Completion of this survey is required for all providers who receive Home and Community Based Waiver funds from Illinois Department of Human Services. The completed survey is to be returned before June 30, 2023, to DHS.BQMQE@illinois.gov. Responses will be audited by the Bureau of Quality Management during an official review of the agency. Providers are required to maintain evidence to support the information provided in the survey.
1. Total number of QIDPs working as ISCs at your agency (as of the date you complete this survey):
2. Total number of new QIDPs working as ISC staff. (New is defined as hired since July 1, 2022, and still currently employed with your organization):
3. Of those identified in #2 above, how many received training in accordance with state/Medicaid requirements prior to providing waiver services:
4. Total number of all ISC staff who received training in accordance with state/Medicaid requirements prior to providing waiver services (All ISC staff is defined as employees hired before June 30, 2022, and still currently employed with your organization):
Training to include:
Detail the steps your agency will take to remedy training gaps for each of the above responses that do not equal 100% of your staff. All corrective action steps must be completed by August 1, 2023.
The Executive Director attests by signing below that the information is accurate and complete as of the date of signature. Failure to maintain records to support the data on this form can impact funding and/or remaining in good standing with the Division.
Illinois Department of Human ServicesJB Pritzker, Governor · Dulce Quintero, Secretary
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