Draft Rule 120 5.17.21

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TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

The General Assembly's Illinois Administrative Code database includes only those rulemakings that have been permanently adopted. This menu will point out the Sections on which an emergency rule (valid for a maximum of 150 days, usually until replaced by a permanent rulemaking) exists. The emergency rulemaking is linked through the notation that follows the Section heading in the menu.

SUBPART A: GENERAL PROVISIONS

  • Section 120.10 Definitions
  • Section 120.20 Purpose
  • Section 120.25 Incorporation by reference
  • Section 120.30 Program description (Repealed)
  • Section 120.40 Service descriptions
  • Section 120.50 Target population

SUBPART B: SYSTEM COMPONENTS

  • Section 120.60 Overview (Repealed)
  • Section 120.65 Conflict of interest free case management
  • Section 120.70 Service provider requirements
  • Section 120.80 Program assurances
  • Section 120.90 Department audit

SUBPART C: INDIVIDUAL RIGHTS AND RESPONSIBILITIES

  • Section 120.100 Overview
  • Section 120.110 Terminations, appeals and fair hearings
  • Section 120.120 Individual's responsibilities

SUBPART D: OPERATIONAL PROCEDURES

  • Section 120.130 Filing an application (Repealed)
  • Section 120.140 Eligibility criteria
  • Section 120.150 Eligibility determination
  • Section 120.160 Person-Centered Planning

AUTHORITY: Implementing Section 3 of the Community Services Act [405 ILCS 30/3] and Sections 5-1 through 5-11 of the Public Aid Code [305 ILCS 5/5-1 through 5-11] and authorized by Section 5-104 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-104] and Section 5 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/5].

SOURCE: Adopted and codified at 7 Ill. Reg. 15630, effective November 9, 1983; emergency amendment at 16 Ill. Reg. 2652, effective February 1, 1992, for a maximum of 150 days; emergency expired June 30, 1992; amended at 18 Ill. Reg. 15600, effective October 5, 1994; amended at 20 Ill. Reg. 4762, effective March 8, 1996; recodified from the Department of Mental Health and Developmental Disabilities to the Department of Human Services at 21 Ill. Reg. 9321; emergency amendment at 22 Ill. Reg. 12185, effective June 24, 1998, for a maximum of 150 days; emergency expired November 21, 1998; amended at 22 Ill. Reg. 22399, effective December 8, 1998.

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.10 DEFINITIONS

Section 120.10 Definitions

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

 "Abuse." See definition found in 59 Ill. Adm. Code 50.10.

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

"Children's Group Home (CGH)". A residential service within the DD Children's Residential Waiver, for children and adolescents (ages 3-21) with developmental disabilities which are designed to provide a structured environment to children and adolescents who cannot reside in their own home. These settings are licensed by DCFS under Title 89, Chapter III, Subchapter e.

"Code." The Mental Health and Development 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 their free and informed choice.

 "Community Day Service." A certified day program that provides assistance with gaining, maintaining or improving skills and functioning. Services can reinforce skills or strategies taught in other settings and may include training and supports to help prevent or slow the loss of skills. CDS takes place in a non-residential setting, separate from the participant's residential setting, whether individually owned or controlled or other . 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). CDS activities shall promote greater independence and support full access to the general community to the same degree as individuals not receiving HCBS waiver services.

"Community integrated living arrangement (CILA)." A certified living arrangement certified where eight or fewer individuals with mental illness or a developmental disability reside together in a home under the supervision of the agency and are provided with an array of services. (Section 3(d) of the Community-Integrated Living Arrangements Licensure and Certification Act)

 "Community living facility (CLF a transitional residential setting which provides guidance, supervision, training, community inclusion, case management and other assistance to ambulatory or mobile individuals (age 18 and older) with a mild or moderate developmental disability who have a goal of eventually moving to a more independent living arrangement. Individuals are required to participate in day activities, such as vocational training or regular employment. A Community Living Facility shall not be a nursing or medical facility and shall serve no more than 20 individuals. CLFs that serve 16 or less individuals are a part of the DDD Adult HCBS Waiver. (Community Living Facilities Licensing Act [210 ILCS 35]).

"Confidentiality Act." The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

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

"Department." The Department of Human Services.

 "Developmental disability." A disability which is attributable to: a) an intellectual disability; or b) a related condition (such as cerebral palsy, epilepsy, autism, or any other conditions) 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 functional limitations in at least three of the major life skill areas: Self-care, Language, Learning, Mobility, Self-direction and Capacity for independent living [405 ILCS 5/1-106].

 "Division (DDD)." The Department's Division of Developmental Disabilities.

