Developmental Disabilities Program Manual - FY23

Table of Contents

  1. Introduction
  2. Definitions
  3. Overview of Services
  4. Policies and Procedures
  5. Program Descriptions
  6. Deliverables/Costs/Payment
  7. Provider Responsibilities
  8. Department Responsibilities
  9. Support Services
  10. Community Services Structure
  11. Billing Instructions
  12. Program Monitoring
  13. Program Budget
  14. Appendix - State Authoritative Sources
  15. Contact Information
  16. Authority

  • Introduction

    The Illinois Department of Human Services (IDHS), Division of Developmental Disabilities' Program Manual is a guide to information about Illinois' developmental disabilities service system. In addition, this document provides supplementary contractual requirements for disability service providers under contract or grant with IDHS.

  • The Division of Developmental Disabilities (Division) has oversight for the Illinois system of programs and services specifically designed for individuals with developmental disabilities. IDHS provides direct services to individuals with developmental disabilities and funds community services provided by local agencies.
  • The Division works as a partner with many local entities statewide to offer an extensive array of services which enable persons with developmental disabilities to reside with their families or in other community living situations, and to develop functional and occupational skills. IDHS funds over 300 of these community service providers in every part of Illinois.

    The Illinois developmental disabilities service system is divided into 7 Community Service regions. Within each region, Division staff manage state funds budgeted for developmental disabilities services. They also coordinate community services and assist with state-operated developmental center admissions.

  • The Division develops policy and provides technical assistance to support service provision statewide.

  • The Division has administrative oversight and funds over 202 private Intermediate Care Facilities for Individuals with Developmental Disabilities (ICFs/DD). These residential settings in the community provide a continuous program of specialized and generic training, treatment, health services and related services that is directed toward the acquisition of the behaviors necessary for the individual to function with as much self-determination and independence as possible and the prevention or deceleration of regression or loss of current optimal functional status (also known as active treatment). ICFs/DD may also offer nursing care and highly structured programs.

    The Division also manages the operations of residential services to individuals with developmental disabilities who reside in state-operated developmental centers (SODCs). These developmental centers generally provide residential services to persons with developmental disabilities who have a higher level of need, or to individuals in crisis. In addition, the SODCs provide an array of services and supports to assist individuals to reside who transition to community living environments. 

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Definitions

Only individuals determined to have a developmental disability are eligible for services within the service system. A person is determined to have a developmental disability if the person has an Intellectual Disability or a Related Condition.

An Intellectual Disability refers to significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior that manifested before the age of 18 years. Significantly sub-average is defined as an intelligence quotient (IQ) of 70 or below on standardized measures of intelligence. This upper limit could be extended upward depending on the reliability of the intelligence test used.

A person with a Related Condition means an individual who has a severe, chronic disability that meets all of the following conditions:

It is attributable to:

  • Cerebral palsy, autism, or epilepsy; or
  • Any other condition, other than mental illness, found to be closely related to intellectual disabilities because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with intellectual disabilities and requires treatment or services similar to those required for these persons.
  • It is manifested before the person reaches age 22.
  • It is likely to continue indefinitely.
  • It results in substantial functional limitations in three or more of the areas following of major life activity: 
    • Self-care
    • Understanding and use of language
    • Learning
    • Mobility
    • Self-direction 
    • Capacity for independent living

In addition, some programs require individuals to meet the Medicaid Home and Community-Based Services Waivers (HCBS Waivers) criteria in order for the State to receive or be eligible for federal matching funds. Criteria for HCBS Waiver eligibility are contained in the Home and Community-Based Services Waiver Manual.

To determine Medicaid Home and Community-Based Services waiver eligibility, a Pre-Admission Screening (PAS) assessment by an Independent Service Coordination (ISC) agency is required for all individuals seeking services. The Provider shall not enroll individuals into Medicaid waiver services until completion of an assessment by an ISC, issuance of a Division Award Memorandum, and completion of Medicaid enrollment.

Residential providers are required to remain operational year-round. The Department will fund those individuals being served by the Provider or for whom bed-hold funding is requested, consistent with the bed-hold policies established by the Department unless the residential provider's rate includes an Occupancy Factor. The Provider shall comply with bed-hold or occupancy code policies and stipulations as issued by the Department. Payment will not be made for individuals receiving waiver services on dates when the individual is not enrolled in Medicaid unless the Division grants prior approval. 

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  • Overview of Services

    An Independent Service Coordination (ISC) agency is responsible for completion of a Pre-Admission Screening (PAS). A PAS is provided by ISC agencies who act as the "front door" for entry into the developmental disabilities system. The role of the PAS process is to ensure compliance with applicable Federal and State laws, arrange for and conduct assessments, make necessary determinations regarding eligibility for services, educate individuals and families, and make referrals and provide linkage to appropriate and needed services. The PAS process prevents inappropriate admissions to long-term care facilities (nursing facilities, Intermediate Care Facilities for Persons with Developmental Disabilities [ICFs/DD] and inappropriate enrollments in waiver programs.

  • The ISC agency is responsible for the provision of Individual Service and Support Advocacy (ISSA) activities. Through the provision of ISSA, the ISC represents the Department's interests in determining whether program services are being provided in the interest of and to the satisfaction of individuals receiving services; alerts the Division when monitoring and technical assistance are necessary; and provides support to individuals, guardians and providers in working through a variety of service issues, including those requiring conflict resolution, increased communication, and possible changes in support levels.
  • The ISC agency has a responsibility to provide independent service coordination through activities which promote service accessibility and continuity of care, and seeks to maximize an individual's potential for independence, productivity, and community integration. An independent service coordinator collects information on individuals seeking developmental disabilities services and enters the information on the PUNS database. An independent service coordinator ensures the completion of comprehensive assessments, development and implementation of an individual's Personal Plan, linkages to support services, and provision of ongoing service monitoring and advocacy. Additional information can be found in Section IV, Program Descriptions.
  • Community residential services are provided in Intermediate Care Facilities for persons with developmental disabilities (ICFs/DD), Specialized Living Centers (SLCs), Supported Living Arrangements (SLAs), Special Home Placements (SHPs), Home Individual Programs (HIPs), Community Living Facilities,(CLF's), Children's Group Homes (CGH), Child Care Institutions (CCI's), and Community Integrated Living Arrangements (CILA's).
  • Day and vocational services include Community Day Services, Individual Supported Employment, Small and Large Group Supported Employment, Adult Day Care, and Enhanced Residential Habilitation (fka At Home Day Services). These services are provided by community-based agencies and organizations to individuals throughout Illinois. These services are designed to enhance a person's skill levels in the major life areas, work-related activities, and employment skills. 
  • Individual and family support services enable people with developmental disabilities to continue to reside in their own or family homes while receiving needed Department-funded support services, such as Respite, Home-Based Support Services, and other in-home support services.
  • State-Operated Developmental Centers (SODCs) provide intensive services that presently cannot be provided in family homes or in community-based residential programs for people with developmental disabilities. Emphasis is placed on assisting people to achieve their personal goals of living where and with whom they choose, coupled with the development of community resources over the past several years, which is intended to target a census reduction at the SODCs. This emphasis is consistent with national trends in residential services where focus has shifted to helping people remain in their homes or community-based residential programs.

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Contract

The IDHS Uniform Grant Agreement (UGA) and/or the Healthcare and Family Services (HFS) Medicaid Waiver Agreement, between the Department and the Provider, is generally referred to as the Agreement and consists of several parts:

  • The IDHS UGA and/or the Medicaid Waiver Agreement containing the standard contract language used for all Department agreements.
  • Contract Attachment "A" containing specific agreement requirements related to programs funded by the Division. In particular, Section II "Applicable Rules and Guidelines," provides a listing of the Federal and State laws, rules, policies, and procedures.
  • Contract Exhibits showing the contract information, the type of services, the method of payment, the method of reconciliation, and contract deliverables.

The Department will initiate the contract/agreement, make it available for the Provider for review and signature, obtain the Secretary's signature and return a copy of the executed agreement to the Provider. The Agreement is not effective until signed by the Secretary.

Amendment Process

The Department will initiate a two-party signed amendment to the contract when:

  • The Department adds services to the Provider's program that are beyond the scope shown in Attachment "A".

The Department will modify the contract by letter notification when:

  • The Department revises the scope of services shown in the Exhibits to the UGA and/or the Medicaid Waiver Agreement; and/or
  • The Department increases or decreases a fixed/maximum funding amount. For example: grant-funded programs such as respite, ISC Grants or adds program services.

