. 305 Certification Renewal
  3. 310 Application acceptance and verification
  4. 315 Non-transferability of a certificate
  5. 320 Cessation of operations
  6. 325 Certificate denial
  7. 330 Hearings

SUBPART D: PROGRAM REQUIREMENTS FOR SERVING INDIVIDUALS WHO RESIDE IN AN ICF/DD, MC/DD, OR SODC

Section

  1. 400 General Requirements for Serving Individuals who reside in an ICF/DD, MC/DD or SODC
  2. 410 Criteria for participation in Developmental Training
  3. 420 Individual Service Plan
  4. 430 Individuals requiring additional services and support in Developmental Training
  5. 440 Criteria for termination, suspension or reduction of Developmental Training services

SUBPART E: PROGRAM REQUIREMENTS FOR SERVING INDIVIDUALS ENROLLED IN A HCBS WAIVER

Section

  1. 500 General requirements for serving individuals enrolled in a HCBS Waiver
  2. 510 Criteria for participation in Community Day Services
  3. 520 Person Centered Planning
  4. 530 Individuals requiring additional services and support in Community Day Services
  5. 540 Criteria for termination, suspension, or reduction of Community Day Services

AUTHORITY: Implementing Section 15.2 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15.2] and the Health Care Worker Background Check Act [225 ILCS 46] and authorized by Section 15.2 of the Mental Health and Developmental Disabilities Administrative Act.

SOURCE: Adopted at 14 Ill. Reg. 17227, effective October 9, 1990; emergency amendment at 16 Ill. Reg. 2662, effective February 1, 1992, for a maximum of 150 days; emergency expired June 30, 1992; amended at 21 Ill. Reg. 2195, effective February 1, 1997; amended at 21 Ill. Reg. 6067, effective May 5, 1997; amended at 21 Ill. Reg. 8297, effective June 25, 1997; recodified from the Department of Mental Health and Developmental Disabilities to the Department of Human Services at 21 Ill. Reg. 9321; amended at 22 Ill. Reg. 7978, effective April 27, 1998; amended at 22 Ill. Reg. 16244, effective August 27, 1998; amended at 23 Ill. Reg. 190, effective December 15, 1998; emergency amendment at 23 Ill. Reg. 4503, effective April 1, 1999, for a maximum of 150 days; amended at 23 Ill. Reg. 10211, effective August 23, 1999; amended at 45 Ill. Reg. _________, effective ____________.

SUBPART A: GENERAL PROVISIONS

Section 119.100 Purpose

a) Certified day programs shall promote independence, personal growth, community participation and integration, economic growth potential and education experiences through a variety of experiences meaningful to the individual and consistent with the individual's choices as reflected in their Individual Service/Personal Plan.

b) Certified day programs shall serve adults 18 years of age or older who have a developmental disability and documented desire or need of day program services. If a provider does not have the capacity to accommodate the individual's particular type or level of disability, this does not render the individual ineligible for participation in a certified day program.

c) Subparts A, B, C and D of this Part apply to programs serving individuals residing in an ICF/DD, MC/DD or State Operated Developmental Center (SODC); Subparts A, B, C and E of this Part apply to programs serving individuals who are enrolled in a HCBS waiver program.

d) Agencies planning to develop and provide certified day program services must do so pursuant to Department's certification in accordance with this Part.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.120 Definitions

For the purposes of this Part, the following terms are defined:

 "Abuse." See definition of abuse in 59 Ill. Adm. Code 50.10. "Act." The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

 "Adaptive behavior." The effectiveness or degree with which the individual approaches the standards of personal independence and social responsibility expected of the individual's age and cultural group as measured by adaptive behavior scales such as the Inventory for Client and Agency Planning (ICAP) (DLM Teaching Resources, One DLM Park, Allen, Texas 75002, 1986) and Scales of Independent Behavior (SIB) (DLM Teaching Resources, One DLM Park, Allen, Texas 75002, 1985).

 "Authorized agency representative." A person who has responsibility for the program's administration including its content and fiscal affairs.

 "Aversive procedures." The application of unpleasant or painful stimuli or stimuli that have a potentially noxious effect, contingent on the exhibition of a specific behavior that is not adaptive. Aversive procedures are prohibited.

"BALC." The Department's Bureau of Accreditation, Licensure and Certification.

 "Behavior management." Efforts to increase adaptive behaviors and to modify problem behaviors or behaviors that are not adaptive and replace them with behaviors and skills that are adaptive and socially productive.

"Behavior Support Strategy." See Individualized Behavioral Support Plan per the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15f].

 "Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Coercion." When an individual, guardian, or family member is compelled by force, intimidation, or threat to act or to fail to act in a manner contrary to how that person would have acted if permitted to act in accordance with his or her free and informed choice. Coercion is prohibited.

"Community Integration" or "integration into the community". Ongoing participation in community life. For individuals in a HCBS Waiver, per 42 CFR 441.301(c)(4)(i), based on the needs of the individual as indicated in their Personal Plan, the State must ensure that the setting chosen by the individual is integrated in, and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving Medicaid HCBS. Examples of on-going participation in community life for individuals with developmental disabilities include:

Time spent out of the living arrangement participating in non-disability specific activities chosen by the individual and guardian, if applicable, that are available to the greater community, such as spiritual and cultural interest, YMCA, YWCA, education, library, clubs, shopping and amusements.

Participation in family activities and celebrations (such as holidays, birthdays, reunions), communication (wireless, electronic and mail) and vacations.

"Critical Incidents." Any alleged, suspected, or actual occurrence of an incident when there is reason to believe the health or safety of an individual may be adversely affected or an individual may be placed at a reasonable risk of harm. Critical incidents for this Part shall include abuse, neglect, and exploitation as defined in 59 Ill. Adm. Code 50. Critical Incidents shall also include deaths not otherwise reportable pursuant to 59 Ill. Adm. Code 50, injuries of known or unknown origin, medical emergencies, unscheduled hospitalizations, unauthorized restraint, missing individuals, peer-to-peer or peer-to-staff acts of aggression, and involvement of law enforcement and/or fire department.

 "Day." A calendar day, unless otherwise indicated.

 "Department" or "DHS." The Department of Human Services.

"Developmental disability." A disability which is attributable to an intellectual disability or a related condition (such as cerebral palsy, epilepsy, autism or any other condition which results in an impairment similar to an intellectual disability and which requires services similar to those required by individuals with an intellectual disability). A related condition must originate before the age of 22, be expected to continue indefinitely, and result in substantial limitations in at least three major life activities areas [405 ILCS 5/1-106].

 "Discharge." The full release of an individual from a program.

"Division of Developmental Disabilities" or "DDD." The Department of Human Services' Division of Developmental Disabilities.

 "Equivalency." Evidence to substantiate compliance with requirements of this Part by means other than indicated in this Part.

 "Exclusion." Preventing an individual's entrance or continuation in a program due to the individual's disability, medical condition, or maladaptive behavior, or due to lack of space in the day program.

 "Family." The individual's spouse; children, mother, father, sister and brother (biological, step, or adopted).

"Financial Exploitation." See definition of financial exploitation in 59 Ill. Adm. Code 50.10

 "Full compliance." A survey finding that a program has no identified deficiencies with the standards in this Part.

 "Guardian." The plenary or limited guardian or conservator of the individual appointed by the court for an individual over age 18 so long as the limited guardian's duties encompass concerns related to service requirements, or the natural or adoptive parent of a minor or a person acting as a parent of a minor.

"Home and Community Based Services (HCBS)." Provides opportunities for Medicaid beneficiaries to receive services in their own home or community under 42 U.S.C. 1396n, Sec. 1915.

 "Imminent risk." A preliminary determination made by BALC of immediate, threatened or impending risk of illness, mental injury or physical injury to an individual as would cause a reasonably prudent person to take immediate action and that is not immediately correctable, such as environmental or safety hazards.

"Implementation Strategy." A document developed by the certified Community Day Service provider that describes and directs the activities and methods used to provide DD Medicaid HCBS Waiver services and supports. The individual's priorities, strengths, support needs, and risk factors identified in the Personal Plan must be addressed and accounted for in the Implementation Strategy for those areas of the Community Day Services provider's responsibility. The document must describe how the CDS agency will support the person to pursue the outcomes included in the Personal Plan and be approved by the individual and guardian, if applicable.

"Independent service coordination (ISC) agency." A contracted entity designated by DDD to carry out certain federal and State requirements related to assessment, determination of eligibility and service coordination for individuals with a developmental disability. This entity provides conflict of interest free case management, including development and monitoring of an individual's Personal Plan, to DD Medicaid HCBS Waiver participants. They also serve as the front line for information and assistance to help individuals and families navigate the system, ensure informed choice, link individuals to services and address problems related to outcomes and quality.

 "Individual." A person who is applying for or receiving services in a certified day program.

 "Individual record" or "record." Materials kept chronologically by a program in the course of providing services to an individual.

 "Individual services plan." Written details of the supports, activities, and resources required for individuals who reside in an ICF/DD, MC/DD or SODC to achieve personal goals. This Plan is developed by the Interdisciplinary Team/residential provider and articulates decisions and agreements made during a person-centered process of planning and information gathering

 "Informed consent." Permission freely granted by the individual or guardian based on full disclosure to the individual or guardian of the benefits and/or liabilities of participation in specific procedures and/or services, including the releases of information, as part of the individual's Individual Service/Personal Plan and Implementation Strategy.

"Intellectual disability." General intellectual functioning with an intelligence quotient (IQ) of 70 or below, on standardized measures of intelligence, accompanied by significant limitations in adaptive functioning. The onset must occur before the age of 18 years.

