III. Waiver Services

Individual Service and Support Advocacy (ISSA)

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

Waiver participants receive ISSA services at least four times each year, approximately once per quarter, from one of 18 designated Pre-Admission Screening/Individual Service and Support Advocacy (PAS/ISSA) agencies. ISSA staff, who must be qualified intellectual disability professionals as defined in federal ICF/MR regulations, serve as an independent resource for families in considering options and resolving issues with providers or services. ISSA staff participate in the development of the individual service plan and approve the final plan, as well as monitor its implementation and the general health, safety and well being of the participant.

ISSA represents the Department's interests in determining whether waiver services are being provided in the interest of and to the satisfaction of individuals receiving the services; alerts the Department when additional monitoring, intervention or technical assistance are necessary; and provides support to individuals, guardians, and providers in working through a variety of service issues, including those requiring conflict resolution, increased communication, and possible changes in support levels.

ISSA is designed to assist but not supplant the guardian and other appropriate advocates in fulfilling their responsibilities. The ISSA contacts the participant and guardian, if one has been appointed, prior to any service planning meetings to identify areas of concern, answer questions, and generally help them prepare for the meetings.

Participants, families or guardians may at any time contact ISSA staff to present a complaint or discuss unresolved issues or problems affecting the participant's health and welfare. ISSA staff will work with the responsible case manager or Service Facilitator to resolve grievances or complaints, particularly those between the participant and service providers. If the grievance continues, ISSA staff will continue the process by involving provider staff of increasing authority, up to and including the executive director of the Service Facilitation or direct service provider. If the grievance cannot be resolved, ISSA staff may contact DHS staff for technical assistance or intervention.

Additionally, the responsible case manager, Service Facilitator, and ISSA inform participants, families and guardians, if one has been appointed, about protections from abuse, neglect, and exploitation. The information provided includes the process for reporting allegations to the to the Department of Children and Family Services hotline for children through the age of 17, as well as the process for reporting allegations to the DHS Office of the Inspector General, for adults aged 18 and older. Participants, families and guardians are informed that anyone who suspects abuse, neglect or exploitation may report an allegation. Information is presented both verbally and in writing.

Residential Habilitation Services

Note: These services are available in the Adult Waiver and the Children's Residential Waiver.

Residential habilitation services are available, based on need, to participants 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:

• case management
• adaptive skill development
• assistance with activities of daily living
• community inclusion
• adult educational supports
• social and leisure skill development that assist the participant to reside in the most integrated setting appropriate to his/her needs.
• personal care and protective oversight and supervision.
• reduction of maladaptive behaviors through positive behavioral supports and other methods.
• may include necessary nursing assessment, direction and monitoring by a registered professional nurse, and support services and assistance by a registered professional nurse or a licensed practical nurse to ensure the participant's health and welfare.

  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 medications 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 services are considered an integral part of residential habilitation services. Meeting the routine nursing needs of participants receiving 24-hour residential services is the responsibility of the residential service provider who may employ or contract with a professional nurse to perform their professional duties including the oversight and training of direct support staff.

  Nursing supports are part-time and limited, 24-hour nursing supports, similar to those provided in a nursing facility (NF) or Intermediate Care Facility for individuals with Developmental Disabilities (ICF/DD), are not available to participants in the Waivers. These services are in addition to any Medicaid State Plan nursing services for which the participant may qualify.

  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.

  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 participant 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:

  1. Community-Integrated Living Arrangement (CILA)

     A living arrangement provided to Adult Waiver participants in a group home, family home or apartment where eight or fewer unrelated adults with developmental disabilities reside under supervision of the community developmental services agency. Residents receive a comprehensive individualized array of residential habilitation, personal support services and supports under the direction of a community support team within the local agency. Four CILA models are defined below:

     1. Twenty-Four Hour CILA

        These homes have on-site shift staff available during all times when participants are present. Staff provide both scheduled and unscheduled supports and services as needed by participants.