Program Descriptions

1. Screening, Advocacy & Service Coordination

Program Name: Pre-Admission Screening (PAS) 
Program Code: 780

Funding Mechanism(s): __X___Grant  _____ Fee-for-Service

Narrative Description: Principal services offered through the Pre-Admission Screening (PAS) program include the provision of prior authorization for all individuals for whom there is a reasonable basis to suspect the presence of a developmental disability who request Medicaid-funded services or the waiver alternative to nursing facility services. Specific PAS functions include the following:

  • Conducting and securing assessments to determine service eligibility;
  • Education of individuals, guardians, and families about service opportunities, including generic and specialized services;
  • Submit to HFS an application for all individuals who are not already enrolled in the Medicaid program and have been selected from PUNS or are being authorized in a DD Waiver. This process is in addition to Information Bulletin DD.16.080; which is specifically related to children under eighteen and IB DD.21.005; if the individual is needing placement specifically related to crisis situations;
  • Notices of determinations provided to individuals and guardians;
  • Assistance with the choice process;
  • Referral;
  • Assistance with service selection and linkage;
  • Assistance in preparation and approval of submissions to the Illinois Department of Human Services (IDHS) for capacity and rate requests when necessary (e.g., CILA and purchase of service programs);
  • Monitoring for four weeks following initiation of services; and
  • Accessibility 24-hours per day, 365 days per year for individuals in times of crisis.

PAS activity is governed by the DD PAS Manual, the Waiver Manual, and the Department of Healthcare and Family Services' Universal Pre-Screening Rule (89 Ill. Adm. Code 140.642). PAS agencies must comply with these and related documents. The Department reserves the right to review and reverse all determinations by PAS agencies, in keeping with procedures and policies laid out in those documents and pertinent information bulletins policy statements issued by the Division and other governmental entities, such as the Department of Healthcare and Family Services.

Eligibility Requirements: Individuals for whom a reasonable basis exists to believe they have a developmental disability who are requesting Medicaid-funded DD services or nursing facility services.

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Program Name: Individual Service and Support Advocacy (ISSA)
Program Codes: 51A-51L (formerly known as 50D)

Funding Mechanism(s): ___Grant___X_____ Fee-for-Service

Narrative Description: The Individual Service and Support Advocacy (ISSA) program provides collaborative assistance to both individual recipients and their providers in order to enhance the delivery and effectiveness of service provision. (Refer to "ISSA Guidelines" and Waiver Manual for detailed program information.) Principal services offered through the ISSA program include the following:

  • A minimum of four visits per year (for those enrolled in a waiver), performed with the foreknowledge of the guardian (if applicable) and allocated according to the following guidelines:
    • One visit for development of the Discovery Tool and/or the Personal Plan (PP);
    • Three additional quarterly visits to ensure waiver services are being implemented as identified in the PP;
    • Additional visits and other monitoring activities or based on the needs and preferences of the individual and/or guardian
  • Collaborative facilitation, with service providers, of conflict resolution for matters of concern to the individual and/or guardian and provider, including satisfaction, health, safety, well-being, and development and implementation of the Personal Plan;
  • Referral to the DD Regional Representative or Bureau of Transitional Services Representative for individuals discharged from an SODC within the past 12 months, for monitoring and/or technical assistance regarding unresolved matters of concern;
  • Annual re-determination of waiver eligibility. Please see Division Information Bulletin DD.19.012;
  • Accessibility 24-hours per day, 365 days per year for individuals in times of crisis; and
  • Review and verification of information submitted for the CILA program.
  • Review and verification of Special Funding Requests and Staff Add-On Requests.

Eligibility Requirements: Recipients of services must be members of the specific population. (See below.)

Eligible Population: Persons served include the following:

  • All persons enrolled in one of the Home and Community-Based Services Waivers, including members of the Bogard class;
  • Members of the Bogard class in Intermediate Care Facilities for Persons with Developmental Disabilities (ICFs/DD), not including State-Operated Developmental Centers. ISC agencies have specific ISSA requirements for Bogard class members who live in an ICF/DD. For Bogard class members only, the ISC must conduct a minimum of 4 quarterly visits a year. ISC agencies must record their visits using the Individual Service and Support Advocacy (ISSA) Visiting Notes; the ISSA Visiting Notes Interpretive Guidelines should be used for guidance. These documents are accessible through the appendix of this section. ISC agencies will not develop a Personal Plan for Bogard class members who live in ICF/DDs; the provider will continue developing an Individual Service Plan (ISP).

Expected Outcomes: Persons receiving ISSA services through the ISC agency will receive the following:

  • For individuals in the waiver, a minimum of four (4) separate direct, in-person contacts for the ISC per year. One contact for Discovery/Plan development; the other to monitor the plan's implementation. Additional contacts will be made based on the needs and preferences of the individual;
  • Collaborative facilitation, with service providers, of conflict resolution, when indicated and in timely fashion, for matters of concern to the individual and/or guardian and provider, including satisfaction, well-being, and programmatic issues;
  • Appropriate and timely referral to the DD Regional Representative, or Bureau of Transitional Services Representative for individuals discharged from an SODC within the past 12 months, for monitoring and/or technical assistance regarding unresolved matters of concern;
  • Enhancement of individual recipient satisfaction, as evidenced by Consumer Satisfaction Survey longitudinal scores; * Annual re-determination of waiver eligibility within required time frames;
  • Review and verification of CILA rate information;
  • Review and verification of Special Funding Requests and Temporary or Long-Term Intensive Staffing;
  • For Children turning 19 years of age, an adult Medicaid application will be submitted to HFS for the transition from the Children's Plan to the Adult Plan; and
  • Any individual with cancelled Medicaid coverage for a period of more than 90 days will require the submission of a new application to HFS for priority processing.

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Program Name: Independent Service Coordination
Program Code: 600

Funding Mechanism(s): _X_ Grant _____ Fee-for-Service

Narrative Description: The Independent Service Coordination (ISC) Program provides education, referral, and linkage services for children and adults with developmental disabilities. General ISC functions include:

  • Intake;
  • Education;
  • Goal setting, referral and linkage to both generic and specialized services;
  • Transportation to facilitate referrals and linkage;
  • Planning (only in those instances where not otherwise provided by other programs);
  • Crisis intervention.

In addition, this ISC program covers the following specific responsibilities:

  • Completion of PUNS database forms, as instructed by the Department, for all individuals in the assigned geographic area who seek inclusion in the database of unmet need;
  • Completion of mandated discharge, linkage and aftercare per 59 Ill. Adm. Code 125 (Discharge/Linkage/Aftercare);
  • Participation in planning efforts for adolescents aging out of the public-school system.

Eligibility Requirements: Persons eligible for ISC are:

  1. Children who are seeking DD services; and
  2. Adults seeking developmental disabilities services whose service needs have not been determined or who are not eligible for PAS or waiver services. Independent Service Coordination is not intended to replace internal strategies provided by direct service providers.

Priority or Target Population: Availability of services to individuals is prioritized as follows, in priority order, beginning with the most critical need:

  • All individuals seeking completion of PUNS forms;
  • Individuals subject to the provisions of 59 Ill. Adm. Code 125 (Discharge/Linkage/Aftercare), as needed by the Department to comply with this provision;
  • Individuals for whom the Department requests involvement due to special circumstances;
  • Adolescents aging out of the public-school system;
  • Individuals whose current services or living situations are unstable, and for whom service coordination services are not provided through other programs; and
  • Individuals who are unable to access services who have few family or natural supports.

Expected Outcomes: The Department will have an accurate database of individuals with unmet needs. Individuals will access developmental disabilities services appropriate to their needs, whether these are of a temporary, time-limited nature (e.g., information and referral) or of long-term duration (e.g., residential services). Individuals requiring mandated contacts will receive them.

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Program Name: Bogard Service Coordination
Program Code: 781

Funding Mechanism(s): _X_ Grant _____ Fee-for-Service

Narrative Description: The Bogard Service Coordination program provides the following services:

  • Provision of assessments and reassessments of needs and goals;
  • Coordination of the Service Plan;
  • Specialized Service facilitation and brokering for persons in nursing facilities;
  • Development of natural support networks;
  • Performance of activities to maintain or improve availability, accessibility, and quality of services;
  • Assistance with the procurement of adaptive equipment through the Department of Healthcare and Family Services;
  • Monitoring the implementation of the Individual Service Plan (ISP), as well as the individual's health, safety and well-being, through site visits to residential and day program sites;
  • Utilization of problem-solving procedures to achieve conflict resolution;
  • Crisis Intervention;
  • Provision of transportation to facilitate the selection of employment and residential services among other options; and
  • Provision of the Bogard choice process, as directed in the Modified Bogard Consent Decree.