"Intermediate Care Facility for Individuals with a Developmental Disability" or "ICF/DD." As defined by 42 CFR 440.150 (2015) serving individuals with developmental disabilities. ICF/DD includes community facilities certified by the Department of Healthcare and Family Services as State Operated Developmental Centers (SODC); Medically Complex for the Developmentally Disabled (77 Ill. Adm. Code 390) (if licensed as MC/DD) and Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) (77 Ill. Adm. Code 350).

See definition in 210 ILCS 47.

 "Interdisciplinary ." A group, coordinate by the ICF/DD, MC/DD, or SODC that provides residential services to the person, consisting of at least the individual, parents (except when a non-legally disabled individual or a legally disabled individual's guardian does not desire them to participate), the guardian, as well as representatives of disciplines and services necessary to identify the individual's needs and to design services and alternatives to meet them. At least one member of the team shall be a qualified intellectual disability professional.

 "Maladaptive behavior." Behavior by an individual that disrupts or prevents the individual or others from participating in program services; or that poses a danger to the individual or others, including but not limited to destruction of property. Maladaptive behavior that reflects an ongoing pattern and/or poses a risk to the individual or others, including risk of continued participation in Community Day Services, should be reflected in the individual's Individual Service Plan or the Personal Plan and Implementation Strategy, as applicable.

"Medically Complex Facilities for Persons with Developmental Disabilities" or "MC/DD". See definition in 210 ILCS 46.

"Monthly summary." Narrative chronological documentation in an individual's record of service provided and its relationship to the Individual Service Plan or the Personal Plan and Implementation Strategy, as applicable.

 "Neglect." Failure to provide adequate medical or personal care or maintenance to an individual which results in physical or mental injury or in the deterioration of an individual's physical or mental condition. (405 ILCS 5/1-117.1).

 "Notice of violation." A report submitted to a provider agency by BALC listing the provider's deficiencies with this Part noted during a survey, a health check, OIG investigation, etc.

"Personal Plan." A written document developed by an ISC agency in conjunction with the individual and guardian, if applicable, as well as family members, providers of services and others (e.g. friends, individual's representatives) as chosen by the individual and guardian, if applicable, that includes an assessment of the individual's strengths, preferences, needs, and desired outcomes. The document describes what is important to the individual, who will or is receiving HCBS Waiver services, regarding delivery of services in a manner which ensures both personal preferences and health and welfare, including risk factors and means to minimize them. It includes the services that are to be furnished to the individual, the amount and frequency of each service, and the type of provider to furnish each service.

"Physical intervention." The use of barriers (e.g. locked doors), materials or equipment to restrict or prevent movement (e.g. the use of arm splints).

 "Plan of correction." A written plan submitted by a provider agency to BALC in response to a notice of violation, which describes the steps the provider will take in order to bring the program or services into compliance and the time-frames for completion of each step.

 "Program." Services provided in non-residential facilities to adults who have a developmental disability and require training in self-help, community living skills, social and leisure skills, communication or productive work.

 "Provider" or "agency." A sole proprietorship, association, partnership, corporation or organization, public or private, either for profit or not-for-profit, which is certified by the Department to operate a day program.

"Provider Support Team." A team from the Community Day Service provider consisting at a minimum of the QIDP, and a DSP, both who directly serve an individual.

 "Qualified Intellectual Disabilities Professional (QIDP)." A QIDP must have at least one year of experience working directly with individuals with intellectual disabilities or other developmental disabilities and be one of the following:

 A doctor of medicine or osteopathy licensed pursuant to the Medical Practice Act of 1987 [225 ILCS 60];

 A registered nurse licensed pursuant to the Illinois Nurse Practice Act of 1987 [225 ILCS 65];

 An occupational therapist or occupational therapist assistant certified by the American Occupational Therapy Association or other comparable body (Illinois Occupational Therapy Practice Act [225 ILCS 75]);

 A physical therapist certified by the American Physical Therapy Association or other comparable body (Illinois Physical Therapy Act [225 ILCS 90]);

 A physical therapist assistant registered by the American Physical Therapy Association or a graduate of a two-year college-level program approved by the American Physical Therapy Association or comparable body;

 A psychologist with at least a master's degree in psychology from an accredited school (Clinical Psychologist Licensing Act [225 ILCS 15]);

 A social worker with a bachelor's degree from a college or university or graduate degree from a school of social work accredited or approved by the Council on Social Work Education or another comparable body (the Clinical Social Work and Social Work Practice Act [225 ILCS 20]);

 A speech-language pathologist or audiologist with a certificate of Clinical Competence in Speech-Language Pathology or Audiology granted by the American Speech Language Hearing Association or comparable body or meet the education requirements for licensure and be in the process of accumulating the supervised experience required for licensure (the Illinois Speech-Language Pathology and Audiology Practice Act [225 ILCS 110]);

 A professional recreation staff person with a bachelor's degree in recreation or in a specialty area such as art, dance, music or physical therapy;

 A professional dietician registered by the American Dietetic Association; or

 A human services professional with a bachelor's degree in a human services field, including, but not limited to sociology, special education, rehabilitation counseling or psychology.

 "Quality assurance." A systematic and objective approach to monitoring and evaluating the appropriateness, adequacy and quality of services and supports that enable individuals with a developmental disability to achieve defined outcomes in their lives.

 "Restraint." The direct restriction through mechanical means or personal physical force of the limbs, head or body of an individual except as part of a medically prescribed procedure for the treatment of an existing physical disorder or the amelioration of a physical disability; restraint is prohibited. The partial or total immobilization of an individual for the purpose of performing a medical or surgical procedure shall not constitute restraint. [405 ILCS 5/1-125]

 "Seclusion." Sequestration by placement of an individual alone in a room from which he or she has no means of leaving; seclusion is prohibited. [405 ILCS 5/1-125]

 "Secretary." The Secretary of the Department of Human Services or his or her designee.

 "Self-administration of medications." An individual's ability to correctly take prescribed medications independently or with verbal prompts when the individual has a mental illness or, if the individual has a developmental disability, has been assessed and determined to be independent with the Department approved self-administration of medication tool, in accordance with 59 Ill. Adm. Code 116.

 "Skills training." Activities that focus on the development of daily living skills which enable individuals to achieve independent functioning.

 "Substantial compliance." An evaluation result that determines that a surveyed program meets the requirements set forth in this Part sufficiently to be at a Level 1 or 2 , as described in Section 119.300, and is in good standing.

"Supported Relocation." If an individual's behavior poses a risk to himself or herself or others and/or if his or her behavior is communicating distress, staff may assist the individual to remove himself or herself from a situation, environment or the proximity to another person to ensure the safety and well-being of all present. Distress may be communicated verbally, behaviorally or may be known based on history. Supported Relocation is intended to help the individual regain a sense of calm and is not to be used as punishment or for the convenience of employees or volunteers. The relocation area should be chosen by the individual whenever possible, i.e. a quiet area away from the source of distress. Staff will remain with the individual if he or she demonstrates this is helpful. The duration of the relocation shall not exceed 30 minutes and at no time will the individual be left alone in a room from which he or she cannot exit. The person may leave the relocation area any time he or she chooses. Staff will monitor the individual if he or she chooses to not have staff present. Staff should assist the individual as outlined in the behavior support strategy; at no time should staff use time-out, restraint or seclusion.

 "Survey." A BALC process to determine the degree of compliance with this Part that a certified day program has maintained. This includes surveyor observation and an on-site desk audit, remote or virtual examination of the following: policies, procedures, records of individuals, written Individual Service Plans or Personal Plan/Implementation Strategy, and the physical plant. Interviews of individuals, guardians, and staff are also a part of the survey.

 "Suspension." The conditional release of an individual from a program.

 "Time-out." Removing an individual from a situation that affords positive reinforcement to an area where reinforcement is not available; time-out is prohibited.

 "Waiver." An action by BALC in which exceptions to this Part are granted on application by a provider for a period not to exceed the duration of the current certificate.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

SUBPART B: PROGRAM REQUIREMENTS FOR CERTIFIED DAY PROGRAMS

Section 119.200 General requirements

a) Certified day program services shall occur in the least restrictive setting possible as appropriate to the individual and as indicated in their Individual Service Plan or Personal Plan. Providers shall have the option to provide site and/or community-based programs.

b) Certified day program services shall be available a minimum of five hours per day, excluding transportation time to and from the service location, and excluding mealtime. Individuals may attend less than 5 hours based on their needs and desires outlined in their Individual Service Plan or Personal Plan.

c) No individual shall be transported to a certified site in a one-way trip that exceeds one hour, excluding chosen community activities. The provider may request waiver from BALC for a one-way trip that exceeds one hour.

d) Coordination and cost of transportation required for individuals shall be the responsibility of the day program provider except as described in Sections 119.400(d) and 119.500(g).

e) An individual shall not receive certified day program services in a building in which the individual resides, except where allowed under Section 119.400(e).

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.205 Criteria for participation

a) An individual receiving certified day program services shall be at least 18 years of age, have a developmental disability and documented desire or need of day program services. If a provider does not have the capacity to accommodate the individual's particular type or level of disability, this does not render the individual ineligible for services.

b) The individual or guardian, if applicable, shall give informed consent to participate in day program services, which shall be documented in the individual's record.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.210 Exclusion, suspension or discharge of an individual (Repealed)

(Source: Repealed at 45 Ill. Reg. _________, effective ____________)

Section 119.215 Program staff

a) The certified day program provider shall designate at least one QIDP whose minimum level of education and experience includes an undergraduate degree in special education or a related human service field as specified in the definition of QIDP.

b) The provider shall designate day program Direct Support Persons (DSP) whose minimum level of education includes a high school diploma or general equivalency diploma (G.E.D.). A day program DSP shall address the individual's needs as identified in the Individual Service Plan or Personal Plan and Implementation Strategy under the professional oversight of the day program QIDP.

c) Staff ratios

1) The provider shall maintain appropriate staff ratios as determined by the Department that will meet the individual's program needs.

