VI. Waiver Activities and Services

A. Out of State Services

B. Individual Service and Support Advocacy (ISSA) (51 A-L)

Note: This activity is available in all three Waiver Programs.

Waiver individuals receive ISSA from one (1) of eight (8) designated ISC agencies. ISC agency staff, who must be Qualified Intellectual Disability Professionals (QIDPs) as defined in federal ICF/DD regulations, serve as an independent resource for families. Through ISSA, ISCs:

Individuals, guardians, if applicable, and/or families may at any time contact the ISC staff to present a complaint or discuss unresolved issues or problems affecting the individual's health and welfare. ISC staff will work with the responsible provider to resolve grievances or complaints, particularly those between the individual and service providers. If the grievance continues, ISC staff will continue the process as outlined in Section 11: Addressing and Resolving Issues or Concerns of the Independent Service Coordination Manual, by involving provider staff of increasing authority, up to and including the ISC executive director. If the grievance cannot be resolved, ISC staff may contact DHS staff for technical assistance or intervention.

A complete description of the role of ISC agencies, including ISSA, can be found in the Independent Service Coordination Manual.

C. Residential Habilitation Services for Adults

Note: These services are available, based on need, to individuals who request the service and meet the priority population criteria for residential services.

Residential habilitation means individually tailored supports that assist with the acquisition, retention, or improvement in skills related to living in the community.

These supports include:

These include monitoring of health status, medication monitoring, and administration of injections or suctioning. It also includes administration and/or oversight of the administration of oral and topical medication consistent with the Illinois Nursing and Advanced Practice Nursing Act (225 ILSC 65) and the Mental Health and Developmental Disabilities Administrative Act (20 ILCSA 1705/15.4).

Nursing supports may be an integral part of an individual's residential habilitation services. Providing delegated nursing service, as described in Rule 116, of individuals receiving 24-hour residential services is the responsibility of the residential service provider who must employ or contract with a professional nurse trainer to perform their professional duties including the oversight and training of direct support staff as described in Rule 116 and the Mental Health and Developmental Disabilities Act.

Delegated nursing supports are limited in scope and availability as described in Rule 116, 24-hour direct nursing services or other licensed services, similar to those provided in a skilled nursing facility (NF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), are not funded by the Adult Waiver. Funded and available services are in addition to any Medicaid State Plan Nursing services for which the individual may qualify.

Waiver funding for supports does not guarantee that services can be provided by a specific provider. Multiple factors may interfere with the capacity of a provider to provide specific health supports.

Residential habilitation includes non-medical transportation between the residence and other community locations where habilitation occurs. These other community locations may include other services, stores, and recreational and socialization activities.

Non-medical transportation occurs between the residence and other community locations where habilitation occurs. Non-medical transportation is an integral part of funding for Community-Integrated Living Arrangements, Community Living Facilities or Child Group Homes, depending on which residential service the individual receives. Training and assistance in transportation usage are provided as needed. For the Children's Residential Waiver, transportation services exclude transportation to and from school.

Residential habilitation may be provided in a variety of ways, including:

D. Community Day Service Programs and Other Day Program Services:

Note: These services are available only in the Adult Waiver Program.

Community Day Services does not include the following:

