Rule 115 Outline of Changes, 2024

Slide 1

Overview of Rule 115

  • June 2024
  • Presented by Andrea Medley
  • Department of Human Servicers, Division of Developmental Disabilities

Slide 2

Before We Begin

  • Questions, errors or discrepancies
    • send to: Andrea.Medley@illinois.gov
    • Subject: Rule 115
    • Identify Section number
  • Thank you for your input and contributions:
    • DHS
    • DD Regulatory Advisory Board members

Slide 3

Rule 115 Background

  • Official reference: 59 Ill. Adm. Code 115 or Title 59 Part 115
  • Rule 115 provides uniform standards and licensure requirements CILAs.
  • Current Rule 115 is available at https://www.ilga.gov/commission/jcar/admincode/059/05900115sections.html
  • Last amended in March of 2003

Slide 4

General Changes

Changes throughout the Rule include:

  • Illinois DDD Adult Waiver requirements
  • Federal HCBS Final Regulations
  • Illinois statutory mandates
  • Updated language
  • Mental Health CILAs no longer included

Slide 5

Table of Contents

New Sections and Titles:

  • 115.130 Rate Components New section number. The title was moved from Section 115.710
  • 115.214 Individuals Requiring Additional Services and Support
  • 115.225 Assessments
  • 115.245 Restraints
  • 115.326 Monitors and Receiverships

Slide 6

Table of Contents

Revised Titles:

  • 115.220 Services and Supports
  • 115.230 Person-Centered Planning
  • 115.530 Compatibility of Individuals and Host Families

Repealed Titles:

  • 115.330 Accreditation
  • 115.700 Purpose
  • 115.710 Rate Components

Slide 7

Section 115.100 Purpose

  • (a) Language updated to specify the Rule is for individuals with Developmental Disabilities only (previously included individuals with Mental illness w/no DD).
  • (b) The objective of CILA has been updated to pursue meaningful and valued lives, as defined by the individual. Language related to active treatment in Waiver services was removed.
  • (d) is new language
  • In (e) language and references to Federal Person Center Planning and Settings requirement have been included.
  • (f) and (g) Includes language on rate methodologies.

Slide 8

115.110 Incorporation by reference

  • No changes to this Section.

Slide 9

115.120 Definitions (New)

The following Definitions have been added to Rule 115:

  • Assigned Independent Receiver; also see Section 115.326
  • Authorized electronic monitoring
  • BALC
  • BQM
  • CILA agency or CILA provider
  • CILA Services
  • Coercion
  • Critical incidents
  • Direct Support Professional or DSP
  • Division of Developmental Disabilities, Division, or DDD
  • Electronic monitoring device
  • Exploitation
  • Host family living arrangement or Host family setting
  • Host family services
  • Implementation Strategy

Slide 10

115.120 Definitions (New)

New definitions continued:

  • Independent Monitor or Monitor; also see Section 115.326
  • Independent Service Coordination agency or ISC
  • Individual representatives
  • Individually Owned or Controlled
  • Intellectual Disability; note: the age of onset has been changed from 18 to 22
  • Personal Plan
  • Provider
  • Provider owned or controlled
  • Provider Support Team
  • Qualified Intellectual Disabilities Professional or QIDP
  • Quality Assurance Review
  • Remote monitoring and supports
  • Restraint
  • Support Services Team or SST
  • Volunteer

Slide 11

Section 115.120 Definitions (Removed)

The following Definitions have been removed:

  • Accreditation
  • Agency supervision
  • Array of services
  • Consumer representative
  • Deemed status
  • Economic self-sufficiency
  • Equivalency
  • Independence in daily living
  • Individual integrated services plan or services plan
  • Interdisciplinary process
  • Linkage

Slide 12

Section 115.120 Definitions (Removed)

Removed definitions continued:

  • Living arrangement
  • Mental disability
  • Mental retardation
  • Moral turpitude
  • OCAPS
  • Paraprofessional
  • Pre-admission screening (PAS) agent
  • Progress note
  • Qualified mental health professional or QMHP
  • Qualified mental retardation professional or QMRP
  • Site
  • Skills training

Slide 13

Section 115.120 Definitions (Revised)

The following definitions have undergone substantial revisions:

