HCBS Settings Countdown: 252 days

HCBS Settings Compliance: 252 days

In this email:

  • Guardian Engagement in Settings Clarification
  • New Resource - Training for DSPs on Settings
  • Update on Room and Board for Residency Agreements

Guardian Engagement Clarification

DDD wants to clarify how to address Home and Community-Based Services (HCBS) Settings-related issues between people receiving services and guardians. This is based on feedback received from the Guardianship and Advocacy Commission/Office of State Guardian and is a correction/update to information shared during a previous training regarding access to locks for people receiving HCBS.

The substituted judgment standard flows between guardian and ward, not service provider and ward. It instructs the guardian on how to make decisions incorporating the ward's wishes. This means that when addressing Settings implementation (lockable doors, visitors, etc.), ISCs and providers should work with the guardian and person receiving services.

The Probate Act's Substituted Judgment standard for decision-making has been updated, and it now requires the guardian to make decisions in conformity with the ward's wishes unless they will cause substantial harm. The guardian still has the final legal authority to make the decision, assuming it's a plenary guardianship, but they should make the decision according to the ward's wishes. If the guardian has a concern about access to a lock posing a safety risk of some kind, that would justify saying no. The ward's wishes and the guardian's reasoning all come into play. The guardian should have a reason for saying no and not following the person's wishes rather than just unilaterally and in a vacuum saying no. In addition, with the new modification of the Settings' rights process through the person-centered planning process, the personal plan should note a modification to Settings rights that is temporary and should be revisited and outlines the safety concerns and the implementation strategies should follow suit.

If there are disagreements, conflict resolution is critical including: 1) addressing through the planning/treatment team/person-centered planning process; 2) involving the ISC agency; and 3) involving an advocacy agency or involving the court where the guardianship was established for challenging disputes.

Lastly, the HCBS Settings Rule explicitly talks about informed consent when establishing modifications. In the latest Settings Rule and Comments/Response (link on the IDHS: Division of Developmental Disabilities HCBS Settings Rule Compliance (state.il.us) website), the federal Centers for Medicare and Medicaid Services (CMS) said the following:

"Comment: Several commenters suggested that CMS consider giving human rights reviewing committees the added responsibility of reviewing modifications, and requiring a clear appeals process for any individual who does not agree to the conditions.

Response: We have amended the regulations to include a requirement for informed consent and we specified that any modification of the additional conditions must be supported by a specific assessed need and justified in the person-centered service plan. We will add further descriptions in future guidance."

DDD along with the Illinois Council on Developmental Disabilities (ICDD) are working to identify additional resources for providers on this topic.

New Resource - Settings Training for DSPs

The Illinois Council on Developmental Disabilities (ICDD), Council on Quality and Leadership (CQL), and IL Division of Developmental Disabilities (DDD) are excited to share the link to the Home and Community-Based Services (HCBS) presentation for DSPs: The HCBS Settings Rule: How Direct Support Professionals Can Make All the Difference!. This presentation (1 hour and 9 minutes) is aimed at direct support professionals working with people receiving HCBS. Learn about what the Settings Rule is and how you can make a difference in the life of the people you support!


* Here is a sample of an Accessible/Plain Language Residency Agreement which can be found under Resources on the IDHS DDD HCBS Settings Rule Compliance webpage.


* Check out the ICDD and CQL webinar on the Settings Rule for people receiving services.



Residency Agreements - Room and Board Clarification (Updated)

DDD has updated the language for 24-hour CILA and Child Group Homes based on comments we have received.

Residency agreements through the HCBS Settings Rule offer people who live in provider-controlled homes the same rights afforded to those who have leases with a separate landlord. Included in this is the right to know how much the person is spending for rent or room and board. For more information, check out the IDHS: Residency Agreement for Provider Owned or Controlled Settings (state.il.us). Please note, the goal of the residency agreement is to make sure people are informed and know their rights and responsibilities just like people in non-provider-controlled homes including knowing the amount, generally, that they will be paying in room and board.

It is recommended for providers to utilize the following for the residency agreement's room and board amounts.