TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.100 PURPOSE
Section 115.100 Purpose
a) The intent of this Part is to provide uniform direction for
the licensure and operation of Community-Integrated Living Arrangement (CILA)
agencies that provide residential services to individuals with developmental
disabilities [Community-Integrated Living Arrangements (CILA) Licensure and
Certification Act [210 ILCS 135].
b) The objective of a community-integrated living arrangement is
to support individuals to pursue meaningful and valued lives, as defined by the
individual, in the community.
c) Agencies planning to develop and support community-integrated
living arrangements shall do so pursuant to the Department licensure in
accordance with this Part.
d) Agencies providing CILA services must comply with applicable
federal and State regulations and laws.
e) Agencies planning to provide CILA services to individuals with
developmental disabilities who are included in the Department's Medicaid Home
and Community-Based Services (HCBS) Waiver for Adults with Developmental
Disabilities:
1) Shall comply with Section 115.230 and 115.310 as well as 59
Ill. Adm. Code 120 and 42 CFR 441.301(c)(1) through (c)(4)(i) through (v),
which specify Person-Centered Planning and Settings requirements for
individuals enrolled in HCBS Waiver services.
2) Shall not have the effect of isolating individuals
receiving Medicaid HCBS Waiver services from the broader community of
individuals not receiving Medicaid HCBS Waiver services as described in 42 CFR
441.301(c)(5)(v) and related federal CMS guidance.
3) Shall meet the additional conditions set forth in 42 CFR
441.301(c)(4)(vi)(A) through (E) and Section 115.200 if the CILA is
provider-owned or controlled.
4) Shall have any modification of the additional conditions set
forth under 42 CFR 441.301(c)(4)(vi)(A) through (D) supported by a specific
assessed need, justified in the Personal Plan, and be documented in the
Personal Plan as specified in 42 CFR 441.301(c)(4)(vi)(F)(1) through (8).
f) CILA services for persons with developmental
disabilities are funded through the rate methodology designated by DDD, as
mandated by Section 9 of the Community-Integrated Living Arrangements Licensure
and Certification Act [210 ILCS 135/9].
g) Rates
for all host family settings, as described in Subpart E, shall be determined by
the Department through the CILA rate methodology. The Department may develop a
version of the methodology specifically modified for host family settings.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
 | TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.110 INCORPORATION BY REFERENCE
Section 115.110
Incorporation by reference
Any rules of an agency of the
United States or of a nationally-recognized organization or association that
are incorporated by reference in this Part are incorporated as of the date
specified, and do not include any later amendments or editions.
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.120 DEFINITIONS
Section 115.120 Definitions
For the purpose of this Part,
the following terms are defined:
"Abuse."
See definition found in 59 Ill. Adm. Code 50.10.
"Applicant."
A person, group of persons, association, organization, partnership, or
corporation that applies for a license to provide community-integrated living
arrangement services under this Part.
"Assigned
Independent Receiver" or "Receiver." A court appointed qualified person, who
assumes custodial responsibility for a CILA agency that is operating without a
license or whose license has been suspended, revoked, or refused renewal. This
person cannot be an owner or an affiliate of the CILA agency which is in
receivership.
"Authorized
CILA agency representative." The administrative head of a CILA agency, or
their designee, appointed by the CILA agency's governing body with overall
responsibility for fiscal and programmatic management.
"Authorized
electronic monitoring." The placement and use of an electronic
monitoring device by an individual in their room in accordance with
the Authorized Electronic Monitoring in
Community-Integrated Living Arrangements and Developmental Disability
Facilities Act [210 ILCS 165/5].
"Aversive
procedures." The application, contingent on the exhibition of a specific
behavior that is not adaptive, of unpleasant or painful stimuli, or stimuli
that have a potentially noxious affect. Aversive procedures have the following
characteristics:
Obvious signs
of physical pain experienced by the individual.
Potential or
actual physical side effects, including tissue damage, physical illness, severe
stress, and/or death.
Dehumanization
of the individual, through means such as social degradation, social isolation,
verbal abuse, techniques inappropriate for the individual's age, and treatment
out of proportion to the target behavior.
"BALC." The Department's
Bureau of Accreditation, Licensure and Certification.
"BQM." The Bureau of
Quality Management in the Department's Division of Developmental Disabilities.
"Certification."
A status granted by the Department to a specific site whose programs operate
under this Part, successfully meet its standards, and provide services to
promote community-integrated living.
"CILA agency"
or “CILA provider.” A developmental disability services agency that is licensed
by the Department to provide community-integrated living arrangement services
for individuals with a developmental disability. (Section 3(b) of the
Community-Integrated Living Arrangements Licensure and Certification Act)
“CILA services.” Residential supports that a CILA agency is
paid to deliver to individuals with developmental disabilities that promote
health, well-being, maximum independence, choice-making, access to the greater
community to the same degree as individuals not receiving HCBS.
"Code."
The Mental Health and Developmental Disabilities Code [405 ILCS 5].
"Coercion."
Any action whereby an individual, guardian, or family member is compelled by
force, intimidation, or threat to act, or refrain from action, in a manner
contrary to how the individual would have acted if permitted to act in
accordance with their free and informed choice.
"Community-integrated
living arrangement (CILA)." A residential setting or site that is certified
by the Department where eight or fewer individuals with a developmental
disability reside together in an apartment, house, or one or more units
in a multi-unit building under the supervision of an agency and
are provided with an array of services. (Section 3(d) of the
Community-Integrated Living Arrangements Licensure and Certification Act).
"Community
integration" or "integration into the community. "Individuals
receiving Medicaid HCBS having opportunities to seek employment and work in
competitive integrated settings, engage in community life, control personal
resources, and receive services in the community to the same degree of access
as individuals not receiving Medicaid HCBS (42 CFR 441.301(c)(2)(i)). Examples
of on-going engagement in community life for individuals with developmental
disabilities include:
Time spent out
of the home participating in non-disability specific activities chosen by the
individual and guardian that are available to the greater community, such as spiritual
and cultural interests, places of worship (e.g., church, temple, mosque,
synagogue or other places of worship), recreational activities, education,
library, clubs, shopping and amusements.
Participation
in activities, celebrations, (e.g., holidays, birthdays, reunions)
communication (wireless, electronic, and/or mail) and vacations.
"Confidentiality
Act." The Mental Health and Developmental Disabilities Confidentiality
Act [740 ILCS 110].