2) During breaks and non-training lunch periods, supervision shall be provided to maintain the safety of the individual.

3) There shall be at least one QIDP for every 30 individuals.

d) Each individual shall have a designated QIDP who shall:

1) Ensure an Implementation Strategy, as outlined in Section 119.540, is developed for each person enrolled in a Home and Community Based Services waiver;

2) Ensure that the services specified in the Individual Service Plan or Personal Plan and Implementation Strategy are being provided;

3) Ensure the input of team members;

4) Identify and address gaps in the provision of service;

5) Monitor the individual's status in relation to their Individual Service Plan or Personal Plan and Implementation Strategy;

6) Ensure the individual's rights of privacy, dignity, respect, and freed from coercion, restrain, seclusion, and time-out;

7) Provide a written record to include the Individual Service Plan or Personal Plan and Implementation Strategy and team meetings; and

8) Notify the Interdisciplinary Team, for persons residing in a long-term care facility or initiate and coordinate a meeting of the team for persons enrolled in HCBS waiver, to review and revise the Individual Service Plan or Personal Plan and Implementation Strategy, annually, if warranted by circumstances, a change in functional status, or at the request of the individual or guardian, as applicable.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.220 Interdisciplinary team (team) (Repealed)

(Source: Repealed at 45 Ill. Reg. _________, effective ____________)

Section 119.225 Assessment of individuals (Repealed)

(Source: Repealed at 45 Ill. Reg. _________, effective ____________)

Section 119.230 Individual services plan (plan) (Repealed)

(Source: Repealed at 45 Ill. Reg. _________, effective ____________)

Section 119.232 Work activities (Repealed)

(Source: Repealed at 45 Ill. Reg. _________, effective ____________)

Section 119.235 Individual rights and confidentiality

To ensure the individual's rights are protected and all services provided to the individual comply with subsections (a) through (d) of this Section, providers shall assure that:

a) The individual's rights are protected in accordance with the Code, except that the use of seclusion or aversive procedures shall not be permitted.

b) Restraint, coercion, time-out, aversive procedures or any similar actions not otherwise described in the definition of "Supported Relocation" are prohibited.

c) Individuals have the right of privacy, dignity, and respect.

d) The individual's right to confidentiality is in accordance with the Act.

e) Staff have informed individuals entering a program of their rights in accordance with this Section and of their right to contact the Guardianship and Advocacy Commission, Equip for Equality, Inc., and the provider's Human Rights Committee. Staff shall offer assistance to individuals in contacting these groups, giving each individual the address and telephone number of the Guardianship and Advocacy Commission and Equip for Equality, Inc. This information shall be given to the individual and his or her guardian in writing. If the individual is unable to read, the information shall be read and explained to him or her in a language he or she understands.

f) There is documentation in the record that staff have advised the individual and his or her guardian of the individuals rights. If any of those rights are restricted, the following must occur:

1) there must be documentation in the record that:

A) staff have provided justification for the restriction of the individual's rights in accordance with Chapter 2 of the Code; and

B) staff have offered to assist in contacting the Guardianship and Advocacy Commission.

C) the Behavior Management and Human Rights Committees have reviewed and approved the restriction.

2) Documentation and justification of rights restrictions must also be shared with the appropriate ISC (for individuals enrolled in a HCBS waiver), ICF/DD, MC/DD or SODC as appropriate.

3) A restriction of rights must be reflected in the individual's Individual Service Plan or Personal Plan.

g) Individuals or guardians shall be permitted to present grievances and to appeal adverse decisions of the provider including the authorized agency representative. The provider agency representative's decision on the grievance shall be subject to review in accordance with the Administrative Review Law [735 ILCS 5/Art. III]. For all individuals enrolled in a DD Medicaid Waiver, their rights to present grievances and to appeal adverse decisions of the provider agency are detailed in 59 Ill. Adm. Code 120.

h) The authorized agency representative's decision on the grievance shall constitute a final administrative decision and shall be subject to review in accordance with the Administrative Review Law [735 ILCS 5/Art. III].

i) The individual is not excluded, suspended or discharged from services and services are not reduced for exercising any of his or her rights or for the guardian exercising those rights on the individual's behalf.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.240 Positive Behavior Supports

a) The provider shall develop policies and procedures and shall govern the use of all behavior interventions used to modify behaviors that are maladaptive. The provider will implement a behavior support strategy to assist the individual in developing replacement behavior. Positive Behavior Supports must be supported by a specific assessed need and justified in the individual's Service Plan or Personal Plan.

b) Behavior Support strategy will emphasize adaptive replacement behaviors that are consistent with the individual's developmental level and learning, emotional and environmental needs. The strategy must include positive reinforcement techniques, adaptive skill building and only employ restrictive or physical intervention techniques for the safety of the individuals and/or others.

c) The program and/or the Behavior Support strategy shall not include corporal punishment, seclusion, abuse, neglect, aversive procedures, time-outs, restraints, coercion and/or exploitation of individuals.

d) The Behavior Support strategy must help the person develop and use an adaptive alternative response, rather than punish the display of the maladaptive behavior.

e) Physical intervention should only be used to protect the individual or others from bodily harm. When physical intervention is incorporated in to a Positive Behavior Support strategy, the least intrusive intervention appropriate to the behavior will be outlined in the strategy.

f) Physical intervention that is not included in a Positive Behavior Support strategy may be used in order to protect the immediate safety and wellbeing of individuals. Use of a physical intervention that is not included in a Positive Behavior Support strategy must be reviewed by the QIDP and Supervisor to determine whether physical intervention was warranted by the situation and whether the development or amendment of a Positive Behavior Support strategy is warranted.

g) Procedures used to prevent maladaptive behaviors that are not part of the Positive Behavior Support strategy shall not be repeated more than three times within a six-month period without being incorporated into the Positive Behavior Support strategy.

h) Whenever procedures with restrictions or intrusion are used to manage maladaptive behavior:

1) The Provider Support Team shall determine and document in the record that the harmful effects of the behavior clearly outweigh all of the potentially harmful effects of the procedure;

2) The procedure shall be an integral part of the strategy which will lead to a less restrictive way to manage, and ultimately eliminate the behavior;

3) The record shall document that informed consent was obtained; and

4) The program's Behavior Management Committee and Human Rights Committee shall review and approve the procedure in accordance with Section 119.245.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.245 Committees

a) Each agency shall have a Human Rights Committee that will establish or ensure a process for the periodic review of human rights issues involved in the individual's services and supports. A program which uses behavioral interventions as specified in Section 119.240 for managing maladaptive behavior shall establish a Behavior Management Committee. Each Committee must have at least five members. Members shall not be shared between committees with the exception of a physician, Registered Nurse, or Nurse practitioner/physician assistant.

b) The Human Rights Committee shall:

1) Review program policies, procedures and practices which restrict an individual's rights;

2) Inform the agency of any complaints involving individual's rights, violations and any corrective actions;

3) Approve positive interventions and supports prior to their implementation and review those procedures at least every six months;

4) Maintain minutes, including attendance and decisions made; and

5) Be comprised in the following manner:

A) When the interventions used restrict an individual's rights, a professional qualified to evaluate their use, such as a physician or pharmacist, shall be a member of the committee.

B) At least one member shall be a representative of a person with a disability.

C) At least one member shall be from outside the agency.

D) The committee shall have different individuals representing subsections (B) and (C).

c) The Behavior Management Committee shall:

1) Approve behavior interventions to be used during the day program prior to their implementation and review those interventions at least every six months;

2) Maintain minutes, including attendance and decisions made;

3) Ensure the individual, as they desire, is included in the meetings in which their services and supports are discussed, supported to have meaningful interactions and be accommodated, if necessary.

4) Be comprised in the following manner:

A) Members shall include persons qualified to evaluate published behavior management studies and the technical adequacy of proposed behavior management interventions. Persons are qualified by training and experiences such as a clinical psychologist to review oversight procedures.

B) At least one member shall be a representative of a person with a disability.

C) At least one member shall be from outside the agency.