Eligibility Requirements: The individual must be an adult with a developmental disability who has been designated in writing by IDHS as a Bogard class member. Bogard class members are defined in the modified Bogard Consent Decree, pg.1, Section A., as persons, 18 years of age or older, with Developmental Disabilities (this term is further defined in Section III of the modified decree), who, on or after March 23, 1986, resided in an Intermediate Care or Skilled Nursing Facility in Illinois as a Medicaid recipient for a period of more than 120 days in the aggregate. No person first admitted to an Intermediate Care Facility or a Skilled Nursing Facility on or after April 1,1994, will be a member of the class.

Eligible Population: Bogard class members who receive Bogard ISC services are those class members living in nursing facilities, nontraditional DD settings (such as State Operated Mental Health Centers, shelter care homes, their own or family homes, apartments without DD services), and State Operated Developmental Centers. (Note: Bogard class members who receive Individual Service and Support Advocacy services are those class members receiving waiver services [such as Community-Integrated Living Arrangement, Community Day Services or Home-Based Support Services] or Intermediate Care Facilities for persons with Developmental Disabilities [not including State-Operated Developmental Centers]).

Expected Outcomes: Individuals will develop new skills and maintain existing ones through specialized services or active treatment, receive adaptive equipment as appropriate, live in appropriate community-based residential settings if they so choose, and receive service coordination on a regular basis.

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2. Residential Services

Program Name: Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD)
Program Code: N/A

Funding Mechanism(s): _____  Grant ___X _ Fee-for-Service

Narrative Description: An ICF/DD is a residential facility of three or more persons, or a distinct part thereof, serving residents of which more than 50 percent have a developmental disability or a related condition. Such facilities are licensed by the Department of Public Health as an Intermediate Care Facility for individuals who have a developmental disability. The ICF/DD is a continuous program of specialized and generic training, treatment, health services and related services that is directed toward the acquisition of the behaviors necessary for the individual to function with as much self-determination and independence as possible and the prevention or deceleration of regression or loss of current optimal functional status. It does not include services to maintain individuals who are able to function with little supervision or in the absence of a continuous program. ICFs/DD are certified by the federal Centers for Medicare and Medicaid Services to receive Medicaid payments. The individuals for whom such payments are made shall be receiving active treatment in accordance with 42 Code of Federal Regulations 483.440. (References: 42 CFR 440.150, 42 CFR 483.440(a), 89 Ill. Adm. Code 144 and 77 Ill. Adm. Code 350.)

Eligibility Requirements: Individuals who have a developmental disability or a related condition and who have had a comprehensive evaluation covering physical, emotional, social, and cognitive factors, conducted by an appropriately constituted interdisciplinary team, and who are in need of continuous habilitation services. (References: 42 CFR 440.150 and 77 Ill. Adm. Code 350.)

Priority or Target Population: Individuals with developmental disabilities who are unable to have needs met in the community.

Expected Outcomes: Individuals will develop new living skills and maintain existing living skills.

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Program Name: State-Operated Developmental Centers
Program Code: N/A

Funding Mechanism(s): _____ Grant ___X__ Fee-for-Service

Narrative Description: State Operated Developmental Centers (SODCs) are specialized Intermediate Care Facilities Developmental Disabilities (ICFs/DD) for persons with developmental disabilities who are unable to be served in a community setting due to intense behavioral and/or medical needs. Admission to one of the seven SODCs occurs only after a careful screening by the Independent Service Coordination (ISC) agency and review by a team that includes the individual, guardian, family, current and prospective service providers, Region/Transition staff from the Division and representatives from the SODC. Intensive services will be provided to the individual with the goal of restoring a community living situation for the person as quickly as possible. Essential to successful habilitation in an SODC is the participation in transitional services by the appropriate PAS agency and community service providers.

Eligibility Requirements: Must have a developmental disability and require intensive supports/supervision not available in a community setting. Persons must be screened by an ISC agency and be approved for admission by an SODC representative.

Priority or Target Population: Individuals with developmental disabilities who are unable to have needs met in the community.

Expected Outcomes: The individual will receive intensive services with the goal of restoring them to a living situation in the community as quickly as possible.

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Program Name: Supported Living Arrangement (SLA)
Program Code: 42D

Funding Mechanism(s): _____ Grant __X___ Fee-for-Service

Narrative Description: A Supported Living Arrangement (SLA) is a residential program approved by the Division to help individuals reach a higher level of independent living. The SLA provides, through direct or consultative staff, minimum support, training and direction that enhance the individuals' skills and lead to total independence and social integration in the community. Individuals may live in their own apartments, shared apartments, single family homes, shared homes, apartment complexes, boarding houses, group homes or in congregate living arrangements. The function of the SLA is to normalize living conditions and as far as possible, replicate home-style living as it exists in the community.

Eligibility Requirements: Not Applicable. This program is not being expanded, nor are vacancies being filled.

Priority or Target Population: No placements are being made in this program.

Expected Outcomes: Individuals will successfully integrate into the community by living in their own homes, working in the community, and participating in social activities in the community.

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Program Name: Special Home Placement (SHP)
Program Code: 41D

Funding Mechanism(s): ____ Grant __X__ Fee-for-Service

Narrative Description: A Special Home Placement (SHP) residential program is provided in a home that is expected to provide an appropriate environment, adequately meeting physical, social, and intellectual needs of an individual with developmental disabilities. This is a family home that is licensed by DCFS and supervised by a child welfare agency if children are served. IDHS approves adult homes. Up to five children or two adults may be served in each home. The program meets the needs of individuals who benefit from interaction in a family setting. SHP settings are foster care models, where an individual with developmental disabilities resides with a host family. This is a non-Medicaid, state-funded program.

Eligibility Requirements: Not Applicable. The program is not being expanded nor are vacancies being filled.

Priority or Target Population: No placements are being made in this program.

Expected Outcomes: Individuals will live in family homes while receiving services tailored to meet their needs.

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Program Name: Children's Group Home
Program Code: 17D

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Residential Services for children with developmental disabilities programs are designed to provide a structured environment to children and adolescents who cannot reside in their own home. Residential services are provided in a setting that is licensed by the Department of Children and Family Services (DCFS) as a Child Group Home (CGH) (17D). CGH settings can serve no more than ten children. Children must be enrolled in a school program approved by the Illinois State Board of Education. Tuition is paid for by the local school district. For Child Group Home (CGH - 17D) services, the child must be determined eligible for the Residential Waiver for Children and Young Adults with Developmental Disabilities (Children's Residential Waiver).

Eligibility Requirements: Parent/guardian must be a resident of the State of Illinois. The child must be enrolled in a school program approved by the Illinois State Board of Education. A determination must have been made and documented in the Individualized Education Program by the child's interdisciplinary team that the child's needs cannot be met without the provision of a residential setting outside the family home. The parent/guardian must agree that the child's educational, social, emotional, and/or habilitative needs require the provision of residential services outside the home. The child must be determined to have a developmental disability. Application must be completed before age 17 years and six months.

Individuals must be screened for eligibility and offered an informed choice by an IDHS-designated Independent Service Coordination (ISC) agency prior to receiving services. Individuals must be enrolled in the Children's Residential Waiver if placement will occur in a CGH setting. If receiving services through another Medicaid waiver, the individual must choose to receive services through the DD Medicaid waiver and cannot be enrolled in any other Medicaid waiver including IDHS Division of Rehabilitation Services, Department on Aging, or the Department of Healthcare and Family Services (HFS)/ Division of Specialized Services for Children Medically-Fragile Technology-Dependent Waiver.

Priority or Target Population: Children with a developmental disability with an immediate, long term need due to unexpected loss of current residence, physical or sexual abuse, neglect, incapable caregiver, or loss of a caregiver.

Expected Outcomes: Children will receive services and supports in a safe environment and will eventually return home to family or move to a less restrictive community setting.

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Program Name: Child Care Institution Programs
Program Code: 19D

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Residential Services for children with developmental disabilities programs are designed to provide a structured environment to children and adolescents who cannot reside in their own home. Residential services are provided in a setting that is licensed by the Department of Children and Family Services (DCFS) as a Residential School/Child Care Institution (CCI - 19D). CCI settings are licensed to serve more than seven children. Children must be enrolled in a school program approved by the Illinois State Board of Education. Tuition is paid for by the local school district. Residential funding by the Division is infrequent and is usually provided only after in-home supports have been tried and have failed. Access to 19D has been limited to children in crisis situations as determined by the Division when possible. The Division exhausts other community-based services before consideration of 19D services.

