Illinois Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.22.006
Community Day Services (CDS) is a program of day habilitation that assists with acquisition, retention, or improvement in self-help, socialization, and adaptive skills that takes place in a non-residential setting, separate from the participant's private residence or other residential living arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, and personal choice.
CDS providers must be certified by the Bureau of Accreditation, Licensure and Certification as a CDS provider. CDS providers are able to bill 31U (site-based), 31C (community-based) and/or 31V (virtual) for services provided to individuals with intellectual and developmental disabilities.
All public health criteria included in this document are subject to change. As research and data on this novel coronavirus continue to develop, this plan can and will be updated to reflect current local, state and federal guidance.
This Information Bulletin replaces DD.21.013
Overarching:
Under COVID-19, our CDS providers needed to adjust their services, supports, policies, and procedures to adapt to the new safety precautions required to safely support individuals with I/DD. The Division developed a tool to ready providers for reopening, the "Illinois CV Provider Preparedness Self-Assessment." Providers continue to be responsible for implementing standards and safeguards to help protect individuals' health and safety.
When making decisions about prevention strategies and individual behaviors, CDS providers should consider current information about COVID-19 community levels and the risk of severe illness for the population served. See the map of COVID-19 community levels in Illinois on the IDPH website: https://dph.illinois.gov/covid19.html.
The State developed the Illinois Risk Benefit Discussion Tool as a resource for individuals, their families/guardians, and their provider to have important discussions in weighing the benefits and risks of participation. Providers can use this instead of their own developed tool. If a provider chooses to use their own tool, they should consider this tool as the floor of what would be required in their own document.
In addition, individuals should continue to work with their Independent Service Coordination (ISC) agencies to develop a Personal Plan that best meets their needs and identifies a provider to implement the plan.
Helpful Links for Individuals and Providers:
State of Illinois COVID-19 response page
Illinois Department of Public Health Information on COVID-19 Outpatient Treatment
Illinois Department of Public Health Information on COVID-19 Testing Locations
Guidance for Employers and Employees on Workers' Rights and Safety During the Restore Illinois Plan PDF
CDC Guidance, COVID-19 Community Levels
CDC Guidance, "When You've Been Fully Vaccinated"
Department of Human Services DDD COVID-19 Resources People who need to take extra precautions:
Disability and Health
CDC COVID-19 Communication Tools and Resources:
General Health Screening:
- Providers should adopt a screening process and screen all staff and individuals prior to transport and/or participation in programming. Encourage staff, individuals, and visitors to check for symptoms of COVID-19 prior to traveling to or entering a CDS site.
- Symptoms of COVID-19 include fever, chills, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste or smell, sore throat, runny nose, vomiting or diarrhea. Staff and individuals experiencing symptoms should remain home and seek evaluation by a health care provider. includes a range of symptoms. Providers should review the most updated guidance from the CDC.
Vaccination Status:
- Vaccination is the leading public health prevention strategy for limiting the adverse consequences of COVID-19. CDS providers should promote COVID-19 vaccination, boosters, and additional doses, and if possible, provide opportunities for vaccination for all eligible staff and clients.
- Because CDS providers provide services to individuals who are at higher risk for severe COVID-19 illness, staff at CDS sites should be up to date on COVID-19 vaccinations.
- Staff are considered "up to date" on COVID-19 vaccinations when they have received all CDC-recommended COVID-19 vaccines, including any booster dose(s) when eligible.
- Individuals should be encouraged to be up to date on their COVID-19 vaccinations, however, services cannot be denied based on vaccination status.
- In order to determine if a person is up to date on their COVID-19 vaccinations, providers may ask staff and individuals to share their proof of vaccination. However, staff and/or individuals are not required to share their proof of vaccination.
Core Infection Prevention Measures:
In addition to vaccination, the following COVID-19 prevention strategies outlined in this guidance can protect CDS staff and individuals, especially those who are not up to date with COVID-19 vaccination, and allow the delivery of in-person services to continue.
Masking:
- Because CDS providers serve individuals who are at higher risk for severe illness related to COVID-19, staff should continue to wear well-fitting masks both on and off the CDS site to limit the risk of exposure.
- It is recommended that individuals, especially those who are not up to date with vaccinations, wear a well-fitted mask or face shield while attending CDS, particularly when the COVID-19 Community Level is medium or high.
- Staff and individuals may choose to wear a respirator (e.g., N95 or KN95), which, if worn properly, can provide a higher level of protection than a cloth or procedural mask.
- CDS providers should have disposable surgical or procedure masks available for use by staff, individuals, and visitors.
- In accordance with the Reopen Illinois plan, when conducting CDS activities in a community based (31C) setting, staff and individuals should follow the masking guidance of the location they're visiting.
Hand Hygiene
- Signage should be posted, reminding individuals and staff to wash hands.
