Appendix A - Definitions

When used in this manual the terms below have the following meaning:

  • Accreditation, Licensure, and Certification: Entity within DHS responsible for the surveying, licensing, and certifying of DHS-funded community-based programs.
  • Active Treatment (AT) for Individuals with a Developmental Disability: A continuous program for each individual that includes aggressive, consistent implementation of a program for specialized and generic training, treatment, health services and related services that are directed toward:
    1. The acquisition of behaviors necessary for the individual to function with as much self-determination and independence as possible
    2. The prevention or deceleration of regression or loss of current optimal functional status. Active treatment does not include services to maintain generally independent individuals who are able to function with little supervision or in the absence of a continuous active treatment program.
  • Aging, Department on (DoA): State agency in Illinois responsible for planning and coordinating State resources for persons who are elderly (age 60 and above).
  • Alzheimer's Disease: Alzheimer's Disease and related disorders are one type of dementia. (See the definition of dementia)
  • Appeals Process:  Due process by which an individual may have the following determinations made during the Pre-Admission Screening process reviewed at another level.
    1. The determination that the individual does or does not require 24-hour nursing care.
    2. The determination that the individual does or does not require active treatment related to the disability.
  • Assessment Process: Second phase of the Pre-Admission Screening process in which required evaluations and assessments are performed.
  • Audiologist: Professional who specializes in non-medical evaluation and rehabilitation or hearing disorders, usually not a physician, and licensed under the Illinois Speech-LanguagePathology and Audiology Practice Act. (225 ILCS 110/1 et seq.)
  • Brain Stem Level Functioning: The individual is unable to control any part of or function of a bodily part from below the bottom of the brain stem. The individual may or may not have control of his or her respiratory system.
  • Centers for Medicare and Medicaid Services (CMS):  the Federal agency responsible for administering the Federal Medicaid and Medicare programs.  Formerly called the Health Care Financing Administration, or HCFA. 
  • Comatose: An abnormally deep stupor occurring in illness or due to an injury. The individual cannot be aroused by external stimuli.
  • Community Integrated Living Arrangement (CILA): Flexible service arrangement for individuals with a developmental disability that focuses on the service needs of the individual in his or her home or a community setting where eight or fewer individuals with disabilities live together.  CILAs are licensed by the State. 
  • Convalescent Care: The care involved and the gradual return to health after an acute illness. To be considered for convalescent care, the individual must be discharged from a hospital setting. Usually convalescent care is obtained in a nursing facility setting. On occasion, an ICF/MR may be able to provide such care.
  • Dementia: A condition that is characterized by impairment in short-term or long-term memory, and one or more of the following: impairment in abstract thinking, judgement, higher cortical functions such as disturbances in language (aphasia), the completion of complex motor activities (apraxia), or the inability to recognize familiar objects (agnosis), or significant personality change.
  • Determination Process: The final phase in the PAS process. Based on the completed assessments, determinations are made on the individual's need for 24-hour nursing care and the need for active treatment related to the disability. The need for 24-hour nursing care and active treatment, along with the individual's age and level of disability, establish the options available to the individual for alternative residential support services. If warrented, the DD PAS agency will refer an individual to the local MHPAS agency for determination of the need for psychiatric rehabilitation services.
  • Developmental Disability (DD): A disability which is attributable to an intellectual disability or a related condition. (Refer to the definitions of an intellectual disability and related condition for further details.)
  • Dual Sensory Impairment: Concomitant hearing and visual impairments. The combination of these impairments causes such severe communication, mobility, developmental, self-care, or work-related problems that the individual cannot be accommodated in programs solely for individuals who have a hearing or visual impairment. An individual is considered to have a visual impairment if unable to travel in and out of his/her own environment without assistance and, because of visual deficits, has reduced ability to see print.
  • Healthcare and Family Services, The Illinois Department of  (HFS): The State agency in Illinois responsible for administering the Federal Medicaid program (Title XIX), and other Federal and State public assistance programs. Formerly called the Illinois Department of Public Aid.