     2. Host Family CILA

        Serves individuals with developmental disabilities in their own residence. Host families consist of one or more persons who are unrelated to the individual with a developmental disability and who are under contract with the provider agency to provide host family services. No more than two individuals with developmental disabilities may reside with any single host family. The two support models are:

        • Traditional care: the full-time residence of the paid care givers. The paid care givers own, lease or rent the residence.
        • Shared living:  may house either full or part-time paid care givers in which individuals other than shift staff employees provide more than 50% of the residential coverage. The individuals, care givers or provider agency own, lease or rent the residence.

        The difference between traditional care and shared living models is shift employees routinely share supervision, care and training responsibilities with the host family care givers in the shared living model.

     3. Intermittent CILA

        Serves individuals whose service plan documents that they do not require 24-hour, on-site staff presence and documents the situations in which individuals may safely be away from direct staff supervision. Intermittent Residential services in apartments or family homes have staff available on call 24 hours per day. On-site shift staff are available to provide both scheduled and unscheduled supports and services as needed by the participants served and as specified in each participant's service plan.

     4. Family CILA

        Similar to Intermittent CILA, except that individuals are provided support in the family home.

  2. Community Living Facility (CLF)

     Serves Adult Waiver participants in a licensed residential setting. A Community Living Facility is not a nursing or medical facility and, to be eligible under the waiver, serves no more than 16 adults.

  3. Temporary Intensive Staffing

     Provides funding for Adult Waiver participants with additional time-limited intensive staffing to provide temporary intensive supports for individuals receiving CILA or DT services who have a time-limited immediate need for intensive staffing.  This service requires prior approval.

  4. At Home Day Program

     Part of the residential habilitation program for Adult Waiver participants. At Home Day Programs are based in the individual's CILA home and provide a structured individualized program of in-home and community habilitation activities for individuals who are unable to participate in out-of-home day programs because the individual:

     • Has an illness or medical conditions or severe maladaptive behaviors that prevent participation in a vocational or day program.
     • Is over the age of 60 and declines to participate in traditional out-of-home day programs.
     • Is unable to locate a traditional day program to serve him/her or the day program is not appropriate to meet his/her needs.

     The At Home Day Program requires prior approval.  See Section VIII, Service Authorization and Prior Approval for prior approval requirements for At Home Day Program.

  5. Child Group Home

     Available to Children's Residential Waiver participants, and is a residential program licensed by the Department of Children and Family Services to serve no more than 10 children. Child Group Home services are individually tailored supports that assist with the acquisition, retention, or improvement in skills related to living in the community. Child Group Homes are designed to provide a structured environment and a range of habilitative and therapeutic services to children and adolescents who cannot reside in their own home.

Day Habilitation and Other Day Program Services

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

1. Developmental Training

   A program of day habilitation that provides assistance 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.

   Developmental Training focuses on enabling the participant to attain or maintain his or her maximum functional level and services are coordinated with any physical, occupational, or speech therapies in the service plan. In addition, day habilitation services may serve to reinforce skills or lessons taught in other settings.

   Developmental Training includes a range of adaptive skills in the areas of motor development, attention span, safety, problem solving, quantitative skills, and capacity for individual living. Developmental training may enhance a participant's ability to engage in productive work activities through a focus on such habilitative goals as compliance, attendance, and task completion. Developmental Training may include training and supports designed to maintain skills and functioning and to prevent or slow regression.

   Developmental Training includes the reduction of maladaptive behaviors through positive behavioral supports and other methods.

   To foster community integration and learning in natural environments, Developmental Training may be furnished in generic non-residential community environments, as well as in sites specifically certified for Developmental Training.

   Such community-based Developmental Training programs include purposeful and meaningful activities designed to improve, maintain, or prevent the loss of independence, skills and functions enabling each participant to access and participate in relationships, activities and functions of community life. Activities may consist of job exploration activities (not paid employment) or volunteer work, recreation, educational experiences in natural community settings, maintaining family contacts and purposeful activities and services where persons without disabilities are present.