Eligibility Requirements: Parent/guardian must be a resident of the State of Illinois. The child must be enrolled in a school program approved by the Illinois State Board of Education. A determination must have been made and documented in the Individualized Education Program by the child's interdisciplinary team that the child's needs cannot be met without the provision of a residential setting outside the family home. The parent/guardian must agree that the child's educational, social, emotional, and/or habilitative needs require the provision of residential services outside the home. The child must be determined to have a developmental disability. Application must be completed before age 17 years and six months. Individuals must be screened for eligibility and offered an informed choice by an IDHS-designated Independent Service Coordination (ISC) agency prior to receiving services.

Individuals living in a CCI (19D) setting are not eligible for services and supports under the Adult DD Waiver.

Priority or Target Population: Children with a developmental disability with an immediate, long term need due to unexpected loss of current residence, physical or sexual abuse, neglect, incapable caregiver, or loss of a caregiver.

Expected Outcomes: Children will receive services and supports in a safe environment and will eventually return home to family or move to a less restrictive community setting.

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Program Name: Community Living Facility (CLF)
Program Codes: 67D, 67E, 67O

Funding Mechanism(s): _____ Grant __X___ Fee-for-Service

Narrative Description: A CLF is a residential setting licensed by the Department of Public Health (IDPH) that serves individuals with developmental disabilities in skill training programs that provide guidance, supervision, training, and other assistance, with the goal of eventually assisting these individuals in moving to independent living. These programs include housekeeping, money management, social skills, and community living skills. Individuals are required to participate in day activities, such as vocational training, Community Day Services, or employment. A CLF shall not be a nursing or medical facility and shall house no more than 20 residents, excluding staff, except as provided for in Section 18 of the Community Living Facilities Licensing Act [210 ILCS 35/18]. (Reference: 77 Ill. Adm. Code 370.240).

Eligibility Requirements: Adults age 18 and over who have a developmental disability and who have been determined, by an appropriate evaluation, to have a reasonable potential for returning to their own homes or leading independent lives. Such persons shall not require prenatal or maternity care, unless adequate prenatal and other medical services from community sources are not available to them; shall not require mental health treatment or have serious mental or emotional problems; shall not be destructive to property or self; shall not require nursing or personal care other than oversight and supervision; shall not have a communicable disease including active tuberculosis. (Reference: 77 Ill. Adm. Code 370.520) Individuals must be screened for eligibility and offered an informed choice by an IDHS-designated Independent Service Coordination (ISC) agency prior to receiving services. Individuals must be enrolled in the Adult DD Waiver if placement will occur in an in-state, CLF that serves 16 or fewer individuals (i.e. a waiver CLF site). 

Priority or Target Population: Adults age 18 and over who have a developmental disability and who are enrolled in the Adult DD Waiver for waiver 67D CLF sites. Individuals must meet the crisis criteria outlined in the Waiver Manual or be selected from the PUNS database based on available funding. For non-waiver 67E CLF sites, the individual must meet the requirements specified above except for being enrolled in the Adult DD Waiver. For 67O CLF funding for an out-of-state placement, the individual must be determined to have a developmental disability, may be any age and must receive Division prior approval.

Expected Outcomes: Adults will receive services to achieve sufficient independence to return to their own homes or lead independent lives.

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Program Name: Community-Integrated Living Arrangement (CILA)
Program Codes: 60D, 61H, 62H, and 63H

Funding Mechanism(s): ___ Grant _X__ Fee-for-Service

Programs 60D, 61H, 62H and 63H are based on fee-for-service. Grant Program 65H ended December 31, 2021. All individuals in 65H were converted to either 60D 24-Hr or 61H, 62H and 63H Intermittent CILA program codes.

Narrative Description: A flexible living arrangement for adults with developmental disabilities that focuses on the service needs of the individual in his or her home or a community setting where eight or fewer individuals live together under the supervision of a licensed agency. CILA services are provided in compliance with 59 Ill. Adm. Code 115 (Standards and Licensure Requirements for Community-Integrated Living Arrangements). Programs 60D, 61H, 62H and 63H are being expanded as appropriations permit.

Intermittent CILA (ICILA) services may be appropriate for waiver funded individuals who express interest in non-institutional, independent living options and who have a current Personal Plan which documents that the individual does not require continuous staff supervision (24/7 supports). Residential options within ICILA include living in one's own home, in a family member or relative's home or in an agency-controlled home that is not a 24-hour CILA.

Eligibility Requirements: Individuals served in this program must be determined to have a developmental disability and must not be a danger to self or others, as defined in the Procedures Manual for Developmental Disabilities Pre-Admission Screening.

Individuals must be screened for eligibility and offered an informed choice by an IDHS-designated Independent Service Coordination (ISC) agency prior to receiving services.

If receiving services through another Medicaid waiver, the individual must choose to receive services through the Adult DD Waiver and cannot be enrolled in any other Medicaid waiver including the IDHS Division of Rehabilitation Services, the Department of Aging, or the Department of Healthcare and Family Services (HFS) Division of Specialized Services for Children Medically-Fragile Technology-Dependent Waiver.

Priority or Target Population Criteria: Individuals must meet the crisis criteria outlined in the Waiver Manual or be selected from the PUNS database based on available funding.

Expected Outcomes: Individuals will live in small, community-based residential settings as alternatives to institutions while receiving services tailored to meet their needs. Some individuals eventually may move from 24 hour supports to less intensive supports as a result of habilitation received in CILA.

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3. Day Services

Program Name: Community Day Services (CDS) and SODC CDS
Program Codes: 31C, 31U, 38C, and 38U

Funding Mechanism(s): _____ Grant __X___ Fee-for-Service

Narrative Description: Community Day Services (CDS) is a program of day habilitation that assists the individual with acquisition, retention, or improvement in self-help, socialization and adaptive skills that takes place in a non-residential setting, separate from the participant's private residence or other residential living arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, and personal choice. CDS may include a range of adaptive skills in the areas of motor development, attention span, safety, problem solving, quantitative skills, and capacity for individual living. It also enhances a participant's ability to engage in productive work activities through a focus on such habilitative goals as compliance, attendance, and task completion. CDS developmental supports includes the reduction of maladaptive behaviors through positive behavioral supports and other methods. CDS programs include purposeful and meaningful activities that are designed to improve, maintain, or prevent the loss of independence, skills and functions enabling each participant to access and participate in relationships, activities, and functions of community life. Activities may consist of job exploration activities (not paid employment) or volunteer work, recreation, educational experiences in natural community settings, maintaining family contacts and purposeful activities and services where persons without disabilities are present.

CDS is governed by 59 Ill. Admin. Code 119 (Minimum Standards for Certification of Community Day Services Programs).

Eligibility Requirements: For Programs 31C and 31U, an individual must usually be enrolled in the Adult DD Waiver and must meet the Criteria for Participation of Individuals in Rule 119. For Program 38C and 38U, the individuals must reside in an SODC.

Priority or Target Population Criteria: For Programs 31C and 31U, individuals who have been identified to not currently be receiving any support services from the Division or the IDHS Division of Rehabilitation Services (except vocational rehabilitation services). With this population, if requests exceed available capacity, the State will prioritize based on the support service priority populations in the Waiver Manual.

For Programs 38C and 38U, the individual must reside in an SODC and be able to participate in an off-campus Community Day Services program.

Expected Outcomes: Outcomes should be based on progress towards resolution of identified needs as outlined in the individual's Personal Plan. These outcomes may include the following:

  • Progress in acquisition of basic living skills;
  • Reduction in maladaptive behavior with corresponding increase in adaptive behavior;
  • Increase in attaining skills;
  • Progress toward acquisition of vocational skills;
  • Movement toward becoming a worker who is compensated commensurately with the task either with or without a job coach;
  • Movement toward productive work in an integrated work setting in which non-disabled workers are also employed; and
  • Maintenance or increase in level of program satisfaction by the individual as evidenced by agency or State-level surveys of elements of satisfaction.

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Program Name: Supported Employment Program (SEP)
Program Codes:  33G, 36G, and 36U

Funding Mechanism(s): ____ Grant __X__ Fee-for-Service

Narrative Description: Supported Employment Program (SEP) services consist of on-going supports that enable individuals with disabilities to sustain employment in integrated settings at competitive wages. The program is designed to promote regular interaction with persons without disabilities, who are not paid caregivers or service providers and facilitate maintenance and enhancement of employment that is aligned with an individual's interests, skills, desires and conditions of employment. SEP services may be provided, with prior authorization, in individual placements or in group settings.