 "Grant agreement." When fully executed the obligating instrument providing the basis for Departmental financial participation in grant-in-aid programs and which formalizes the contractual relationship between the Department and the provider indicating the amount of Department funds which will be paid to the provider for the provision of services as described in the grant agreement and the agency plan. Requirements for grant-in-aid funded providers are contained in the Department's rules at 59 Ill. Adm. Code 103.

 "Guardian." The plenary or limited guardian or conservator of the individual appointed by the court for an individual over age 18 (when the limited guardian's duties encompass concerns related to service requirements), the natural or adoptive parent of a minor, or a person acting as a parent of a minor. All references in this Part to an "individual and/or guardian" include the guardian only if applicable.

"Habilitation." An effort directed toward the alleviation of a developmental disability or toward increasing the level of physical, mental, social or economic functioning of an individual with a developmental disability. Additionally, it may include efforts to prevent loss of skills or decelerate loss of function. Habilitation may include, but is not limited to diagnosis, evaluation, medical services, personal care, day care, special living arrangements, training, education, employment related services, protective services, counseling and other services provided to individuals with developmental disability by developmental disabilities programs.. (Section 1-111 of the Code)

 "Home and Community-Based Services (HCBS) waiver." A Federally approved program which allows services that support individuals to remain in their own homes or live in a community setting, instead of an institution. HCBS is person-centered care which is delivered in the home and community.

"Individual." A person with developmental disabilities who is requesting, is receiving or has received services under this Part.

 "Implementation Strategy." A document developed by a licensed or certified provider agency in conjunction with the individual and if applicable, the individual's guardian, that describes and directs the activities and methods used to provide services and supports for the areas of an individual's Personal Plan for which the provider agency has agreed to be responsible. The 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 provider agency's responsibility. The document must describe how the provider agency will support the person to pursue the outcomes included in the Personal Plan and be approved by the individual and/or guardian.

 "Independent Service Coordination (ISC) Agency." An entity designated by the Department's Division of Developmental Disabilities to carry out 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.

 "Individually owned or controlled." A physical setting in which the individual resides that is owned, co-owned, leased or rented by the individual. This setting is not provider owned or controlled.

 "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 age 18 years.

"

 "Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/DD)." As defined by 42 CFR 440.150 (2015).

"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]

"Person-centered planning." A process that addresses health and long-term services and support needs in a manner that reflects individual preferences and outcomes. The planning process, and the resulting Personal Plan, will assist the individual in achieving personally defined outcomes in the most integrated community setting, ensure delivery of services in a manner that reflects personal preferences and choices, and contribute to the assurance of health and welfare.

 "Personal Plan." A written document developed by an ISC agency in conjunction with the individual and guardian as well as family members, providers of services and others (e.g. friends or individual's representatives) as chosen by the individual and guardian, that includes an assessment of the individual's strengths, preferences, needs, and desired outcomes. The document describes what is important to the individual 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.

"Program." The Medicaid Home and Community-Based Services Waiver Programs implemented in this Part.

"Provider." A community developmental services organization in accordance with the Business Corporation Act [805 ILCS 5 through 415], that is under an agreement with the Department to provide HCBS Waiver services for individuals with a developmental disability.  "Provider-owned or controlled". A physical setting in which the individual resides that is a) owned, co-owned, leased or rented by a provider of Home and Community-Based Services; or b) owned, co-owned, leased or rented by a third party that has a direct or indirect financial relationship with a provider of Home and Community-Based Services.

"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]

 "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 Nursing 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 Dietician 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 review." The Division's Bureau of Quality Management (BQM) process to determine the degree of compliance with quality assurance requirements in this Part that a provider agency has maintained. This can include reviewer observation and an on-site examination, desk audit, remote or virtual form of examination of the following: policies, procedures, records of individuals, written Personal Plan and Implementation Strategies. Reviewers shall use an instrument containing National Core Indicators to interview individuals and employees. Observation of a sample of individuals, drawn from across provider agency sites statewide, is also a part of the review.

"Seclusion." Sequestration by placement of an individual alone in a room from which he or she has no means of leaving; seclusion is prohibited.

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

"Service coordination." The coordination and monitoring of supports to assist an individual in planning and evaluating necessary services to ensure a comprehensive array of supports and services to meet an individual's needs, personal goals and choices as defined in the individual service/support plan.