3. 3. • Activities related to the development of hobbies or leisure/cultural interests or to promote personal health and wellness (e.g. yoga class, meditation group, etc.).
      • Activities related to training and education for self-determination and self-advocacy.
      • Activities that encourage interaction among individuals who do not reside together.
      • Activities that encourage discussion of current events.
      • Activities that encourage exploration of the individual's community.
   4. Virtual Setting
      • VDS providers are limited to Community Day Service providers certified by the Bureau of Accreditation, Licensure and Certification (BALC)
      • VDS providers, regardless of their location, use video to provide VDS services. The individual must be located where they are able to effectively participate in the scheduled activities with as few distractions as possible.
      • If needed, VDS providers should develop audio options or include closed captioning with video to accommodate individuals whose disabilities impair their ability to participate by video alone, such as individuals with vision or hearing-impairments.
      • VDS must be an interactive and/or active learning environment.
      • Use of video-teleconference software can include Microsoft's Skype, Adobe's Connect, Google's Hangout or Classroom, WebEx, Go-to-Meeting, Zoom, etc.
      • The individual and VDS provider must have the hardware (computer, tablet or cell phone with video capability with speakers and microphone or headset, etc.) and video-teleconference software required for the communication to be two-way and real-time.
      • A VDS facilitator must always be present during active programming.
      • A guest speaker is authorized as long as a VDS facilitator is present and leading/moderating the program.
      • VDS can be provided to no more than 10 individuals per activity unless the programming is enhanced by additional people. Examples of situations where more than 10 participants might be appropriate include exercise classes where interpersonal communication is not involved or gameplay sessions where "teams" of individuals are playing against one another. As a general rule, if the session envisions or requires direct communication between participants and the leader, no more than 10 individuals are allowed.
   5. Service Limits
      1. VDS hours are included in the annual maximum of 1,200 hours, monthly maximum of 115, and 5 hour daily maximum for any combination of day programs.
         • VDS is limited to 45 hours per month and 520 hours per year.
   3. Supported Employment Program (SEP) (33G, 36G, or 36U)
      The Supported Employment Program offers long-term services and supports that enable individuals with disabilities to maintain Individual and Group employment that is consistent with the definition of Competitive Integrated Employment.
      Competitive Integrated Employment is work that is performed on a full-time or part-time basis, including self-employment, for which an individual is compensated at or above minimum wage and not less than the customary rate paid by the employer for the same or similar work performed by other similarly situated employees who are not individuals with disabilities.
      Competitive Integrated Employment includes equitable access to benefits and advancement opportunities. In order for employment to meet this threshold, individuals with disabilities must be eligible for the level of benefits and have opportunities for advancement that are similar to those for other employees who are not individuals with disabilities and who have similar positions.
      Competitive Integrated Employment can only occur at integrated locations where employees with disabilities interact with other persons who are not individuals with disabilities (co-workers, supervisors, customers, general public) to the same extent as employees who are not individuals with disabilities and who are in comparable positions. Interaction must extend beyond job coaches or others who are associated with the provision of supports. Competitive Integrated Employment may occur in settings with a natural absence of customers or the general public such as work that occurs at a community business after traditional hours. As long as non-disabled workers in similar positions would have an equitable experience, the work could be considered integrated.
      Employment environments must meet the requirements of the HCBS Settings rule and allow ample opportunity for the individual receiving services and supports to engage in routine interactions with customers, co-workers and other individuals who do not have disabilities.
      All individuals approved for the Home and Community Based Support (HCBS) Waiver for Adults with Developmental Disabilities may access the Supported Employment Program with prior approval. Requests will only be considered for individuals who meet the following criteria:

• Requests to activate Supported Employment Program funding must follow the Division of Developmental Disabilities' prior approval process.
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• The expected outcome of the Supported Employment Program is sustained Competitive Integrated Employment that is well matched to the individuals' interests, strengths, priorities, schedules and preferences as outlined in the Personal Plan, Implementation Strategies and related documentation such as Individualized Plans for Employment and Individual Placement Plans.
• Supported Employment Program activities may include, but are not limited to:

The Supported Employment Program includes services and supports which may be provided on behalf of an individual with a disability. However, a direct service, benefiting the individual's sustained employment outcome, must be provided in order to bill the Supported Employment Program.

Individuals engaged in the Supported Employment Program are encouraged to utilize a variety of independent transportation options. Billing related to Supported Employment Program transportation may only occur if transportation training is included in both the Personal Plan and Implementation Strategies and when the transportation training is provided. The Supported Employment Program does not reimburse directly for discreet trips to and from work locations.

Agencies which provide and bill for Supported Employment Program services and supports must maintain records of the duration, nature and case specifics of employment supports

Permanent records of all individuals served in the Supported Employment Program must include

Daily records of all individuals served in the Supported Employment Program must be retained for 5 years and include

See X. Service Authorization and Prior Approval for prior approval requirements for Supported Employment.