   Developmental Training includes transportation between the residence and other community locations where Developmental Training occurs. The cost of this transportation is included in the rate paid to providers of Developmental Training services. Training and assistance in transportation usage are provided as needed.  Developmental Training does not include the following:

   1. Special education and related services (as defined in Section 601 (16) and (17) of the Individuals with Disabilities Education Act) which otherwise are available to the participant through a local education agency.
   2. Vocational rehabilitation services which otherwise are available to the participant through a program funded under Section 110 of the Rehabilitation Act of 1973.

2. Supported Employment (SEP)

   Supported Employment services consist of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely without supports, and who, because of their disabilities, need supports to perform in a regular work setting. Supported employment includes activities needed to sustain paid work by participants, including supervision and training.

   Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant.

   Supported employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting.

   Supported employment may be provided in integrated and competitive work settings in a business or industry that primarily employs people without disabilities.

   Supported employment does not include sheltered work or other similar types of vocational services furnished in specialized facilities.

   Supported employment may include services and supports that assist the participant in achieving self-employment through the operation of a business. However, Medicaid funds may not be used to defray the expenses associated with starting up or operating a business. Such assistance may include:

   • Aiding the participant to identify potential business opportunities.
   • Assistance in the development of a business plan, including potential sources of business financing and other assistance in developing and launching a business.
   • Identification of the supports that are necessary in order for the participant to operate the business.
   • Ongoing assistance, counseling and guidance once the business has been launched.

   Transportation will be provided between the participant's place of residence and the employment site or between habilitation sites (in cases where the participant receives waiver services in more than one place) as a component part of supported employment services. The cost of this transportation is included in the rate paid to providers of supported employment services.

   See Section VIII, Service Authorization and Prior Approval for prior approval requirements for Supported Employment.

3. At Home Day Program: See Residential Habilitation above

4. Adult Day Care

   Adult day care is available to participants who are aged 60 and older. Participants who are not yet 60 may also be served if day habilitation or employment services are determined by the service planning team not to be appropriate because the participant is medically fragile.

   Adult day care services are generally furnished four or more hours per day on a regularly scheduled basis, for one or more days per week, or as specified in the service plan, in a non-institutional, community-based setting, encompassing both health and social services needed to ensure the optimal functioning of the participant. Meals provided as part of these services shall not constitute a "full nutritional regimen" (three meals per day).

   Transportation between the participant's place of residence and the adult day care center is provided as a component part of adult day care services. The cost of this transportation is included in the rate paid to providers of adult day care.

   Adult Day Care provided in a setting governed by the Community Care Program rule (89 Ill. Adm. Code 240) of the Department on Aging.  See Section VIII, Service Authorization and Prior Approval for prior approval requirements for adult day care.

5. Regular Work/Sheltered Employment

   Regular Work/Sheltered Employment provides long-term employment in a sheltered environment for individuals whose functional levels require supervision but who are not precluded from future movement into a Supported Employment position or a competitive employment position.

   Regular Work/Sheltered Employment provides general work supervision, including direction and on-the-job training in such areas as work expectations, workplace behavior, compliance to workplace safety standards, production and task completion.

   This program provides the opportunity to participate in productive work and to be compensated for that work in accordance with the Fair Labor Act of 1938 (29 U.S.C. 208).

   While this service is offered to Waiver participants, the payments for the services by the State are not claimed under Medicaid. The payment rate for Regular Work/Sheltered Employment includes transportation costs. 

6. Other Day Program

   Other Day Program is an out-of-home, center-based program that provides a structured individualized program of community habilitation activities for adults for whom the more traditional day programs are not available or appropriate and who choose to participate in a variety of approved alternative day activities.

   Other Day Program requires prior approval and is available only to individuals who are receiving CILA residential services under the waiver.

