Rule 120 Outline of Changes, 2024

Slide 1

Overview of Rule 120

  • June 2024
  • presented by: Andrea Medley, Strategic Planning Unit
  • Department of Human Services, Division of Developmental Disabilities

Slide 2

Background

  • Official reference: 59 Ill. Adm. Code 120 or Title 59 Part 120
  • Rule 120 provides uniform standards for all DDD Waiver Services
  • Available on the DHS website: PART 120 Medicaid Home And Community-Based Services Waiver Program For Individuals With Developmental Disabilities: Sections Listing (ilga.gov)
  • Last revised December 1998

Slide 3

Before We Begin:

  • Thank you for your contributions to the revisions
    • DDD Regulatory Advisory Board
    • DHS Staff
  • If you have questions, errors or discrepancies
    • send to: Andrea.Medley@illinois.gov
    • Subject should read Rule 120
    • Identify Section number

Slide 4

General Changes include

  • Federal HCBS Waiver requirements:
    • Settings
    • Person Centered Planning
    • Conflict of Interest Free Cases Management
  • Updated language, for example:
    • PAS agency to ISC agency
    • DPH has been changed to HFS (in most of instances)
    • ICF/MR has been changed to ICF/DD
    • SNF/PED has been changed to MC/DD

Slide 5

Table of Contents

  • NEW Sections
    • 120.65 Conflict of interest-free case management
    • 120.95 Electronic Signatures
  • REVISED Title
    • 120.160 Person-Centered Planning

Slide 6

Section 120.10 Definitions

NEW definitions include:

  • Abuse
  • Adult
  • Children's Group Home (CGH)
  • Coercion
  • Community Day Service (CDS)
  • Conflict of Interest Free Case Management
  • Developmental disability (DD)
  • Division of Developmental Disabilities (DDD) or Division
  • HFS
  • Home and Community-Based Services (HCBS) Waiver
  • Implementation Strategy
  • Independent Service Coordination (ISC) agency
  • Individually owned or controlled

Slide 7

Section 120.10, NEW definitions continued:

  • Intellectual disability
  • Modification
  • Natural supports
  • Neglect
  • Person-centered planning
  • Personal Plan
  • Provider-owned or controlled
  • PUNS
  • Qualified Intellectual Disabilities Professional (QIDP)
  • Quality assurance review
  • Restraint
  • Restriction
  • Seclusion

Slide 8

Section 120.10, The following definitions were removed:

  • Community residential alternatives (CRA)
  • Developmental training
  • Home individual program (HIP)
  • Individual service/support plan
  • Mental retardation
  • Nursing facility
  • Pre-admission screening and resident review (PASARR) agents
  • Purchase of service contract
  • Qualified mental retardation professional
  • Respite
  • Special home placement (SHP)
  • State-operated developmental center

Slide 9

Section 120.10, The following definitions were revised:

  • Community Integrated Living Arrangement
  • Community Living Facility
  • Guardian
  • Habilitation
  • Intermediate Care Facility for Individuals with Intellectual Disabilities
  • Provider
  • Supported Employment

Slide 10

Section 120.20 purpose

  • Language added to specify Rule 120 pertains to all three DD waivers:
    • Adults with Developmental Disabilities Waiver
    • Children's Residential Waiver
    • Children Support Waiver
  • Language added to include ISC agencies

Slide 11

Section 120.25 Incorporation by reference

  • No changes to this section

Section 120.30 Program description (Repealed)

  • This Section was previously repealed

Slide 12

Section 120.40 Service Descriptions

  • Details of specific services have been removed
  • (a) Services must be provided as indicated in the Personal Plan and Implementation Strategy
  • (b) Community inclusion and daily living have been added to Residential habilitation
  • (c) Added description of Day and Employment services
  • (d) Added description of Home-Based Support Services

Slide 13

Section 120.50 Target Population

  • Individuals served under Rule 120 includes children
    • Children can enter waiver at 3 years old
    • Children/young adults can remain in children's waivers up through age 21
  • (b) - (g) Individuals coming into a DDD Waiver include individuals who are:
    • On PUNS living at home, living in private ICFs/DD, or in MCs/DD
    • Individuals being subjected to abuse, neglect, or homelessness
    • Aging out of DHS children services
    • Aging out of DCFS services
    • Bogard class members
    • Part of an ICF/DD downsizing agreement Section

Slide 14

Section 120.60 Overview (Repealed)

  • This Section was previously repealed

Slide 15

120.65 Conflict of Interest-free Case Management

  • (a) Conflict of interest free case management is conducted by the ISCs and described in Federal Person-Centered Planning requirements
  • (b) Case management includes:
    • Determination of eligibility
    • Development and annual update of the Personal Plan
    • PUNS
    • Ensuring informed choice of all services and providers
    • Ensure health, safety, welfare, well-being, and satisfaction of individuals served
    • Supporting individual in advocacy, exercising rights, securing and maintaining services
  • (c) A conflict of interest in case management exist when a case manager is:
    • A provider agency
    • Relative by blood or marriage to the Individual or paid caregiver
    • A person who is financially responsible for individual
    • A person empowered to make financial or health-related decisions for individual

Slide 16

120.70 Service Provider Requirements

  • (a) Requires providers to be enrolled in IMPACT; language regarding the Uniform Grant Agreement has been removed.
  • (b) Language removed regarding the purchase of service contract
  • (d) Added language from the federal HCBS Waiver regulations regarding provider-owned or controlled residential and non-residential settings;
    • (d)(1) - (d)(5) refers to all HCBS settings

Slide 17

Section 120.70 Service Provider Requirements, continued

  • (d)(6) is specific to a provider own or control residential settings
  • (f)(1) Updated language on quality assurance reviews/actions
    • Also includes language on sanctions
  • (f)(2) Language added regarding Licensure and certification surveys/actions
    • Also includes language on sanctions
    • (g) Provides guidance on restraint
  • (h) outlines provider's actions when reducing or terminating services to an individual
  • (g) Language updated to clarify appeals by providers are for administrative actions by DHS (i.e. licensure and certification denials, notice of deficiencies, etc.)