Eligibility Requirements: For programs 33G, 36G and 36U, all individuals approved for the Adults DD Waiver may access SEP with prior approval. Requests for SEP will only be considered for individuals who meet the following criteria:

  • enrolled in the Adults DD Waiver; and
  • require supportive services to work in an integrated employment environment; and
  • have defined, related, and ongoing/long term employment support need identified in his or her Personal Plan (Career and Income section); and
  • currently employed, either individually or in group employment, at competitive wages and in an integrated setting; and
  • supported within the proper ratio

Employment environments must meet the requirements of the HCBS Settings Rule and allow ample opportunity for the individual receiving services and supports to engage in routine interactions with customers, co-workers and other individuals who do not have disabilities.

SEP individual awards are contingent upon a successful DRS Outcome within 90 days of the initial/new request.

Priority or Target Population: Eligible individuals who require supportive services to sustain employment in integrated environments at competitive wages.

Expected Outcomes: Individuals receiving services and supports through the Supported Employment Program will sustain and/or enhance employment as outlined in the Careers and Income section of their Personal Plan.

Employment outcomes may include but are not limited to:

  • Enhanced skill acquisition - improved performance, efficiency, accuracy or quality;
  • Development of natural supports / paid support reduction;
  • Increased earning capacity;
  • Career advancement;
  • Access to employer benefits;
  • Progression to Individualized employment (for individuals supported in SEP Group).

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Program Name: Virtual Day Services (temporary service), Adult Day Care, Enhanced Residential Habilitation (fka At Home Day Program).
Program Codes: 31V, 35U, and 37U

Funding Mechanism(s): ____ Grant __X__ Fee-for-Service

Narrative Description: Virtual Day Services (31V) is a temporary day service available as-long-as Appendix K is approved for Waiver services during the COVID-19 pandemic. The VDS option was first approved August 31, 2020 and is tied to the Appendix K and will expire upon Appendix K expiration. Please see the Informational Bulleting DD.20.018 for complete information on 31V.

Adult Day Care (35U) program provides direct support and supervision of adults 60 years of age and older. Intervention and activities of adult day care promote physical well-being and fitness, socialization and tasks that stress the maintenance of coordination skills, as well as reducing the rate of loss of current skills that normally accompany the physical aspect of the aging process. All providers of Adult Day Care must be contracted with the Illinois Department on Aging.

Enhanced Residential Habilitation (fka At Home Day Program) (37U) provides a structured, individualized program of in-home and community habilitation activities for individuals who are unable to participate in out-of-home day programs due to medical or behavioral issues, or who are over age 60 and choose not to participate in an out-of-home day program.

Eligibility Requirements: Individuals must be determined to have a developmental disability and must be enrolled in the Adult DD Waiver. Prior approval is required from the Division in order to provide and bill for these services.

Priority or Target Population:: In order to participate in Program 37U, individuals must reside in a CILA setting. For Program 31V and 35U, individuals must be enrolled in the Adult DD Waiver.

Expected Outcomes: Receiving services through Programs 31V, 35U, or 37U will decrease the need for institutional placement or by providing skills that promote independence in daily living and economic self-sufficiency. Additionally, receiving Program 35U services will enable individuals to maintain or improve their current functioning or ability level by decelerating regression or loss of optimal levels.

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4. Other Support Services

Program Name: In-Home Respite, Group Respite, Voucher Respite
Program Codes: 87D, 880, 450-0010

Funding Mechanism(s): __X__ Grant __X__ Fee-for-Service

Group Respite and Voucher Respite are grant based and In-Home Respite is based on fee-for-service.

Narrative Description: Respite services are intended to provide short-term relief to the primary caregiver of a person with a developmental disability. It is also intended to maintain individuals with developmental disabilities in the community, thus deflecting the need for long term supports. Group Respite (880, Grant) provides supports to children and adults with developmental disabilities in a community-based setting of 2 or more individuals for a portion of the day. In-Home Respite (87D, FFS) provides individual support in the family home. Providers must be contracted with the Division and in compliance with applicable rules and regulations which govern the particular setting. Voucher Respite (450-0010) provides individual support in the family home or in the community. Provider agencies will issue vouchers to participating families to purchase or to otherwise provide for services and activities.

Eligibility Requirements: Individuals must be determined to have a developmental disability. Individuals receiving waiver funded services through the Division of Developmental Disabilities (Home-Based Support Services, Community Integrated Living Arrangements, Community Day Services, Supported Employment, etc.) are not eligible to receive respite services. https://intranet.dhs.illinois.gov/oneweb/page.aspx?item=139146

The respite allocation can be used interchangeably between the Residential Respite and In-Home Respite programs.

Priority or Target Population: Preference for In-Home Respite is given to adults and children who need care because of their developmental disability. Children and adults with developmental disabilities who are not enrolled in an Adult Waiver residential service or receiving Home-Based Support Services (HBS).

Expected Outcomes: Respite services are intended to provide short-term relief to the primary caregiver of a person with a developmental disability. It is also intended to maintain individuals with developmental disabilities in the community, thus deflecting the need for long term supports.

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Program Name: Residential Respite
Program Code: 89D

 Funding Mechanism(s): ____ Grant __X__ Fee-for-Service

Narrative Description: Respite services are intended to provide short-term relief to the primary caregiver of a person with a developmental disability. It is also intended to maintain individuals with developmental disabilities in the community, thus deflecting the need for long term supports. Residential Respite (89D) provides supervision and care on an individual basis in a licensed residential setting. Providers must be contracted with the Division and in compliance with applicable rules and regulations which govern the particular setting.

Eligibility Requirements: Individuals must be determined to have a developmental disability. Individuals receiving waiver funded services through the Division of Developmental Disabilities (Home-Based Support Services, Community Integrated Living Arrangements, Community Day Services, Supported Employment, etc.) are not eligible to receive respite services. https://intranet.dhs.illinois.gov/oneweb/page.aspx?item=139146

The respite allocation can be used interchangeably between the Residential Respite and In-Home Respite programs.

Priority or Target Population: Preference is given to adults and children who need care because of their developmental disability. Children and adults with developmental disabilities who are not enrolled in an Adult Waiver residential service or receiving Home-Based Support Services (HBS).

Expected Outcomes: Respite services are intended to provide short-term relief to the primary caregiver of a person with a developmental disability. It is also intended to maintain individuals with developmental disabilities in the community, thus deflecting the need for long term supports.

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Program Name: Home-Based Support Services (HBS)
Program Code: See Below

Funding Mechanism(s): _____ Grant __X__ Fee-for-Service

Narrative Description: Home-Based Support Services (HBS) is an option within the Adult DD Waiver and the Children's Support Waiver. HBS includes any of the individually designed, separately covered services, or assessment of the need for these services, to assist individuals to live in a private family home or a private house or apartment that they own or lease. Home-Based Support Services are tailored to meet individuals' evolving needs and preferences for supports, without having to leave their homes.

Individuals and their guardians may choose from the particular array of separate HBS services, up to a monthly dollar cost maximum set by statute, that best meets the evolving needs of the individual. All services provided must be for the direct benefit of the individual and must be directly related to their disability.

Services and Supports include the following:

Services Available to Both Adults and Children:

  • Self-Directed Assistance (55A)
  • Personal Support (55D)
  • Behavior Intervention and Treatment from a licensed or approved professional (56U)
  • Training for Unpaid Caregivers (55B)
  • Adaptive Equipment (53E)*+
  • Assistive Technology (53T)*+
  • Home Accessibility Modifications (53H)*+
  • Vehicle Modifications (53V)*+
  • Temporary Assistance (53C)*+

Additional Services Available to Adults Only:

  • Nursing, RN (55N)
  • Nursing, LPN (55P)
  • Non-Medical Transportation (limited to no more than $500 per month) (55T)
  • Personal Emergency Response System (55W)
  • Community Day Services (31C, 31U)
  • Supported Employment (Individual, Small or Large Group) (33G, 36G, 36U)*
  • Adult Day Care (35U)*
  • Behavior Therapy, and Counseling from a licensed professional (58U, 58G, 57U, 57G)
  • Speech, Physical and Occupational Therapies (52S, 52P, 52O)*
  • Temporary or Long Term Intensive Staff (53D)*

NOTE:  Services and supports marked with a star (*) require prior approval.

NOTE:  Services and supports marked with a plus (+) are in addition to the monthly dollar cost maximum

Eligibility Requirements: Individuals who meet all of the following criteria are eligible for HBS:

  • Enrolled in the Adult DDWaiver or the Children's Support Waiver;
  • Need an array of services to remain in the home and avoid or delay residential services;

All services received must be included in the HBS array and within the HBS monthly or annual dollar cost maximum.

Priority or Target Population: Individuals who are eligible for waiver services and have been determined to be in crisis or who have been selected from the PUNS database.