"Continuous
supervision or support." Direction or assistance provided to an individual
under the auspices of the licensed CILA agency (i.e., not an Intermittent CILA).
An employee or any other person compensated or in a volunteer capacity, but not
the guardian of the individual, with responsibility for care of individuals
served from the licensed CILA agency, or another agency through which any
portion of CILA services is being provided, must be physically present on-site
all hours individuals are present, unless otherwise specified in an
individual’s Personal Plan and provided for in their Implementation Strategy.
Continuous supervision or support may range from being in immediate line of
sight to the individual receiving services, to present and accessible to the
individual receiving services, depending on the individual's Implementation
Strategy.
"Critical
Incidents." Any alleged, suspected, or actual occurrence of an incident
when there is reason to believe the health or safety of an individual may be
adversely affected or an individual may be placed at a reasonable risk of
harm. Critical incidents for this Part shall include abuse, neglect, and financial
exploitation as defined in 59 Ill. Adm. Code 50. Critical Incidents shall also
include deaths not otherwise reportable pursuant to 59 Ill. Adm. Code 50,
injuries of known or unknown origin, medical emergencies, unscheduled
hospitalizations, missing individuals, peer-to-peer or peer-to-staff acts of
aggression, and involvement of law enforcement and/or fire department.
"Day."
A calendar day, unless otherwise indicated.
"Department"
or "DHS." The Illinois Department of Human Services.
"Developmental
disability." An intellectual disability or other severe, chronic disability, other
than mental illness, found to be closely related to an intellectual disability
because this condition results in impairment of general intellectual
functioning or adaptive behavior similar to that of persons with ID, and
requires services similar to those required for a person with an intellectual
disability. In addition, a developmental disability:
is manifested
before the individual reaches 22 years of age;
is likely to
continue indefinitely;
results in
substantial functional limitations in three or more of the following areas of
major life activity: self-care, receptive and expressive language, learning,
mobility, self-direction, capacity for independent living, or economic self-sufficiency;
and
reflects the
individual's need for a combination and sequence of special interdisciplinary
or generic services, individualized supports, or other forms of assistance that
are of lifelong or extended duration and are individually planned and
coordinated (modified from the American
Association on Intellectual and Developmental Disabilities, Intellectual Disability: Definition,
Diagnosis, Classification, and Systems of Supports, 12th Edition (2021)).
"Diagnosis."
A category of disability stated in accordance with the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) or the most
recently published version (800 Maine Avenue, S.W., Suite 900, Washington, DC 20024
(2013).
"Direct
Support Professional" or "DSP". Any person who provides
habilitative care, services, or support to individuals with developmental
disabilities and is listed on the Department's Health Care Worker Registry as a
trained DSP or DDD Aide under its Program section. DSPs shall be trained in
accordance with this Part and function under the supervision of a Qualified
Intellectual Disabilities Professional (QIDP), a Licensed/Registered Nurse, or
other higher-level employee authorized by the CILA agency.
"Division of Developmental Disabilities,"
"Division," or "DDD." The Department’s Division of
Developmental Disabilities.
"Electronic
monitoring device." A surveillance instrument with a fixed position
video camera or an audio recording device, or a combination thereof, that is
installed in an individual's bedroom under the provisions of the Authorized Electronic Monitoring in Community-Integrated
Living Arrangements and Developmental Disability Facilities Act and
broadcasts or records activity or sounds occurring in the room [210 ILCS 165/5].
"Employee."
For the purposes of this Part, any individual hired, employed, or retained by a
CILA agency, whether paid or on an unpaid basis.
"Entitlements."
Government-related financial benefits available to individuals who qualify on
the basis of need, disability and/or income, such as Title XVIII (Medicare) (42
U.S.C. 1395b-1 (1996)), Title XIX (Medicaid) (42 U.S.C. 1396a (1996)) and
Veteran's Administration benefits (38 U.S.C. 521, 541, 542 (1996)).
“Exploitation”
or "Financial Exploitation." See definition of financial exploitation
found in 59 Ill. Adm. Code 50.10.
"Governing
body." The policy-making authority of a CILA agency that establishes
policies concerning the CILA agency's operation and the welfare of individuals;
provides for the CILA agency's administration by appointing an authorized CILA agency
representative to implement its policies; and exercises general oversight of
the CILA agency's operation, its fiscal affairs and programmatic content to
implement the organization's mission.
"Guardian."
The plenary or limited guardian or conservator of the individual appointed by
the court for an individual over age 18 (when the limited guardian's duties
encompass concerns related to service requirements), or the natural or adoptive
parent of a minor, or a person acting as a parent of a minor. All references in
this Part to an "individual and/or guardian" include the guardian
only if applicable.
"Habilitation."
Individually tailored supports that assist individual
with developmental disabilities with the acquisition, retention, or improvement
in skills related to living in the community. Services are developed in
accordance with the needs of the individual and include supports to foster independence and encourage development of a full life in the community, based upon what is important
to and for the individual, as documented in their Person-Centered Plan. This includes
assisting and teaching individuals to attain new and maintain and
improve existing skills in areas of self-care, daily living, adaptive skills, leisure, and community integration,
including building and maintaining relationships. Additionally, it may
include efforts to prevent regression or decelerate loss of function. Habilitation
may include, but is not limited to, diagnosis, evaluation, medical services,
residential care, day care, special living arrangements, training, education,
employment related services, protective services, counseling, and other
services provided to individuals with a developmental disability by
developmental disabilities programs. [405 ILCS 5/1-111]
"Host
family." One or more persons unrelated to the individual with
developmental disabilities, employed by or contracting with the CILA agency,
who reside with the individual.
“Host family
living arrangement” or “Host family setting”. A 24-hour residential setting,
serving as an alternative to a typical shift staff arrangement. The setting is
the residence for the person with a developmental disability and the host
family.
"Host
family living arrangement − traditional care model." A 24-hour
residential alternative to a typical shift staff arrangement. The setting is
the residence for the person with a developmental disability and the full-time
residence for the paid host family. It is owned, leased, or rented by the paid
host family. In these settings, host families consist of one or more persons
who are unrelated to the individual with a developmental disability, and who
contract with the CILA agency.