D) The committee shall have different individuals representing subsections (B) and (C) of this subsection.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.250 Medications and medical care

a) The administration of medication shall be governed as described in 59 Ill. Adm. Code 116 and the Illinois Nurse Practice Act.

b) All medications shall be specifically prescribed for the individual by a physician, advanced practice nurse, or physician assistant.

c) The provider as it exercises program oversight may, as needed, guide the individual in self-administration of medications as part of the training program for independent living if the individual is not capable of self-administration.

d) Medications shall be secured from unauthorized access and only a physician, pharmacist, registered or licensed practical nurse or program personnel authorized to provide program oversight shall have access to medications.

e) Programs shall provide an area for care of individuals who become ill.

f) Programs shall have available the American Red Cross First Aid Kit or the equivalent contents. Provider agency staff must review and restock contents quarterly and/or as need.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.255 Environmental management

a) Buildings owned, leased, or otherwise controlled by the provider for the program shall:

1) Be safe and clean;

2) Be free from vermin and infestation;

3) Conform with the NFPA 101, Life Safety Code (National Fire Protection Association, 2015);

4) Conform with the Environmental Barriers Act [410 ILCS 25] and 71 Ill. Adm. Code 400 (Illinois Accessibility Code);

5) Have a normal temperature and humidity comfort range in accordance with the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), Handbook of Fundamentals (National Association of American Society of Heating, Refrigerating, and Air Conditioning, United Engineering Center, 345 East 47th Street, New York, New York 10017, 2017); and

6) Have a written preventive maintenance program which includes a schedule for inspection and service of equipment and physical plant.

b) Toilets and bathrooms shall provide privacy and be located and equipped to facilitate accessibility and independence. When needed by the individual, special assistance or devices shall be provided.

c) The provider shall maintain copies of inspections performed by local and state inspectors in regard to health, sanitation and environment.

d) The provider shall develop, implement and maintain a disaster preparedness plan which shall be reviewed annually, revised as necessary, and ensure that:

1) Records and reports of fire and disaster training are maintained;

2) A record of actions taken to correct noted deficiencies in disaster drills or inspections is maintained;

3) Staff know how to react to fire, severe weather, missing persons, medical emergencies, poison control, deaths, and any other emergency situations;

4) Individuals can react to fire and severe weather emergencies or they are receiving training;

5) Staff and individuals can locate fire-fighting equipment, first aid kits, evacuation routes and procedures; and

6) A telephone is available with a list of the local telephone numbers of the poison control center, the police, the fire department and emergency medical personnel, and is accessible to all staff and individuals.

e) The provider shall have procedures for evacuation which ensure that:

1) Evacuation drills are conducted at a frequency determined by the provider based on the needs and abilities of the individuals served;

2) Evacuation drills occur at least annually;

3) Special provisions are made for those individuals who cannot evacuate the building without assistance, including those with physical disabilities and individuals who are deaf and/or blind;

4) All personnel are trained to carry out their assigned evacuation tasks;

5) Corrective action is taken when inefficiency or problems are identified during an evacuation drill; and

6) Drills include actual evacuation of individuals to safe areas.

f) The provider shall monitor and regulate hot water temperatures to ensure safety (i.e. handwashing); water temperature shall not exceed 110 degrees

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.260 Administrative requirements

a) Authorized agency representative

 The provider shall appoint an authorized agency representative whose qualifications and duties are defined in writing and include authority for program administration and management.

b) Provider policy requirements

1) The program shall have written policies which shall be reviewed annually, revised as necessary and shall describe:

A) Goals and objectives reflecting annual and long-range plans;

B) The population served, including age groups, disabilities and the geographic service area;

C) The services provided in response to individual and community needs including:

i) The hours and days of operation;

ii) The methods used to perform initial screening and assessment of individuals;

iii) A description of processes used for development and update of the Implementation Strategy and service plan, as applicable;

iv) The use and approval of Positive Behavior Supports;

v) Handling emergencies and disasters; and

vi) Maintenance of buildings, vehicles and equipment.

2) Program policy shall ensure the availability of professional, administrative and support staff to assess and address the needs of individuals. This includes personnel and consultants who can communicate, either verbally or non-verbally, with individuals.

c) Personnel requirements

1) Programs shall not discriminate in the hiring or employment of staff on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation or military status in any of its activities or operations.

2) Personnel policies and procedures shall be in writing and available for review.

3) The program shall have written job descriptions or contractual agreements for every position, including consultant and direct-service volunteer positions, which list the job title, duties and responsibilities, minimum experience and educational requirements, immediate supervisor and subordinates.

4) Staff shall be licensed, registered or certified by the State, if required.

5) When non-professional contractual workers or volunteers are used in direct services, they shall be supervised in the provision of services by professional employees.

6) A certified day program provider shall not employ a person (including contractual workers or volunteers who are responsible for care of individuals) in any capacity until the provider has conducted the following registry checks concerning the potential employee. If the registry has information substantiating a finding of abuse or neglect against the person, the agency shall not employ him or her in any capacity.

A) Health Care Worker Registry. The provider shall not employ an individual 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.

i) Such inquiry shall not occur more than 30 calendar days prior to the first day of employment.

ii) 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.

iii) 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.

iv) For purposes of annual checks, providers must establish a schedule that results in completion of checks annually (within 365 calendar days). This 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.

B) DCFS State Central Register/Child Abuse and Neglect Tracking System (CANTS). Providers shall not employ an individual 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.

i) Such inquiry shall not occur more than 30 calendar days prior to the first day of employment.

ii) 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 DHS, the provider shall not employ him or her in any capacity.

iii) 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 89 Ill. Adm. Code 385.

iv) 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, as described in Section 119.261(b), by DHS.

v) For purposes of annual checks, providers must establish a schedule that results in completion of checks annually (within 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.

C) Illinois Sex Offender Registry. Providers shall not employ an individual in any capacity until the provider has inquired of and received the results from the Illinois Sex Offender Registry concerning the individual.

i) Such inquiry shall not occur more than 30 calendar days prior to the first day of employment.

ii) If the Registry reflects the existence or contains information that indicates a finding, the provider shall not employ him or her in any capacity.

iii) 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.

iv) For purposes of annual checks, providers must establish a schedule that results in completion of checks annually (within 365 calendar days). This 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.

D) Illinois Department of Healthcare and Family Services Sanctions List. Prior to employment of an individual or utilization of a subcontractor or licensed practitioner, the provider shall confirm 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.

i) Such inquiry shall not occur more than 30 calendar days prior to the first day of employment.

ii) This list is maintained on the HFS OIG web site and 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.

iii) If an individual or entity is found to be on the sanctions list, the provider shall confirm eligibility with HFS' OIG and per HFS guidelines.

iv) Providers must establish a schedule that results in completion of checks annually (within 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.

7) The provider must comply with 225 ILCS 46, the Health Care Worker Background Check Act. A provider shall not knowingly hire or retain any person outside of the provisions of the Health Care Worker Background Check Act.

8) A person listed on the Health Care Worker Registry may request a waiver of the prohibition against employment by completing an application on a form prescribed by the Illinois Department of Public Health in accordance with 225 ILCS 46, the Health Care Worker Background Check Act and as described in Section 119.261(a).

9) A waiver of an indication on the CANTS Register may be requested in accordance with Public Act 097-0441 and as described in Section 119.261(b).

d) Staff and volunteer training

1) Training in principles and practices in the following areas shall be provided to direct service and professional staff:

A) Cardiopulmonary resuscitation (CPR), back blows/ab thrusts (e.g. Heimlich maneuver) and first aid;

B) Concepts of treatment, habilitation, and rehabilitation including behavior management, age appropriateness and psycho-social rehabilitation depending on the needs of the individuals served or to be served;

C) Medication Administration as outlined in 59 Ill. Adm. Code 116.40;

D) The purpose and concepts of Person-Centered Planning;

E) Age and cultural appropriateness;

F) Safety, fire, and disaster procedures including:

i) Use of fire-fighting equipment; and

ii) Familiarity with the disaster preparedness plan.

G) Abuse, neglect, exploitation, coercion, and critical incident prevention response and reporting (see subsection (f) of this Section):

H) Individual rights in accordance with Chapter 2 of the Code and maintaining confidentiality in accordance with the Act;

I) Infection control and sanitation;

J) Food preparation and handling for staff who prepare and serve food to individuals; and

K) Office of Inspector General Investigations of Alleged Abuse or Neglect in State-Operated Facilities and Community Agencies [59 Ill. Adm. Code 50].

2) The provider shall provide an orientation and training program for volunteers specific to volunteer duties and shall provide supervision as necessary. Volunteers with responsibility for care of individuals served must complete and demonstrate competency in the training areas specified in subsection (d)(1).

e) Quality assurance

1) There shall be a written quality assurance plan and ongoing activities designed to review and evaluate services to individuals, operation of programs and to resolve identified problems.

2) The scope of quality assurance shall include reviewing semi-annually, or more frequently if problems are identified, at least the following:

A) Implementation Strategies, if applicable, are developed according to the Personal Plan, reviewed and updated at least annually and more often if warranted;

B) The use of Positive Behavior Supports including behavior management procedures;

C) Unusual incidents relative to services to individuals;

D) Service utilization;

E) Individuals' records ensuring they meet the requirements of this Part;

F) Subcontracted services to ensure the needs of individuals are being met; and

G) The status of individuals receiving service.

3) Records of quality assurance reviews and activities shall be filed separately from the records of individuals.

f) Critical incidents

1) The provider shall have written policies and procedures for handling, investigating, reporting, tracking and analyzing critical incidents through the provider's management structure, up to and including the authorized agency representative. The provider shall ensure that staff demonstrate their knowledge of and follow such policies and procedures.

2) Within 24 hours after becoming aware of an incident, the provider shall report to the appropriate law enforcement agencies any incident which is subject to the Criminal Code of 2012 [720 ILCS 5].

3) The provider shall ensure that suspected instances of abuse or neglect against individuals in programs that are certified by the Department are reported to the Office of Inspector General (Section 1-17 of the Department of Human Services Act [20 ILCS 1305/1-17(k)(1)]) as well as to DDD.

4) Incidents, other than those required to be reported to the Office of Inspector General, shall be electronically reported to DDD through its Critical Incident Reporting and Analysis System (CIRAS) (https://www.dhs.state.il.us/page.aspx?item=97101). Incidents to be reported are specified in Section 119.120 under Critical Incidents.

g) Individual's record

1) The program shall ensure the confidentiality of an individual's record in accordance with the Act and shall ensure safekeeping of all records against loss or destruction. Individuals or their guardians shall have access to the individual's record upon request.