  • Abuse; now references OIG Rule 50
  • Agency; replaced with "CILA agency/CILA provider"
  • Aversive procedures; includes characteristics
  • Certification; granted by the Department and specific to a site
  • Community-integrated living arrangement (CILA); "under one continuous roof" was removed, "home" replaced with "an apartment, house, or one or more units in a multi-unit building"
  • Community integration or integration into the community; includes Federal Person-centered planning language and person-centered concepts
  • Continuous supervision or support; supervision or support is provided "unless otherwise specified in an individual's Personal Plan and provided for in their Implementation Strategy"

Slide 14

Section 115.120 Definitions - Revised

Revised definitions continued:

  • Developmental Disability; replaced "mental retardation" with "Intellectual Disability", removed specific examples of Developmental Disabilities other than ID
  • Diagnosis; updated reference to DSM-5
  • Habilitation; included person-centered concepts
  • Mental health professional or MHP; referenced 89 Ill. Adm. Code 140
  • Mental illness; updated reference and diagnoses to DSM-5
  • Natural environment; sites "are not licensed, certified, accredited or identified as a provider"
  • Natural supports; removed language regarding informal agreement
  • Neglect; now references OIG Rule 50

Slide 15

Section 115.120 Definitions (Revised)

Revised definitions continued:

  • Notice of violation; "violation" replaced with "deficiency" in definition and throughout the rule
  • Professional; included volunteers, does not include DSPs
  • Seclusion; seclusion is prohibited
  • Substantial compliance; does not include a Level 3
  • Survey; included "licensure and certification survey", in addition to on-site, can also be conducted by "desk audit, remote, or virtual"
  • Time Out; Time out is prohibited, removed 30-minute time frame
  • Waiver; added, "Waivers may be granted only for that which is allowable under this Part."

Slide 16

115.130 Rate Components

  • In (a)(2) Program Cost Centers includes "program support cost" and "occupancy factor".

Slide 17

115.200 Description

This section has been updated and now:

  • Provides a description of CILA settings and services, including requirements around Federal Person-centered Planning (b) and Settings regulations (c).
  • (d) includes specific requirements around a provider owned/controlled CILA settings.
  • (f) "no decline" language has been removed. The language has been revised into three parts:
    • Providers must assess the needs of individuals to ensure the setting and services are appropriate.
    • Providers must work with the division in order to explore possible options and alternatives for services before denying someone.
    • Provider must provide reasonable accommodations or modifications for individuals who already reside in a CILA.

Slide 18

115.205 Respite Services for Persons with a Developmental Disability

  • Language removed that required the provider to obtain approval from the Division prior to serving an individual.

115.210 Criteria for Participation of Individuals

  • The process to request an "age waiver" has been included. An "Age Waiver" allows individuals to receive CILA services at age 17 1/2.

Slide 19

115.214 Individuals Requiring Additional Services and Support

This is a new section and outlines the process the provider support team must follow when individuals need additional supports

  • Process addresses:
    • recent acute medical conditions
    • sudden intense behavioral episodes
    • But, not limited to medical and behavioral
  • These actions should be taken prior to termination of CILA services

Slide 20

115.215 Criteria for Termination from a CILA Agency

  • The title has been changed from Criteria for termination of an Individual to Criteria for Termination from a CILA Agency.
  • (b), details requirements for the notice of termination
  • The previous language on bed holds has been removed from (d), occupancy factor in the rate was added and is accounted for in 115.130 (a)(2).

Slide 21

115.220 Services and Supports

  • The title has been changed from Community Support Team to Services and Supports.
  • This section describes the role (and requirement) of the Provider Support Team, which is new to Rule 115.
  • In (a)(15) updated language on individual's funds, based on statue.
  • In (a)(17) -new requirement to provide sex education, based on statue.

* In (c) the requirements for the QIDP have been updated.

Slide 22

115.225 Assessments

  • Section 115.225 is a new section. Some of the information was previously included in Section 115.230.
  • Outlines the assessments that must be in the individual's record
  • In (c)(3) a screening for health issues or risk (which is the HRST) has been included.
  • The SLOF (Specific Level of Functioning) is no longer a required assessment.
  • The SIB-R (Scales of Independent Behavior- Revised) is no longer an allowable functional assessment instrument. All individuals in CILA must have an ICAP as indicated in (d)(2).