"Host
family living arrangement − shared living model." A 24-hour
residential alternative to a typical shift staff arrangement. The setting is
the residence for the person with a developmental disability and may house
either full or part-time paid host family in which more than 50 percent of the
residential coverage is provided by individuals other than shift staff
employees. It is owned, leased, or rented by the individuals, host family, or CILA
agency. In these settings, host families consist of one or more persons who
are unrelated to the individual with a developmental disability, and who are
employed by or contract with the CILA agency. The difference between
traditional care and shared living models is shift employees routinely share
supervision, care, and training responsibilities with the host family in the
shared living model.
"Host
family services." Residential supports, provided in a host family living
arrangement, that a CILA agency is paid to deliver to individuals with
developmental disabilities that promote health, well-being, maximum
independence, choice-making, and access to the greater community to the same
degree as individuals not receiving HCBS.
"Imminent
risk." A preliminary determination of immediate, threatened, or impending
risk of illness, mental injury, or physical injury to an individual as would
cause a reasonably prudent person to take immediate action and that is not
immediately corrected, such as environmental or safety hazards.
"Implementation
Strategy." A document developed by the licensed CILA agency in conjunction
with the individual or the individual’s guardian that describes and directs the
activities and methods used to provide services and supports for the areas of
an individual's Personal Plan for which the CILA agency has agreed to be
responsible. The priorities, strengths, support needs, and risk factors
identified in the Personal Plan must be addressed and accounted for in the
Implementation Strategy for those areas of the CILA agency's responsibility.
The document must describe how the CILA agency will support the person to
pursue the outcomes included in the Personal Plan and be signed by the person,
guardian, and ISC.
"Independent
Monitor" or "Monitor." An individual,
employee, contractor, or any other person compensated or in a volunteer
capacity with a business entity who has been assigned by the
Department to oversee the business affairs of a CILA when any of the following
situations occur:
The CILA agency is operating
without a license;
The Department has suspended,
revoked, or refused to renew the existing license of the CILA agency;
The Department has issued a notice
to terminate or not renew its agreement with the CILA agency;
The CILA agency is closing or has
informed the Department that it intends to close and adequate arrangements for
transition of individuals have not been made at least 30 days prior to closure;
The Department determines that an
emergency (a threat to the health, safety, or welfare of individuals that the
CILA agency is unwilling or unable to remedy) exists; or
The Department, with the
Department of Healthcare and Family Services, terminates the CILA provider’s
participation in the federal reimbursement program under Title XIX (Medicaid)
of the Social Security Act (42 U.S.C. 7).
The monitor cannot be Department
or State agency staff. The monitor shall observe operation of the facility,
assist the facility by advising it on how to comply with the State regulations,
and shall report periodically to the Department on the operation of the
facility.
"Independent
Service Coordination agency" or "ISC". A contracted entity
designated by DDD to carry out certain federal and State requirements related
to assessment, determination of eligibility and service coordination for
individuals with a developmental disability. This
entity provides conflict of interest free case management, including development and monitoring of an individual's
Personal Plan, to DDD Medicaid HCBS Waiver participants. They also serve as the front line for information and
assistance to help individuals and families navigate the system, ensure
informed choice, link individuals to services and address problems related to
outcomes and quality.
"Individual"
or "individuals." A person or persons who receives or receive
community-integrated living arrangement services.
"Individual representatives." Persons chosen by
individuals and representing the interests of individuals served by a CILA
agency such as family members, guardians, and advocates.
"Individually
owned or controlled." A
physical setting in which the individual resides that is owned, co-owned,
leased, or rented by the individual. This setting is not provider-owned or
controlled.
"Informed consent."
Permission freely granted by the individual or guardian based on full
disclosure to the individual or guardian of the benefits and/or liabilities of
participation in specific procedures and/or services, including releases of
information, as part of the individual's Personal Plan and Implementation
Strategy.
"Intellectual
Disability." A disorder with onset during the
developmental period (before the individual reaches age 22), that includes both
intellectual and adaptive deficits in conceptual, social, and practical
domains. The following criteria must be met:
deficits in intellectual functions
such as reasoning, problem solving, planning, abstract thinking, judgment,
academic learning, and learning from experience confirmed by both clinical
assessment and individualized, standardized intelligence testing (generally
indicated with an IQ score of about 70 or below);
deficits in adaptive functioning
that result in failure to meet developmental and sociocultural standards for
personal independence and social responsibility. Without ongoing support, the
adaptive deficits limit functioning in one or more activities of daily life,
such as communication, social participation, and independent living, across
multiple environments, such as home, school, work, and community; and
onset of intellectual and adaptive
deficits during the developmental period.
(Modified
from the American Psychiatric
Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th
ed.) and the American
Association on Intellectual and Developmental Disabilities, Intellectual Disability: Definition, Diagnosis,
Classification, and Systems of Supports, 12th Edition (2021)).
"Intermittent supervision or
support." Supervision or support provided to an individual under the
auspices of a licensed CILA agency less than 24-hours per day (i.e., not a 24
hour or host family CILA). When employees are not on-site, supervision or
support shall be provided by means of 24-hour on-call availability and by a
variety of alternatives or supports, such as natural and remote supports.
"Mental
health professional" or "MHP." See definition of mental health
professional found in 89 Ill. Adm. Code 140.453.
"Mental
illness." For purposes of this Part, mental illness refers to the target
population of adults with serious mental illness (SMI), as established by the
Department's Division of Mental Health and defined as:
Individuals
with serious mental illness are adults whose emotional or behavioral
functioning is so impaired as to interfere with their capacity to remain in the
community without supportive treatment. The mental impairment is severe and
persistent and may result in a limitation of their capacities for primary
activities of daily living, interpersonal relationships, homemaking, self-care,
employment, or recreation. This impairment may limit their ability to seek or
receive local, State, or federal assistance such as housing, medical and dental
care, rehabilitation services, income and food assistance, or protective
services.