Expected Outcomes: Individuals will receive supports and services needed to remain successfully within their own homes, maintaining and enhancing functional skills, thereby delaying, or preventing out-of-home placement.

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Program Name: Behavior Intervention and Treatment; Counseling-Individual and Group; Therapy-Individual and Group
Program Codes: 56U, 57U, 57G, 58U, 58G

Funding Mechanism(s): _____ Grant __X___ Fee-for-Service

Narrative Description: Behavior Intervention and Treatment (56U) includes ongoing behavioral assessment, functional analysis, development of positive intervention strategies and techniques, participation in the development and/or implementation of services and/or supports, training of family, direct support, and other workers on the specifics of the individual's plan; and monitoring the effectiveness of the interventions.

Counseling (57U and 57G) means a treatment approach in which one or more mental health staff meet with one or more individuals in ongoing periodic formal sessions; and use relationship skills to promote the individuals' abilities to deal with daily living issues associated with their emotional, cognitive, or behavioral problems using a variety of supportive and re-educative techniques. Counseling includes direct contact time and participating in the development of the Personal Plan.

Therapy (58U and 58G) means a treatment approach in which one or more professionals deliberately establish a relationship with one or more individuals seen simultaneously, if applicable, in ongoing periodic formal sessions with the goal of ameliorating or reducing the symptoms of emotional, cognitive, or behavioral disorder and promoting positive emotional, cognitive and behavioral development. Therapy includes direct contact time and participating in the development of the Personal Plan. 

Eligibility Requirements: For 56U, the individual must be enrolled in one of the DD Medicaid waivers. For all other therapy services, the individual must be enrolled in the Adult Waiver. For Programs 56U, 57U, 57G, 58U and 58G, services must be based on assessments documenting the need for the service, must be included in the Personal Plan, and must be approved by the Person Centered Planning team.

Priority or Target Population: These services are provided only to individuals who are also receiving other waiver services.

Expected Outcomes: For Programs 56U, 57U, 57G, 58U and 58G, individuals will improve behavioral functioning. It is the goal of these services to diminish in frequency, intensity and/or duration and will eventually be eliminated completely. 

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Program Name: Physical Therapy, Occupational Therapy, Speech Therapy
Program Codes: 52P, 52O, 52S

Funding Mechanism(s): _____ Grant __X___ Fee-for-Service

Narrative Description: Physical Therapy, Occupational Therapy, and Speech Therapy for restorative purposes are covered under the Medicaid State Plan. Physical Therapy, Occupational Therapy and Speech Therapy (52P, 52O, and 52S) are an extension of the Medicaid State Plan services but are habilitative in nature. Waiver therapy services consist of the evaluation and/or treatment of persons with disabilities by the various methods within the scope and practice of physical therapy, occupational therapy and speech therapy as described respectively in the Illinois Physical Therapy Act (225 ILCS 90/); the Illinois Occupational Therapy Practice Act (225 ILCS 75/); and the Illinois Speech-Language Pathology and Audiology Practice Act (225 ILCS 220/). These therapies must be provided by licensed therapists or licensed/certified therapist assistants consistent with the practice acts.

Eligibility Requirements: For Programs 52P, 52O and 52S, waiver funding may be used for these services only if Medicaid State Plan funding is not available for the individual and prior approval is received from the Division.

Priority or Target Population: These services are provided only to individuals who are also receiving other waiver services.

Expected Outcomes: For Program 52P, 52O and 52S, the individual will improve or maintain his or her current functioning or ability level.

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Program Name: Temporary Assistance
Program Code: 53C

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Temporary Assistance (TA) is provided on a temporary emergency basis because of the absence or incapacity of the person(s) who normally provide unpaid care. Absence or incapacity of the primary caregivers must be due to a temporary cause such as hospitalization, illness, injury, or other emergency situations. Temporary Assistance is not available for caregiver absences for vacations, educational or employment-related reasons, or other non-emergency reasons. No Temporary Assistance may be delivered during the typical school day relative to the age of the individual or during times when educational services are being provided.

Eligibility Requirements: This service is available in the Children's Support Waiver and Adult Waiver Programs. For the Adult Waiver, this service is available to individuals who are authorized for Home-Based Support Services (HBS).

The cost of these services is not counted toward the monthly maximum. This service is limited to no more than 60 consecutive days.

Priority or Target Population: These services are provided only to individuals who are also receiving other waiver services.

Expected Outcomes: For 53C (Temporary Assistance), In the absences or incapacity of the primary caregiver:

  • The individual will learn adaptive skills needed to reach outcomes identified in Personal Plan
  • Person will receive assistance in activities of daily living in the home or community.

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Program Name: Self-Direction Assistance
Program Code: 55A

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Self-Direction Assistance (SDA) assists the individual, guardian, if applicable, and/or family in arranging for, directing, and managing the Home-Based Support Services (HBS) Program. It also offers practical skills training to enable individuals, guardians, if applicable, and/or families to independently direct and manage Waiver services. SDA is an optional service, meaning individuals, guardians, if applicable, and/or families are not required to purchase this support.

Eligibility Requirements: This service is available to individuals in the Children's Support Waiver and Adult Waiver Programs.

Priority or Target Population: These services are provided only to individuals who are also receiving other waiver services.

Expected Outcomes: Expected outcomes include improved ability to manage services and supports associated with Home Based Support Services. Individual and/or family obtains a greater understanding and improved ability on recruiting and hiring personal support workers, managing workers, effective communication and problem-solving.

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Program Name: Training and Counseling Services for Unpaid Caregivers
Program Codes: 55B and 55C

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: These services include training and counseling services for individuals who provide unpaid support, training, companionship, or supervision to individuals receiving waiver services.

For purposes of these services, an individual is defined as any person, family member, neighbor, friend, companion, or co-worker who provides uncompensated care, training, guidance, companionship, or support to an individual served in the Waiver. This service may not be provided to train paid caregivers.

Training includes instruction about treatment regimens and other services included in the Personal Plan, use of equipment specified in the Personal Plan, and includes updates as necessary to safely maintain the individual at home. Counseling must be aimed at assisting the unpaid caregiver in meeting the needs of the individual. All training for individuals who provide unpaid support to the individual must be included in the individual's Personal Plan.

Training furnished to individuals who provide uncompensated care and support to the individual must be directly related to their role in supporting the individual in areas specified in the Personal Plan. Counseling similarly must be aimed at assisting unpaid individuals who support the individual to understand and address individual needs.

Eligibility Requirements: These services are available in the Children's Support Waiver and Adult Waiver Programs.

Priority or Target Population: These services are provided only to individuals who are also receiving other waiver services.

Expected Outcomes: Expected outcomes for 55B and 55C includes increased ability to provide support by the unpaid caregiver for the individual.

For 55B (HBS Training for Unpaid Caregivers, children & adults)

  • Unpaid caregiver receives instruction about treatment regimens and other services included in the Personal Plan, use of equipment specified in the Plan, and updates as necessary to safely maintain the individual at home.
  • Training will be directly related to caregiver's role in supporting the individual in areas specified in the Plan.
  • Unpaid caregiver receives training in CPR instruction, first aid, and programs on disability-specific topics such as behavior intervention techniques, epilepsy, autism, etc.

For 55C (HBS Counseling for Unpaid Caregivers, children & adults)

  • Unpaid caregiver receives assistance in meeting the needs of the individual as indicated in the Personal Plan.
  • Unpaid caregiver gains understanding to address individual's needs.

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Program Name: Personal Support
Program Code: 55D

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Personal Support services include a range of training and assistance to enable individuals to accomplish tasks they would normally do for themselves if they did not have a disability. These services may include:

  1. Teaching adaptive skills to assist the individual to reach personal goals.
  2. Personal assistance in activities of daily living.
  3. Assistance in performing age-appropriate housekeeping chores such as bed making, dusting, and vacuuming, which are essential to the health and welfare of the individual, rather than for the individual's family.
  4. Services provided on a short-term basis because of the absence or need for relief of the primary caregivers.

Personal Support services may be provided on an episodic or on a continuing basis. Health-related services may include personal care (support with hygiene, support with going to the bathroom, etc.). Additionally, Personal Support Workers (PSWs) may be integrated into a behavior plan. The PSW can assist the individual to implement a behavioral, occupational therapy, physical therapy, or speech therapy plan to the extent permitted by state law, as prescribed in the Personal Plan, and as trained on by the healthcare professional who developed the plan. Implementation activities include assistance with exercise routines, range of motion, reading the therapist's directions, helping the individual remember and follow the steps of the Personal Plan or hands-on assistance. It does not include the actual service the professional therapist provides. PSWs should not administer medications as this is not permitted by State law.

Eligibility Requirements: This service is available in the Children's Support Waiver and Adult Waiver Programs.

