HCBS Settings Rule: Right to Freedom from Restraint

Illinois Department of Human Services

Information Bulletin

Division of Developmental Disabilities



This Information Bulletin (IB) outlines the requirement that providers will ensure all individuals receiving waiver funded Home and Community Based Services (HCBS) are free from restraint. This includes individuals receiving any services in individually controlled Community Integrated Living Arrangements (CILAs), provider owned/controlled CILAs, Child Group Homes (CGHs), Community Living Facilities (CLFs), Community Day Services (CDS), and through the Home-based Support Services (HBS) program.


The Centers for Medicare and Medicaid Services (CMS) has specific rights that must be afforded individuals receiving services funded by the HCBS waiver, regardless of the setting type. Among those rights is the expectation waiver participants are assured the right to be free from restraint.

Details of the HCBS Settings Rule requirements may be reviewed at 42 CFR §441.301(c)(4)(i-v) and include: 3d) Ensures an individual's right of freedom from restraint.


Right to Freedom from Restraint

Many providers choose not to employ the use of restraints while supporting people. While the Settings Rule does state that individuals have the right to be free from restraint, the Illinois Adults with Developmental Disabilities waiver approved by CMS does allow for the use of restraint in narrow circumstances and with proper training. For details on when and how restraint can be used in a waiver setting in Illinois, please refer to the waiver application at Application for 1915(c) HCBS Waiver: IL.0350.R05.02 - Jan 01, 2024 (as of Jan 01, 2024) (illinois.gov) (pdf), pages 224 - 232, continued on page 17. The use of restraint is considered a modification to the Settings rule. Please see the Modifications section below for details on how to develop and document the modification.


People have the right to be free from restraint in their homes and while receiving services outside their home. This includes all forms of restraint (mechanical, chemical or personal physical). The Independent Service Coordination (ISCs) agencies share the IDHS: Rights of Individuals Form, IL462-1201.pdf (state.il.us) annually and require a signature from the person and/or guardian. Providers also should share the document and review it with individuals whom they support as well as staff. This document should be shared with all individuals when they initiate services, whether residential or community day services, and annually thereafter. Guardians should also be provided a copy of the rights document. Providers are welcome to develop and share additional information with individuals as well.

Providers must train all staff on what a restraint is and on the Settings Rule requirement that individuals receiving waiver services have the right to be free from restraint. Per the waiver, if a provider agency is utilizing restraint, the provider agency staff must receive developmentally appropriate training initially (at hire) and annually thereafter that shall include:

  1. Restraint techniques;
  2. Restrictive interventions;
  3. Restorative practices; and
  4. Identifying signs of distress during restraint.

Modification of the Right to Freedom from Restraint Requirement

  1. Modifications are considered a deviation from the individual's right to be free from restraint. It must be supported by a specific, individually assessed need and justified in the Personal Plan. Modifications also must be reviewed by the Human Rights Committee (HRC) or Behavioral Management Committee (BMC) and must comply with the process outlined in Rules 115 and 120. The HRC manual details the process for HRC reviews. The Personal Plan and Implementation Strategy should include the following:
    1. Specific and individualized assessed need for which the modification is required
    2. Less restrictive interventions and supports attempted without success prior to imposing any modifications
    3. Data collection and review of less restrictive interventions and supports. In addition, if the modification is needed due to the presence of behaviors that pose a risk to the individual or others, include collection and review of data related to the effectiveness of methods used to reduce the undesired behavior
    4. Schedule of periodic reviews of data as outlined in the Behavior Intervention and Treatment Implementation and Billing for a rights restriction.
    5. Assurance interventions and supports pose no harm to the individual.
    6. Informed consent of the individual and the individual's guardian, if applicable.
  2. The prospective, or current provider agency, is responsible for providing items 1-6 above and documenting these items in the Implementation Strategy. In addition, the Implementation Strategy of all other individuals living in the home must address the specific supports that will be provided to assist them to have visitors of their choosing at any time.


If an individual, guardian or concerned person does not feel a person is receiving services compliant with the HCBS Settings Rule, they can complain to the provider or to the ISC. They can also go through the formal HCBS Settings complaint process by using the web form: IDHS: DHS DD Services Complaints (state.il.us), email: DHS.HCBScomplaints@illinois.gov or phone number: (877) 657-0005.

Effective Date:

This Information Bulletin is effective April 9, 2024