2) The program shall maintain a chronological record for each individual. Records shall be accessible at a site attended by the individual designated by the program. Records can be paper or electronic and must be accessible and convenient to staff contributing to the Individual Service Plan or Personal Plan.

A) Each entry shall be legible, dated and authenticated by the signature and title of the person making the entry.

B) Corrections shall be initialed and made in such a way as to leave the original incorrect entry legible.

C) When symbols or abbreviations are used, the program shall provide a legend, standardized throughout the program, to explain them.

3) The following information shall be obtained and recorded when an individual enters a program, and shall be updated as necessary:

A) Identifying information including name, date of birth, sex, race, a copy of state ID, Medicaid number, birth certificate, current photograph if the individual consents to having his or her picture taken; social security number (this may be stored separately from the record if necessary to protect against identify theft), and legal status;

B) The name, address and telephone number of the guardian or the person to be notified in case of an emergency;

C) The language spoken or understood by the individual including, in the case of an individual who is deaf or hard of hearing, the individual's preferred mode of communication, e.g., American sign language, signed English, aural, oral or tactile communications device;

D) Psychological assessments and recommendations;

E) Prescribed medications, allergies to foods, other medications and substances;

F) Physical and dental examinations and medical history;

G) Consent to receive emergency medical services; and

H) Copies of the authorization for release of information.

4) The following shall be entered in the individual's record during the period of service:

A) Written informed consent by the individual or guardian to participate in a certified day program;

B) Prior service history;

C) A copy of the Individual Service Plan or Personal Plan and Implementation Strategy;

D) Documentation of approval to use Positive Behavior Supports and the results of their use; and

E) A monthly summary (documentation of the individual's involvement in and response to services as indicated in the Individual Service Plan or Personal Plan and Implementation Strategy).

h) Financial and operational requirements

 Programs shall comply with 59 Ill. Adm. Code 103 (Grants).

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.261 Application for waiver of the prohibition against employment

a) Hiring of direct care employees

 A provider shall not knowingly hire or retain any person after January 1, 1998 in a full-time, part-time or contractual direct care position if that person has been convicted of committing or attempting to commit one or more offenses outlined in Section 25 of the Health Care Worker Background Check Act [225 ILCS 46/25]) unless the applicant or employee obtains a waiver pursuant to subsection (b) of this Section.

b) Health Care Worker Registry request for waiver

1) An applicant, employee, or nurse aide may request a waiver of the prohibition against employment per Section 40 of the Health Care Worker Background Check Act [225 ILCS 46/40] and 77 Ill. Adm. Code 955.

2) Provider staff may assist the applicant, employee or nurse aide in completing the application.

3) The outcome of the waiver request shall be determined by the Illinois Department of Public Health per Section 40 of the Health Care Worker Background Check Act [225 ILCS 46/40] and 77 Ill. Adm. Code 955.

c) DCFS CANTS Waiver

1) Public Act 097-0441 directs DHS to establish a waiver process from the prohibition of employment or termination of employment for any applicant or employee listed on the DCFS' State Central Register seeking to be hired or maintain his or her employment with a community developmental services provider agency.

2) The provider must comply with 59 Ill. Adm. Code 119.260(c)(6)(B).

3) Application for waiver

A) Waiver requests with all required and any supplemental materials should be submitted via email at DHS.CANTSDDWaiver@illinois.gov to DDD. Waiver requests and supporting materials should be submitted via email; however, requests may be faxed to (217) 782-9444, or mailed to Division of Developmental Disabilities, Bureau of Quality Management, 600 East Ash, building 400, Mail Stop 2 North, Springfield, IL 62703. Faxed and mailed waiver requests must be clearly marked as "DCFS CANTS Waiver Request." Waiver requests submitted by telephone will not be considered.

B) The provider or the individual listed on the DCFS' State Central Register (or their authorized representative) may submit waiver requests to DDD.

C) If a provider submits a waiver request for more than one employee or prospective employee at the same time, each request must be a separate submission.

D) Upon receipt, DDD will review submitted materials and advise the waiver applicant, authorized representative or provider, in writing, if any additional information is required.

E) DDD will provide a response in writing to each waiver request within  30 calendar days after receipt and review of all applicable materials and responses from waiver applicant and/or provider. DDD's review will include, but is not limited to, DCFS' investigative reports and DHS' OIG intake and investigation reports.

F) Delays, without good cause, in receiving requested materials from the waiver applicant or provider that exceed 30 calendar days will result in DDD issuing a denial of the waiver request. Waiver requests denied for waiver applicant or provider delays may be resubmitted for consideration.

G) If a waiver request is approved, it will be specific to a position and provider.

H) If a waiver request is approved, it will be automatically revoked upon notice to provider of another listing of the waivered individual on the DCFS' State Central Register.

I) All decisions by DDD regarding waiver requests will be final.

4) Required materials for waiver submission:

A) First, full middle, and last name of waiver applicant;

B) Address (street and mailing, if different) of waiver applicant;

C) City, state, and zip code of waiver applicant;

D) Maiden name, if applicable, and other names used by waiver applicant;

E) Telephone numbers of waiver applicant;

F) Date of birth of waiver applicant;

G) Social Security Number of waiver applicant;

H) CANTS finding(s) - the DCFS' C.A.N.T.S. Background Check Information Form(s);

I) Name, address, phone, email, and contact for provider where position is sought or sought to be continued;

J) Position held or sought;

K) Work history, including current position;

L) Correspondence from provider where position is desired or sought to be continued on provider's letterhead which includes:

i) A signed statement of support for the waiver request from the provider's chief executive officer;

ii) The length of time the individual has been employed by the provider;

iii) Information regarding previous employment by the provider in residential and day programs for people with intellectual/developmental disabilities; and

iv) Applicable information regarding the individual's work history with the provider organization, e.g., evaluations, any past disciplinary action (or lack thereof), positive recognition for work well done, etc.

M) Any additional information the individual would like to provide regarding the waiver request.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.270 Accreditation (Repealed)

(Source: Repealed at 45 Ill. Reg. _________, effective ____________)

SUBPART C: CERTIFICATION REQUIREMENTS

Section 119.300 Issuing a certificate and period of certification

a) BALC shall issue a certificate after receipt of a completed application, including the authorized agency representative's signature and the date, and after verifying the provider's compliance with this Part.

b) Providers shall obtain application forms by writing to:

Bureau of Accreditation, Licensure and Certification

Department of Human Services

DHS.BALC@illinois.gov

c) BALC shall survey providers and their certified program. BALC shall review the provision of services, observe individuals and staff, and inspect the records and premises for the purpose of determining compliance with this Part.

d) BALC shall survey providers to determine their compliance with this Part at the time of initial certification or certificate renewal. As a result of an on-site survey, certified day program providers shall be recognized according to levels of compliance with standards as set forth in this Part, as specifically defined in interpretive guidelines made available to agencies. All findings shall be corrected. Agencies with findings from Level 1 to Level 2 will be considered to be in good standing with BALC. Although in good standing, a Level 2 finding will result in a notice of violation and requires a provider to submit a Plan of Correction. Findings from Level 3 to Level 5 will result in a notice of violations, a plan of correction, and defined sanctions. Findings resulting in Level 6 will result in a notice of violations and defined sanction. The levels of compliance are:

1) Level 1 (100%) - Full compliance with certified day program standards.

2) Level 2 (99-93%) - Acceptable compliance with certified day program standards. A written plan of correction will be required from the provider within 10 days of the notice of violation.

3) Level 3 (92-85%) - Partial compliance with certified day program standards. An administrative warning is issued. The provider shall submit an acceptable written plan of correction within 10 days of the notice of violation. A re-survey by the Department shall occur within 90 days of the notice of violation.

4) Level 4 (84-79%) - Minimal compliance with certified day program standards. The provider shall submit an acceptable written plan of correction within 10 days of the notice of violation. The Department will issue a probationary certificate and prohibit new enrollments. A re-survey by the Department shall occur within 60 days of the notice of violation.

5) Level 5 (78% or below) - Unsatisfactory compliance with certified day program standards. The provider shall submit an acceptable written plan of correction within 10 days of the notice of violation, and the Department will issue a restricted license and prohibit new enrollments. A re-survey by the Department shall occur within 30 days of the notice of violation.

6) Level 6 - Revocation of the provider's certificate to provide certified day program services. Revocation shall occur as a result of a provider's consistent and repeated failure to take necessary corrective actions to rectify documented violations, and/or the provider agency's failure to protect clients from situations that produce an imminent risk.

e) Prior to initiating formal action to sanction a certified day program Certificate, BALC will allow an organization an opportunity to take corrective action to eliminate or ameliorate a violation of this Part except in cases in which BALC determines that emergency action is necessary to protect the public or individual interest, safety or welfare.

f) Subsequent to an on-site survey, BALC shall issue a written notice to a provider agency/organization. BALC shall specify the particular Sections of this Part, if any, with which the provider is not compliant. BALC's notice shall require any corrective actions be taken within a specified time period as required by this Part.

g) If the Department does not approve a provider for certificate renewal or denies a certificate, it shall notify the provider in writing of the opportunity for a hearing per Section 119.470.

h) Sanctions will be imposed according to the following definitions:

1) Administrative notice - A written notice issued by BALC that specifies rule violations requiring a written plan of correction with time frames for corrections to be made and a notice that any additional violation of this Part may result in a higher-level sanction. (Level 3)

2) Probation - Compliance with standards is minimally acceptable and necessitates immediate corrective action. Individuals' life safety or quality of care are not in jeopardy. The probationary period is time limited to 90 days. During the probationary period, the provider must make corrective changes sufficient to bring the provider back into good standing with the Department. Failure to make corrective changes within that given time frame may result in a determination to initiate a higher-level sanction. The admission of new individuals shall be prohibited during the probationary period. (Level 4)