 "Supported employment program (SEP)." Intensive supports provided to individuals with developmental disabilities to obtain and sustain full-time or part-time paid work (at or above minimum wage) in an integrated business, industry, or community setting. Individuals receiving SEP shall be provided opportunities for advancement similar to those employees without disabilities who have similar positions. Supports shall occur at locations where the individual interacts with employees without disabilities, as well as regular interaction with persons who are not paid care givers or service providers. Supports may be provided individually or in group settings of no more than six individuals with disabilities. Individuals in SEP shall not be isolated from individuals who do not have disabilities.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.20 PURPOSE

Section 120.20 Purpose

a) The intent of this Part is to provide uniform direction for providers, individuals and guardians, if applicable, enrolled in one of the Medicaid Home and Community-Based Services Waiver Programs (HCBS):

1) The Waiver for Adults with Developmental Disabilities

2) The Children's Residential Waiver

3) The Children's Support Waiver

b) This Part also provides direction to Independent Service Coordination agencies in regards to case management activities.

c) Healthcare and Family Services (HFS) is the single State Medicaid Agency designated to administer and oversee the administration of the Medicaid program under Title XIX, Medical Assistance, of the Social Security Act (42 U.S.C.A. 1395a (2018) and 42 CFR 431 (2017)) and the Illinois Public Aid Code [305 ILCS 5].

d) The Department of Human Services is designated as a State Operating Agency having primary responsibility for overseeing the delivery of HCBS Waiver services to individuals with developmental disabilities under the Code.

e-d)  Healthcare and Family Services and the Department have entered into an interagency agreement to specify their respective roles and responsibilities regarding the Home and Community-Based Services Waiver Program (HCBS) for individuals with developmental disabilities.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.25 INCORPORATION BY REFERENCE

Section 120.25 Incorporation by reference

Any rules of an agency of the United States or of a nationally-recognized organization or association that are incorporated by reference in this Part are incorporated as of the date specified and do not include any later amendments or editions.

(Source: Added at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.30 PROGRAM DESCRIPTION (REPEALED)

Section 120.30 Program description (Repealed)

(Source: Repealed at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.40 SERVICE DESCRIPTIONS

Section 120.40 Service descriptions

a) The services covered under the Medicaid HCBS waiver programs shall be rendered as specified by the Division, in accordance with a written Personal Plan and Implementation Strategy and shall be designed to ensure the continuity of supports and services for individuals. HCBS Waiver services, for the purpose of this Part, does not include:

1) Special education and related services (as defined in Sections 602(16) and (17) of the Individuals with Disabilities Education Act (20 U.S.C.A. 1400 (2015)) which otherwise are available to the individual through a local education agency; or

2) Vocational rehabilitation services which otherwise are available to the individual through a program funded under Section 110 of the Rehabilitation Act of 1973 (29 U.S.C.A. 794 (2018)).

a

b) Residential habilitation services

HCBS Residential Habilitation services are designed to assist children/young adults and adults in acquiring, retaining and improving skills related to living in the community. These services include self-help, socialization, community inclusion, daily living and adaptive skills necessary to reside successfully in HCBS Waiver settings.

c) Day and employment services are provided to adults enrolled in the Adult DD Waiver program and are intended to enhance individual life skills, community, and social skills, work related activities and employment skills. :

d) HCBS Home Based Support Services is an individualized designed program of separately covered services, or assessment of the need for these services, to assist individuals to live in a private family home or an individually owned or controlled home. HBS has a monthly dollar cost maximum set by DHS. All services provided must be for the direct benefit of the individual and must be directly related to their disability. HBS, and the services available within the program, are further detailed at 59 Ill. Adm. Code 117.

e) The HCBS Waivers provide a variety of other services and supports to address an individual's habilitation, mobility, emotional, cognitive or behavioral needs. The services must be included in the Personal Plan and can be provided in a variety of ways including, but not limited to, direct support and/or treatment, evaluations, intervention strategies, staff training, equipment, environmental modifications and emergency supports.

1) 

2) 

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.50 TARGET POPULATION

Section 120.50 Target population

Individuals to be served under this Part are Medicaid-eligible Illinois adults and children with developmental disabilities who otherwise would require ICF/DD [42 CFR §440.150] level of care. Adults entering the waiver must be at least be age 18 years or older; children entering a waiver must at least be age 3 years old and can remain through age 21. Individuals served shall meet Illinois Medicaid eligibility standards, meet non-financial eligibility criteria under this Part and be: :

a) Residents of State-Operated facilities who are able to function more independently in the community and/or who prefer services in a HCBS services Waiver.

b) On DHS's waiting list for HCBS services.

c) Individuals being subjected to abuse, neglect, or homelessness.

d) Residing as an adult in child group homes.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.60 OVERVIEW (REPEALED)

Section 120.60 Overview (Repealed)

(Source: Repealed at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.65 CONFLICT OF INTEREST FREE CASE MANAGEMENT

Section 120.65 Conflict of Interest Free Case Management

a) The Department shall contract with Independent Service Coordination (ISC) agencies to provide conflict of interest free case management as described in 42 CFR 431.301(c)(1)(vi).

b) Case management shall include:

1) Determination of eligibility. The Department has the responsibility to oversee the accuracy, quality, and appropriateness of functions provided by ISC and reserves the right to review and approve or reject determinations of eligibility made by ISC agencies.

2) Development and annual update of the Personal Plan as described in 42 CFR 441.301(c)(1)(vi) and section 120.160 b).