   See Section VIII, Service Authorization and Prior Approval for prior approval requirements for Other Day Program.

Professional Services

1. Behavior Services

   To receive behavior services under the waivers, the services must be based on behavioral assessments documenting the ongoing need for the service, be included in the individualized service plan and must receive written approval from the service planning team. Prior approval is not required for behavior services. 

   1. Behavior Intervention and Treatment

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

      Behavior intervention and treatment includes a variety of individualized, behaviorally-based treatment models consistent with best practice and research on effectiveness that are directly related to the participant's therapeutic goals.

      Interventions include, but are not limited to:

      • Applied Behavior Analysis
      • Relationship Development Intervention (RDI)
      • Floor Time

      These services are designed to assist participants to develop or enhance skills with social value, lessen behavioral excesses and improve communication skills. The key elements are:

      • The approach is tailored to address the participant's specific behavioral needs.
      • Targeted skills are broken into small, attainable tasks.
      • Direct support staff, informal caregiver and family training is a key component so that skills can be generalized and communication promoted, especially in the areas of prevention, intervention and stabilization.
      • Services must be directly related to the participant's therapeutic goals contained in the service plan and, if applicable, coordinated with the participant's individual education plan (IEP).
      • Success is closely monitored with detailed data collection.

      For each of the waivers, the following individuals are among the vital members of the behavior team and must be involved in the initial training session to initiate services, and must remain involved with the behavior consultant so that they are able to carry through and reinforce the behaviors being worked on by the team.

      • Adult Waiver: Direct support staff and unpaid informal caregivers of participants receiving intensive behavior treatment.
      • Children's In-Home Support Waiver: Families of children receiving intensive behavior treatment. The parents need not be available for all treatment sessions, but must be present at team meetings.
      • Children's Residential Waiver: Direct support staff and families of participants receiving intensive behavior treatment.

      A behavior consultant assesses the participant, including analysis of the presenting behavior and its antecedents and consequences, and develops written behavior strategies based upon the participant's individual needs. The strategies are a component of the service plan and must be approved by the participant, guardian if one has been appointed, family, responsible case manager or Service Facilitator, Individual Service and Support Advocate and the other members of the planning team.

      Trained team members implement the planned behavior services. For the Children's Support Waiver, responsible relatives implementing behavior services may not bill these hours to the Waiver Program.

      The behavior consultant performs the following activities:

      • Monitors progress on at least a monthly basis and more frequently if needed to address issues with the participant's outcomes.
      • Revises the behavior strategies as needed to ensure efficacy and prepares a progress report to the service planning team every six months. This progress report is available to State staff upon request to evaluate the efficacy of the treatment.
      • Supervises implementation of the behavior plan, including training of the personal support staff, unpaid informal care givers and family to ensure they properly apply the interventions, understand the specific services and outcomes for the participant being served, and know the procedures for regularly reporting participant progress.
      • Works closely with the participant's informal care givers, direct support workers family, teachers and other school personnel and personal support workers in the participant's home and other natural environments.

   2. Behavior Counseling (Individual and Group)

      Note: This service is available only in the Adult Waiver.

      Behavior Counseling is a treatment approach in which a licensed professional meets with one or more individuals in ongoing periodic formal sessions, and uses relationship skills to promote the individuals' abilities to deal with daily living issues associated with their emotional, cognitive or behavioral problems using a variety of supportive and re-education techniques.

      The individual service planning team must recommend behavior counseling prior to an individual receiving service. The individual service plan must include documentation of the individual's need for behavior counseling and the services to be provided by the licensed professional.

      A behavior counseling plan must be developed and approved in writing by the service planning team within 45 days of initial contact. This plan should include:

      1. A brief summary that describes the emotional, cognitive or behavioral concerns to be addressed by counseling. The description should note the frequency and severity of problem behaviors.
      2. A summary of psychiatric diagnoses and medications and their effects on behavior if the individual has a dual diagnosis with a mental illness or is taking psychoactive medications.
      3. Description of person-centered, specific, measurable goals that will be addressed by counseling. Goals should include time frames for estimated attainment.
      4. Description of specific, person-centered counseling strategies to be provided by the counselor to assist the individual to meet the goals.