Priority or Target Population: These services are provided only to individuals who are also receiving other waiver services.

Expected Outcomes: Expected outcomes for 55D include the individual's ability to live more independently, improve general functioning or maintain ability levels.

  • Maintains or improves individual's adaptive skills necessary to reach personal goals.
  • Provide support and assistance in activities of daily living.
  • Provide services on a short-term basis because of the absence, incapacity or need for relief of those persons who normally provide care.

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Program Name: Nursing (RN and LPN)
Program Codes: 55N and 55P

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Nursing services are available within the monthly maximum budget for Adult Waiver individuals who are authorized for Home-Based Support Services (HBS). Nursing services are in addition to any Medicaid State Plan nursing services for which the individual may qualify, must be specified in the Personal Plan, and be within the scope of the Illinois Nursing and Advanced Practice Nursing Act (225 ILSC 65).

Eligibility Requirements: This service is available in the Adult Waiver Program.

Priority or Target Population: These services are provided only to individuals who are also receiving other waiver services.

Expected Outcomes: Helping the individual regain independence to become as self-sufficient as possible while maintaining or improving current disease or condition and level of functioning.

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Program Name: Transportation (Non-Medical)
Program Code: 55T

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Non-Medical transportation includes services to enable individuals to gain access to Waiver and other community services, activities and resources specified by the Personal Plan. Non-Medical transportation services are offered in addition to medical transportation services available under the Medicaid State Plan. Whenever possible, individuals should use family, neighbors, friends, or community agencies which can provide this service without charge.

Eligibility Requirements: This service is available in the Adult Waiver Program.

Priority or Target Population: This service is available within the monthly maximum to Adult Waiver individuals who are authorized for Home Based Support Services (HBS).

Expected Outcomes: For 55T (HBS Transportation, adults only)

  • Individual is able to gain access to waiver and other community services, activities, and resources, as specified in their Personal Plan.

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Program Name: Emergency Home Response Services
Program Code: 55W

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: : Emergency Home Response Services are limited to adults who live alone, or who are alone for significant parts of the day and have no regular caregiver for extended periods of time, and who would otherwise require extensive routine supervision.

Emergency Home Response Service (EHRS) is an electronic device that enables Adult Waiver individuals to secure help in an emergency. The individual may also wear a portable help button to allow for mobility.

The system is connected to the individual's phone and programmed to signal a response center once the "help" button is activated. Installation, upkeep, and maintenance of devices/systems may be provided.

Eligibility Requirements: This service is available in the Adult Waiver Program.

Priority or Target Population: This service is available within the monthly maximum budget for individuals who are authorized for Home-Based Support Services (HBS) within the Adult Waiver.

Expected Outcomes: For 55W (HBS Emergency Home Response, adults only)

  • The individual is able to function with greater independence in the home and the individual's health, safety and welfare are maintained due to the availability of the electronic device.

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Program Name: Bogard Specialized Services
Program Codes: 75A-76Z

Funding Mechanism(s): _____ Grant _X__ Fee-for-Service

Narrative Description: Bogard Specialized Services are aggressive, accountable, competent, and knowledgeable interactions that are habilitative in nature and directed toward meeting the individual's wants and needs. The services must have functional outcomes and be based upon a Service Plan that is developed through the cooperative efforts of an Interdisciplinary Team (IDT), that includes the Bogard class member and the guardian, if applicable. These services should take advantage of all opportunities that exist in the natural environments which make up the individual's day. Bogard Specialized Services are governed by the Modified Consent Decree and all pertinent guidelines.

Eligibility Requirements: The individual must be an adult with a developmental disability who has been designated in writing by IDHS as a Bogard class member. Bogard class members are defined in the modified Bogard Consent Decree, pg.1, Section A., as persons, 18 years of age or older with Developmental Disabilities (this term is further defined in Section III of the modified decree), who, on or after March 23, 1986, resided in an Intermediate Care or Skilled Nursing Facility in Illinois as a Medicaid recipient for a period of more than 120 days in the aggregate. No person first admitted to an intermediate care facility or a skilled nursing facility on or after April 1, 1994, will be a member of the class.

Priority or Target Population: Bogard class members residing in nursing facilities whose functioning can be enhanced or maintained by Specialized Services.

Expected Outcomes:

  • Bogard class members residing in nursing facilities will become more independent, self-sufficient, self-reliant, and able to achieve their fullest potential.
  • Bogard class members residing in nursing facilities will learn and maintain the skills that they want and need to know.

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Program Name: Demonstration/Special Project
Program Code: 450

Funding Mechanism(s): __X___ Grant _____ Fee-for-Service

Narrative Description: Services offered will be negotiated with the Division. This program code is used to support a variety of programs that offer unique services or trial services, sometimes on a time-limited basis.

Eligibility Requirements: The individual must be determined to have a developmental disability.

Priority or Target Population: Target population will be negotiated with the Division on a case by case basis.

Expected Outcomes: Expected outcomes will be negotiated with the Division on a case-by-case basis.

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Program Name: Dental Services
Program Code: 400

Funding Mechanism(s): __X__ Grant _____ Fee-for-Service

Narrative Description: This program provides dental care to children and adults and promotes:

  • A comprehensive array of dental care services;
  • Long-term dental hygiene through prevention and training (i.e., reducing gum disease, tooth decay, and tooth loss);
  • Immediate dental care needs of the target population who are unable to secure dental care and services in traditional community settings because of their disability; and
  • Sharing and disseminating information and technical assistance to others serving individuals with disabilities.

Eligibility Requirements: The individual must be determined to have a developmental disability.

Priority or Target Population: Individuals who have a developmental disability and cannot secure appropriate dental services in other community settings.

Expected Outcomes: It is expected that individuals served in this program will receive dental services that they otherwise would be unable to obtain. In addition, services delivered to individuals and billable through Medicaid, Medicare or Private insurance may not be claimed/charged to/paid/reimbursed through this grant.

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Program Name: Epilepsy
Program Code: 250

Funding Mechanism(s): _X_ Grant _____ Fee-for-Service

Narrative Description: This program provides client and family support services for individuals diagnosed with epilepsy, their families, and the community at large. The support services included in this program are: (a) information and referral; (b) comprehensive case management for individuals who do not have case management services through other resources; (c) counseling; (d) assistance in managing financial needs; (e) support groups; and (f) medical liaison services designed specifically to assist an individual who has epilepsy. These services may be provided at any location where the individual lives, works, or receives services such as community agency, the individual's residence, the individual's workplace, or any other community setting.

Eligibility Requirements: The individual must be determined to have a developmental disability with epilepsy as a related condition.

Priority or Target Population: Children or adults who have a developmental disability with epilepsy as a related condition, their families, and the community at large.

Expected Outcomes: This program assists participants in managing the debilitating effects of epilepsy, preserving their community living arrangement, and maximizing their independence. This program also assists in establishing a broader understanding of epilepsy within the community at large.

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Program Name: Related Support
Program Code: 73D

Funding Mechanism(s): ____ Grant _X__ Fee-for-Service

Narrative Description: The Related Support program (73D) provides funds for staffing and services in a community setting. Documentation that all other resources and funding available have been exhausted is required for Program 73D.

Eligibility Requirements: Not Applicable. The program is not being expanded nor are vacancies being filled.

Priority or Target Population: No placements are being made in this program.

Expected Outcomes: Individuals will continue to live in their current community setting through the receipt of these services.

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Program Name: Adaptive Equipment, Assistive Technology, Home Accessibility Modifications, Remote Support, Vehicle Modifications
Program Codes: 53E, 53T, 53H, 53V

Funding Mechanism(s): _____ Grant ___X__ Fee-for-Service

Narrative Description: Adaptive Equipment (53E) includes devices, controls, or appliances that enable individuals to increase their ability to perform activities of daily living, or to perceive, control or communicate with the environment in which they live.

Assistive Technology (53T) is available in all three waiver programs. Assistive technology devices are items, pieces of equipment, or product systems, whether acquired commercially, modified, or customized, used to increase, maintain, or improve functional capabilities of participants. Assistive technology services directly assist a participant in the selection, acquisition, or use of an assistive technology device.

Assistive technology includes the following:

  • Evaluation of the participant's assistive technology needs, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the participant in the customary environment of the participant.
  • Services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for participants.
  • Services consisting of selecting, designing, fitting, customizing, adopting, applying, maintaining, comparing, and training.