The individual
must have one of the following diagnoses that meets DSM-5 criteria and that is
the focus of the treatment being provided:
Delusional Disorder (F22)
Brief Psychotic Disorder (F23)
Schizophreniform
Disorder (F20.81)
Schizophrenia
(F20.9)
Schizoaffective
Disorder (F25.x)
Catatonia
Associated with another Mental Disorder (Catatonia Specifier) (F06.1)
Other
Specified Schizophrenia Spectrum and Other Psychotic Disorder (F28)
Unspecified
Schizophrenia Spectrum and Other Psychotic Disorder (F29)
Bipolar
I Disorder (F31.xx)
Bipolar
II Disorder (F31.81)
Cyclothymic
Disorder (F34.0)
Unspecified
Bipolar and Related Disorder (F31.9)
Disruptive
Mood Dysregulation Disorder (F34.8)
Major
Depressive Disorder Single episode (F32.xx)
Major
Depressive Disorder, Recurrent episode (F33.xx)
Obsessive-Compulsive
Disorder (F42)
Posttraumatic
Stress Disorder (F43.10)
Anorexia
Nervosa (F50.0x)
Bulimia
Nervosa (F50.2)
Postpartum
Depression (F53.0)
Puerperal
Psychosis (F53.1)
Factitious Disorder Imposed on another (F68.A)
And the
individual must meet the criteria for either treatment history or functional
criteria as follows:
Treatment
history covers the individual's lifetime treatment and is restricted to
treatment for the DSM-5 diagnosis specified in this definition. To qualify
under treatment history, the individual must meet at least one of the following
criteria:
Continuous
treatment of six months or more, including treatment during adolescence, in
one, or a combination of, the following modalities: inpatient treatment, day
treatment or partial hospitalization;
Six months
continuous residence in residential programming (e.g., long-term care facility
or assisted, supported, or supervised residential programs);
Two or more
admissions of any duration to inpatient treatment, day treatment, partial
hospitalization, or residential programming within a 12-month period;
A history of
using psychotropic medication management, case management, or outreach and
engagement services over a one-year period, either continuously or
intermittently; or
Previous
treatment in an outpatient modality, and a history of at least one mental
health psychiatric hospitalization.
Functional
criteria have been purposely narrowed to descriptors of the most serious levels
of functional impairment and are not intended to reflect the full range of
possible impairment.) To qualify under functional criteria, the individual
must meet at least two of the following conditions:
Has a serious
impairment in social, occupational, or school functioning;
Is unemployed
or working only part-time due to mental illness and not for reasons of physical
disability or some other role responsibility (e.g., student or primary
caregiver for dependent family member); is employed in a sheltered setting or
supportive work situation; or has markedly limited work skills;
Requires help
to seek public financial assistance for out-of-hospital maintenance (e.g.,
Medicaid, SSI, other indicators);
Does not seek
appropriate supportive community services, e.g., recreational, educational, or
vocational support services, without assistance;
Lacks
supportive social systems in the community (e.g., no intimate or confiding
relationship with anyone in their personal life, no close friends or group
affiliations, is highly transient or has inability to co-exist within a family
setting);
Requires assistance
in basic life and survival skills (e.g., must be reminded to take medication,
must have transportation to mental health clinic and other supportive services,
needs assistance in self-care, household management, food preparation or money
management, is homeless or at risk of becoming homeless); or
Exhibits
inappropriate or dangerous social behavior that results in demand for
intervention by the mental health and/or judicial/legal system.
If the
individual does not currently meet the functional criteria, but is currently
receiving treatment and has a history within the past five years of functional
impairment meeting two of the functional criteria that persisted for at least
12 months, and there is documentation supporting the professional judgment that
regression in functional impairment would occur without continuing treatment,
then the individual will be determined to have met the functional criteria.
"Natural
environment." A setting where an individual not receiving HCBS typically
spends time, including home, work, places of worship, community centers,
libraries, parks, recreation centers, educational settings, or other public
buildings. These sites are not licensed, certified, accredited or identified as
a provider.
"Natural
supports." Unpaid assistance provided to an individual with a
developmental disability typically by a person who has some type of friendship,
kinship or other relationship (co-worker, member of the same social group) with
the individual, whom the individual accepts into their life and with whom the
individual has chosen to spend some duration of time and not just a single
action done out of courtesy.
"Neglect."
See definition found in 59 Ill. Adm. Code 50.10.
"Notice
of deficiency." A report submitted to a CILA agency by the Department
listing the CILA agency's deficiencies with this Part noted during a survey.
"Personal
Plan." A written document developed by an ISC agency in conjunction with
the individual and guardian as well as family members, providers of services
and others (e.g., friends or individual’s representatives) as chosen by the
individual and guardian that includes an assessment of the individual's
strengths, preferences, needs, and desired outcomes. The document contains the
outcomes that the individual requires in their life, describes what is
important to the individual regarding delivery of services in a manner which
ensures both personal preferences and health and welfare, including risk
factors and means to minimize them. It includes the services that are to be
furnished to the individual, the amount and frequency of each service, and the
type of provider to furnish each service.
"Plan of
correction." A written plan submitted by a CILA agency to the Department,
in response to a notice of deficiency, that describes the steps the CILA agency
will take in order to bring a program or services into compliance, and the
time-frames for completion of each step.
"Professional."
An employee, contractual worker, or any other person, compensated or in a
volunteer capacity designated as a professional by virtue of license,
certification, or education. For the purpose of this Part, Direct Support
Professionals are not included in this definition.
"Provider."
See definition of "CILA agency."
"Provider-owned or controlled."
A physical setting in which the individual resides that is:
owned, co-owned, leased or rented by an
agency that provides Home and Community-Based Services; or
owned, co-owned, leased or rented by a
third party that has a direct or indirect financial relationship with an agency
that provides Home and Community-Based Services.
"Provider Support Team." A team consisting of the
QIDP and a DSP; a nurse, or other professional staff (such as occupational
therapist or speech therapist) when necessary, and other staff as consistent
with the individual’s Personal Plan and Implementation Strategy, all of whom
directly serve the individual.
"Psychotropics."
Drugs used for antipsychotic, antidepressant, antimanic and/or antianxiety
purposes as listed in the American Hospital Formulary Services (AHFS) Drug
Information Manual (American Society of Health-System Pharmacists, 7272
Wisconsin Avenue, Bethesda MD 20814 (2018)) (AGENCY NOTE: This document is
published annually and updated quarterly.); the Physician's Desk Reference
(PDR) (Medical Economics Company, Five Paragon Drive, Montvale NJ 07645-1742 (2017))
(AGENCY NOTE: This document is published annually.); and the Drug Facts and
Comparisons (Facts and Comparisons, 111 West Port Plaza, Suite 300, St. Louis
MO 63146-3098 (2017)) (AGENCY NOTE: This document is published annually and
updated monthly.).