      Each individual or group counseling contact requires a clinical narrative documenting the specific counseling service provided as well as the specific date and time that 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 established treatment goals. 

      Counseling includes:

      1. Participation in individual service plan development and review, consultation with other members of the service planning team related to the need for counseling supports, as well as previous attempts to address the needs.
      2. The development of the individualized counseling plan.
      3. Assessing information on the frequency and severity of the individual's presenting problems.
      4. Individual face-to-face contacts addressing goals identified in the individual's counseling plan.

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

   3. Psychotherapy (Individual and Group)

      Note:  This service is available only in the Adult Waiver.

      Psychotherapy is a treatment approach in which a licensed professional deliberately establishes a relationship with one or more individuals seen simultaneously, if applicable, in ongoing periodic formal sessions with the goal of ameliorating or reducing the symptoms of emotional, cognitive or behavioral disorder and promoting positive emotional, cognitive and behavioral development.

      The individual service planning team must recommend psychotherapy prior to the individual receiving services. The individual service plan must include documentation of an individual's need for psychotherapy and the services to be provided by the licensed professional.

      A psychotherapy plan must be developed and approved in writing by the service planning team within 45 days of initial contact. This plan should include:

      1. A brief description of the emotional, cognitive or behavioral concerns to be addressed by therapy. The description should note the frequency and severity of the problem behaviors, as well as previous attempts to address the concerns.
      2. A summary of psychiatric diagnoses and medications and their effects on behavior if the individual is dually diagnosed with a mental illness or is taking psychoactive medications.
      3. A description of person-centered, specific, measurable goals that will be addressed by therapy. Goals should include time frames for estimated attainment.
      4. A description of specific, person-centered therapeutic strategies to be provided by the behavior therapist to assist the individual to meet the goals.

      Each individual or group therapy contact requires a clinical narrative documenting the specific therapy service provided as well as the specific date and time that 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 toward established therapy goals.

      Psychotherapy includes:

      1. Participation in individual service plan development and review, consultation with other members of the service planning team related to the need for therapy supports.
      2. Development of the individualized psychotherapy plan.
      3. Assessing information on the frequency and severity of an individual's presenting problems.
      4. Individual face-to-face contacts addressing goals identified in the individual's psychotherapy plan.

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

2. Therapies

   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 participants are eligible for additional physical, occupational and speech therapy services of a habilitative, not a restorative nature, when prior approved.

   See Section VIII, Service Authorization and Prior Approval for prior approval requirements for therapies.

   Each of the therapies must be recommended in writing by the individual service planning team. The team must develop an individual service plan that includes documentation of the individual's specific therapy needs and the specific services to be provided by the licensed professional. All services must be included in the single, comprehensive, integrated service 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 workers and others to incorporate effective therapeutic activities in daily life rather than on intensive professional treatments focused on short-term acute restorative needs.

Adaptive Equipment, Assistive Technology, Vehicle Modifications and Home Accessibility Modifications

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

1. Adaptive Equipment

   Note: This service is available in all three waiver programs.

   Adaptive equipment, as specified in the service plan, includes performance of assessments to identify the type of equipment needed by the participant; devices, controls or appliances that enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, access or communicate with the environment in which they live; other durable medical equipment not available under the Medicaid State Plan that is necessary to address participant functional limitations; and necessary initial training from the vendor to use the adaptive equipment.

   It may also include necessary maintenance and repairs to adaptive equipment. Items reimbursed with Waiver funds are in addition to any medical equipment and supplies furnished under the Medicaid State Plan and exclude those items that are not of direct remedial benefit to the participant. All items shall meet applicable standards of manufacture, design and installation.