3) Restricted Certificate - A provider agency is sanctioned for unsatisfactory compliance. The admission of new individuals shall be prohibited during the restricted licensure period. Corrective action sufficient to bring the provider back into good standing with the Department must be taken within 60 days. During the restricted licensure period, a Division monitor will be assigned to oversee the progress of the provider in taking corrective action. Depending on the severity of the violations, individuals may be moved to another certified day program site supervised by the same provider or a site supervised by another provider. If individuals are moved to a site supervised by another provider, funding for the services will also be moved. If corrective actions are not taken, the provider will be subject to a higher-level sanction. (Level 5)

4) Denial of Certificate - Denial of a certificate is withdrawal by formal actions of the certified day program certificate. The denial shall be in effect until such time that the provider is eligible for a re-application and the provider can demonstrate its ability to operate in good standing with the Department. The Department has the right not to reinstate a certificate. If denial of a certificate occurs as a result of imminent risk, all individuals will be immediately relocated to another provider and all certified day program funding will be transferred. (Level 6)

5) Financial penalty - A financial penalty may be imposed upon finding of violation in any one or combination of the provisions of this Part. In determining an appropriate financial penalty, the Department may consider the deterrent effect of the penalty on the organization and on other providers, the nature of the violation, the degree to which the violation resulted in a benefit to the organization and/or harm to the public and any other relevant factor to be examined in mitigation or aggravation of the organization's conduct. The financial penalty may be imposed in conjunction with other sanctions or separately.

6) Targeted Certificate - A provider agency with multiple certified day program sites may be sanctioned for non-compliance according to the performance of the respective sites. Failure of one site to comply may result in a sanction-level determination for the individual site and may not impact on the license of the parent agency. One exception to the foregoing shall be a provider's continuous administrative failure to implement corrective changes for a site in accordance with a finding of violations and stipulated time frames to come into compliance. The certified day program certificate of the provider may be subject to sanctions in those cases.

7) Higher level sanctions may be imposed in situations where there are repeat violations.

i) If a provider requests a waiver of any standard in this Part, it shall present to BALC a plan of correction to comply with the required standard, including a timetable for compliance and its rationale for the waiver request. Standards identified in Sections 119.325(a)(1)(A), (B), (C) and (D) shall not be waived.

j) If a provider is not able to comply with a standard in this Part due to insufficient funding or no funding, the following shall occur:

1) The provider shall request a waiver of the specific standard in its plan of correction which shall state that the provider cannot comply with the standard due to insufficient funding or no funding;

2) BALC shall review the waiver request and determine if the waiver shall be granted, except that no waiver shall be granted for any standard identified in Sections 119.325(a)(1)(A), (B), (C), and (D); and

3) If BALC determines that a waiver should be granted, it shall waive the specific standard.

k) If a provider requests an equivalency for any standard in this Part, it shall present a written description to the Department of the equivalency containing specific reference as to how the equivalency meets the standard. An equivalency shall not be granted on standards identified in Sections 119.325(a)(1)(A), (B), (C), and (D).

l) A certificate shall be valid for two years unless denied by the Department.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.305 Certification Renewal

a) BALC shall mail an application to the provider. Each certified provider shall complete and submit a renewal application to BALC at least 120 days before expiration of the current certification.

b) Prior to recertification, BALC shall survey the provider.

c) The Department shall recertify a provider in compliance with this Part for an additional two-year period.

d) When the Department does not approve a provider for recertification, the Department shall notify the provider, in writing, within 60 days after the decision.

e) The notice shall include a clear and concise statement of the violation on which the determination is based and notice of the opportunity for a hearing in accordance with Section 119.330 of this Part.

f) BALC shall consider approving written requests for the development and certification of new providers when the following conditions are presented to the Department and verified:

) the provider shall not force the relocation of individual away from participating relatives.

2) 

3) 

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.310 Application acceptance and verification

a) Applications for certification shall be deemed received by BALC on the postmarked date.

b) BALC shall notify a provider of any error or omission made on the application within 30 days. If the provider fails to respond to the notice within 30 days, BALC shall terminate the application process and notify the provider within 30 days.

c) BALC shall either approve or disapprove the completed application within 90 days after its receipt.

d) BALC shall verify information supplied in applications.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.315 Non-transferability of a certificate

a) The certified agency must notify BALC and DDD within five business days of any change of ownership including the type of ownership, the names of all owners, partners, and stockholders. When a change in ownership occurs, the potential owners must meet all qualifications of a certified day program.

b) A certificate is not assignable or transferable.

c) Change in ownership or discontinuation of operations causes the certificate to be void.

c) Certification documents and all copies shall remain Department property and shall be returned by the provider within ten days after notifying the Department of a change in ownership.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.320 Planned cessation of program operations

a) When a provider decides to terminate operation of a program, it shall notify the following entities of its decision at least 60 days in advance of termination:

1) DDD and BALC;

2) Individuals who must be transferred or discharged;

3) The individual's guardian and members of the individual's family, when applicable;

4) The residential provider; and

5) The individual's Independent Service Coordination Agency (ISC) staff, as applicable.

b) The notice shall state the proposed date and reason for the program's termination.

c) The ISC shall advise individuals who are enrolled in the HCBS waiver on available alternatives and shall assist them in securing alternative services. For residents of licensed long-term care facilities, the facility shall assure placement.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

Section 119.325 Certificate denial

a) The Department shall deny certification at any time if the provider:

1) Fails to maintain full compliance with standards identified in:

A) Sections 119.235 (a) through (e);

B) Sections 119.240 (c), (h)(4), (i);

C) Sections 119.250 (a), (b); and

D) Sections 119.255 (a)(1) through (a)(3), (b), (d)(1) through (d)(6), (e)(1), (e)(3), (e)(5), (e)(6);

2) Fails to maintain substantial compliance with all standards in this Part other than those identified in subsection (a)(1) of this Section;

3) Fails to submit a plan of correction acceptable to the Department for any violations resulting from an on-site survey by the Department within 30 days of receipt of the notice of violation. A plan will be acceptable to the Department if the proposed correction will cause compliance with the applicable standard and if the timetable is reasonable. Criteria for the timetable being reasonable include that the correction be made immediately if the standard not complied with affects the safety or health of individuals, or that compliance occurs within the period of certification for all other standards noted as deficient;

4) Submits false information either on Department forms, plan(s) of correction or during an on-site survey;

5) Refuses to permit or participate in a scheduled or unscheduled survey; or

6) Willfully violates any rights of individuals being served as identified in the Code or in the Act.

b) The Department shall refuse to certify a program or shall deny a certificate if the owner, authorized agency representative or certificate holder has been convicted of a felony, or a misdemeanor involving moral turpitude, as shown by a certified copy of the court of conviction.

c) If the Department determines that individuals are at imminent risk which has not or cannot be corrected, it shall immediately close the affected program, plan for the immediate removal of all individuals and deny the certificate of the provider. The affected program shall not operate and shall not receive Department funding during the period of any appeal.

d) If a provider contests the Department's certification decision pursuant to subsection (a), (b) or (c) of this Section, it may request a hearing in accordance with Section 119.330, by providing written notice. The Department shall notify the provider of the time and place of the hearing not less than 14 days before the hearing date.

e) If the provider does not provide written notice, the Department shall deny the certificate.

f) The Department shall immediately notify the Department of Healthcare and Family Services of the decertification of any provider.

(Source: Amended at 45 Ill. Reg. _________, effective ____________)

SUBPART D: PROGRAM REQUIREMENTS FOR SERVING INDIVIDUALS WHO RESIDE IN AN ICF/DD, MC/DD, OR SODC

Section 119.400 General Requirements for Serving Individuals who reside in an ICF/DD, MC/DD or SODC

a) Developmental Training (DT) shall be provided to individuals who reside in ICF/DDs and MC/DDs in accordance with 89 Ill. Adm. Code 140.647 as well as Subparts A through C of this Part. The DT provider must have a contract for services with the ICF/DD or MC/DD that is responsible for ensuring outside services meet the needs of each individual under the applicable provision of 89 Ill. Adm. Code 140.652.

b) When an individual who resides in a State Operated Developmental Center participates in DT, services shall be provided as indicated in their Individual Service Plan as well as Subparts A through C of this Part. The DT shall have an agreement with the appropriate SODC.

c) When warranted, the DT provider shall participate in the interdisciplinary team process which is initiated and coordinated by the ICF/DD, MC/DD or SODC that provides residential services to the individual.

d) Coordination and cost of transportation for individuals who reside in ICF/DD, MC/DD or SODC shall be provided as described in 119.200(d) unless the DT provider and the residential provider agree otherwise.

e) The Department shall grant a waiver of the requirements in 119.200(e) for individuals who reside in an ICF/DD, MC/DD or SODCs whose physicians have determined that participation in a program away from the residence will present a risk to the individual's health. Physicians shall document and annually update this medical determination in the individual's records.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.410 Criteria for participation in Developmental Training

a) Developmental Training shall be provided to individuals as described in 119.100(b) and 119.400(a) or (b).

b) The need for active treatment services shall be identified as described in 89 Ill. Adm. Code 140.642 and Section 140, Table H for individuals who reside in ICFs/DD or MCs/DD.

c) The individual or guardian, if applicable, shall give informed consent to participate in Developmental Training programs, which shall be documented in the individual's record.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.420 Individual Service Plan

a) An Individual Service Plan shall be developed by the ICF/DD, MC/DD or SODC that provides residential supports and shall identify the responsibilities of the Developmental Training (DT) program in executing the Plan.