Slide 23

115.230 Person-Centered Planning

  • In section 115.230, the title has been changed from Interdisciplinary Process to Person-Centered Planning.
  • (a) the requirement has been added for providers to comply with Federal and State (Rule 120) requirement regarding Person centered planning.
  • Again, the provider's responsibility regarding initial and annual assessment has been moved to the previous section (115.225).
  • (b) the Implementation Strategy is introduced.
  • Previous language required providers to review the Plan semi-annually for individuals with a mental illness - this is no longer required.
  • Providers must update, "the Implementation Strategy as the Personal Plan is modified, or more often if warranted by a change in functional status or at the request of the individual or guardian" as indicated in (b)(6).
  • In 115.225 (d)(3), "An annual psychiatric examination for individuals with a mental illness" is required.

Slide 24

115.240 Medical Services and Medications

  • Providers are required to ensure that when medical services and/or medications are provided in a CILA, they are provided or administered according to the Mental Health and Developmental Disabilities Administrative Act, the Illinois Nurse Practice Act, and 59 Ill. Adm. Code 116.
  • In (c), the Rule now specifies the AIMS (Abnormal Involuntary Movement Skills) must be used to screen for abnormal involuntary movements. Previously the Rule did not identify a specific tool.
  • In (d), the requirement for the physician to see an individual who is taking psychotropic medications every 3 months has been removed. The new language requires a physician to see the individual "at least every six months, and more frequently if required by a psychiatrist".

Slide 25

115.245 Restraints

Section 115.245 is new to the Rule

  • This section outlines:
    • How restraints must be implemented
    • Time frames
    • Documentation and reporting requirements
    • Staff training requirements
  • This section includes:
    • Restraints that are prohibited (a),
    • Restraints that are allowed as identified in the personal plan (b),
    • Restraints not included in the personal plan (c).
    • Required training (d).
    • Language and an avenue for reporting complaints regarding restraints to the Division (e).

Slide 26

115.250 Individual Rights and Confidentiality

  • (a) CILA providers are required to share a copy of and to explain the Rights of Individuals form (IL 462-1201)
  • The Rights have been updated to include individuals being free from exploitation and coercion
  • Restraint is only allowed when it follows the requirements specified in Section 115.245
  • (a)(3)(D) added to clarify that seclusion, time-out and aversive procedures, are prohibited.
  • (b) identifies rights related to provider-owned or controlled living arrangements; this corresponds to language in 115.200 (d).

Slide 27

Section 115.300 Environmental Management of Living Arrangements

* (a)(2), Providers should assist individuals to obtain/maintain Carbon Monoxide Detectors and First Aid Kits in individually owned or controlled CILAs

  • (a)(4) the provider is required to provide education and provide information on fire safety and disaster preparedness
  • (b) providers are required to comply with locally adopt building codes; language has been added to include codes for attic spaces and impractical evacuation capability.
  • (c)(2) language added that requires Carbon Monoxide detectors in provider owned or controlled CILAs

Slide 28

Section 115.300 Environmental Management of Living Arrangements

Section 115.300 continued

  • (c)(6)(G) language from the Federal Settings requirements has been added language from the
  • (c)(7) the following language has been added:
    • (A), requires the setting be physically accessible to the individuals served in the setting
    • (E) requires removal of snow ice sleet from walks ramp ways
    • (F) requires maintenance of vegetative growth on the premises
    • (H) Each provider must evaluate the quality of food prior to its consumption

Slide 29

Section 115.300 Environmental Management of Living Arrangements

Section 115.300 continued

  • In (c)(8), the provider's disaster preparedness plan must include disasters and/or public health crises.
  • In (c)(9)(A) & (B), language has been added regarding evacuation drills, including overnights.
  • (d) outlines living arrangement requirements for "individuals who receive continuous supervision and support and choose to reside with their families or in living arrangements owned or leased by the individuals".
  • (f) Requires CILA providers to cooperate with BALC when visiting/inspecting any type of CILA home.