3) Enrolling and maintaining individuals on the Division's database for individuals who desire or need Waiver services.

4) Ensuring the provision of informed choice of all services and providers.

5) Linking individuals to services and addressing problems related to outcomes and quality.

c) Conflict of interest occurs when the entity providing case management is:

1) A provider agency, a person who has an interest in or who is employed by a provider.

2) A person that is related by blood or marriage to the individual or to any paid caregiver of the individual.

3) A person that is financially responsible for the individual.

4) A person that is empowered to make financial or health related decisions for the individual.

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.70 SERVICE PROVIDER REQUIREMENTS

Section 120.70 Service provider requirements

a)  New and current provider agencies shall operate under an agreement with the Department and shall be enrolled as Medicaid providers in the Illinois Medical Program Advanced Cloud Technology (IMPACT) system, with the Department of Healthcare and Family Services. Providers shall meet Department standards applicable to the specific services to be provided and shall demonstrate competency to provide services.

1)  The provider agreement shall note that the provider voluntarily requests assignment of payment for program services to the Department which shall arrange for payment to the provider.

2)  The provider agreement and related attachments shall be the obligating instruments which provide the basis for financial participation for the Medicaid home and community-based services waiver program.

b) Service providers shall:

1) Meet the fiscal, program and reporting requirements of the Medicaid home and community-based services waiver program

2) Be willing to serve former or potential residents of State-operated developmental centers or community ICF/DDs.

3) Be in compliance with applicable Medicaid provider requirements, appropriate licensure procedures and/or standards as well as Department operational procedures for purchase of service or grant programs (see the Department's Rules at 59 Ill. Adm. Code 103, 113, 115 and 119).

4) Comply with intake, assessment, monitoring and billing procedures established for services under this Part.

c) Provider owned or controlled residential and non-residential settings must have all of the following qualities, and such other qualities as determined to be appropriate, based on the needs of the individual as indicated in their Personal Plan [42 CFR 441.301(c)(4)]:

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 and an option for a private bedroom or unit in a residential setting. The setting options are identified and documented in the Personal Plan and are based on the individual's needs, preferences, and, for residential settings, resources available for room and board.

3) Ensure an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint.

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.

6) Provider-owned or controlled residential setting(s), in addition to the qualities described in subsections (d)(1) through (d)(5), must meet the following additional conditions:

A) The residential setting is a specific physical place that can be owned, rented or occupied under a legally enforceable agreement (consistent with the guidelines issued by the Department) by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity. For settings in which landlord tenant laws do not apply, the State must ensure that a lease, residency agreement or other form of written agreement, as determined by the Department, will be in place for each HCBS participant, and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction's landlord/tenant law.

B) Each individual has privacy in their residential setting:

i. Residential settings have entrance doors lockable by the individual, with only appropriate staff having keys to doors.

ii. Individuals sharing a residential setting have a choice of roommates in that setting.

iii. Individuals have the freedom to furnish and decorate their residential setting within the lease or other agreement.

C) Individuals have the freedom and support to control their own schedules and activities and have access to food at any time.

D) Individuals can have visitors of their choosing at any time.

E) The setting is physically accessible to the individual. All communal areas must meet standards set forth by the ADA and other federal, state, or municipal regulations. Providers must ensure sites are certified and have capacity for a non-ambulatory individual before offering placement. The non-ambulatory capacity is indicated in the certification letter given to each provider by BALC for every site.

F) Any modification of the additional conditions, under subsection (e)(6)(A) through (D), must be supported by a specific assessed need and justified in the Personal Plan. The following requirements must be documented in the Personal Plan:

i. Identify a specific and individualized assessed need.

ii. Document the positive interventions and supports used prior to any modifications to the Personal Plan.

iii. Document less intrusive methods of meeting the need that have been tried but did not work.

iv. Include a clear description of the condition that is directly proportionate to the specific assessed need.

v. Include regular collection and review of data to measure the ongoing effectiveness of the modification.

vi. Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated.

vii. Include the informed consent of the individual and guardian.

viii. Include an assurance that interventions and supports will cause no harm to the individual.

d) ) Provider payments

Providers who will deliver authorized services to individuals determined eligible under the Medicaid HCBS Waiver programs shall be paid by the Department on a monthly basis on submission of service reports/billing statements.

e) ) Monitoring of providers

Service providers shall cooperate with quality assurance reviews, licensure surveys, monitoring, evaluations and information requests conducted by the Department , Healthcare and Family Services or by other entities that are authorized by Healthcare and Family Services or the Department, such as Individual Service Coordinators, , auditors or evaluators.

f) ) Appeals by providers

1) As the single State Medicaid agency, the Department of Healthcare and Family Services is responsible for conducting all provider hearings and rendering the final administrative decision. The appeal requirements and process are contained in the Department of Healthcare and Family Services rules at 89 Ill. Adm. Code 104.200 through 104.210.

