PUNS Clarification and Additional Guidance

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.21.001 FINAL

Purpose

This Information Bulletin is intended to clarify the PUNS categories, the process for accumulating time on PUNS and the process for moving from one category to the other. It will also provide additional guidance to assist with the transition for youth approaching 18 years of age.


Background

In the fall of 2019, the Division of Developmental Disabilities (DDD) revised the PUNS guidelines to make the selection process more transparent and predictable for individuals with developmental disabilities and their families. There are now just 2 categories: Seeking Services and Planning for Services; both are defined below. In addition, PUNS selections are no longer made by selecting several people from each category. Instead, PUNS selections are made based on an individual's length of time in the Seeking Services category. This means that those who have been on the list the longest, in the Seeking Services category, will be selected first.


Current PUNS categories

The Seeking Services category is for individuals with a developmental disability who currently need or want supports and are in situations (including but not limited to) the following:

  • Individuals who have (or will shortly) graduate from school and will need day supports (i.e., there are no other employment, day or natural support options available/planned).
  • The Individual is dissatisfied with current living arrangement and would like to live in his/her own home (with supports) or have DD residential services.
  • The Individual currently lives in an out-of-home residential setting that is not funded by the Division of DD and wishes to return to their family home (and family concurs). The family is capable of providing care but would like support to return this individual to the home.

For the scenarios below, the ISC will assess each individual and their current circumstances to determine if a crisis (homelessness, abuse, or neglect) exist. If the individual is in crisis, the ISC should continue to assess and process all situations that rise to the Crisis level, without placing the individual on PUNS. Individuals that do not meet the crisis criteria, and are in the following situations, should be placed on PUNS in the Seeking Services category.

  • An individual whose caregiver is progressing toward being unable to provide care for any number of reasons (age of the caregiver, physical/psychological/health condition of caregiver, health or other situation of the individual). The individual and/or family are coping for now but supports are, and will be, needed.
  • The individual has a deteriorating living situation or natural support system, which requires supports from an outside entity or agency.
  • Cases where, although the individual has not been directly affected, a death in the family (especially of a care giver's spouse or other family member who may have assisted in providing care) or other circumstance, has affected the individual's situation requiring a need for additional support.
  • Situations where the caregiver(s) must work to provide income to pay the rent, etc. If services are not provided, the caregiver(s) would have to remain at home to provide support to the individual, and effectively be unable to continue working.

The Planning for Services category is for people who do not currently want or need supports but may in the future. It is helpful to know about these situations even though the individual/ family is not anticipating the need for services. The Planning for Services category is for individuals who are not currently seeking services but will be seeking if something happens to the caregiver (e.g. caregiver becomes ill or passes away) or other family circumstances change.

It is also appropriate for individuals who currently receive funding or services through entities other than DD, and whose eligibility will eventually terminate due to the age of the individual. This individual is not in crisis and does not have a current need or desire for DD services. This might include, but is not limited to, individuals who are funded through:

  • Early, Periodic Screening, Diagnosis and Treatment (EPSDT) program
  • Medically Fragile/Technology Dependent Children's Waiver
  • Individual Care Grant supports through the mental health system
  • Illinois State Board of Education or public-school system.


Clarification of Existing PUNS Guidelines

Both children and adults can enroll in PUNS. The selection for Children and Adult services occur separately.

  • Children on PUNS:
    • Children can be enrolled on PUNS beginning at 2.5 years old and up through age 18.
    • Children can enroll on PUNS to request Children's Home Based Services or Child Group Home services.
    • If funding is identified to do a PUNS selection for the children's waivers, selection will be based on a child's cumulative length of time in the Seeking Services category prior to age 18.
    • PUNS selections will not be made from the Planning for Service category.
  •  Adults on PUNS
    • People 18 and over can enroll on PUNS for DD Adult waiver services.
    • Adults must be in the Seeking Services category to accumulate time toward the PUNS selection.
    • Time spent on PUNS, while under the age of 18, does not count toward selection for Adult DD Waiver Services.
    • Currently, the wait time for new individuals on PUNS, age 18 or over, who want or need DD Adult Waiver services is 5 or more years. The Division has committed, per the May 3, 2019 Reasonable Pace Proposal, to having no adult wait more than 5 years or 60 months by Fiscal Year 25 (July 2024). The Reasonable Pace Proposal can be found in the Seventh Annual Report of the Monitor- Attachment A: Ligas Implementation Plan, FY2019 with Revisions, 5/3/2019 (pdf)
  •  PUNS in general:
    • Children or Adults enrolling on PUNS can be placed directly into the Seeking Services category, given that they meet the criteria described in the description of Seeking Services above.
    • An individual's time on the PUNS begins once they enter the Seeking Services category. A person does not accumulate time while in the Planning for Service Category.
    • PUNS selections are only made from the Seeking Services category, as funding is available. PUNS selections are not made from the Planning for Services category.
    • In order to move from one PUNS category to the other, individuals and/or their guardian, if applicable, must notify their ISC. Movement from one category to the other is not automatic. This includes: 
  • An individual who is turning or who has just turned 18 years old and who wants to enroll as an adult must notify their ISC. Changing categories at age 18 is not automatic.
  • An individual currently in the Planning for Services category and now wants to move to the Seeking Services category must notify their ISC. Changing categories is not automatic.
  • An individual who is currently in the Seeking services category and is no longer wanting or needing DD Waiver services, for whatever reason, and choses to move to the Planning for services category must notify their ISC. Changing categories is not automatic.
  •  The ISC agency should not complete a PUNS form on individuals:
    • For whom there is no reasonable basis to believe the presence of a developmental disability.
    • Who are already receiving services funded through a DDD Waiver. This includes individuals that are receiving DDD Waiver funding for CDS only or HBS and who might want to increase their supports in the future. The Division will soon release guidance on the process for increasing supports for those who are already in a DD waiver service.
    • Who do not want DDD Waiver services now or in the future.
    • Who, upon assessment, the ISC determines they meet the Crisis Criteria as described above.
    • Who are transitioning from State-Operated Developmental Centers into a DDD Waiver service.
    • Who are transitioning from State-Operated Mental Health Centers and found to be appropriate for DDD Waiver services.
    • Who are transitioning from the Department of Children and Family Services into a DDD Waiver service.
    • Who are a part of an ICF/DD Downsizing agreement with DDD and have chosen to go into a DDD Waiver service.

 
New Guidance Regarding PUNS

  • When the ISC conducts the annual PUNS update with individuals who are 17 years old, the ISC will have a conversation with the individual and/or their guardian, if applicable, to ensure the information above is clearly explained.
    • The ISC must inquire whether the individual wants to move from Planning for Services to Seeking Services at age 18. Moving to the Seeking Services category at age 18 means the individual will begin to accumulate time on the list and determine when they will be selected from PUNS for adult waiver services.
    • For people who chose to move from Planning for Services to Seeking Services at age 18, the ISC will take the necessary steps to ensure this occurs on or before their 18th birthday.
  • ISC must document (and make available for review/audit) that they conducted the above conversation, the individual/guardian's choice of category and the follow up actions, if any. The ISC agency should give everyone who signed the updated PUNS form a copy of the signed form. 


Effective Date:

January 1, 2021.