b) Services provided by the DT shall demonstrate an integrated and consistent approach to the goals identified by the Interdisciplinary Team.

c) The DT provider must:

1) Explain to the individual all rights stated in Section 119.235 and provide the individual with a copy of those rights. This shall be documented in the individual's record;

2) Document in the record those services being provided to the individual until an Individual Service Plan is developed; and

3) Within 30 days after an individual's entry into the program, develop documentation for developmental training that:

A) Is based on assessment results;

B) Reflects the individual's or guardian's preferences for goals, objectives, and services;

C) Identifies services and supports to be provided and by whom; and

D) Has objectives that:

i) Are measurable;

ii) Have timeframes for completion; and

iii) Have a person assigned responsibility;

E) Includes the names and titles of all staff and other persons contributing to the Individual Service Plan; and

F) Is signed by the QIDP, the individual, and/or guardian, if applicable.

d) The individual and/or guardian, as applicable, shall be offered a copy of the Individual Service Plan.

e) The Individual Service Plan shall become a part of the individual's record.

f) At least monthly, the QIDP shall:

1) Review and document in the record that services are being implemented;

2) Review and document in the record that services identified in the Individual Service Plan continue to meet the individual's needs or require modification to better meet the individual's needs; and

3) Send a copy of the update and/or status of the individual to the residential provider. This should also be sent anytime there is an issue that needs to be addressed by the Interdisciplinary Team.

g) The team shall review services, at least annually, and shall note the status of the individual including any progress or loss of skills which might require modification to the Individual Service Plan.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.430 Individuals requiring additional services and support in Developmental Training

The Developmental Training (DT) provider may request additional staff for individuals whom the Interdisciplinary Team has assessed and who require and who are receiving specialized services stated in one of the following levels:

a) Level I. For individuals requiring and receiving staff assistance for the following specialized care: aids or appliances for visual or auditory deficits or both; aids, appliances or equipment for physical disabilities; in dwelling catheterization; insulin injections for stabilized diabetics; cardiovascular or respiratory medications and multiple daily monitoring; incontinence care and assistance in personal care; seizure medication and monitoring of unstable condition; or a moderately serious level of maladaptive behavior as measured by the Inventory for Client and Agency Planning (ICAP) (Houghton Mifflin Harcourt, 125 High St #900, Boston MA 02110 (1986)) or other assessment determined by the Department.

b) Level II. For individuals requiring and receiving staff assistance for the following specialized care: personal care and assistance with transfer and movement about the facility; insulin injections for diabetics who are not stabilized; ostomy care; or a serious level of maladaptive behavior as measured by the ICAP or other assessment determined by the Department.

c) Level III. For individuals requiring and receiving staff assistance for the following specialized care: intermittent catheterization; wound care; respiratory care; tracheotomy care; tube feeding; or a very serious level of maladaptive behavior as measured by the ICAP or other assessment determined by the Department.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.440 Criteria for termination, suspension, or reduction of Developmental Training services

a) The Department recognizes there will be discontinuation of Developmental Training (DT) services if:

1) An individual transfers to another qualified provider; or

2) An individual or individual's guardian, if applicable, voluntarily withdraws the individual from the provider's program.

b) The provider shall consider discontinuation of Developmental Training for an individual, within normal hours/days of operation, if:

1) The medical needs of the individual cannot be met by the Developmental Training as documented in the individual's record;

2) The behavior needs of an individual cannot be met by the Developmental Training to ensure the physical safety of the individual and/or others as documented in the individual's record;

3) The individual no longer benefits from the services provided by the Developmental Training as documented in the individual's record; or

4) The individual or individual's guardian, if applicable, takes repeated actions that prevent the consistent implementation of the individual's Individual Service Plan resulting in substantial risk of harm to the individual or others as documented in the individual's record. The language in this paragraph is in no way intended to limit efforts on the part of an individual or guardian to advocate for better or more appropriate services.

c) If the DT program administration determines reasonable and appropriate action as described in Section 119.240 has been taken without success to address and stabilize the individual's presenting medical and/or behavioral needs and program administration begins considering suspension, reduction of hours, or discontinuation of services for the individual, the Developmental Training provider shall contact the ICF/DD, MC/DD or SODC QIDP and request an Interdisciplinary Team meeting. The ICF/DD, MC/DD or SODC will schedule an Interdisciplinary Team meeting, pursuant to its Federal and State regulations, to discuss the DT provider's concerns.

d) The Developmental Training provider must:

1) Have documentation in the individual's record that supports the recommendation for suspension, reduction of hours, or discharges in accordance with Subsections (b)(1) through (4);

2) Provide a reasonable time to prepare the individual, guardian, if applicable, and the residential service provider for the suspension, reduction of hours, or discharge;

3) Communicate, prior to and during the Interdisciplinary Team meeting, that a suspension, reduction of hours, or discontinuation of DT services is being considered.

e) If the DT provider determines it can continue to serve the individual with available resources and/or technical assistance, inclusive of any enhanced services and supports identified and secured through the process described in Section 119.240, another Interdisciplinary Team meeting of the involved parties will be convened by the residential provider in no more than 30 days to review progress. The process of convening a meeting and a subsequent meeting to review progress may be repeated.

f) If the Interdisciplinary Team determines the DT provider can no longer meet the needs of the individual, the provider will notify the individual, the individual's guardian, if applicable, in writing, of discontinuation or reduction of DT services for the individual.

g) The ICF/DD, MC/DD or SODC will work to implement an alternative setting or other appropriate services and supports within 30 days of the provider's written notice to discontinue or reduce DT services. The DT provider will provide assistance to support efforts to secure appropriate alternative services and supports.

h) If alternative services and supports will not be implemented within 30 days of the provider's notification to discontinue or reduce DT services, the Interdisciplinary Team will convene a meeting with the individual, the individual's guardian, if applicable, the DT provider and others as determined by the individual or guardian, to determine the course of subsequent action.

i) In situations where the individual has demonstrated and is documented to be a current and expected on-going danger to self and/or others and/or is at extreme risk of harm, the DT provider may make the decision to take immediate action to suspend the individual until a recommunication is presented as described in Section 119.240.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

SUBPART E: PROGRAM REQUIREMENTS FOR SERVING INDIVIDUALS ENROLLED IN A HCBS WAIVER

Section 119.500 General requirements for serving individuals enrolled in a HCBS Waiver

a) Community Day Service (CDS) shall be provided to individuals who are enrolled in the Adult Developmental Disability HCBS Waiver in accordance with 59 Ill. Adm. Code 120 and Subparts A through C of this Part.

b) CDS programs shall comply with Person-Centered Planning requirements by documenting and addressing the needs, interests and outcomes identified by the individual and guardian, if applicable, as outlined in Section 119.530(a).

c) CDS programs shall comply with 42 CFR 441.301(c)(4) which specifies Settings requirements. CDS settings must have all the following qualities, and such other qualities as determined to be appropriate, based on the needs and preferences of the individual as indicated in their Personal Plan. A CDS must:

1) Be integrated in and support full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to:

A) Seek employment and work in competitive integrated settings;

B) Engage in community life, to the extent chosen by the individual;

C) Control personal resources; and

D) Receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.

2) Be selected by the individual from among setting options including non-disability specific settings. The setting options are identified and documented in the Personal Plan and are based on the individual's needs and preferences.

3) Ensure individual's rights as described in Section 119.235(a) through (d).

4) Optimize, but not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact.

5) Facilitate individual choice regarding services and supports, and who provides them.

d) CDS shall be a certified day program provided under the Developmental Disability Adult waiver that provides assistance with gaining, maintaining or improving skills and functioning. Services can reinforce skills or lessons taught in other settings and may include training and supports to help prevent or slow the loss of skills.

e) CDS takes place in a non-residential setting, separate from the participant's private residence or other residential living arrangement. It can be provided in a site certified by the Department (site based CDS) or in community locations where members of the general community typically congregate (non-site based).

f) CDS activities shall promote greater independence and personal choice, as well as support full access to the general community to the same degree as individuals not receiving waiver services. Such activities should be reflected in the individual's person-centered plan as outlined in Section 119.530. Activities can include:

1) Increasing capacity for independent living through increasing skills including fine and gross motor skills, problem solving, safety skills, activities of daily living, personal budgeting, and adaptive skills to support positive behavioral health.

2) Participating in Pre-vocational activities. Pre-vocational activities are not intended to be indefinite; such activities should assist the individual to move forward to other service options. Activities include:

A) Job and career exploration; this cannot be paid employment.

B) Supports to enhance cooperation, attendance, and task completion.

3) Supporting opportunities for the individual to seek employment and work in competitive integrated settings.

4) Exploring volunteer opportunities or volunteering in their community.

5) Training in a specific skill (e.g. use of personal technology or assistive devices) or learning about different topics, including topics of personal interest, self-determination, and self-advocacy.

6) Participating in experiences chosen by an individual based on their interests.

7) Engaging in community activities, groups, associations, classes, or clubs of the individual's choosing to develop social networks.

8) Discovering or participating in hobbies, leisure, cultural, or other interests in the community to promote personal health and wellness (e.g. yoga class, walking group, etc.).

9) Participating in formal and informal associations or community and/or neighborhood groups of the individuals choosing.