"Qualified
Intellectual Disabilities Professional" or "QIDP". A QIDP must
have at least one year of experience working directly with individuals with
intellectual disabilities or other developmental disabilities and be one of the
following (42 CFR 483.430):
a doctor of medicine or osteopathy
licensed pursuant to the Medical Practice Act of 1987 [225 ILCS 60];
a registered professional nurse
licensed pursuant to the Nurse Practice Act [225 ILCS 65];
an occupational therapist or
occupational therapist assistant certified by the American Occupational Therapy
Association or other comparable body pursuant to the Illinois Occupational
Therapy Practice Act [225 ILCS 75];
a physical therapist certified by
the American Physical Therapy Association or other comparable body pursuant to
the Illinois Physical Therapy Act [225 ILCS 90];
a physical therapist assistant registered
by the American Physical Therapy Association or a graduate of a two-year
college-level program approved by the American Physical Therapy Association or
comparable body;
a psychologist with at least a
master's degree in psychology from an accredited school pursuant to the
Clinical Psychologist Licensing Act [225 ILCS 15];
a social worker with a bachelor's
degree from a college or university or graduate degree from a school of social
work accredited or approved by the Council on Social Work Education or another
comparable body, pursuant to the Clinical Social Work and Social Work Practice
Act [225 ILCS 20];
a speech-language pathologist or
audiologist with a certificate of Clinical Competence in Speech-Language
Pathology or Audiology granted by the American Speech Language Hearing
Association or comparable body or meeting the education requirements for
licensure and being in the process of accumulating the supervised experience
required for licensure pursuant to the Illinois Speech-Language Pathology and
Audiology Practice Act [225 ILCS 110];
a professional recreation staff
person with a bachelor's degree in recreation or in a specialty area such as
art, dance, music, or physical therapy;
a professional dietician
registered by the American Dietetic Association; or
a human
services professional with a bachelor's degree in a human services field,
including but not limited to sociology, special education, rehabilitation
counseling and psychology.
"Quality
assurance." A systematic and objective approach to monitoring and
evaluating the appropriateness, adequacy and quality of services and supports
that enable individuals with a developmental disability to achieve defined
outcomes in their lives.
"Quality
assurance review." A BQM process to determine the degree of compliance
with quality assurance requirements in this Part that a CILA agency has
maintained. This can include reviewer observation and an on-site, desk audit,
remote or virtual form of examination of the following: policies, procedures,
records of individuals, written Personal Plan and Implementation Strategies.
Reviewers shall use an instrument containing national indicators to interview
individuals and employees. Observation of a sample of individuals, drawn from
across CILA sites statewide, is also a part of the review.
"Relative."
Spouse, parent, stepparent, son, daughter, brother, sister, stepbrother,
stepsister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin,
or any such person denoted by the prefix "grand" or "great"
or the spouse of any of the persons specified in this definition.
"Relief."
A paid service for caregivers that provides support to individuals with
developmental disabilities in host family living arrangements. Relief services
enable the caregivers to have free time apart from the individuals with
developmental disabilities.
"Remote
Monitoring and Supports." The use of electronic interactive technology (e.g.,
a device, a product, or system) to provide supports and services, absent of
direct care staff, in accordance with the Health Care Affordability Act [305
ILCS 5/12-21.21]. Remote monitoring and supports are meant to increase
independence and daily living skills of individuals.
"Residence."
See "living arrangement."
"Respite."
Services provided to individuals who are unable to care for themselves,
furnished on a short-term basis due to the absence of or need for relief of
those persons normally providing care.
"Restraint."
The direct restriction through mechanical means or personal physical force
of the limbs, head, or body of an individual except as part of a medically
prescribed procedure for the treatment of an existing physical disorder or the
amelioration of a physical disability. The partial or total immobilization
of an individual for the purpose of performing a medical or surgical procedure
shall not constitute restraint. Momentary periods
of physical restriction by direct person-to-person contact, without the aid of
material or mechanical devices, accomplished with limited force, and that are
designed to prevent an individual from completing an act that would
result in potential physical harm to the individual or another shall not
constitute restraint, but shall be documented in the individual’s record.
[405 ILCS 5/1-125]
"Seclusion."
Sequestration by placement of an individual alone in a room from
which he or she has no means of leaving; seclusion is prohibited. [405
ILCS 5/1-126]
"Secretary."
The Secretary of the Department or their designee.
"Self-administration
of medications." An individual with a developmental disability's ability
to correctly take prescribed medications independently or has been assessed and
determined to be independent in accordance with 59 Ill. Adm. Code 116.
"Substantial
compliance." An evaluation result that determines that a surveyed program
meets the requirements set forth in this Part sufficiently to be at a Level 1
or 2, as described in Section 115.440, and in good standing.
"Support
Services Team" or "SST". Contracted entities that provide an interdisciplinary technical assistance and
training response to persons with a developmental disability in a medical or
behavioral situation that challenges their ability to live and thrive in the
community.
"Survey"
or "licensure and certification survey." A process to determine the
degree of compliance with this Part that a CILA agency has maintained. This
includes surveyor observation and an on-site, desk audit, remote, or virtual examination
of the following: policies, procedures, records of individuals, written Personal
Plan and Implementation Strategies, and the physical plant. Interviews of
individuals and employees and observation of a sample of CILA sites are also a
part of the survey.
"Tardive
dyskinesia." An abnormal involuntary movement disorder associated with the
long-term use of antipsychotic medications. It may be persistent or transient
and is characterized by a variable mixture of facial, ocular, oral, lingual,
truncal or limb movements.
"Time-out."
Contingent removal from a situation in which reinforcement occurs into a
situation from which reinforcement does not occur, for a reasonable period of
time; time-out is prohibited.
"Treatment."
An effort to accomplish an improvement in the mental condition or related
behavior of an individual. Treatment includes, but is not limited to,
hospitalization, partial hospitalization, outpatient services, examination,
diagnosis, evaluation, care, training, psychotherapy, pharmaceuticals, and
other services provided for individuals by mental health agencies or
psychiatric hospitals. [405 ILCS 5/1-128]
"Volunteer."
An unpaid person whose activities (e.g., helping with yardwork, assisting in
recreational activities, teaching a cooking or yoga class) are organized and
supervised by the CILA agency to supplement the services the CILA agency
provides or other activities designated by the CILA agency.
"Waiver."