   Some examples of covered adaptive equipment include reachers; grabbers; voice-activated, motion-activated and electronic devices; and specialized computer software. Lift chair mechanisms, communication devices and mobility devices may be covered if not covered by the Medicaid State Plan.

   Some examples of items that are not covered adaptive equipment are furniture, recreational or quality of life items, such as televisions, stereos, boom boxes, fitness equipment, microwave ovens and other general appliances.

   Medical equipment and supplies are not considered adaptive equipment.

2. Assistive Technology

   Note: This service is available in all three waiver programs.

   Assistive technology devices are items, pieces of equipment, or product systems, whether acquired commercially, modified, or customized, used to increase, maintain, or improve functional capabilities of participants. Assistive technology services directly assist a participant in the selection, acquisition, or use of an assistive technology device. Assistive technology includes the following:

   • Evaluation of the participant's assistive technology needs, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the participant in the customary environment of the participant.
   • Services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for participants.
   • Services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices.
   • Coordination and use of necessary therapies, interventions, or services with assistive technology devices, such as therapies, interventions, or services associated with other services in the individual service plan.
   • Training or technical assistance for the participant, or, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant.
   • Training or technical assistance for professionals or other persons who provide services to, employ, or are otherwise substantially involved in the major life functions of participants.

3. Home Accessibility Modifications

   Note: This service is available in the Adult Waiver and the Children's Support Waiver.

   Home Accessibility Modifications include those physical adaptations to the private residence of the participant or the participant's family, required by the participant's service plan, necessary to ensure the health, welfare and safety of the participant or and which enable the individual to function with greater independence in the home and necessary repair to the adaptations.

   Home accessibility modifications may be either permanent or not permanent. Permanent home modifications are either structural modifications or items that are attached to the home. All services must be provided in accordance with applicable State or local building codes.

   For modifications to agency-owned CILA sites, please see the CILA User Guide. 

   Examples of home accessibility modifications include:

   • Ramps
   • Lifts/elevators necessary to enter or leave the home or to access a bedroom or a bathroom, including porch or stair lifts and hydraulic, manual or electric lifts.
   • Bathroom modifications, including roll-in showers, sink modifications, bathtub modifications, toilet modifications, grab bars, adapted water faucet controls, floor urinal and bidet adaptations and plumbing modifications and turnaround space adaptations.
   • Widening of doorways/hallways (may include minimally necessary floor covering to cover the new floor area).
   • Specialized accessibility/safety adaptations/additions including grab bars; necessary handrails beyond those normally required by building codes; lowered or adaptive door handles; adapted fire alarms, sprinklers, smoke detectors and doorbells; automatic door openers/doorbells; voice-activated, light-activated, motion-activated and electronically-activated devices; fire safety adaptations; and electrical wiring associated with the above.

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

   • Cosmetic refurbishment
   • Items that add value to the home
   • Roof repair
   • Installation or repair of furnace/air conditioning
   • Replacement of floor covering; replacement or repair of stairs, windows, driveways or sidewalks
   • Installation of hot tubs, spas, whirlpool tubs, saunas and replacing an existing tub with a new tub
   • Room renovation, exterior renovation, or renovations to a porch or deck
   • Adaptations that add to the total square footage of the home
   • Seasonal items such as swimming pools and related equipment

   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.

4. Vehicle Modifications

   Note: This service is available in the Adult Waiver and the Children's Support Waiver.

   Vehicle Modifications are adaptations or alterations to an automobile or van that is the participant's primary means of transportation to accommodate the special needs of the participant.

   Vehicle adaptations are specified by the service plan as necessary to enable the participant to integrate more fully into the community and to ensure the health, welfare and safety of the participant. Examples of vehicle modifications include:

   • Lifts or ramps
   • Door modifications
   • Seating modifications
   • Safety/security modifications
   • Inside height modifications

   The following modifications are specifically excluded from coverage:

   • Adaptations or improvements to the vehicle that are of general utility, and are not of direct remedial benefit to the participant.
   • Purchase or lease of a vehicle.
   • Regularly scheduled upkeep and maintenance of a vehicle except upkeep and maintenance of the modifications.