E. Professional Services

To receive behavior services under the waivers, the services must be based on assessed need and reflected in the Personal Plan. Prior approval is not required for behavior services.

A behavior consultant, as defined above, is authorized to bill for services when supervising someone who is in training to become a behavior consultant or working on their license as long as the behavior consultant is present and participating in the behavior services session.

Each individual behavior services contact requires a clinical narrative documenting the specific behavior service provided as well as the specific date and time the service was rendered. The behavior consultant must maintain documentation that reflects a brief description of the session's focus (which may only include a narrative on the administrative billing work that was completed) and/or periodic reviews of progress towards established treatment goals. If the behavior consultant is billing for the time used to develop the plan, there should be documentation in addition to the behavior plan.

Documentation is required for billing related to services provided when not working directly with the individual. This documentation should include the following elements:

Behavior Intervention and Treatment can be provided to individuals who are temporarily absent from, but will be returning to, their residential setting (SNF, Hospital, etc.) as long as the current temporary provider (SNF, Hospital, etc.) approves the therapy service to be provided in their location, the service is being provided and supporting documentation is maintained. Location of the service should be part of the supporting documentation.

Since each behavior consultant must enroll in IMPACT to provide services to waiver participants, billing for services must be done under the provider who provided the service.

Each individual or group counseling contact requires a clinical narrative documenting the specific counseling service provided as well as the specific date and time the service was rendered. The counselor or psychotherapist must maintain documentation that reflects a brief description of the session's focus and periodic reviews of progress towards agreed upon treatment goals.
Counseling includes:

Group counseling includes sessions in which the counselor meets with two or more individuals to address their individual goals identified in their individualized counseling plans.

Counseling can be provided to individuals who are temporarily absent from, but will be returning to, their residential setting (SNF, Hospital, etc.) as long as the current temporary provider (SNF, Hospital, etc.) approves the counseling service to be provided in their location, the service is being provided and supporting documentation is maintained. Location of the service should be part of the supporting documentation.

Since each counselor must enroll in IMPACT to provide services to waiver participants, billing for services must be done under the provider who provided the service.

Each individual or group therapy contact requires a clinical narrative documenting the specific therapy service provided as well as the specific date and time the service was rendered. The clinical psychologist must maintain documentation that reflects a brief description of the session's focus and periodic reviews of progress toward established therapy goals for each individual.

Psychotherapy incudes:

Group therapy includes sessions in which therapist meets with two or more individuals to address goals identified in their individualized psychotherapy plans.

Therapy can be provided to individuals who are temporarily absent from, but will be returning to, their residential setting (SNF, Hospital, etc.) as long as the current temporary provider (SNF, Hospital, etc.) approves the therapy service to be provided in their location, the service is being provided and supporting documentation is maintained. Location of the service should be part of the supporting documentation.

Since each therapist must enroll in IMPACT to provide services to waiver participants, billing for services must be done under the provider who provided the service.

F. Physical Therapy, Occupational Therapy, and Speech Therapy (52P, 52O, 52S)

Note: These services are available only in the Adult Waiver.

Physical therapy, occupational therapy, and speech therapy for restorative purposes are covered under the Medicaid State Plan. Adult Waiver individuals are eligible for additional physical, occupational, and speech therapy services of a habilitative, not a restorative nature, when prior approved.

See X. Service Authorization and Prior Approval for prior approval requirements for therapies.

Each of the therapies must be based on assessment(s) that document the individual's specific therapy needs and the specific services to be provided by the licensed professional. All therapy services must be reflected in the Personal Plan regardless of funding source.

The focus of ongoing, long-term habilitative physical therapy, occupational therapy, and speech therapy services should be working with the individual, family members, direct support professionals and others to incorporate effective therapeutic activities in daily life rather than on intensive professional treatments focused on short-term acute restorative needs.

G. Adaptive Equipment, Assistive Technology, Vehicle Modifications, Home Accessibility Modifications, and Remote Support

Note: These services are available in the Adult Waiver. All these services but Remote Support are available in the Children's Support Waiver. Adaptive Equipment and Assistive Technology are available through the Children's Residential Waiver.