  • Home and Community-Based Waiver, also called the Waiver: A Medicaid source for funding community-based habilitation services and support designed as an alternative to placement in an institutional setting for individuals with a developmental disability. DHS has approval to claim Medicaid reimbursement under three waivers:  the Waiver for Adults with Developmental Disabilities, the In-Home Supports Waiver for Children and Young Adults with Developmental Disabilities, and the Residential Waiver for Children and Young Adults with Developmental Disabilities.
  • Human Services (DHS), Department of: For purposes of this manual, the State agency in Illinois responsible for planning and coordinating State resources for those individuals with a developmental disability.
  • Identification Screen (ID Screen) also called the Level 1 Screen: The first phase of the PAS process, documented on the OBRA-1 form.  If as a result of the Level I Screen, it appears that an individual may have a developmental disability or a severe mental illness, the individual is referred for further assessment and determination.
  • Intellectual Disability: Refers to significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested before the age of 18 years.  significantly subaverage 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. 
  • Intermediate Care Facility (ICF): A facility which provides basic nursing care and other restorative services under periodic medical direction. Many of these services may require medical skill in administration. These facilities are licensed as nursing facilities by the Illinois Department of Public Health (IDPH) and certified for Medicaid participation by the Illinois Department of Healthcare and Family Services (HFS). When the term Intermediate Care Facility or ICF is used in this Manual, it does not include ICFs/DD unless specified.
  • Intermediate Care Facility for Individuals with a Developmental Disability (ICF/DD): A facility of 3 or more individuals, or a distinct part of an ICF, which provides active treatment to individuals who have a developmental disability, and can provide a nursing facility level of care. These facilities are licensed by IDPH as ICFs/DD and are certified for Medicaid participation by HFS. When ICF/DD is used in this Manual, it includes intermediate care facilities for individuals with a developmental disability with a capacity of 16 or fewer individuals (ICF/DD-16) and Specialized Living Centers (SLCs).
  • Intellectual Disability (ID): Refers to significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested before the age of 18 years.  Significantly subaverage is defined as an intelligence quotient (IQ) of 70 or below on standardized measures of intelligence.  This upper limit could be extended upward dependingon the reliability of the intelligence test used. 
  • Long-Term Care Facility for Individuals under age 22: Commonly known as skilled nursing facility for pediatric residents (SNF/PED), it is a facility which provides skilled nursing care to individuals generally under 22 years of age. These facilities are licensed by IDPH, and are certified by HFS.
  • Medicaid (Title XIX): Health care benefits provided under Title XIX of the Social Security Act.
  • Medicaid Eligible: A determination made by the Department of Human Services, Division of Human Capital Development. The determination means the individual's income and assets are inadequate to pay for medical care per the State's guidelines and the individual belongs to an eligible class, for example, dependent children and their parents, aged, blind, or disabled.
  • Nursing Facility (NF): A long-term care setting that provides a level of nursing care for people who have a disability, are infirm or in need of convalescence.  It is licensed by the IDPH and certified for participation in Medicaid by IDPA. NF refers only to ICF or SNF, not ICF/DD, ICF/DD-16, or SNF/PED.
  • Omnibus Budget Reconciliation Act of 1987 (OBRA-87): A Federal law which included a number of changes in the requirements that must be met for States to receive reimbursement under Title XVIII and XIX of the Social Security Act (Medicare and Medicaid). The provisions in this law are updated annually.
  • Organic Brain Syndrome: A constellation of psychological or behavioral signs or symptoms due to presumed organic cause without reference to specific organic etiology, which manifest themselves as one or more of the following: disturbance in orientation; impairment of memory; impairment in the level of consciousness and attention; impairment of intellectual functions (comprehension, calculation, knowledge, learning); defective judgement; liability, shallowness, and similar instabilities of the affect; and overall changes in the personality, with the appearance of conduct foreign to the individual's natural or unusual behavior.
  • Pre-Admission Screening (PAS) Agencies: Independent community agencies selected by DHS to carry out certain Federal and State requirements related to the assessment, determinations, and service arrangement of individuals with a developmental disability and/or a mental illness.  PAS agencies specialize in either developmental disabilities PAS activities or mental health PAS activities. 