An action by the Department in which exceptions to this Part are granted on
application by a CILA agency for a period not to exceed the duration of the
current license. Waivers may be granted only for that which is allowable under
this Part.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.130 RATE COMPONENTS
Section 115.130 Rate Components
The components of Department reimbursement for CILA services
for persons with developmental disabilities may include, but shall not be
limited to, the following, using costs as reported on the Consolidated
Financial Report, or its successor, and other sources as deemed appropriate by
the Department:
a) Base
support costs may include allowances for "room and board",
"program", "transportation", and
"administration". Base support costs are considered to be those that
are incurred in the delivery of CILA supports to individuals with developmental
disabilities for the purchase of services that are common to all individuals
receiving CILA services.
1) Room
and board cost centers
The "room and board"
allowance includes costs incurred in keeping a home in normal operation. Cost
centers under the room and board major allowance category may include:
A) Housing;
B) Utilities;
C) Telecommunications;
D) Building
and Property Insurance;
E) Maintenance
and Housekeeping;
F) Food
Supplies;
G) Nonfood
Supplies; and
H) Other,
not elsewhere classified.
2) Program
cost centers
The program allowance includes
costs incurred in providing habilitation services and supports to the extent
allowed by the CILA rate model. Cost centers under the program major category
may include:
A) Direct
care staff and supervision;
B) Fringe
benefits;
C) Other
supplies;
D) Miscellaneous
consultant services;
E) Program
support cost; and
F) Occupancy
factor.
3) Transportation
Transportation cost may be incurred
while CILA providers assist and/or train the persons living in the CILA home in
the activities of daily living.
4) Administration
All administrative costs
associated with CILA agency overhead expenses as they relate to the delivery of
CILA services are included within the "administration" cost center
reimbursement. CILA agency overhead is assumed to include all the costs
associated with administrative staff, administrative clerical staff, office
space costs, office operating expenses, insurance, management consultants,
accounting, the cost of hiring staff, staff physical examinations, staff travel
and training, conferences, conventions, association fees, and all other costs
incurred in the overhead associated with the delivery of CILA services.
b) Non-base
support costs are expenses incurred due to the special added services required
by specific persons living in CILAs to the extent allowed by the CILA rate
model. Non-base supports can include other individually required supports such
as additional staffing, nursing, special dietary needs, and therapies.
Non-base support awarded as billable supports or additions to the rate
generated by the CILA rate model must be indicated as necessary by the CILA
agency and ISC agency, are not common to all individuals residing in CILAs, and
may be required more intensely soon after an individual moves into a CILA, with
decreasing need for them over time. Department staff review all requests for
individual non-base supports and must approve any reimbursements added to an
individual's CILA rate or awarded as billable supports. The need for non-base
support hours must be periodically (at least annually) reviewed by professional
assessment; the individual’s assessment results shall be reported to the
Department for its review and decision making regarding a continued need for
non-base support hours.
c) An
individual CILA rate does not include costs associated with providing day
programs to individuals living in CILAs. All day program authorizations the
individual is approved for must be billed as a separate service or support.
d) Third
party payment information concerning an individual's unearned income is
obtained from the Reporting of Community Services (ROCS) System and used to
calculate the third-party payment. The third-party payment may be subtracted
from the top line rate to produce the bottom-line rate, or the rate paid by the
Department to the community CILA agency.
e) DDD
may develop, implement, and modify different CILA rate methodologies for different
types of CILA services and supports.
(Source: Added at 47 Ill. Reg. 8485,
effective May 31, 2023)
SUBPART B: SERVICE REQUIREMENTS
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.200 DESCRIPTION
Section 115.200 Description
a) A CILA is a residence where an individual with developmental
disabilities may reside and receive services and supports coordinated by a
licensed CILA agency as outlined in their Personal Plan and Implementation
Strategy. The individual or guardian actively participates in choosing CILA
services and in choosing a home from among those available to the general
public and/or housing owned or controlled by a CILA agency.
b) CILA
agencies shall comply with Person-Centered Planning requirements outlined in 42
CFR 441.301(c)(1) through (c)(3); 59 Ill. Adm. Code 120; Section 115.230; the
provider agreement; and attachments to the provider agreement.
c) CILAs
shall comply with 42 CFR 441.301(c)(4), which specifies settings requirements
for individuals receiving services through the Medicaid HCBS Waiver. CILA
settings shall have all of the following qualities, and other qualities as
determined to be appropriate, based on the needs of the individual as indicated
in their Personal Plan. A CILA setting and/or services shall:
1) Be integrated in, and support full access of individuals
receiving Medicaid HCBS to, the greater community, including opportunities to:
A) engage in community life to the extent chosen by the
individual;
B) control personal resources; and
C) receive services in the community to the same degree of access
as individuals not receiving Medicaid HCBS;
2) Ensure
an individual's rights of privacy, dignity, and respect;
3) Ensure
freedom from coercion and restraint (except as specified in Section 115.245);
4) Optimize,
but not regiment, individual initiative, autonomy, and independence in making
life choices, including but not limited to, daily activities, physical
environment, and with whom to interact; and
5) Facilitate
individual choice, with the assistance of an ISC agency, regarding services and
supports and who provides them.
d) A
provider-owned or controlled living arrangement shall also meet the following
additional conditions:
1) Be a
specific physical place that can be owned, rented, or occupied under a legally
enforceable agreement, as determined by the Department and by the individual
receiving services. The individual shall have, at a minimum, the same
responsibilities and protections from eviction that tenants have under the
landlord/tenant law of the State, county, city, or other designated entity. For
settings in which landlord/tenant laws do not apply, the State must ensure that
a lease, residency agreement or other form of written agreement, as determined
by the Department, will be in place for each HCBS participant, and that the
document provides protections that address eviction processes and appeals
comparable to those provided under the jurisdiction's landlord tenant law.
2) Each
individual shall have privacy in their living arrangement:
A) Entrance
doors shall be lockable by the individual, with only the individual and
appropriate staff having keys to doors.
B) Individuals
sharing living arrangements shall have a choice of roommates in that setting.
C) Individuals
shall have the freedom to furnish and decorate their living arrangements within
the lease or other agreement.
3) Individuals
shall have the freedom and support to control their own schedules and
activities and have access to food at any time.
4) Individuals
shall be able to have visitors of their choosing at any time.