Slide 30

115.310 Geographic Location of Community-Integrated Living Arrangements (CILA)

  • (a) - (c) outlines characteristics for the location/operation of CILA settings according to Federal HCBS Settings requirements
  • (d) Refers to existing CILA sites (Settings validation process)
  • (e) New language regarding CILA sites in multi-unit buildings
    • No more than 25% of the total units in each building are provider owned or controlled CILAs
    • Each unit must meet the requirements for a CILA outlined in Section 115.300

Slide 31

Section 115.310 continued:

  • The "800-foot rule" for CILA locations has been removed
  • (f) New provider owned or controlled CILA sites cannot be:
    • Adjacent to any Medicaid HCBS waiver-funded residential or day program site or property owned or controlled by the same CILA provider
    • Located in a building that is also a publicly or privately-operated facility that provides inpatient institutional treatment
    • Located in a building on the grounds of, or adjacent to, a publicly or privately-operated facility that provides inpatient institutional treatment
    • Any of the settings defined in 42 CFR 441.301(c)(5)
  • (g) New provider owned or controlled CILA sites must comply with the HCBS Settings requirements prior to being licensed

Slide 32

Section 115.310 continued:

  • (h) Individually owned or controlled homes/apartments are presumed to be in compliance with the Settings requirements
    • a private residence owned by an unrelated caregiver (who is paid for providing HCBS Waiver services to the individual) are considered provider-owned or controlled settings and will be evaluated as such
  • Proximity Waiver
    • (i) Can be requested for HCBS adult waiver funded residential sites converting to CILA
    • (j) Can be requested for a potential provider-owned or controlled CILA site to be adjacent to another HCBS Waiver site by the same provider
    • Must meet criteria outlined by the Division
    • Must be requested and approved by DDD prior to the provider obtaining the potential site
    • Request must be submitted to: DHS.HCBS@illinois.gov

Slide 33

115.320 Administrative Requirements

  • Language in (b) now includes contractual workers, volunteers, or practitioners- all who have the responsibility of caring for individuals.
  • (b)(3) the registry check information has been updated.
  • (b)(4) - (9) is all new language regarding registries and sanction list.
  • Language in (c)(2) has been enhanced regarding Human Rights and Behavior Management Committees. New language outlines the make-up and task of the committees.
  • (c)(3) "Exploitation" has been included
  • (c)(3)(B) Statement added regarding a process for reporting complaints regarding individual rights.

Slide 34

Section 115.320 continued

  • (c)(4)(A) Additional characteristics added/updated as follows: (creed), gender identity, gender expression, age, national origin (ancestry), ethnicity, disability, marital status, sexual orientation.
  • (c)(7) language included on remote monitoring and supports, based on statute.
  • (d) Trainings
    • "…paraprofessional, contractual workers, or volunteers with responsibility for direct care of individuals" has been added to the language
    • (1)(A), "back blows/abdominal thrusts" replaced "Heimlich maneuver"
    • (1)(C), "public health emergencies; and fire procedures and the use of fire equipment such as a fire extinguisher" has been added.
    • (1)(D), "exploitation, coercion and critical incidents" have been added as well as a reference to OIG Rule 50

Slide 35

Section 115.320 continued

  • (d)
    • (1)(I) references the AIMS specifically
    • (1)(L) requires "Water temperatures at 100 and 110 degrees"
    • (1)(M) language updated and includes reference to Rule 116. Requires Authorized direct care staff to be re-evaluated by a Nurse-Trainer at least annually
  • (g) changed from "unusual" to "critical" incidents; "exploitation" has been added.
    • (g)(3) includes: suspected instances of abuse, neglect or exploitation are reported to within four hours of discovery
  • (h)(3)(A), additional pieces of identifying information have been added
  • (h)(3)(B) the court appointed guardianship order, if applicable, has been added

Slide 36

115.321 Application for Waiver of the Prohibition Against Employment

  • Removed details of requesting a waiver which is outlined in the Health Care Worker Background Check Act; a Waiver request is still required as outlined in this Section
  • (c) Added information regarding CANTS

115.325 Monitoring and Evaluation

  • Included the website for finding information regarding CILA provider compliance scores, status of administration actions and substantiated OIG findings.

Slide 37

115.326 Monitors and Receiverships

  • New Section, required by CILA Act
  • This process can occur based on:
    • A disproportionate number or percentage of complaints regarding licensure issues;
    • A disproportionate number or percentage of substantiated cases of abuse, neglect or exploitation involving a CILA agency;
    • An apparent unnatural death of an individual served by a CILA agency;
    • Any egregious or life-threatening abuse or neglect within a CILA agency; or
    • any other significant event as determined by the Department.
  • Process initiated with a review by DHS

Slide 38

115.330 Accreditation (Repealed)

  • This Section number has been "Repealed"; the Section number and name were left in for historical purposes.

115.400 Applicability

  • Minor changes only.