- Frequent hand washing by staff and individuals is important to limit the spread of COVID-19, and an adequate supply of soap/paper towels and/or alcohol-based hand sanitizer should be available.
- Providers should provide hand washing capability or alcohol-based hand sanitizer to staff and individuals.
- Individuals should be supported to properly wash their hands at regular intervals.
- Staff should wash hands for 20 seconds every 30 minutes while providing meals, prior to and during food preparation and gloves must be worn by staff preparing food per pre-COVID food handling protocols.
- Individualss should wash their hands before and after eating.
- Additional trash receptacles may be needed and/or repositioned to collect used paper towels.
Considerations for Improving Ventilation:
When indoors, improving ventilation and increasing the number of times fresh or filtered air enters a room can help reduce viral particle concentration and have been proven to decrease COVID-19 transmission .
When consulting with their HVAC professional, providers should consider the following approaches to improving ventilation:
- Increasing the introduction of outdoor air.
- Ensuring ventilation systems are operating properly as defined by ASHRAE Standard 62.1
- Optimizing the use of engineering controls to reduce or to eliminate exposures.
- Exploring options to improve ventilation delivery and indoor air quality in all shared spaces. The higher number of air exchanges per hour will result in better results with respect to purging airborne contaminants. Refer to the CDC suggested options for Air Changes per Hour (ACH).
- Using portable room air cleaners with a High-Efficiency Particulate Air (HEPA) filter to enhance air cleaning. Air cleaners need to have the appropriate CADR (Clean Air Delivery Rate) rating for the room size [e.g., a 300-ft2 room with an 11-foot ceiling will require a portable air cleaner labeled for a room size of at least 415 ft2 (300 × [11/8] = 415)]3. CDC FAQ #5 Ventilation in Buildings
- The following resources provide evidence-based guidance:
Signage:
Efficacy of Portable Air Cleaners and Masking for Reducing Indoor Exposure to Simulated Exhaled SARS-CoV-2 Aerosols - United States, 2021 MMWR Morb Mortal WKLY Rep / July 9, 2021 / 70(27);972-976 DOI:
- Display signage at entry with face covering requirements and social distancing guidelines in multiple languages as needed. IDPH has developed various signage PDF that can be utilized.
- Signs should be displayed reminding staff, visitors, and individuals to wash their hands frequently and cover their nose and mouth with a tissue when coughing or sneezing.
- All allowed visitors must follow the same guidance as staff and individuals, including screening and the donning of a face covering.
Disinfecting/Cleaning Procedures:
- Please reference CDC guidelines for recommended practices on disinfecting.
- Water fountains and communal kitchen utensils should be cleaned frequently and not used if at all possible (e.g. coffee makers, toasters, etc.). Consider utilizing a designated staff person to serve or distribute shared use items in a cafeteria or break room.
- The entire facility, including equipment and furniture, must be cleaned each night or prior to a new group of individuals utilizing a space.
- Sanitize items used in activity between users: game pieces, craft tools, etc.
Staff and Individuals Who Have COVID-19 (Isolation)
- Staff or individuals who are symptomatic or test positive for COVID-19 should be directed to remain at home or be sent home immediately and referred to a provider for evaluation if they become ill at the CDS site, per IDPH and CDC guidelines.
- Staff or individuals should not return to a CDS site until all of the following are true:
- They have had no fever for at least 24 hours without the use of medicine that reduces fever.
- Symptoms, such as cough or shortness of breath, and overall condition have improved.
- At least 5 days have passed since symptoms first appeared.
- Providers should adopt a screening process and screen all staff and individuals prior to transport and/or participation in programming.
- Asymptomatic COVID-19 positive staff may return to work after at least 5 days have passed since the date of their positive test.
- Asymptomatic COVID-19 positive individuals may return to CDS activities after at least 5 days have passed since the date of their positive test.
- Staff and individuals returning to CDS sites after at least 5 days of isolation should wear a well-fitted mask for an additional 5 days when around others. If staff and individuals are not able to wear a well-fitted mask, they should not return to CDS until after 10 full days of isolation.
- Educate staff and individuals on the need for early treatment for COVID-19 (within 5-7 days of starting symptoms) to avoid severe complications such as hospitalization and death. More information can be found.
Staff and Individuals who have been Exposed to COVID-19 (Quarantine)
- Develop protocols for if a staff or individual has been in close contact with someone that has tested positive for COVID-19. Close contact is a household contact or being within 6 feet for greater than 15 minutes.
- Staff and individuals who are NOT up to date on their COVID-19 vaccinations and are exposed to someone with COVID-19 should quarantine for 5 days followed by strict mask use for an additional 5 days. If staff and individuals are not able to wear a well-fitted mask, they should not return to CDS until after 10 full days of quarantine.