5) The setting shall be physically accessible to the
individual. All communal areas must meet standards set forth by the Americans
with Disabilities Act (ADA) and other federal, State, or municipal
regulations. CILA providers must ensure sites are certified and have capacity
for individuals who use wheelchairs or other mobility devices before offering
placement. The capacity for individuals who use wheelchairs or other mobility
devices is indicated in the certification letter given to each CILA provider by
the Department for every site.
6) Any
modification of the additional conditions under subsections (d)(1) through (5)
must be supported by a specific assessed need and justified in the Personal
Plan. The Personal Plan shall:
A) Identify
a specific and individualized assessed need.
B) Document
the positive interventions and supports used prior to any modifications to the
Personal Plan.
C) Document
less intrusive methods of meeting the need that have been tried but did not
work.
D) Include
a clear description of the condition that is directly proportionate to the
specific assessed need.
E) Include
regular collection and review of data to measure the ongoing effectiveness of
the modification.
F) Include
established time limits for periodic reviews to determine if the modification
is still necessary or can be terminated.
G) Include
the informed consent of the individual and guardian.
H) Include
an assurance that interventions and supports will cause no harm to the
individual.
e) CILA services are intended to promote the safety, well-being,
and involvement of the individual in community life.
f) CILA providers:
1) Shall thoroughly assess the needs of the individual to
determine if the provider's CILA setting and services are appropriate. No
otherwise qualified individual shall be denied placement in a CILA solely on
the basis of their diagnosis.
2) Shall assess their ability to serve individuals and shall not
deny placement unless and until the provider has worked with the Division to
explore all possible options and alternatives.
3) Must provide reasonable accommodations or modifications for
individuals who reside in the CILA home and require such accommodations or
modifications. Providers should access all available resources, including but
not limited to, home modifications available in the DD Adult waiver and
community resources.
g) Based on their needs, individuals shall receive supervision
and supportive services which may range from continuous to intermittent. A
CILA setting shall promote maximum independence, choice-making, access to the
community and skill building for each individual as indicated in their Personal
Plan.
h) The CILA agency shall request in writing to the Department for
approval to change the staffing model from the one funded and in use (e.g.,
from 24-hour-shift staff to host family home, or from 24-hour-shift staff to
intermittent supports), for a person receiving CILA service. The Department
shall review and act upon the request within 15 working days. The Department
shall make its decision based on the needs of the individuals receiving services
and the ability of the proposed staffing model to equally provide for their
needs.
i) Once accepted for service by a CILA agency, termination of
services may only occur pursuant to Section 115.215.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.205 RESPITE SERVICES FOR PERSONS WITH A DEVELOPMENTAL DISABILITY
Section 115.205 Respite Services
for Persons with a Developmental Disability
a) An individual with a developmental disability not currently
receiving CILA services may be considered for a short term stay of no more than
two consecutive weeks for respite services in an available CILA site only if:
1) The individual to be provided respite services meets the
eligibility criteria as defined in Section 115.210;
2) The space to be used does not cause the applicable CILA site
to exceed Department authorized physical capacity as defined by Section
115.300;
3) All individuals and/or guardians of the individuals residing
in the living arrangement support and understand to the best of their ability
the use of and the request for respite services;
4) Space used for respite services is not the space normally used
by anyone regularly receiving services at this CILA site who is temporarily
away;
5) The individual receiving respite services has bedroom space
available for their use; and
6) The CILA agency has a Residential Respite contract with the
Department.
b) Prior to accepting an individual for respite services, a CILA
agency will require that the individual have a physician statement that he or
she does not have any contagious disease. Additionally, the CILA agency will
document that the individual will not jeopardize in other ways the health and
safety of the individuals living there.
c) Requests for respite services needed for longer than two weeks
must be reviewed and approved by the Department prior to the end of the initial
two-week period. Such extensions will be considered only in emergency
situations.
d) Payment for respite services provided in CILA settings will be
determined case by case and will depend upon the needs of the individual and
the funding currently available for respite.
e) Guests (individuals not receiving CILA or respite services at
this location) of individuals living at the site may spend the night or weekend
if that is agreeable to all other individuals with whom the home is shared and
with appropriate arrangements by the CILA agency. Such guests shall not be
considered to be receiving respite services and shall not be subject to the
requirements of this Part.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.210 CRITERIA FOR PARTICIPATION OF INDIVIDUALS
Section 115.210 Criteria for
Participation of Individuals
a) An individual receiving services in a CILA shall be at least
18 years of age (unless the age waiver exception in subsections (b) and (c)
applies), have a developmental disability and be in need of CILA services and a
supervised living arrangement. If a CILA agency does not have the capacity to
accommodate the individual's particular type or level of disability, this does
not render the individual ineligible for CILA services.
b) CILA agencies can request an age waiver to allow individuals
who are at least 17.5, but not yet 18 years of age, to receive services in a
CILA. If a CILA agency requests an age waiver the CILA agency shall present in
writing to the Department its rationale for the waiver request and describe the
following:
1) the individual's level of functioning;
2) behavioral, medical, and/or mental health needs of the
individual;
3) the profiles of the other people currently residing in the
proposed setting (i.e., gender, ages, interests, peer group dynamics, level of
functioning, etc.);
4) other residential options that have been explored;
5) the education plan of the individual (i.e., will the
individual continue school);
6) crisis (homeless, abuse, neglect) status, if applicable; and
7) problems in the individual’s current placement, if applicable.
c) The Department will provide a written response to the waiver
request indicating approval or denial of the request. The provision of a
waiver does not constitute authorization of services.
d) The individual or guardian shall give informed consent to
participate in a CILA, which shall be documented in the individual's record.
e) The individual or guardian shall agree to participate in the
development of the Individual's Personal Plan as well as the development and provision
of an Implementation Strategy that corresponds with their Personal Plan.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.214 INDIVIDUALS REQUIRING ADDITIONAL SERVICES AND SUPPORT
Section 115.214 Individuals Requiring
Additional Services and Support
There are occasions when an
individual receiving CILA services requires additional services and support as
a result of changes in medical or behavioral health. Examples include, but are
not limited to, a gradual deterioration of health and/or behavioral stability
or a more recent acute medical condition and/or sudden intense behavioral
episodes. The CILA agency must take reasonable and appropriate action to
address and stabilize the individual's situation for the health and safety of
the individual and/or others.
a) When
an individual receiving CILA services requires additional services and support,
the CILA agency's Provider Support Team shall be convened. The CILA agency's
designated QIDP shall:
1) Convene a meeting including, but not limited to,
the individual, the individual's guardian, the Provider Support Team, relevant
staff as determined by the QIDP (e.g., CILA agency administrative leadership
staff, as necessary), and a representative of the ISC agency.
