Illinois Department of Human Services
Division of Developmental Disabilities
This Information Bulletin (IB) outlines the requirement that providers will ensure that all individuals receiving Home and Community Based Services (HCBS) waiver-funded services must be free from acts of coercion at all times. This includes individuals receiving services in individually controlled Community Integrated Living Arrangements (CILAs), provider owned/controlled CILAs, Child Group Homes (CGHs), Community Living Facilities (CLFs of 16 residents or fewer), Community Day Services (CDS), and through the Home-Based Services (HBS) program.
The Centers for Medicare and Medicaid Services (CMS) has specific rights that must be afforded individuals receiving services funded by the HCBS waiver, regardless of the setting type. Among those rights is the expectation that waiver participants are assured the right to be free from coercion at all times.
Details of the HCBS Settings Rule requirements may be reviewed at 42 CFR §441.301(c)(4)(i-v) and include:
3c) Provider ensures an individual's right to freedom from coercion.
Right to Freedom from Coercion
Individuals have the right to be free from coercion at all times. There are no exceptions to this part of the Settings Rule and therefore, there should never be a modification in an individual's Personal Plan or Implementation Strategy regarding freedom from coercion.
All providers must have a policy affirmatively stating that individuals shall be free from coercion at all times and staff must be trained on the policy and the underlying concept. This training must include examples of overt coercion (e.g., if you don't eat all of your dinner, you will not be allowed to watch television tonight) and more subtle forms of coercion (if you don't come along on our trip to the grocery store today, no one will get to go). Another subtle form of coercion is seen when staff use the individual's desire to please them to control or influence their actions or behavior (e.g., staff while nodding says to an individual who does not want spaghetti for dinner "But remember, you like spaghetti. Remember how much you liked it last time?"). The use of intimidation, threats or guilt to persuade an individual to do something that they do not want to do all constitute coercive tactics and must not be used.
This does not prohibit formal support plans that include a systematic schedule of reinforcement. If there is a concern that a support plan is a form of coercion, the provider should have the support plan reviewed by the Human Rights Committee.
People have the right to be free from coercion in their homes and while receiving services outside their home. Coercion can include threats and efforts to influence or pressure individuals to choose something they do not want. Providers must also train staff on this concept and have policies in place that prohibit this. This training should include examples of both overt and subtle forms of coercion. The Independent Service Coordination (ISCs) agencies share the IDHS: Rights of Individuals Form, IL462-1201.pdf (state.il.us) annually and require a signature from the person and/or guardian. Providers also should share the document and review it with individuals whom they support as well as staff. The Rights of Individuals Form should be shared with all individuals when they initiate services, whether residential or community day services, and annually. Guardians should also be provided a copy of the rights document. Providers are welcome to develop and share additional information with individuals as well.
If an individual, guardian or concerned person does not feel a person is receiving services compliant with the HCBS Settings Rule, they can report this to the provider or to the ISC. They can also go through the formal HCBS Settings complaint process by using the web form: IDHS: DHS DD Services Complaints (state.il.us), email: DHS.HCBScomplaints@illinois.gov or phone number: (877) 657-0005.
This Information Bulletin is effective 12/18/2023.