These services all require prior approval by the Division. See X. Service Authorization and Prior Approval for prior approval requirements for these items.

The cost of these services is not counted toward the monthly maximum.

Requirements for Adaptive Equipment, Assistive Technology, Home Accessibility Modifications, Vehicle Modifications, and Remote Support eligibility for funding through the DDD HCBS Waiver(s):

Note: There are also other restrictions and items which are not covered.

Adult Home-Based Service, Day Program Only, and/or Children's Support Waiver recipients are limited to $15,000 maximum per individual per five-year period for any combination of Adaptive Equipment, Assistive Technology, Vehicle Modifications, and Home Accessibility Modifications. Within the five-year maximum, there is also a $5,000 maximum per address for permanent home modifications for rented homes. See Appendix C-4 of the Adult Waiver and Children's Support Waiver.

CILA participants are limited to $15,000 maximum per individual per five-year period for any combination of Adaptive Equipment, Assistive Technology, Vehicle Modifications, Home Accessibility Modifications (individually controlled), and Remote Support - Equipment (which includes consultation, training, installation, equipment costs (lease or purchase), and/or maintenance/repair service agreements), and any monthly monitoring costs for Remote Support.

The five-year period begins in the fiscal year the claim is paid out of. As an example, if a $15k invoice is paid in FY22, the entire $15k maximum would reset at the beginning of FY27, which begins on July 1, 2026. If an invoice for $10k is paid in FY22, and an additional $5k is paid in FY23, the $10k would become available in FY27, or all $15k would be available in FY28.

Children's Residential Waiver (Children's Group Home - 17D) are limited to a $15,000 maximum per individual per five-year period for any combination of adaptive equipment and assistive technology.

Note: There are two sections to the form - one if a CILA provider or Self-Direction Assistant is to bill for another provider and the second is if the payment is to be redirected to any payee other than the provider. See Payee Designation Link: http://www.dhs.state.il.us/page.aspx?item=63107

Excluded are those adaptations or improvements to the home that are of general utility. Examples of items not considered to be covered home modifications include:

Modifications to basements or attics are generally not included, due to safety concerns, egress concerns and potential isolation from the rest of the family. Fencing is generally not included unless elopement behavior is present and cannot be addressed in other ways.

The following modifications are specifically excluded from coverage:

The individual, a family member with whom the individual lives or has consistent and on-going contact, or a non-relative who provides primary long-term support to the individual and is not a paid provider of such services must own the adapted vehicle.

H. Self-Directed Services (Home Based Support Services (HBS))

Note: More information about Home Based Services can be found in the Consumer Handbook for Home-Based Services located online.

This restriction of self-directed services is subject to appeal. The outcome of the appeal process is final. In this event, agency-directed services would be made available and documented in the Personal Plan. The ISC works to ensure service continuity and health and welfare during the transition.

Personal Support services include a range of training and assistance to enable individuals to accomplish tasks they would normally do for themselves if they did not have a disability. These services may include:

Personal Support services may be provided on an episodic or on a continuing basis. Health-related services may include skilled or nursing care as an extension of behavioral and therapy services. The PSW can assist the individual to implement a behavioral, occupational therapy, physical therapy, or speech therapy plan to the extent permitted by state law, as prescribed in the PCP, and as trained on by the healthcare professional who developed the plan. Implementation activities include assistance with exercise routines, range of motion, reading the therapist's directions, helping the individual remember and follow the steps of the PCP or hands-on assistance. It does not include the actual service the professional therapist provides. PSWs should not administer medications as this is not permitted by State law.

Personal Support may be provided in the individual's home and may include supports necessary to participate in generic community activities outside the home. Individuals may not receive Personal Support services during the typical school day relative to the age of the individual or during times when educational services are being provided.

Personal Support may include supports provided to an individual while hospitalized in order to foster communication, provide intensive personal care, and/or promote behavioral stabilization for the purpose of smooth transitions or preserve functional abilities. These are services in the Personal Plan that cannot be provided by hospital staff and are not a substitute for services the hospital is obligated to provide through its conditions of participation or under Federal or State law, or under another applicable requirement. Services in the Personal Plan that cannot be provided by hospital staff will be provided by the Personal Support Worker.