Slide 18

120.80 Program Assurances

  • (b) Informing individuals of choice
    • All individuals in a HCBS Waiver must have a Personal Plan
    • language regarding individual choice updated to reference the Settings Rule (42 CFR 441.301(c)(4)(v)
  • (c) language on Average per capita expenditures updated

Slide 19

Section 120.90 Department Audit

  • No changes to this Section

Slide 20

120.95 Electronic Signatures

  • This Section is new
  • (a) Electronic signature or computer-generated signature codes are allowed
  • (b) Allowable for provider and ISC agency; must have a policy in place to govern use
  • (c) Must include adequate safeguards as outlined
  • (d) Must include a verification process as outlined
  • (e) Each document generated by a user must be separately authenticated

Slide 21

Section 120.100 Overview of Rights

  • (a)(1) Seclusion is not permitted
  • (a)(2) Language pursuant to OIG rule 50; individuals shall also be free from seclusion, coercion and restraint. Restraint is only allowed as outlined in statue in administrative rules.
  • (a)(4) ISC must explain rights and document it using the Right of Individuals Form (IL462-1201)
  • (a)(5)
    • The justification for any restriction of Individual's HCBS Waiver rights, as indicated in Section 120.70 (e)(6)(A) - (E) [*(e) should be (d)]
    • Individual rights restriction must be documented/justified in the Personal Plan and Implementation strategy,
    • Restrictions must also be reviewed/approved by the agencies Human Rights Committee prior to implementation
  • (a)(6) Individual's confidentiality is governed by the Confidentiality Act [740 ILCS 110]

Slide 22

Section 120.100 Overview of Rights continued

  • (b) Updated classes of individuals to include religion (creed), gender identity, gender expression, age, national origin (ancestry), ethnicity, marital status, sexual orientation, or military status
  • (d)(1) New language - individuals requesting or receiving HCBS Waiver services have the right to a written notice of:
    • (A) Denial of clinical eligibility by the Division or an ISC agency
    • (B) Denial of service(s) by the Division
    • (d)(2) Individual has the right to appeal the reduction, suspension, termination, or denial of HCBS services

Slide 23

Section 120.110 Appeals and Fair Hearings

  • (a)(1)-(5) Outlines the appealable actions
    • Each statement identifies who took the action
    • (a)(4) New language - Denial of clinical eligibility
  • (b) New language - Individual communicates desire to appeal to the ISC
    • Must occur within 10 working days of notice
    • Must be followed by a written request to appeal
  • (c) New language - the ISC has 45 days (changed from 60) to gather and submit information
    • (1) outlines the documents to be gathered
    • (1)(D) Includes documents from provider

Slide 24

Section 120.110 Appeals and Fair Hearings continued

  • (d)(4) If DDD does not support the appeal, DDD will notify all parties that appeal will continue to HFS for an Administrative Hearing
    • (e) If DDD does not support the appeal, DDD will forward the appeal and all documents reviewed to HFS for an administrative hearing
  • g) The hearing may be held by telephone

Slide 25

Section 120.110 Appeals and Fair Hearings continued

  • (j) Individuals should not be suspended, terminated, or have services reduced until the appeal is resolved, except as described in (j)(1)
  • (j)(1) Service can be terminated prior to the outcome of the Administrative Hearing based on:
    • Extreme risk of harm or jeopardizing individual's health, and
    • The ISC has taken necessary actions as outlined
    • (j)(4) If the conditions of subsections (i)(l)(A) or (B) exist, the agency (including the QIDP), the Individual (if possible), the guardian, the ISC agency, and a Department representative will work together to secure alternative services

Slide 26

120.120 Individual's Responsibilities

  • (a) - (d) Individual's responsibilities
  • (d) Added a reference to the Identity Protection Act [5 ILCS 179]

Slide 27

120.130 Filing an Application (Repealed)

  • This section was previously repealed

Slide 28

Section 120.140 Eligibility Criteria

  • (a) The criteria for age refers to the DDD waivers
  • (c) the language specifies eligibility criteria
    • Developmental Disability is present
    • The individual can benefit from active treatment
    • The individual does not require 24-hour nursing care
  • (c)(1) Individuals assessed can choose ICF/DD or Waiver
  • (e) Added language- individuals should not be in another waiver

Slide 29

Section 120.150 Eligibility Determination

  • Individuals must be served by the ISC in the geographic area where the person resides
  • The ISC is responsible for compiling information and determining clinical eligibility

Slide 30

Section 120.160 Person-Centered Planning

  • Title changed to Person-Centered Planning
  • (a) All entities must comply with Federal and Department Person-Centered Planning requirements
  • (b) Discovery Process
  • (c) Personal Plan
  • (e) Implementation Strategy

Slide 31

Closing

  • Questions, errors or discrepancies
    • send to: Andrea.Medley@illinois.gov
    • Subject: Rule 120
    • Identify Section number