2) The Department shall conduct informal reviews of provider appeals to attempt to resolve issues without a formal hearing.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.80 PROGRAM ASSURANCES

Section 120.80 Program assurances

In addition to program requirements specified in other Sections of this Part, assurances for the Medicaid Home and Community-Based Services Waiver Program will include:

a) Level of care determination.

An evaluation and periodic (at least annual) reevaluations of the individual's need for the level of care provided in an ICF/DD, as defined by 42 CFR 440.150 (2006), shall be conducted for an individual when there are indications that the individual might need such services in the near future. .

b) Informing individuals of choice

All individuals participating in HCBS Waivers must have a Personal Plan (Section120.160) which facilitates individual choice regarding services and supports, and who provides them per 42 CFR 441.301(c)(4)(v)).

c) Average per capita expenditures

The average per capita Medicaid expenditures, including Home and Community-Based Services, will not exceed 100 percent of the average per capita expenditures that would have been made under the Medicaid State plan for the level(s) of care specified for this waiver had the waiver not been granted. The State must therefore limit participating individuals and expenditures under this program to meet the per capita cost requirements.

d) Rate methodology Rates for reimbursement of program services shall be established by the Department and approved by the Department of Healthcare and Family Services. Rate levels shall be determined for each type of Medicaid HCBS service by unit of service provided, e.g., per hour, per day. Providers shall receive written notification of rates and rate changes at least annually.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.90 DEPARTMENT AUDIT

Section 120.90 Department audit

The Department requirements for service providers annual audits are found in 89 Ill. Adm. Code 507 Section.

(Source: Amended at 28 Ill. Reg. 7535, effective May 17, 2004)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.100 OVERVIEW OF RIGHTS

Section 120.100 Overview of Rights

a) Observation and protection of rights of individuals

1) The observation and protection of rights of individuals receiving developmental disability services in the public and the private sector as set forth in Chapter 2 of the Code, except that the use of seclusion will not be permitted, are applicable to all Sections of this Part.

2) Individuals receiving HCBS Waiver services must be free from abuse, neglect, coercion, and restraint.

3) The Department, ISCs and service providers shall ensure that individuals, guardians, if applicable, and others as designated by the individual receive a complete explanation of their rights and responsibilities at the time of service initiation, annually thereafter, and on request.

4) The advisement of the individual's rights shall be documented in the individual's record on the Right of Individuals form [IL462-1201];

5) The justification for any restriction of individual's HCBS Waiver rights, as indicated in section 120.70 e) 6) A) through E), shall be:

A) Documented in the individual's Personal Plan and Implementation Strategy as outlined in section 120.160 of this part.

B) Reviewed and approved by the provider agency's Human Rights Committee before the restriction is implemented.

6) The right of individuals confidentiality shall be governed by the Confidentiality Act.

b) Non-discrimination

In accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C.A. 2000d (2009)), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A. 794 (2015)), the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 through 12213 (2008) and 47 U.S.C.A. 225 and 611 (2010)) and the regulations at 45 CFR 80 (2005) and 45 CFR 84 (2010), the Department assures that no individual shall be subjected to discrimination under this Part on the grounds of race, color, national origin, sex, or disability.

c) Confidentiality of case information

For the protection of individuals, any information about an individual or case is confidential and may be used only for purposes directly related to the administration of the Medicaid HCBS Waiver programs. The Department and service providers shall inform all entities to whom information is furnished that this material is confidential, subject to the provisions of the Confidentiality Act and shall be so considered by the entity. An authorization for release of information shall be used to secure the individual's or guardian's, if applicable, consent to share information.

d) Notice of action

Individuals requesting or receiving HCBS Waiver services have the right to a written notice of disposition of the request, a reduction, suspension, denial or termination of HCBS Waiver services. Such notice must be communicated in writing at least 10 calendar days prior to the effective date of the action, except, in an emergency, the provisions of Section 120.110(i)(2) of this Part shall apply. Notices shall contain the following information:

1) A clear statement of the action to be taken;

2) A clear statement of the reason for the action;

3) A specific policy reference which supports such action; and

4) A complete statement of the individual's right to appeal, including the provider's grievance process, the Department's informal review process and HFS' hearing process.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.110 TERMINATIONS, APPEALS AND FAIR HEARINGS

Section 120.110 Terminations, appeals and fair hearings

a) The individual, parents, guardian, or the individual's representative may appeal the following actions:

1) Refusal of the Division to accept a request for services.

2) Failure of the Division or ISC agency to act on a request for services within the mandated time period.