The need for Personal Support and the scope of the needed services must be documented in the Personal Plan. The service authorizations must specify the monthly number of hours of Personal Support and the hourly rate. The hourly rates are subject to review and approval by the Division on either a targeted or a random sample basis.

Personal Support is not intended to:

Personal Support is a service provided on a 1:1 basis based on the needs in the Personal Plan. However, if more than one individual wishes to receive services from one PSW during a community outing, they can negotiate a rate with the PSW and share the services. All individuals should receive equal services and all health and safety concerns should be addressed prior to the outing.

All Personal Support providers, whether agencies or personal support workers, must comply with the same timekeeping requirements as providers of other waiver services. Personal Support services are included in the individuals' monthly cost limit/individual budget. The State of Illinois has not set a specific service maximum.

Individual providers of Personal Support who are not employed by a provider agency receive ongoing supervision by the Employer of Record who is one person designated by the individual receiving waiver services and can be the individual and/or guardian, if applicable, other family member, or close associate.

The Employer of Record is the person who is ultimately responsible for ensuring wages are paid. They are also responsible for overseeing the services outlined in the monthly budget and signing Service Agreements, Service Authorizations, and time sheets. In addition, the Employer of Record may help with hiring, training, supervising, and firing PSWs.

The Employer of Record can be the individual receiving waiver services (if you do not have a guardian), a guardian (if they are not also your PSW), or other adult members of your family or a trusted associate. The Employer of Record can be the same person who is your Representative Payee for Social Security benefits. The Employer of Record can't also be a PSW.

If the individual or their family choose to hire PSWs directly, the F/EA will assist with the hiring process and be available for consultation if questions arise. The Division contracts with Avenues to Consumer Employer Services and $supports (ACES$) to provide F/EA services in Illinois. ACES$ will handle personal support worker new hire paperwork and payroll/tax functions. If you choose to hire your own PSWs, you must use ACES$. ACES$ is not the employer of the PSW, they only assist with the employer functions required by their contract with DDD.

The Employer of Record is responsible for signing timesheets. They can't pass this responsibility on to the ISC or Self Direction Assistant if they use this service.

For the Adult Waiver, this service is available to individuals who are authorized for Home-Based Support Services (HBS). The cost of these services is not counted toward the monthly maximum. This service is limited to no more than 60 consecutive days.

Temporary Assistance (TA) is provided on a temporary emergency basis because of the absence or incapacity of the person(s) who normally provide unpaid care.

Absence or incapacity of the primary caregivers must be due to a temporary cause such as hospitalization, illness, injury, or other emergency situations.

Temporary Assistance is not available for caregiver absences for vacations, educational or employment-related reasons, or other non-emergency reasons.

No Temporary Assistance may be delivered during the typical school day relative to the age of the individual or during times when educational services are being provided.

See X. Service Authorization and Prior Approval for prior approval requirements for Temporary Assistance.

Nursing services are available within the monthly maximum to Adult DD Waiver individuals who are authorized for Home-Based Support Services (HBS). Nursing services are in addition to any Medicaid State Plan nursing services for which the individual may qualify, must be listed in the personal plan, and be within the scope of the Illinois Nursing and Advanced Practice Nursing Act (225 ILSC 65).

This service is available within the monthly maximum to individuals who are authorized for Home-Based Support Services (HBS) within the Adult Waiver.

Emergency Home Response Services are limited to adults who live alone, or who are alone for significant parts of the day and have no regular caregiver for extended periods of time, and who would otherwise require extensive routine supervision.

Emergency home response service (EHRS) is an electronic device that enables Adult Waiver individuals to secure help in an emergency. The individual may also wear a portable help button to allow for mobility.

The system is connected to the individual's phone and programmed to signal a response center once the "help" button is activated. Installation, upkeep, and maintenance of devices/systems may be provided.

Self-Direction Assistance (SDA) is a waiver service provided by a Self-Direction Assistant (SDA).