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

Self-Directed Services

Self-directed services are available in the Children's Support Waiver and through the Home-Based Support Services (HBS) option in the Adult Waiver. The individual service descriptions below identify the services that are available within each option. See Section V for additional information about self-directed service options.

Some specific waiver services included in the array of self-directed services require prior approval. See Section VIII, Service Authorization and Prior Approval, for additional information.

1. Service Facilitation

   Note: This service is available in the Adult Waiver and the Children's Support Waiver.

   This service is available within the monthly and yearly maximum to all Children's Support Waiver participants, and to Adult Waiver participants who are authorized for Home-Based Support Services (HBS).

   Service facilitation includes case management services that assist participants and families in gaining access to needed Waiver and other Medicaid State Plan services, as well as medical, social, educational and other services, regardless of the funding source for the services.

   Service Facilitators are responsible for day-to-day oversight and administration of the service plan and for ensuring participant health, safety and welfare.

   Service facilitators assist the participant, family and guardian, if one has been appointed, in the following:

   • Designing an array of habilitation and support services to meet the participant's needs.
   • Convening a service planning team, or convening the team as directed by the participant, family or guardian. In addition to the participant, guardian (if applicable), family members and/or other individuals important to the participant, service facilitator, and ISSA, the team may include other professionals and service providers as needed.
   • Writing or updating the individual service plan at least annually or more often, if needed, based on assessment information and discussion among the participant, guardian, family and other members of the service planning team.
   • Ensuring the completion of service agreements or service authorizations between the participant and service providers.
   • Working with the fiscal employer agency to monitor the expenditure of funds according to the individual budget, service plan and service agreements/authorization.
   • Working with the fiscal employer agency to determine that domestic employee providers of services, such as Personal Support and Non-Medical Transportation, are qualified and competent to provide the specific services the participant is receiving.

2. Personal Support

   Note: This service is available in the Adult Waiver and the Children's Support Waiver.

   This service is available within the monthly and yearly maximum to all Children's Support Waiver participants and to Adult Waiver participants who are authorized for Home-Based Support Services (HBS).

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

   • Teaching adaptive skills to assist the individual to reach personal goals.
   • Personal assistance in activities of daily living.
   • Assistance in performing age-appropriate housekeeping chores such as bed making, dusting and vacuuming, which are essential to the health and welfare of the participant, rather than for the participant's family.
   • Services provided on a short-term basis because of the absence or need for relief of the primary caregivers.

   Personal Support services may be provided on an episodic or on a continuing basis. Health-related services may include skilled or nursing care and medication administration to the extent permitted by State law.

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

   The need for Personal Support and the scope of the needed services must be documented in the individual service 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:

   • Include professional services, home cleaning services, recreation fees or other community services used by the general public.
   • Provide one-to-one supports in a day program. An enhanced day program rate may be requested as necessary to meet this need within the monthly maximum.

   All Personal Support providers, whether agencies or domestic employees, must comply with the same timekeeping and audit trail requirements as providers of other waiver services. Personal Support services are included in the participants' monthly cost limit/individual budget. The State 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 can be the participant and/or legal representative, other family member or close associate. The employer of record (participant and/or legal representative, family or close associate) is also responsible for hiring, training, ensuring competency, and firing individual providers.

   The Service Facilitator and fiscal employer/agent (FE/A) are available to assist with these responsibilities if the participant or family needs such assistance. The fiscal employer agent provides assistance with provider enrollment, payroll processing and billing for domestic employees.

3. Temporary Assistance

   Note: This service is available in the Children's In-Home Support Waiver and Adult Waiver Program.

   This service is available to Adult Waiver participants who are authorized for Home-Based Support Services (HBS). The cost of these services is not counted toward the monthly maximum.