- Staff and individuals who ARE up to date on COVID-9 vaccinations do not need to quarantine following an exposure but should wear a mask for 10 days after the exposure. If staff and individuals are not able to wear a well-fitted mask, they should not return to CDS until after 10 full days of quarantine.
- For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure.
- If symptoms occur, individuals should immediately isolate until a negative test confirms symptoms are not attributable to COVID-19.
- In general, staff and individuals should not attend CDS with symptoms of an infectious disease until they have been evaluated by a healthcare provider.
Programming and Support (Physical Distancing):
- CDS providers should consider configuring activity spaces to allow for physical distancing of at least 6 feet between individuals who are not up to date on COVID-19 vaccines or at higher risk for severe illness, especially in higher-risk activities such as congregate meals and physical activity.
- CDS providers may consider arranging seating to provide a minimum of 6 feet between individuals or, whenever feasible, staggering meals so that all individuals are not without masks at the same time.
- Providers should assess the ability of their site(s) to appropriately serve individuals with consideration of vaccination status, comfort, and safety of individuals.
- Providers should consider making groups static based on proof of vaccination status, with no mixing of individuals and/or staff between groups.
- Providers should consider limiting the number of people occupying restrooms at one time to prevent long lines or crowds.
- CDS providers should consider lunch breaks and/or snacks to be facilitated so that groups eat together in their programming space.
- Additionally, pay special attention to putting on and removing face masks for purposes of eating. The front of the face mask is considered contaminated and should not be touched during removal. Hand hygiene should be performed immediately after removal. See CDC guidance on how to safely wear and take off a mask for additional instructions.
- The following are still considered appropriate recommendations:
- When possible and appropriate, programming should happen in the community or outdoors.
- Avoid activities that involve multiple individuals handling the same object (e.g., ball toss).
- Avoid vocal performances or sing-alongs; instrumentation should not include wind instruments.
- Providers should be prepared to explain policies and procedures, including safety measures and screening processes, to individuals using developmentally appropriate language that the individual can understand. The use of social stories can assist in this process.
- In the event a provider becomes aware of a positive case of staff or individual in their CDS program, they should notify their local health department as well as impacted individuals, families and partnering providers.
- Providers must deep clean their facility and transportation vehicles if exposure to COVID-19 has occurred. No staff or individuals should use the facility or transport until this has occurred.
Transportation Guidance:
For CDS programs that are providing individuals with transportation:
- Providers should prepare policies that support both vaccinated and unvaccinated/undetermined staff and individuals for safe transport.
- Providers should ensure every individual receives a screening for COVID-19 symptoms BEFORE being allowed to enter a vehicle carrying other people to a CDS site. This may be done by the driver, residential provider, family member, or other designated staff member.
- Providers should provide alcohol-based hand sanitizer at the entrance of the vehicle. All riders should wash or sanitize hands prior to boarding or exiting the vehicle.
- The interior of each vehicle should be sanitized before and after use by individuals and staff.
- Providers should ensure that staff and driver(s), wear a well-fitted mask, and encourage riders to wear a well-fitted mask or face covering when in the vehicle. Consider requiring masks for individuals using transportation when the COVID-19 Community Level is medium or high.
- All riders in the vehicle during transport should wear source control (face covering), or physical distancing if feasible, regardless of vaccination status.
- If the riders are from the same household or are up to date on their vaccinations, then they would not need to sit in a staggered manner.
- Riders from the same facility may sit one to a seat, the rows do not need to be staggered.
- If a rider in the vehicle is identified as being COVID-19 positive, CDC cleaning and disinfecting protocol should be performed as soon after the confirmation as practical and before the vehicle is put back in service.
- Other riders who were transported in a vehicle with another rider who tested positive for COVID-19 must be notified immediately, and should not participate in CDS until they receive guidance from the local health department.
Billing:
- CDS programs may operate Monday through Friday for a minimum of 5 hours per day. CDS providers can bill for a maximum of 5 hours per day. Note: if multiple day programs or supported employment are used, there must be Implementation Strategies that define exactly the hours billed for each type of service to ensure the 1,200 hours is divided appropriately. The ISC is responsible for ensuring all services are reflected and itemized appropriately.
- CDS programs can only bill for hours when the individual is actively participating in day program activities.
- CDS providers have the option to bill CDS under 31U, 31C, or 31V or any combination during each day, depending on the support provided.
- 31U billing will be used for CDS provided in a site-based setting.
- 31C billing will be used for CDS provided at a community location.
- 31V billing will be used for CDS provided virtually.
- CDS Providers may transport an individual(s) directly from their residence to a community activity. Travel time from the individual's residence to the first community location is not authorized to be billed but all travel time between community locations is allowed to be billed. Travel time from the final community location back to the individual's residence is not authorized to be billed.
This guidance should not be construed as legal advice, as a provider you should consult your legal counsel.
Effective Date:
March 5, 2022
