Summary of Specific Provider Qualifications and Credentials

Individual Service and Support Advocacy must be provided by:

• Qualified staff of an independent agency that does not provide direct services.
• Staff must be a qualified mental retardation professional (or QSP in Illinois) as defined in federal ICFMR regulations.
• Staff who have had required background checks.

Agencies must comply with:

• Requirements of the DHS contract and contract attachments.
• Requirements of Rule 50, Medicaid Home and Community-Based Services Waiver Program for Individuals with Developmental Disabilities (59 Ill. Adm. Code 120) in serving individuals enrolled in the waiver programs.
• Comply with the requirements of Rule 50, Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities.  Comply with the requirements of Rule 51, Office of Inspector General: Adults with Disabilities Abuse Project.
• Comply with the requirements of Rule 331, Unusual Incidents, if serving children.The Individual Service and Support Advocacy (ISSA) Guidelines contain specific guidance on the qualifications and responsibilities of the ISSA.

• Requirements of the DHS contract and contract attachments.
• Requirements of Rule 120, Medicaid Home and Community-Based Services Waiver Program for Individuals with Developmental Disabilities (59 Ill. Adm. Code 120) in serving individuals enrolled in the waiver programs.
• The requirements of the Rule 116, Administration of Medication in Community Settings.Comply with the requirements of Rule 50, Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities.

• Be licensed by the Department of Public Health according to Rule 370 (77 Ill. Adm. Code 370), including requirements for reporting of deaths and allegations of abuse and neglect to the Department of Public Health.
• Serve no more than 16 residents, be located in state and not be located on a campus setting.

• Be a licensed Child Welfare Agency (89 Ill. Adm. Code 401) with Child Group Home license (89 Ill. Adm. Code 403).
• Comply with the requirements of the Unusual Incidents rule (89 Ill. Adm. Code 331) and Behavior Treatment in Residential Child Care Facilities (89 Ill. Adm. Code 384). 

• Requirements of the DHS contract and contract attachments.
• Requirements of Rule 120, Medicaid Home and Community-Based Services Waiver Program for Individuals with Developmental Disabilities (59 Ill. Adm. Code 120) in serving individuals enrolled in the waiver programs.
• Comply with the requirements of Rule 50, Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities.
• Comply with the requirements of Rule 51, Office of Inspector General: Adults with Disabilities Abuse Project.

• Be a certified Developmental Training (DT) provider under Rule 119, which governs Developmental Training (59 Ill. Adm. Code 119).
• Be open and serving all enrolled individuals in DT at least five hours per weekday, and be open and providing services at least 240 days per year.

• Have a current contract with the Department on Aging.
• Must be in compliance with Rule 240, Community Care Program (89 Ill. Adm. Code 240).

• Have CILA licensure.
• Be provided by the same agency as the individual's residential services.

• Behavior intervention and treatment providers must be one of the following provider types.A Level I provider must be a:
  • Licensed clinical psychologist, or
  • Nationally certified Behavior Analyst (certified by the Behavior Analyst Certification Board).
• A Level II provider must be a:
  • Nationally certified Associate Behavior Analyst (certified by the Behavior Analyst Certification Board),
  • Professional certified to provide Relationship Development Assessments,· Early Intervention Specialist with a Developmental Therapy credential or equivalent experience and training, or
  • Professional with a Bachelor's Degree and who has completed at least 1,500 hours or training or supervised experience in the application of behaviorally-based therapy models.

• Licensed clinical psychologist,
• Clinical social worker,
• Social worker,
• Marriage or family therapist,
• Clinical professional counselor, or
• Professional counselor.

• Licensed clinical psychologist,
• Clinical social worker,
• Marriage or family therapist, or
• Clinical professional counselor.

• A licensed physical therapist.
• A licensed physical therapy assistant under the direct supervision of a licensed therapist enrolled as a Medicaid State Plan Provider and waiver provider. The assistant is not required to enroll in the Medicaid State Plan nor the waiver program. Services are billed by the licensed supervisor.

• A licensed occupational therapist.
• A certified occupational therapy assistant under the direct supervision of a licensed therapist enrolled as a Medicaid State Plan Provider and waiver provider. The assistant is not required to enroll in the Medicaid State Plan nor the waiver program. Services are billed by the licensed supervisor.

• Be an agency that is in compliance with contractual requirements and that does not also provide Individual Service and Support Advocacy services.
• Comply with the requirements of Rule 50, Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities.
• Comply with the requirements of Rule 51, Office of Inspector General: Adults with Disabilities Abuse Project.
• Comply with the requirements of DCFS Rule 331, Unusual Incidents, if serving children.
• Employ or contract with staff who are professionals as defined in federal regulations as a Qualified Mental Retardation Professional (QMRP). All staff in this role must be QMRPs.
• Employ or contract with staff who are approved by the Division of Developmental Disabilities as a QMRP and must meet the training requirements set by the Department for QMRPs. All staff in this role must meet these requirements.
• Employ or contract with staff who pass Criminal Background, Health Care Workers Registry and CANTS (if working with children) checks completed by the employing agency prior to delivering Service Facilitation.

• Agencies must be an entity that is in compliance with contractual requirements.
• Agencies must have required all employees to pass Criminal Background and Health Care Workers Registry checks completed by the employing agency prior to delivering Personal Support.
• Agencies providing services under the Children's Support Waiver shall require all employees having access to children (through age 17) to pass State Central Register (CANTS) and Illinois Sex Offender Registry checks prior to delivering Personal Support.
• A previous amendment removed the requirement for a high school diploma or GED for domestic employees providing Personal Support.  Agencies must require personal support workers to meet requirements for Direct Support Personnel training prior to providing Personal Support.
• Domestic employees of the individual/guardian/employer representative must be aged 18 or older and must be deemed by the individual's guardian or family to be qualified and competent to meet the participant's needs and carry out responsibilities assigned via the service plan. By signing the Service Authorization, the individual, guardian, or employer representative deems the domestic employee qualified and agrees to provide necessary training and supervision.
• Domestic employees hired on or after July 1, 2007 must pass Criminal Background and Health Care Workers Registry checks prior to delivering Personal Support. If they are serving children (through age 17), they must also pass State Central Register and Illinois Sex Offender Registry checks prior to delivering Personal Support.
• For the Children's Home-Based Support Services program, a previous amendment allows relatives to provide Personal Support (except legally responsible relatives). 
• For Adult Home-Based Support Services program, payment will not be made for Personal Support services by the spouse or child of the participant. Other relatives who provide Personal Support must meet the same standards as Personal Support workers who are unrelated to the participant.
• For the Adult Waiver, there are special IRS requirements that apply if a guardian is also the domestic employee. Per the IRS, the same person cannot be both the employer and the domestic employee. An employer representative must be identified to take on the responsibilities of the employer of record. The representative can be anyone chosen by the participant or guardian who can sign the service authorization and time sheets.

• Non-Medical Transportation providers must:
  • Have a valid driver's license and be licensed to drive in Illinois.
  • Have proof of automobile liability insurance in accordance with State law.
• Providers of non-medical transportation services may include enrolled providers who are:
  • An agency that is approved to provide Service Facilitation or Personal Support services or domestic employees who are deemed by the individual, guardian or family to be qualified to provide Personal Support, or
  • Bus companies, taxi companies and other public transportation companies. Employees of transportation companies are exempt from the Criminal Background check and Health Care Workers Registry check requirements and from training requirements.

• A licensed clinical psychologist,
• A licensed clinical social worker,
• A licensed social worker,
• A licensed clinical professional counselor,
• A licensed professional counselor, or
• A licensed marriage and family counselor.