One- and Two-Person CILA Request - Community Integrated Living Arrangements (CILA)

Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.14.038
One- and Two-Person CILA Request - Community Integrated Living Arrangements (CILA)
June 30, 2014

Purpose

This Information Bulletin will outline the requirements and process for a licensed CILA provider agency to request CILA services in a one- or two-person CILA setting with 24-Hour shift staff supports as funded through the Division of Developmental Disabilities' (DDD) Medicaid Waiver services.

This procedure does NOT apply to individuals who currently receive or will receive CILA services in the following types of CILA settings:

  • Host Family or Foster Care,
  • Intermittent; or
  • Family-Intermittent.

Process and Procedure 

CILA providers that must initiate or change CILA services to a one- or two-person CILA with 24-Hour shift staff supports after normal business hours during the week, weekend or holiday must make their emergency request to the ISC agency in order to submit such a request. It will be the ISC agency's responsibility to ensure the DDD staff gets the request the next business day. 

The DDD will not be responsible for misdirected or undelivered funding requests.  DDD does not make a commitment to fund any person for an amount or period of time in a one- or two-person CILA with 24-Hour shift staff supports prior to the DDD's receipt and final approval of a complete funding application request.

Without prior approval or a CILA Award for a one- or two-person CILA with 24-Hour shift staff supports, or if the CILA provider agency does not submit a complete funding application request for the individual, the DDD will calculate any individual transitioned to such a capacity CILA with a minimum capacity of four (4) persons.  The minimum four-person CILA rate will remain in effect until such time as the CILA provider submits the appropriate funding application request to apply for an individual's funding to be calculated at a one- or two-person CILA with 24-Hour shift staff supports, and the DDD approves funding for the individual at a smaller capacity CILA.

It is the CILA provider's responsibility to convene a case conference and assemble required documentation to support the individual's need for a one- or two-person CILA with 24-hour shift staff supports.

The award for a one- or two-person CILA will be effective from the effective date on a PAL (so long as the conditions of the PAL have been met) or when a decision is rendered by the DDD.  A final decision by the DDD will only be after the receipt and review of a complete funding application request submitted by the CILA provider.  When approved, the DDD will determine whether the funding for an individual will be for a six- or 12-month period. The individual's CILA Rate sheet will specify the effective and ending date for funding of a one- or two-person CILA.

It is the CILA provider agency's responsibility to apply at least 30 calendar days prior to the end of the approved time period for uninterrupted continued funding at a one- or two-person if the individual's extreme need warrants or the individual continues to pose an imminent risk to harm other people.  When the CILA provider does not apply before the end date of a one- or two-person CILA for continued funding, the DDD will convert the individual's funding to a four-person CILA rate at the end of the approved time.

  1. Emergency Application for One- or Two-Person CILA with 24-Hour Shift Staff Supports

    An emergency situation would be defined as an individual who suddenly and unexpectedly poses an imminent risk to others with whom they live at their current CILA site and whose extreme medical and behavioral needs will not likely be met with only additional staff supports.

    The DDD will respond to a agency's request for emergency approval of a one- or two-person CILA within two (2) business days. Once approved by DDD and upon DDD issuing a pre-award letter for a one- or two-person CILA the CILA provider will have 30 calendar days to submit a complete funding application for the individual to be funded.

    A CILA provider that transitions an individual to a CILA home without a pre-award letter (PAL) from the DDD or receipt of a signed CILA award for a one-or two-person CILA with 24-Hour shift staff supports DDD does so at the agency's own expense.

    In an emergency situation it is the CILA provider's responsibility to request placement and funding approval for a one- or two-person CILA with 24-Hour shift staff supports. Provider agencies that must initiate services after normal business hours (Monday - Friday) during the week, or on a holiday, or weekend must submit the request on the first business day (Monday - Friday) following the individual's transition to a CILA with these supports.  It is the provider's responsibility to assure the ISC agency staff received the one- or two-Person CILA with 24-Hour shift staff support request.

    The requesting provider must also contact their Region Facilitator or Bureau of Transitional Services (BTS) Representative staff via email within DDD that a one- or two-person CILA with 24-hour shift staff support request has been submitted. It is recommended the provider's contact with the BRS/BTS staff stipulate the name of the ISC agency, date and time the request was sent to the PAS/ISC/ISSA agency. The DDD will not be responsible for misdirected or undelivered requests.