  • Pre-Admission Screening (PAS) Qualified Intellectual Disability Professional (QIDP): Any and all references to a PAS QIDP indicate that the individual has met all academic and clinical requirements in order to receive classification as a QIDP. Further details regarding the required credentials of a QIDP are found under the definition of Qualified Intellectual Disability Professional.
  • Psychiatrist: A licensed physician who has completed an accredited psychiatric residency training program.
  • Psychologist: A professional licensed or registered with the Illinois Department of Financial and Professional Regulation as a "clinical psychologist."
  • Public Aid, Illinois Department of (IDPA): The former name for the Illinois Department of Healthcare and Family Services. 
  • Public Health, Illinois Department of (IDPH): The State agency in Illinois responsible, among other things, for the licensure of long-term care facilities such as ICFs, ICFs/DD, SNFs, SNFs/PED, and Sheltered Care facilities.
  • Qualified Intellectual Disability Professional (QIDP): A QIDP is an individual who meets one of the following criteria and has a minimum of one year of experience working directly with individuals with intellectual disabilities or a related condition:
    • A licensed doctor of medicine or osteopathy.
    • A licensed registered nurse.
    • A certified occupational therapist or occupational therapy assistant.
    • A certified physical therapist.
    • A certified physical therapy assistant or a graduate of an approcved two year college-level program.
    • A psychologist with a master's level degree from an accredited or approved program.
    • A social worker with a bachelor's degree from an accredited or approved program.
    • A speech-language pathologist or audiologist.
    • A professional recreation staff person with a bachelor's degree in recreation or in a speciality area such as art, dance, music, or physical therapy.
    • A registered professional dietician.
    • A human services professional with a bachelor's degree in a human services field including, but not limited to, sociology, special education, rehabilitation counseling, or psychology.
  • Rehabilitation Services, Division of: An office within DHS responsible for developing and coordinating vocational and in-home support services and resources for the benefit of individuals with disabilities below the age of 60.
  • Related Condition:  A severe, chronic disability that meets all of the following conditions:
    1. It is attributable to Cerebral palsy or epilepsy or any other condition, other than mental illness, found to be closely related to intellectual disability  because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with intellectual disability persons, and requires treatment or services similar to those required for these persons.
    2. It is manifested before the individual reaches age 22.
    3. It is likely to continue indefinitely.
    4. It results in substantial functional limitations in three or more of the following areas of major life activity:
      1. Self-care
      2. Language
      3. Learning
      4. Mobility
      5. Self-direction
      6. Capacity for independent living
  • Severe Mental Illness: According to the Screening Assessment Rule (89 Illinois Administrative Code 140.642), an individual is considered to have a severe mental illness if he or she has one of the following diagnoses: schizophrenia; delusional disorder; schizoaffective disorder; psychotic disorder not otherwise specified; bipolar disorder I - mixed, manic, and depressed; bipolar disorder II; cyclothymic disorder; bipolar disorder not otherwise specified; major depression, recurrent; and due to his or her mental illness exhibits resulting substantial functional limitations. The functional limitation must be of an extended duration expected to be present for at least a year, which results in substantial limitation in major life activities affecting at least two of the following areas: i) self-maintenance; ii) social functioning; iii) community living activities; iv) work related skills.
  • Shelter Care:  A setting for maintenance and personal care licensed by Illinois Department of Public Health.  This type of setting is typically provided for the indigent and consists of room and board only.
  • Skilled Nursing Facility (SNF): A facility which provides skilled nursing care, continuous skilled nursing observations, restorative nursing, and other services under professional direction with frequent medical supervision. These facilities are licensed by IDPH and certified by HFS for Medicaid participation.
  • Skilled Nursing Facility for Pediatric Residents (SNF/PED): See the definition for long-term care facility for individuals under age 22.
  • Speech-Language Pathologist: A professional who is licensed or registered with the Illinois Department of Financial and Professional Regulation as a speech-language pathologist.
  • State Guardian, Office of (OSG): A State entity authorized to serve as guardian for individuals who have a developmental disability (as well as for other individuals) and who require a guardian to address their personal, medical, residential, and/or financial service needs.--*+