   Temporary Assistance (TA) includes the same activities, requirements and responsibilities as Personal Support set forth in the above subsection. They are provided on a temporary emergency basis because of the absence or incapacity of the persons who normally provide unpaid care. This may include persons who provide substantial amounts of unpaid care, but who also receive payment for some hours of Personal Support.

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

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

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

   See Section VIII, Service Authorization and Prior Approval for prior approval requirements for Temporary Assistance.

4. Nursing

   Note: This service is available only in the Adult Waiver Program.

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

5. Emergency Home Response Services

   Note: This service is available only in the Adult Waiver Program.

   This service is available within the monthly maximum to participants 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 participants to secure help in an emergency. The participant may also wear a portable "help" button to allow for mobility.

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

6. Transportation (Non-Medical)

   Note: This service is available only in the Adult Waiver Program.

   This service is available within the monthly maximum to Adult Waiver participants 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 service plan.

   This service is offered in addition to medical transportation services available under the Medicaid State Plan and must not replace them. Whenever possible, participants should use family, neighbors, friends or community agencies which can provide this service without charge.

   Transportation to and from covered Medicaid State Plan services and to and from day program services is excluded.

7. Training and Counseling Services for Unpaid Caregivers

   Note: These services are available in the Adult Waiver and the Children's Support Waiver.

   These services are available within the monthly and yearly maximum to all Children's Support Waiver participants and to Adult Waiver participants 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 participants.

   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 a participant 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 service plan, use of equipment specified in the service plan, and includes updates as necessary to safely maintain the participant at home. Counseling must be aimed at assisting the unpaid caregiver in meeting the needs of the participant. All training for individuals who provide unpaid support to the participant must be included in the participant's service plan.

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

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

8. Day Programs

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

   The services below are available within the monthly maximum to Adult Waiver participants who are authorized for Home-Based Support Services (HBS) option.  See Section III.C for additional information about these services:

   • Developmental Training
   • Supported Employment
   • Adult Day Care
   • Regular Work/Sheltered Employment

   The statewide day program maximums (115 hours per month, 1,100 hours per state fiscal year for any combination of day programs) and the agreed hours in the HBS Service Agreement determine the maximum hours a provider may bill for day programs.

   The Division of Developmental Disabilities recommends that providers limit billing for day program services to 92 hours per month for individuals in self-directed options so that the individuals may access other needed services within the monthly maximum throughout the state fiscal year.

   Billing for 92 hours per month is sufficient to allow day program providers to be paid for the full state fiscal year (92 x 12 = approximately 1,100 hours). Please see Section X for additional billing guidance.

9. Behavior Services

   The services below are available within the HBS monthly maximum to Adult Waiver participants who are authorized for Home-Based Support Services (HBS). See Section III.D for more information about these services:

   • Behavior Intervention and Treatment
   • Individual and Group Counseling
   • Individual and Group Psychotherapy

   The provider may bill for services that directly benefit the individual, that are within the statewide maximums and the agreed hours in the HBS Service Agreement and that the provider delivered personally and documented.

10. Therapies

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

    These services are available within the monthly maximum to Adult Waiver participants who are authorized for Home-Based Support Services (HBS).  See Section III.D for additional information about these services and Section VIII, Service Authorization and Prior Approval for prior approval requirements for therapies:

    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy

    The therapist may bill for services that directly benefit the individual, that are within the statewide maximums and the agreed hours in the HBS Service Agreement and that the therapist delivered and documented.

11. Adaptive Equipment, Assistive Technology, Home Accessibility Modifications and Vehicle Modifications

    Note: These services are available in the Adult Waiver and the Children's Support Waiver.

    These services are available to all Children's Support Waiver participants, and to Adult Waiver participants who are authorized for Home-Based Support Services (HBS).

    The cost of these services is not counted toward the monthly maximum.  See Section III.E for more information about these services.

    See Section VIII, Service Authorization and Prior Approval for prior approval requirements for these items.