Slide 39

115.410 License Application

  • (a)(1)
    • Requires prospective CILA providers to complete new provider requirements within one of year of requesting a licensure application.
    • Request for applications must be emailed to BALC instead of mailed.
  • (a)(2) requires prospective CILA providers to comply with Federal Settings and Person Centered Planning requirements.
  • New provider agencies are no longer required to submit their budget and estimated first year expenses/revenues.
  • (b) "non-refundable" and licensure fee renewals have been added to the language.
  • (d) Agency will notify BALC and DDD within 60 business days of any change of ownership
  • (e) CILA agencies must be operational within 18 months

Slide 40

115.420 Application Acceptance and Verification

  • (a) and (c) Included language on an electronic submission
  • (b) CILA agency has 60 days to complete an application

Slide 41

115.430 Issuing a License and Period of Licensure

  • (b) language was added that requires compliance with Rule 120, the Federal Settings and Person Centered Planning requirements.
  • (b)(1)
    • The Department will conduct unannounced survey, "scheduled surveys" has been changed to "unannounced surveys".
    • Language has been added, in addition to investigating complaints, the Division will also investigate health and safety issues and other concerns as deemed warranted by the Department.
  • (c), language has been revised- during the provisional licensure period, the provider can operate one CILA site, serving up to eight individuals

* In both (d) and (e) the specific time frames for a valid license have been removed and replaced with reference to the Statue.

Slide 42

115.440 License Sanctions and Revocation

  • "Violation" has been replaced with "deficiency"; no major changes in this section.

115.450 Non-transferability of license

  • No changes to this section.

Slide 43

115.460 Cessation of Operations

  • Language added to (a), provider agencies must have Department approval if ceasing operation in less than 60 days.
  • In (a)(4) language has been added; providers are expected to work cooperatively with the ISC to supply records and other documents for individuals who are transitioning.

115.470 Hearings

  • The address has been removed for the Bureau of Administrative Hearings and now refers to the notice that will be sent to the providers.

Slide 44

115.500 Program Description

  • This section had minor language changes only.

115.110 Compliance with this Part

  • Statement added to clarify that host families are in fact CILAs as defined and 115.120.

115.520 Program Requirements

  • (j) Added requirement for providing relief care in host family settings.

Slide 45

115.530 Compatibility of Individuals and Host Families

  • The title has been changed from "Pairing of Individuals" to "Compatibility of Individuals".

115.540 Department Approval of Host Family Services

  • (c)(1), (C) and (F) is new language; "monitoring of the setting" has been removed.
  • (d), new language added: Parents, other relatives, and legal guardians may not provide host family services.

Slide 46

115.550 Number of Individuals Served in Host Family Settings

  • (c) Allows a waiver of the number of individuals to be served in a Host Family CILA
  • Host Family waivers should be sent to DHS.BALC@illinois.gov
  • In (c)(5), The CILA provider must also submit supporting documentation (the practice is not new, just adding the language to the Rule).
  • In (C)(8), the time frames for responding to waiver request have been removed from (c)(8) and added to (f).

Slide 47

115.560 Number of Individuals Living in Host Family Settings

  • In (c), Provider can request a waiver to allow up to 8 people to live at a HF site (standard is 6, including individual(s) with developmental disabilities)
  • Host Family waivers should be sent to DHS.BALC@illinois.gov
  • (C)(5) the CILA provider must submit a standardize form for the waiver request and include supporting documents

Slide 48

115.570 CILA Agency Requirements

  • Minor language changes only.

115.580 24-Hour Service

  • Minor language changes only.

115.590 Minimum CILA Agency/Caregiver Contract Requirements

  • Minor language changes only.

115.600 Relief Services

  • In (b), language regarding relief staff has been updated and moved from Section 200.

Slide 49

115.610 Conflicts of interest

  • No changes to this Section.

115.620 Quality Assurance Plan

  • Minor language changes only.

115.700 Purpose (Repealed)

  • This Section number has been "Repealed"; the Section number and name were left in for historical purposes. The contents of this Section are now in Section 115.100.

115.710 Rate Components (Repealed)

  • This Section number has been "Repealed"; the Section number and name were left in for historical purposes. The contents of this Section are now in Section 115.130.

Slide 50

In Closing

  • Questions, errors and discrepancies
    • send to: Andrea.Medley@illinois.gov
    • Subject: Rule 115
    • Identify Section number