    The CILA provider must complete and submit both the Additional Staff Support and One- or Two-Person CILA Request (pdf) (IL462-4424) and the Clinical Need Summary (pdf) (IL462-4423) for an Emergency Pre-Award Letter (PAL) for a One- or Two-Person CILA with 24-Hour Shift Staff Supports. Both forms must be filled out online or typed.

    Both forms are forwarded to the ISC agency for review and signature. The ISC agency has one (1) business day to review and forward to the DDD.  After review and approval, DDD will facilitate the effective date to be effective up to two (2) business days prior to the DDD's receipt of the request.

    1. Components of an Emergency Application for a One- and Two-Person CILA with 24-hour Shift Staff Supports

    2. Additional Staff Support and One- or Two-Person CILA Request  (IL462-4424)

      • Identify the individual's name, Social Security number, and Medicaid RIN, Requesting Agency Name, Agency FEIN, and Agency ID number
      • Fill in the Date of the Request
      • Check whether the request is for 60D CILA and/or 31U DT
      • Check "Emergency" in Section 4 for this is a One- or Two-Person CILA with 24-hour Shift Staff Request
      • The CILA provider will print, sign, date and provide an email contact address on the request before forwarding to the ISC agency for review.

    3. Clinical Need Summary (IL462-4423)

      • Fill in the individual's name, Social Security number, and Medicaid RIN, Requesting Agency Name, Agency FEIN and Agency ID number
      • Provide a brief narrative explanation of the individual's medical, physical, and/or behavioral needs that require one- or two-person CILA with 24-hour shift staff supports. The narrative should be concise in the explanation of the individual's need
      • Specify the duties and responsibilities the staff in a one- or two-person CILA will be performing.
      • Attach the Clinical Need Summary Form (IL462-4423) for all One- or Two-Personal CILA Requests.

      Both forms are forwarded to the appropriate ISC agency for review and signature. The ISC agency has one (1) business day to review and forward to the DDD. Upon receipt, review and approval, the DDD will set the effective date for awarded additional staff supports for up to two business days prior to the Division's receipt of the request.

  2. Non-Emergency Application One- or Two-Person CILA with 24-Hour Shift Staff Supports

    After a PAL has been issued a non-emergency application for a one- or two-person CILA with 24-hour shift staff supports must be submitted by the CILA provider.  In non-emergency situations when the individual may require a temporary period in a one- or two-person CILA with 24-hour shift staff supports the CILA provider is to submit a CILA funding application request.

    The CILA provider is also responsible for reapplying for continued funding for an individual in a one- or two-person CILA with 24-hour shift staff supports prior to the end date.

    The non-emergency CILA funding application request for a one- or two-person CILA with 24-hour shift staff supports must consist of at least the following:

    • A cover letter from the CILA provider agency's Executive Director or designee;
    • The Additional Staff Support and One- or Two-Person CILA Request (IL462-4424) - In Section 4, mark "Application" or "Renewal" as appropriate;
    • An Application for 60D CILA Support Services and Instructions  (IL462-4425);
    • An Individual/Guardian Information Form (IL462-2026); 
    • Case Conference Summary (IL462-4422); 
    • A Behavioral or Medical Questionnaire with required relevant and current supporting documentation as specified on the questionnaire
    • A recommendation of support by the CART or SST team;
    • A proposed staff schedule, ONLY if the request specifies more than one (1) staff person on duty at any time in a one-person CILA with 24-Hour Shift Staff Supports; or
    • If the request specifies one (1) staff person solely assigned to one person in a two-Person CILA with 24-Hour Shift Staff Supports.

  3. Case Conference Process

    The case conference is convened by the QIDP from the CILA provider agency making the request for a one-or two-person CILA with 24-hour shift staff supports.  The QIDP is responsible for inviting the required participants as well as other key participants as determined necessary based on the individual's need. Participants may participate either in person or via conference call.  If a required or key participant is absolutely unable to attend, he or she may submit verbal or written comments to the QIDP prior to the case conference. The QIDP will either distribute the written comments prior to the case conference or verbally report the comments during the case conference.

    The case conference is to be scheduled in advance of the deadline to submit the funding request for a one- or two-person CILA with 24-hour shift staff supports after a Pre-Award Letter (PAL) has been issued. Ideally, the case conference is convened within the first 15 days of issuing a PAL for a one- or two-person CILA with 24-hour shift staff support services.  For a renewal request of a one- or two-person CILA with 24-hour shift staff supports, if convenient and appropriate, the case conference can occur at such time as the individual's service team is scheduled for the annual review.