3) Denial of service by the Division; or

4Denial of clinical eligibility

5) Suspension, termination or reduction of services by the Division.

b) The appeal request shall be submitted within 10 working days after the date the individual or guardian receives the notice of action following the agency grievance process. The appeal request must be submitted to the Division of Developmental Disabilities' Appeals Unit by:

1) Encrypted email to the Program Development/Appeals Unit supervisor,

2) Fax to 217-558-2799 Attn: Appeals Unit supervisor

3) Mail to DHS/DDD - Program Development

Attn. Appeals Unit supervisor

  600 E. Ash St. Bldg. 400, 3rd Floor South

  Springfield, IL 62703

c) Within 30 working days after the notice of appeal is received, the Division shall conduct an informal review of the appealed action and reverse, modify or leave unchanged the decision. The appellant, the appellant's representative (if any) and the service providers shall be notified in writing of the Division's action within 10 working days after the informal review. The written notification shall include:

1) A clear statement of the action to be taken.

2) A clear statement of the reason for the action.

3) A specific policy reference which supports such action; and

4)  A complete statement of the individual's right to appeal the decision to the Department of Healthcare and Family Services (HFS).

d)  The appeal shall be filed with, and received by, Healthcare and Family Services within 10 working days after the date the individual or guardian receives the written notification from the Department.

e) The hearing shall be conducted by an impartial hearing officer appointed by HFS.

f) The hearing shall be held by telephone .

g) HFS's hearing rules for assistance appeals, as set forth at 89 Ill. Adm. Code 104, shall apply, except that subsection (c) of this Section shall apply rather than any similar HFS rule.

h) Following the hearing, the Director of the HFS shall issue a final administrative decision in accordance with 89 Ill. Adm. Code 104.70. Copies of the decision shall be mailed to the appellant, the appellant's representative (if any), the service provider, and the Supervisor of the Division's Appeals Unit.

i) The receipt of the request for an appeal shall stay the decision pending the final administrative decision or the withdrawal of the appeal. If the decision being appealed is in regard to suspension, termination or reduction of services, services shall not be suspended, terminated or reduced until the appeal is resolved, except as described below.

1)  Services may be suspended, terminated, or reduced before the final administrative decision only if all of the following conditions are met:

A) The physical safety or health of the individual or others is in extreme risk of harm.

B) Appropriate services are not available at the provider agency;

C) The provider agency has documented attempts to identify and ameliorate the probable causes of maladaptive behaviors and to seek staff training or technical assistance to meet the individual's needs; and

D) The ISC agency has:

i) Reviewed the individual's record;

ii) Gathered the necessary clinical information;

iii) Reviewed the actions of the provider;

iv) Met with the individual; and

v) Determined that a delay in termination, suspension or reduction in services would put the physical health or safety of the individual or others in extreme risk of harm and has documented that fact in the individual's record.

2)  If all the requirements of subsection (i)(1) of this Section have been met, services to the individual may be terminated, suspended or reduced and the notice of action shall be given in accordance with Section 120.100(d) of this Part as soon as possible, but in no case later than 48 hours after the termination, suspension or reduction in services.

3) The provider shall hold the individual's place open until the appeal is resolved.

j) The following outlines the criteria for termination of services from a provider agency, unless specified otherwise in Administrative code.

1) A provider agency may terminate its services if:

A) An individual transfers to another qualified provider; or

B) An individual or individual's guardian, voluntarily withdraws the individual from the provider agency's services.

2) A provider agency shall consider a termination of services to an individual if any of the following conditions occur:

A) The medical needs of the individual cannot be met by the provider agency as documented in the individual's record.

B) The behavioral needs of an individual cannot be met by the provider agency to ensure the physical safety of the individual and/or others as documented in the individual's record.

3) If the provider agency determines that reasonable and appropriate action has been taken without success to address and stabilize the individual's presenting medical and/or behavioral situation and agency administration begins considering discontinuation of provider services for the individual, the provider agency shall convene a meeting that includes, but is not limited to, the individual, the individual's guardian, and the ISC agency.

A) The provider agency must communicate prior to the meeting and during the meeting that termination of services from this provider is being considered.

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

C) If prior to concluding a meeting, the provider agency determines it can no longer meet the needs of the individual, and the ISC agency agrees, the ISC agency will notify the DDD in writing and will work to implement an alternative or other appropriate services and supports within 30 calendar days of the meeting. The provider agency will assist to secure appropriate alternative services and supports. The provider agency will notify the individual, guardian, and the Department, in writing, of termination of its services to the individual within 5 days of this decision.

D) If prior to concluding a meeting, the provider agency determines it can no longer meet the needs of the individual, and the ISC agency does not agree with the agency's determination, the ISC agency shall follow the protocol for resolving issues or concerns.

E) Should it appear to the provider agency that an alternative setting or other appropriate services and supports will not be implemented within 30 calendar days of the ISC agency's written notification to the Department the provider agency will convene a meeting with the individual, the guardian, and the ISC agency to determine the course of subsequent action.