10) Learning to navigate the local community, including learning to use public transportation and/or private transportation available in the local area, with or without supports based on the individual's needs.

g) Coordination and cost of transportation for individuals who are enrolled in HCBS Waiver services shall be provided as described in 119.200(d) unless the provider and the individual or the individual's guardian, if applicable, agree otherwise as documented in the Personal Plan.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.510 Criteria for participation in Community Day Services

a) In addition to the criteria found in Section 119.100(b), individuals participating in Community Day Services shall be enrolled in the Developmental Disability Adult Waiver program.

b) The individual or guardian, has indicated the desire and/or need for Community Day Services as indicated in the individual's Personal Plan.

c) The individual or guardian, if applicable, shall approve the Implementation Strategy, as outlined in Section 119.530(b), to correspond with the individual's Personal Plan.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.520 Person Centered Planning

a) Community Day Service (CDS) agencies shall comply with Person-Centered Planning requirements as outlined in 42 CFR 441.301(c)(1) through (c)(3) and 59 Ill. Adm. Code 120. Person-centered plans must reflect the services and supports that are important for meeting the needs and desires of individuals for the delivery of services and supports.

b) CDS providers must comprehensively address the needs of individuals enrolled in a HCBS Waiver through the development of an Implementation Strategy as it relates to his or her Personal Plan.

1) Within 20 calendar days of the provider's signature on the Personal Plan, an Implementation Strategy shall be developed that:

A) Is based on the Personal Plan, developed by the ISC agency, and assessment results;

B) Includes the participation of the individual and guardian, if applicable, and the ISC as necessary;

C) Reflects the individual's and guardians, if applicable, agreement as indicated by a signature on the Implementation Strategy or staff notes indicating why there is no signature and why the individual's and guardian's agreement is not reflected;

D) Describes and directs the activities and methods used to provide services and supports the areas of an individual's Personal Plan for which the Community Day Services provider is responsible;

E) Addresses and accounts for the priorities, strengths, support needs, and risk factors identified in the Personal Plan for those areas of the Community Day Services provider's responsibility;

F) Addresses outcomes identified in the Personal Plan in which the CDS agency agreed to support the individual; and

G) Identifies the agencies services to support the individual in attaining skills or achieving outcomes identified in the Personal Plan, detailing timeframes for completion, staff positions assigned responsibility, and benchmarks for determining the success of the strategies.

2) The Implementation Strategy shall:

A) Identify the CDS services chosen by the individual and guardian, if applicable, and shall indicate the type and the amount of supervision provided to the individual;

B) Include the names and titles of all employees and other persons contributing to the Personal Plan; and

C) Be signed by the individual, guardian, if applicable, and provider agency representative(s).

3) The individual and guardian, if applicable, shall be given a copy of the Implementation Strategy and subsequent updates.

4) The Implementation Strategy and subsequent updates shall become a part of the individual's record.

5) At least monthly, the QIDP shall review the Implementation Strategy. The summary must be signed and dated by the QIDP each month and kept in the individual's record. The following shall be documented in the individual's monthly summary:

A) Services are being implemented as identified in the Implementation Strategy;

B) Services identified in the Implementation Strategy continue to meet the individual's needs or require modification to better meet the individual's needs;

C) Outcomes are being supported as specified in the Personal Plan and Implementation Strategy;

D) Progress is being made toward outcomes as identified in the Personal Plan and Implementation Strategy. In situations when there is no progress made, provider agencies must document barriers and/or reasons why progress was not made; and

E) Actions are recommended when needed.

6) Updates shall be made to the Implementation Strategy as the Personal Plan is modified, or more often if warranted by a change in function status or at the request of the individual or guardian, if applicable.

7) All services specified in the Implementation Strategy, whether provided by an employee of the licensed agency, consultants, or sub-contractors, shall be provided by or under the supervision of a QIDP.

8) The provider agency must ensure that current copies (digital or paper) of the individuals' Personal Plans and Implementation Strategies are kept at the CDS agency. The provider agency must also ensure that direct care workers (including employees, contractual persons, and host family members) are knowledgeable about the individuals' Personal Plans and Implementation Strategies, are trained in their implementation, and maintain records regarding the individuals' progress toward the outcomes of the Personal Plans and Implementation Strategies.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.530 Individuals requiring additional services and support in Community Day Services

a) There are occasions when an individual receiving Community Day Services requires additional attention and support as a result of changes in medical or behavioral health. Examples include a gradual deterioration of health and/or behavioral stability or reflect a more recent acute medical condition and/or sudden intense behavioral episodes. The agency must take reasonable and appropriate action to address and stabilize the individual's situation for the health and safety of the individual and/or others.

b) When an individual receiving Community Day Services requires additional services and support, the agency's Provider Support Team shall be convened and include agency administrative leadership staff as necessary. The agency's designated QIDP shall:

1) Convene a team meeting including, but not limited to, the individual, the individual's guardian, if applicable, and relevant staff as determined by the QIDP and others as determined by the individual or guardian. A representative of the ISC agency and residential provider, if applicable, must also be invited, with the provider making reasonable accommodation for them to attend. The ISC and residential provider are invited to learn of issues, provide input, and be prepared to take follow up actions.

2) The team will consider the current system of services and supports, including the use of internal provider's resources, external consultants, and the effectiveness of the current Personal Plan, Implementation Strategy, or other service planning documents.

A) If not in place and indicated by the occasion, a behavioral support strategy will be developed to outline actions that will be taken. If there is a current behavior support strategy, it will be reviewed and revised as necessary.

B) In situations of complex medical conditions, the team will review the individual's current Personal Plan to ensure needed medical services and supports are reflected. The team shall inform the ISC agency of changes needed to the Personal Plan.

C) The team will determine whether the provider will request additional staff supports, Support Services Team consultation, admission to a Short-term Stabilization Home, and/or other supports, as applicable.

D) Should the team request additional staff supports, Support Services Team consultation, or admission to a Short-term Stabilization Home, the Department will respond to the request(s) as soon as possible but no later than ten working days.

c) The steps outlined above must be followed by the provider prior to a discontinuation or reduction of Community Day Services as outlined in Section 119.540.

d) Following the team meeting described in Section 119.530(b)(1), it is expected that at least 30 days will be invested in determining the effectiveness of the current behavior support strategy or medical services, including any relevant revisions. The team shall also determine the benefits of any additional staff resources and consultations before proceeding with discontinuation or reduction of Community Day Services. The 30 days is exclusive of absences from the Community Day Service for necessary medical, behavior, or personal care related services.

(Source: Added at 45 Ill. Reg. _________, effective ____________)

Section 119.540 Criteria for termination, suspension, or reduction of Community Day Services

a) The Department recognizes there will be discontinuation of Community Day Services if:

1) An individual transfers to another qualified provider; or

2) An individual or individual's guardian, if applicable, voluntarily withdraws the individual from the provider's program.

b) The provider shall consider discontinuation of Community Day Services for an individual, within normal hours/days of operation, if:

1) The medical needs of the individual cannot be met by the Community Day Service as documented in the individual's record;

2) The behavior needs of an individual cannot be met by the Community Day Service to ensure the physical safety of the individual and/or others as documented in the individual's record;

3) The individual no longer benefits from the services provided by the Community Day Service as documented in the individual's Personal Plan and Implementation Strategy; or

4) The individual or individual's guardian, if applicable, takes repeated actions that prevent the consistent implementation of the individual's Implementation Strategy resulting in substantial risk of harm to the individual or others as documented in the individual's record. The language in this paragraph is in no way intended to limit efforts on the part of an individual or guardian to advocate for better or more appropriate services.

c) If the Program administration determines that reasonable and appropriate action as described in Section 119.240 has been taken without success to address and stabilize the individual's presenting medical and/or behavioral needs and program administration begins considering discontinuation or reduction of Community Day Services for the individual, the provider agency's assigned QIDP shall convene a meeting that includes, but is not limited to, the individual, the individual's guardian, if applicable, a representative of the Independent Service Coordination agency, Department representative, and others as determined by the individual or guardian. The provider must communicate prior to the meeting and during the meeting that discontinuation or reduction of Community Day Services is being considered.

1) If the provider determines it can continue to serve the individual with available resources and/or technical assistance, inclusive of any enhanced services and supports identified and secured through the process described in Section 119.240, another meeting of the involved parties will be convened by the provider in no more than 30 days to review progress. The process of convening a meeting and a subsequent meeting to review progress may be repeated.

2) If the provider determines it can no longer meet the needs of the individual, the provider will notify the individual, the individual's guardian, if applicable, the Independent Service Coordination agency and the Department, in writing, of discontinuation or reduction of Community Day Services for the individual.

3) The Independent Service Coordination agency will work to implement an alternative placement or other appropriate services and supports within 30 days of the provider's written notice to discontinue or reduce Community Day Services. The ISC shall communicate the status of their search to the individual, guardian (if applicable) and the Community Day Service prior to the provider's meeting.

4) If alternative services and supports will not be implemented within 30 days of the provider's notification to discontinue or reduce services, the provider will convene a meeting with the individual, the individual's guardian, if applicable, the Individual Service Coordination agency, a Department representative, and others as determined by the individual or guardian to determine the course of subsequent action.

d) In situations where the individual has demonstrated and is documented to be a current and expected on-going danger to self and/or others and/or is at extreme risk of harm, the provider, may implement an immediate suspension or discharge of the individual. In such situations, the individual, the guardian, if applicable, the Department, the ISC agency, and the provider will work together to identify alternative services needed. This can occur without implementing the process described in Section 119.240.

e) Should discontinuation or reduction of Community Day Services, within normal hours/days of operation, by a provider result in termination from the Waiver or a reduction in Waiver services, the Department shall issue a notice to the individual and guardian, if applicable, including the right to appeal according to 59 Ill. Adm. Code 120.

(Source: Added at 45 Ill. Reg. _________, effective ____________)