    The QIDP is responsible for completing the Case Conference Summary (IL462-4422) within two (2) business days following the Case Conference. Upon completion of the Case Conference Summary it is to be distributed (preferably electronically) to all participants. Participants have two (2) business days to provide any comments or corrections.

    The CILA provider can apply to the DDD for a one- or two-person CILA with 24-hour shift staff support services for by submitting either:

    • The Determination of Medical Needs Questionnaire with required current and relevant supporting documentation for an individual's medical or physical issues; or
    • The Determination of Behavioral Needs Questionnaire with required current and relevant supporting documentation for an individual's behavioral issues

    Both questionnaires require support documentation and synthesized summary data to be considered a complete request. The supporting documentation and synthesized summary data submitted must be the most current and relevant to the individual's extreme and extraordinary medical, physical and behavioral needs.

    Supporting documentation that is not current or relevant to the individual's current circumstances for requesting a one- or two-person CILA with 24-hour shift staff supports should be excluded. The information submitted is to substantiate the individual's long-term exceptional and extraordinary medical, physical or behavioral need for a one- or two-person CILA with 24-hour shift staff support services.

    When submitting a renewal request for a one- or two-person CILA with 24-hour shift staff support services the supporting documentation must be relevant to the time between the previous award for for a one- or two-person CILA with 24-hour shift staff support services and submitting the current request.

    When a one- or two-person CILA with 24-hour staff supports may be needed, it is the service provider's responsibility to promptly secure the services of professionals to assess the individual, make recommendations and develop program plans to address the individual's needs, participate in a case conference, and assist in preparing the long-term additional staff support request.

    1. Case Conference Summary Participants

      Any request for a one- or two-person CILA with 24-hour shift staff supports requires a case conference consisting of the individual's service team. The service team is required to consist of the following participants:

      • The Individual Served (as appropriate)
      • The Individual's Guardian (if applicable)
      • Family Member (Authorized by Individual or Guardian)
      • The Individual's QIDP with the Provider Agency
      • Provider Agency Management Representative
      • ISC Representative
      • DDD Representative (See Note)
      • CART and/or SST if involved
      • Other Provider Agency Staff
      • Behavior Analyst
      • Therapists
      • Medical Professionals

      NOTE: Participation of a DDD Representative during a case conference in no way obligates, commits, or otherwise binds the DDD to fund a request or recommendation made by the individual's team.

    2. Components of the Case Conference Summary (IL462-4422)

      • Name and SSN of the individual needing additional staff supports
      • Agency Name, FEIN and Agency ID Number requesting staff supports
      • Specify whether the request is for 60D CILA and/or 31U Developmental Training
      • Date of Case Conference
      • List of the participants including name, title and whether the person participated in person, electronically (phone or video), or provided written comments.  NOTE: If the individual is excluded from the case conference the QIDP is required to explain why the individual was excluded;
      • Statement of Need - A brief statement pertaining to the critical medical, physical and behavioral needs of the individual
      • Summary of Current Status -A statement or statements of strategies currently in use, individual's response to strategies, data, and projected challenges
      • Summary of Team Discussion & Recommendations:
        • Statement to continue, modify, discontinue strategies currently in use to resolve the issues prior to requesting further additional staff supports
        • Statement on the development or modification of a positive behavior support plan
        • Statement as to need for referral and follow up with other professionals such as medical, psychiatric, tests or evaluations
        • Statement as to need for referral to CART and SST
        • Statement on the continued need of additional staff supports
      • Follow Up Steps/Person Responsible - List any follow up action recommended by the team; the name of the person responsible; time frame for completion; and if completion is required prior to submitting a request for additional staff support's signature and distribution date by the CILA provider agency QIDP.
      • Signature and distribution date by the CILA provider agency QIDP.

    3. Synthesized Summary Data

      Provide a summary of relevant data that has been synthesized to concisely outline the individual's need for additional staff support. The data should be in summary format with key descriptors. The use of tables with analyzed data, graphs or charts may be beneficial. When possible, provide three (3) months of data when submitting a long-term additional staff support request for the first time. A minimum of two (2) months of data is required when submitting the long-term additional staff support request for the first time. A Renewal/Review of a long-term additional staff support request requires synthesized summary data from the time period between the previous award and when the Renewal/Review Request is being submitteds

      The data summary should not to exceed three pages and should address the following:

      • Targeted Behaviors:  Specifically define each behavior being addressed in support of the request for additional staff supports
      • Antecedents:  Specify any known or suspected triggers that precede or cause the behavior; any activities or events taking place immediately prior to the behavior; any interactions with other people (clients and staff) immediately prior to the behavior; any verbalization, body movement, emotion, reaction, ritual, etc. by the individual prior to the behavior.
      • Frequency of Behavior:  Identify the number of attempts to engage in the behavior or activity that are successful; and he number of attempts to engage in the behavior or activity that are not successful due to staff intervention.
      • Severity of Behavior:  Causes injury to self or others; requires medical intervention; requires police intervention; requires psychiatric hospitalization; High Risk (Safety) outcomes or potential outcomes; property damage.
      • Additional Impact on Others from the Behavior:  Emotional distress; restriction of rights; safety risks; impact on house mates, community members or neighbors

      Synthesized summary data includes, but is not limited to: compiling, tracking, analyzing, trending, graphing and/or analyzing the data contained in incident reports, daily reports, goal reporting, behavior tracking, case notes, etc. Synthesized summary data is to be summarized in a concise written narrative. This data can be presented in a graphic display such as a line graph, bar chart, and/or summary tally tables. Some examples of synthesized summary data can be found at: https://www.dhs.state.il.us/page.aspx?item=XYZ.  IP ADDRESS IS ONLY A PLACE SAVER - Requires Item Number to be added when posted.

  4. Evaluation of One- and Two-Person CILA with 24-Hour Shift Staff Support Requests

    The DDD shall evaluate all requests for one- and two-person CILA with 24-hour shift staff supports and respond with a written award or denial letter to the requesting CILA service provider within 20 business days from the date of receipt of a complete and properly submitted request.

    A request submitted with unsynthesized data consisting of copied incident reports, daily reports, goal reporting, behavior tracking, case notes, etc., will not be accepted and will result in the request being returned as incomplete. Please see examples of synthesized data above.Requests submitted with data and documentation that is not current to the most recent time period after the last award will also be returned as incomplete.

    At the discretion of the Region Facilitator or Bureau of Transition Services (BTS) Representative, if the missing or incomplete information appears to be minor and easily corrected, the facilitator or representative may request via email to the service provider the missing information. An email notification for missing information must include a deadline for receiving the requested information. If not received by the specified date on the email, the additional staff support request will be returned as incomplete. Once the required information is obtained, the requesting CILA service provider may resubmit the request to the Region Facilitator or BTS Representative.

    The DDD's review of a request for one- and two-person CILA with 24-hour shift staff supports will include the following in the request:

    • Exceptional or extraordinary medical, physical, and behavioral needs that give rise to the request
    • Synthesized summary data on the exceptional or extraordinary maladaptive behaviors (documenting frequency and severity of exceptional needs) Projected continuation of the individual's exceptional or extraordinary medical, physical and/or behavioral needs
    • Relevant assessments, evaluations, reports, test results, and recommendations by professional staff and consultants, including psychiatrists, psychologists, medical professionals, therapists, behavior analysts, counselors in Clinical and Administrative Review Team (CART) and Service Support Team (SST)
    • Interventions and programming previously implemented by the service provider to address the individual's exceptional or extraordinary needs
    • The individual's response to programming previously implemented by the service provider to address the exceptional or extraordinary needs
    • The requesting agency's willingness, ability and efforts to implement recommendations by professional staff, consultants, CART and SST

    The DDD may recommend and may require the local CART and SST become a part of the individual's team as a part of or condition of any response to a request for long-term additional staff supports.

    Final approval or denial of a request for a one- or two-person CILA with 24-hour shift staff supports is made by the Division of Developmental Disabilities Director.

  5. Monitoring of One- and Two-Person CILAs

    The DDD and ISC may review individual's services in one- and two-person CILAs with 24-Hour shift staff supports via:

    • Direct observation of the individual
    • Individual progress notes
    • Staff schedules
    • Agency payroll records (DDD Only)
    • Follow-up reports from professionals, consultants, ISSA, CART, and SST.

    The DDD and ISC agency may conduct random, unannounced on-site visits to provide an objective oversight, feed-back and to monitor:

    • Delivery of the one- or two-person CILA with 24-hour shift staff supports for the individual
    • Individual's response to and continued need for a one- or two-person CILA with 24-hour shift staff supports
    • Effectiveness of the one- or two-person CILA with 24-hour shift staff supports in preventing and controlling critical incidents

    In the event the ISC agency has any concerns associated with the implementation of the additional staff support, they will follow the protocol laid out in "Problem and Conflict Resolution: Addressing Issues, Solving Problems, Troubleshooting" an attachment to Information Bulletin DD.11.010 - "ISSA Guidelines: Problem and Conflict Resolution."