4) 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 health or harm, the agency (including the QIDP), the individual, when possible, the guardian, the ISC agency, and a Department representative will work together to achieve the needed services.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.120 INDIVIDUAL'S RESPONSIBILITIES

Section 120.120 Individual's responsibilities

a) Information to establish eligibility

The individual shall provide, as able, the factual information necessary to establish eligibility including the consent to release information as provided for in Section 120.100(c) of this Part. The ISC agency or service provider, with the consent of the individual, may assist in obtaining such information.

b) Reporting changes in personal information and services

1) It is the responsibility of the individual or guardian (if applicable) to report all changes in circumstances (including change in address, housing arrangements, income or assets, eligibility for other benefits or programs) to the Department and to the provider within five working days after the change.

2) It is the responsibility of the individual or guardian (if applicable) to report changes in services currently provided by other entities which might affect the extent of supports or services provided through the Medicaid Home and Community-Based Services Waiver Program. Such information shall be reported to the provider.

c) Application for other benefits

Individuals are required to apply for all other financial benefits, such as Supplemental Security Income, public assistance (the Illinois Public Aid Code [305 ILCS 5]), veterans benefits (38 U.S.C.A. 521, 541, and 542 (2011)), unemployment compensation (the Unemployment Insurance Act [820 ILCS 405]), Social Security retirement and disability benefits (Title II of the Social Security Act, 42 U.S.C.A. 401 (2011)), Worker's Compensation (Workers' Compensation Act [820 ILCS 305]) and Supplemental Nutritional Assistance Program (SNAP), for which they may qualify and to avail themselves of such benefits at the earliest possible date.

d) Social security number

Individuals requesting program services shall supply a social security number for program administration purposes. The service coordinator or provider can assist the individual in making application for a social security number if the individual so wishes.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.130 FILING AN APPLICATION (REPEALED)

Section 120.130 Filing an application (Repealed)

(Source: Repealed at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.140 ELIGIBILITY CRITERIA

Section 120.140 Eligibility criteria

a) The individual's age shall be within guidelines set forth by the DD Adult Waiver, Children's Residential Waiver or the Children's Support Waiver at the time services are initiated.

b) The individual shall be a resident of Illinois.

c) Prior to Medicaid waiver enrollment, an ISC agency shall assess the individual and determine that a developmental disability is present, the individual could benefit from active treatment and the individual does not require 24 hour nursing care. .

1) All individuals requesting program services shall be given a choice of alternative services through the PAS process. The choice shall include both ICF/DD and Home and Community-based Waiver services, which are an alternative to ICF/DD placement.

2) The criteria for this determination are contained in Healthcare and Family Services' 's rule at 89 Ill. Adm. Code 140.642.

d) The individual shall meet all financial and non-financial Medicaid eligibility criteria as specified in the approved State Medicaid Plan.

e) The individual shall not need nursing facility level of care.

f) The individual shall not be receiving services in a nursing facility, Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), Intermediate Care Facility for Developmental Disabilities (ICF/DD), State-Operated facility, Medically Complex facility for the persons with Developmental Disabilities (MC/DD) , hospital or another Medicaid Waiver program (without direct approval from the Secretary of DHS at the time program services are initiated or while being delivered.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.150 ELIGIBILITY DETERMINATION

Section 120.150 Eligibility determination

a) The Department of Health Care and Family Services shall determine the individual's financial eligibility per 89 Ill. Adm. Code 120.

b)  Individuals shall be served by the ISC agency that is located in the geographic area which the person resides. The ISC agency shall be responsible for:

1) Compiling information as needed for the determination of clinical eligibility.

2) Completing a determination of waiver eligibility as described including the  criteria in Section 120.140.

c) Eligibility for services under this Part may be denied for the following reasons:

1) An individual fails to meet the eligibility criteria specified in Section 120.140 of this Part.

2) The applicant does not supply needed information to complete the eligibility determination.

3) The individual's Personal Plan cannot be designed to adequately meet the individual's needs within the service cost limitations.

4) Individuals and expenditures under this program do not meet the per capita cost requirements as specified in Section 120.80(c) of this Part.

d) The ISC agency shall conduct a redetermination of Medicaid HCBS waiver program eligibility within 12 months after the last eligibility determination or redetermination. A redetermination shall also be conducted if, before 12 months have elapsed, there is a change in circumstances affecting eligibility (see Section 120.120(b) of this Part). A redetermination shall include an examination of criteria identified in Section 120.140 of this Part. A redetermination of the presence of developmental disability is not required.