The Self Direction Assistance Guidelines can be found online.

Self-Direction Assistance (SDA) assists the individual, guardian, if applicable, and/or family in arranging for, directing and managing Home Based Support services. It also offers practical skills training to enable individuals, guardian, if applicable, and/or families to independently direct and manage Waiver services. SDA includes providing information to ensure individuals understand the responsibilities involved with directing their services. SDA can assist the Employer of Record (EOR) with the process of timekeeping for PSWs, but they can't replace the responsibility of the EOR. In other words, the EOR must complete and sign the timesheets of the individual's PSW(s) and the SDA can review for accuracy and completion, but the SDA can't complete the timesheets on behalf of the EOR. Additionally, the SDA can't sign the timesheet in place of the EOR. If an SDA provider is also a PSW provider agency, the SDA provider can't provide the same services as the PSW provider agency. In this scenario, the SDA should not be assisting the individual, guardian, if applicable, and/or family with arranging for and directing PSW services because the PSW agency is already completing this process. SDA is only available to those in the Home-Based Supports and Services (HBS) program and should not duplicate the services provided by the ISC.

SDA is an optional service, meaning individuals, guardians, if applicable, and/or families are not required to purchase this support. Provider agency staff fulfilling the role of the SDA are required to be Qualified Intellectual Disability Professionals (QIDPs). SDAs do not have a mandated set of services they are required to provide. If an individual, guardian, if applicable, and/or family desires or needs the support of an SDA, this must be documented in the Personal Plan, including the amount and frequency of services. The details of what SDAs provide to an individual, guardian, if applicable, and/or family must be based on the desired outcomes as well as the needs of the individual reflected in the Personal Plan. Services provided and billed must be within the description outlined in XII. Waiver Activity and Service Billing Guidance. All billable services must be agreed upon by the individual, guardian, if applicable, and/or family, as well as the SDA.

The cost of SDA services comes from the individual's monthly HBS allotment and must be reflected through an HBS Service Agreement. There is no monthly minimum for SDA. The maximum billable amount for an individual must remain within the monthly allotment. Providers may negotiate additional hours if necessary. SDA must be billed through the Reporting of Community Services (ROCS) using the bill code 55A. The most current rate can be found on the DHS website at http://www.dhs.state.il.us/page.aspx?item=109260

Monthly notes, often referred to as Q or QIDP Notes, are not required when providing SDA services. SDA provider agencies must comply with the same timekeeping requirements as providers of other waiver services. They must document date, start time, stop time, individual served and service provided. This documentation must be maintained in the individual's record.

This service is available within the monthly maximum to Adult Waiver individuals who are authorized for Home Based Support Services (HBS).

Non-Medical transportation includes services to enable individuals to gain access to Waiver and other community services, activities and resources specified by the Personal Plan.

Non-Medical transportation services are offered in addition to medical transportation services available under the Medicaid State Plan. Whenever possible, individuals should use family, neighbors, friends or community agencies which can provide this service without charge.

These services are available within the monthly and yearly maximum to all Children's Support Waiver individuals and to Adult Waiver individuals who are authorized for Home-Based Support Services (HBS).

This service includes training and counseling services for individuals who provide unpaid support, training, companionship, or supervision to individuals.

For purposes of this service, an individual is defined as any person, family member, neighbor, friend, companion, or co-worker who provides uncompensated care, training, guidance, companionship or support to an individual served in the Waiver. This service may not be provided to train paid caregivers.

Training includes instruction about treatment regimens and other services included in the Personal Plan, use of equipment specified in the Personal Plan, and includes updates as necessary to safely maintain the individual at home. Counseling must be aimed at assisting the unpaid caregiver in meeting the needs of the individual. All training for individuals who provide unpaid support to the individual must be included in the individual's Personal Plan.

Training furnished to individuals who provide uncompensated care and support to the individual must be directly related to their role in supporting the individual in areas specified in the Personal Plan. Counseling similarly must be aimed at assisting unpaid individuals who support the individual to understand and address individual needs.

Caregivers who are compensated for direct services under this Waiver may not receive this service.