Remote Support (53E and 53T) is video, audio, remote monitoring devices, and other technology which enables an individual to be more independent and less reliant on staff being physically present when receiving CILA supports and services. This service is only available to individuals receiving 60D, 61H, 62H, and 63H CILA services. Remote Support uses Program Code 53E for the purchase/lease and installation costs of equipment and Program Code 53T for ongoing monitoring costs. 60D CILA providers are experiencing a significant savings when individuals utilize Remote Support in their residential settings, so they are highly encouraged to absorb the cost of Remote Supports in their operation.

Home Accessibility modifications (53H) include those physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the individual as it relates to their developmental disability, or which enable the individual to function with greater independence in the home. Modifications to the home shall be covered only when they are necessary to prevent institutional placement, to deinstitutionalize an individual, or to enable the individual to participate in specialized habilitative services for individuals with developmental disabilities.

Vehicle modifications (53V) include vehicle adaptations such as lifts, door or seating modifications, and safety/security modifications which assist individuals with developmental disabilities in transporting.

Eligibility Requirements: For Programs 53T, 53E, 53H and 53V, the individual must currently be receiving other waiver services. Prior approval from the Division is required for Programs 53E, 53H, 53T, 53V and Remote Support.

Additionally, Program 53H is applicable only to CILA sites owned and operated by the provider agency, the private residence of an individual with a developmental disability or the family home where the individual with a developmental disability resides.

For Program 53V, the vehicle must be owned by the individual with a developmental disability or the family of the individual with a developmental disability with whom they reside, and the vehicle modification has to be to the person's primary transportation vehicle. Program 53V funding is not available for vehicles owned or operated by the provider agency.

Remote Support is only authorized for individuals residing in a CILA setting.

Priority or Target Population: Programs 53E, 53T 53H, and 53V are provided to individuals who are assessed to need and benefit from these services.

Expected Outcomes: The individuals served by these programs will increase their ability to function in the environment in which they live and will improve or maintain their current functioning or ability level.

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Program Name: Temporary and Long-Term Intensive Staffing
Program Codes: 53D, 53R, 53S

Narrative Description: Temporary and Long-Term Intensive Staffing in a Community Day Services program (53D), SODC CDS (53S) and Temporary and Long-Term Intensive Staffing in a CILA (53R) provide funding for additional staff to provide temporary or long-term intensive supports for individuals currently receiving services who have a time-limited, immediate, or longer term need for additional staff support.

Eligibility Requirements: For Programs 53D, 53R or 53S, the individual must be enrolled in a Division funded Adult DD Waiver residential service (60D or 61H - CILA), Community Day Services (31C, 31U - CDS) or SODC CDS (38C,38U).

Prior approval from the Division is required.

Priority or Target Population: Programs 53D and 53R are provided to individuals enrolled in an Adult DD Waiver residential service (60D and 61H - CILA) or Community Day Services (31C, 31U - CDS) funded by the Division. Program 53S is provided to individuals being served in an SODC attending a Community Day Service (38C, 38U).

Expected Outcomes: The individuals served by these programs will increase their ability to function in the environment in which they live and will improve or maintain their current functioning or ability level.

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Deliverables/Costs/Payment

Deliverables

All services are expected to have functional and measurable data concerning services provided by funds awarded. The Provider must submit any and all data required by rule or by the Department. The deliverables and their definitions are detailed in the Division's, Attachment "A" and this Program Manual.

Costs

Funding for each program is based upon a Department-approved level for services detailed in the Program Manual and/or the Division's, Attachment "A". The funding level for each program is shown in the Exhibits to the Uniform Grant Agreement (UGA) and/or the HFS Medicaid Waiver Agreement. The Department is not liable for costs incurred by the provider that are not approved. Except as otherwise stated or provided for in the Exhibits to the Uniform Grant Agreement (UGA) and/or the HFS Medicaid Waiver Agreement, no payment for extra charges, supplies or expenses will be made without prior written approval from the Department.

Payment

Provider services will be paid under the following terms and conditions, depending on the type of service covered under the Agreement. Service types are as follows:

  • Fee-for-Service programs receive payment at a Division approved rate subsequent to delivery of services. A specific description of this funding mechanism can be found in Attachment "A". Some Fee-for-Service programs receive payment at a negotiated rate. An example includes HBS Personal Support (55D) services.
  • Grant programs receive payments in accordance with Administrative Code (Title 44, Subtitle F, Chapter I, Part 7000.120). A specific description of this funding mechanism can be found in Attachment "A".

Payment for Fee-for-Service and grant programs is contingent upon funds being made available by the General Assembly and Governor.

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Provider Responsibilities

Funded providers are expected to be in full compliance with all laws, rules, policies, procedures, and mandates specified in the Uniform Grant Agreement (UGA) and/or the HFS Medicaid Waiver Agreement, Attachment "A", other Administrative Rules and all other referenced documents. It is the responsibility of the Provider to notify the Division of any difficulty in meeting these contractual obligations.

Department Responsibilities

Department of Human Services, Division of Developmental Disabilities has the following responsibilities: 

  • Division Region staff shall act as the liaison between the contracting parties.
  • Division staff shall assist in the monitoring, evaluating, or auditing of provider services.
  • The Division shall provide ongoing monitoring of provider services and funding. 
  • The Division shall inform provider agencies of any new IDHS (or Division) policies, procedures, and guidelines. 
  • The Division shall develop and facilitate the dissemination of new Division policies, procedures, and guidelines. 
  • The Division will develop and provide training opportunities as it deems necessary. 
  • The Division will establish levels of reimbursement for programs covered under the Uniform Grant Agreement (UGA) and/or the HFS Medicaid Waiver Agreement, and the Division Attachment "A".

Support Services

ISC and providers may request technical assistance by contacting the Division's Bureau of Community Services for their area. 

Community Services Structure 

The Illinois developmental disabilities service system is divided into seven regions. This system provides a structure for communication, implementation, and coordination of developmental disabilities programs. State staff are assigned to each region, and service providers are also assigned based on their geographic service area.

Please see this List of Community Services Staff, with contact information. Counties serviced by each Region are also identified.

Billing Instructions 

For technical software/computer issues, requests for assistance can be e-mailed to: DoIT.ROCS@Illinois.gov

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Program Monitoring

The Provider will make available to the Secretary of the Department of Human Services or the Secretary's designee, access to data, records and all facilities in which service or administrative operations are performed to ensure compliance with the terms and conditions of the Agreement. The Department will monitor compliance with the conditions specified in the Agreement or herein. Monitoring will be conducted by staff within various offices of the Department, including but not limited to, the Division, the Bureau of Accreditation, Licensure and Certification (BALC); Office of Inspector General (OIG); the Department on Aging's Adult Protective Services (APS); and the Office of Contract Administration (OCA). In addition, the Department of Healthcare and Family Services may monitor on a sample basis some agencies that are enrolled as providers under one of the Home and Community-Based Services Waivers for Persons with Developmental Disabilities.

The Division will share with the Provider any findings arising from the monitoring activities by the Division for review and corrective action. The Provider shall submit corrective action plans to the Division as requested and shall comply with plans of correction approved or imposed by the Division. Monitoring may consist of, but is not limited to, the following:

  • Reviews of all required licenses and certifications
  • Reviews of all provider service and funding plans
  • Reviews of direct service provision
  • Reviews of alleged and substantiated cases of abuse and neglect
  • Reviews of provider quality assurance, records and activities including provider reviews of medication error
  • On-site reviews of client records, personnel files, agency and program policies and procedures, and financial records
  • On-site observations and interviews of clients, guardians, and agency staff (including, but not limited to, program, supervisory, and direct care staff)
  • Reviews of electronic data submissions and verification of data submissions or data accepted in lieu of electronic submission
  • Reviews of utilization patterns
  • Review training records
  • Review of follow up to CART recommendations, if applicable 

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Program Budget

Please Note:

All Providers are expected to have a board-approved budget on file as part of standard operating procedures. Agency Plans are required as described in Section IV of Attachment "A". 

Appendix - State Authoritative Sources

As the Provider, in addition to State and Federal rules and regulations governing the programs you deliver you are responsible for complying with all of the State sources below, if applicable:

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Additional information regarding the developmental disabilities service system may be accessed via the Internet: Division of Developmental Disabilities.

Contact Information

You may also contact the Division of Developmental Disabilities by phone at:

  • Toll Free:  (800) 843-6154
  • Springfield Office:  (217) 557-2827
  • TTY:  (866) 322-6758

Authority

Implementing Section 3 of the Community Services Act [405 ILCS 30/3], the Community Integrated Living Arrangements Licensure and Certification Act [210 ILCS 135], and Sections 15 and 15.2 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15 and 15.2] and authorized by Section 9 of the Community Integrated Living Arrangement Licensure and Certification Act [210 ILCS 135/9], Section 5-104 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-104].

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