(Source: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)

TITLE 59: MENTAL HEALTH

CHAPTER I: DEPARTMENT OF HUMAN SERVICES

PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

SECTION 120.160 PERSON-CENTERED PLANNING

Section 120.160 Person-centered planning

a) 

a) Individuals who are or who will be enrolled in a HCBS Waiver program, guardians, if applicable, ISC and provider agencies shall comply with Person-Centered Planning requirements as outlined in 42 CFR 441.301(c)(1) through (c)(3) and as set forth by the Department.

1) The person-centered planning process:

A) Must be driven by the individual who is or who will be enrolled in a HCBS Waiver program. The ISC agency shall facilitate the process; the guardian, must be included. Other persons invited by the individual and agencies currently providing services shall be invited to contribute to the process.

B) Provides necessary information and support to ensure that the individual directs the process to the maximum extent possible and is enabled to make informed choices and decisions.

C) Is timely and occurs at times and locations of convenience to the individual.

D) Reflects cultural considerations of the individual and is conducted by providing information in plain language and in a manner that is accessible to individuals with disabilities and persons who are limited English proficient.

E) Includes strategies for solving conflict or disagreement within the process, including clear conflict-of-interest guidelines for all planning participants.

F) Providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the Personal Plan, per as indicated in Section 120.65 of this part.

G) Offers informed choices to the individual regarding the services and supports they receive and from whom.

H) Includes a method for the individual to request updates to the plan as needed.

I) Records the alternative home and community-based settings that were considered by the individual.

b) ISC agencies shall initiate the Person-Centered Planning process for each individual who is or who will be enrolled in a HCBS Waiver program by conducting a discovery process designed to gather information about a person's preferences, interests, abilities, preferred environments, activities, and supports needed.

1) The ISC agencies will be responsible for facilitating the Discovery process as outlined by the Department and documenting what they gather.

2) This process should begin with the individual and then include the guardian, advocate or family, and others chosen by the individual. It must also include information from current providers.

3) The information captured during this process is used to develop the Personal Plan which summarizes key and critical areas of the person's life.

c) After the discovery process is complete, the ISC agency shall develop the Personal Plan. The Personal Plan must reflect the services and supports that are important for the individual to meet the needs identified through the discovery process, as well as what is important to the individual with regard to preferences for the delivery of such services and supports. The written plan must:

1) Reflect that the setting in which the individual resides is chosen by the individual. 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.

2) Reflect the individual's strengths and preferences.

3) Reflect clinical and support needs as identified through the Discovery process.

4) Include individually identified and desired outcomes.

5) Reflect the services and supports (paid and unpaid) that will assist the individual to achieve identified outcomes, and the providers of those services and supports, including natural supports.

6) Reflect risk factors and measures in place to minimize them, including individualized back-up plans and strategies when needed.

7) Be understandable to the individual receiving services and supports, and the individuals important in supporting him or her. At a minimum, for the written plan to be understandable, it must be written in plain language and in a manner that is accessible to individuals with disabilities and persons who are limited English proficient.

8) Identify the individual and/or entity responsible for monitoring the plan.

9) Be finalized and agreed to, with the informed consent of the individual in writing, and signed by all individuals and providers responsible for its implementation.

10) Be distributed to the individual and other people involved in the plan.

11) Include those services of which the individual elects to self-direct.

12) Prevent the provision of unnecessary or inappropriate services and supports.

13) Document any modification of the additional conditions, under section 115.70, (e)(6)(A) through (e)(6)(D) of this Part, must be supported by a specific assessed need and justified in the Personal Plan. The following requirements must be documented in the Personal Plan:

A) Identify a specific and individualized assessed need.

B) Document the positive interventions and supports used prior to any modifications to the Personal Plan.

C) Document less intrusive methods of meeting the need that have been tried but did not work.

D) Include a clear description of the condition that is directly proportionate to the specific assessed need.

E) Include a regular collection and review of data to measure the ongoing effectiveness of the modification.

F) Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated.

G) Include informed consent of the individual.

H) Include an assurance that interventions and supports will cause no harm to the individual.

d) The Personal Plan must be reviewed and revised upon reassessment of functional need as required by CFR?441.365(e), at least every 12 months, when the individual's circumstances or needs change significantly, or at the request of the individual.

e) Provider agencies 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, 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 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 provider's responsibility.

F) Justify and document the restriction of an individual's HCBS Waiver rights which are outlined in section 120.70 e) 6) A) through E)

G) Addresses outcomes identified in the Personal Plan that the provider agency agreed to support the individual in.

H) 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 services chosen by the individual and guardian 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.

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

3) The individual and guardian, 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, sign and date the Implementation Strategy. The provider agency shall document 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.

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 functional status or at the request of the individual or guardian.

7) All services specified in the Implementation Strategy, whether provided by an employee of the 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 individuals' Personal Plans and Implementation Strategies are kept at the provider agency.

9) 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: Amended at 20 Ill. Reg. 4762, effective March 8, 1996)