2) The
team will consider the current system of services and supports, including the
use of internal CILA agency resources, external consultants, and the
effectiveness of the current Personal Plan, Implementation Strategy, and other
service planning documents. The CILA provider must notify the ISC agency when
changes to the Personal Plan are needed.
A) If not
in place and indicated by the situation, a behavioral support strategy will be
developed to outline the plan of action. If there is a current behavior
support plan, it will be reviewed and revised as necessary.
B) If
complex medical conditions are a concern, the team will review the current
Personal Plan and Implementation Strategy to ensure needed medical services and
supports are in place.
C) The
team will determine whether the CILA agency will request additional staff
resources or other supports from DDD.
D) The
team will determine whether to request technical assistance, training, short-term residential
stabilization supports, or other necessary consultation from the Division.
E) Should
the team request additional staff resources or other supports as described in
subsection (a)(2)(C) – (D), the Department will respond to the request as soon
as possible but no later than ten business days following receipt of the
request.
b) The
steps outlined in subsection (a) must be followed by a CILA agency prior to
termination of its services (see Section 115.215), except as specified in 59
Ill. Adm. Code 120.110(i).
c) Following
the team meeting described in subsection (a)(1), it is expected that, after
additional staff resources and consultations have been implemented, at least 30
calendar days will be invested in determining the effectiveness of the behavior
support plan or medical services, including any relevant revisions, as well as
the benefit of any additional staff resources and consultations, before
recommending termination of the CILA agency's services. The 30 calendar days
do not include absences from the CILA for necessary medical or behavior-related
services.
(Source: Added at 47 Ill. Reg. 8485,
effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.215 CRITERIA FOR TERMINATION FROM A CILA AGENCY
Section 115.215 Criteria for
Termination from a CILA Agency
a) The community support team shall consider recommending
termination of CILA services of an individual only if:
1) The medical needs of the individual cannot be met by the CILA
program; or
2) The behavior of an individual places the individual or others
in serious danger; or
3) The individual is to be transferred to a program offered by
another agency and the transfer has been agreed upon by the individual, the
individual's guardian, the transferring agency, and the receiving agency; or
4) The individual no longer benefits from CILA services.
b) A notice of termination issued by a CILA provider must:
1) Be in writing;
2) Be sent to the Individual and guardian;
3) Include a time frame for the action;
4) Provide a clear statement of the action to be taken;
5) Provide a clear statement of the reason for the action; and
6) Include a complete statement of the Individual's right to
appeal, including the provider's grievance process.
c) Termination of services shall occur only if the termination
recommendation has been approved by the Department. For individuals enrolled
in the Department's Medicaid DDD Waiver, termination of services is subject to
review according to 59 Ill. Adm. Code 120. For individuals not enrolled in the
Department's Medicaid DDD Waiver, termination of services shall be addressed as
indicated in Section 115.250(c).
d) Absences.
Whenever
individuals are required to be absent from a living arrangement for an extended
period of time, a CILA agency shall not consider this absence as a reason for termination
of services. CILA providers shall protect individual’s rights as outlined in
Section 115.250(c) and are therefore prohibited from coercing, restricting, or
imposing any type of consequence on an individual who chooses to visit their
family, friends or other persons important to the individual as documented in
the individual’s Personal Plan and Implementation Strategy.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.220 SERVICES AND SUPPORTS
Section 115.220 Services and
Supports
a) The CILA agency shall develop and maintain a Provider Support
Team for each individual served. The makeup of the team shall include a QIDP and
a DSP; a nurse, or other professionals (such as occupational therapist or
speech therapist) when necessary; and other staff as consistent with the individual's
Personal Plan and Implementation Strategy. The provider support team shall:
1) Be responsible for all service functions required to support
the outcomes of that area of the individual's Personal Plan for which the CILA agency
has responsibility, including the development of the Implementation Strategy;
2) Provide care and supervision based on the known and assessed
needs of the individual;
3) Help the individual participate in an array of community
support services, as chosen by the individual and guardian tailored to their
needs;
4) In collaboration with the ISC, provide or arrange for direct
service in the community or in other facilities, such as State-operated
facilities, convalescent care facilities, community hospitals or rehabilitation
facilities, based on the assessed needs of the individual and when the
facilities permit;
5) Be available to support the individual on a 24-hour basis.
6) Advocate on behalf of individuals;
7) Assist individuals to obtain and maintain safety and basic
comforts within the CILA setting;
8) Provide on-going services to ensure the maintenance of the
individual's living arrangement during times of absence, such as paying the
rent and utilities;
9) Assist the individual in developing community supports and
relationships as indicated in their Plan, with non-paid persons in the
community, e.g., neighbors, volunteers, and landlords;
10) Provide personal support and assistance to the individual in
gaining access to vocational training, employment opportunities, educational
services, legal services, and leisure recreational, religious, and social
activities as indicated in their Plan;
11) Provide assistance to the individual in obtaining health (including
dietary) and dental services, mental health treatment and rehabilitation
services (including physical therapy and occupational therapy), and substance
abuse services, as needed;
12) Provide supportive counseling and problem-solving assistance
on an on-going basis and at times of crisis, as needed;
13) Assist individuals with activities of daily living through
skill training and acquisition of assistive devices, as needed;
14) Assist the individual in accessing medication information
including observing and reporting effects and side effects of prescribed
medications, as needed;
15) Provide assistance, as needed, in money management. This can
include representative payeeship and protecting individual funds. The CILA
provider may accept funds from an individual for safekeeping and
management if the service provider receives written authorization from the individual
or the individual's guardian, as applicable. The CILA
provider shall maintain a written record that shall include, but not be
limited to, all financial arrangements and transactions involving each
individual recipient's funds. The CILA provider shall allow each individual
and guardian access to that written record [210 ILCS 135/9.1];
16) Assist individuals to access transportation, as needed;
17) Provide access to sex education,
related resources and services that
supports an individual's right to sexual health and healthy sexual practices
and to be free from sexual exploitation and abuse. The individual
shall be assessed on whether he or she has decision making capacity to give
consent to sexual activity; and for developmentally appropriate sex
education materials and resources. Course
material in sex education must be approved by the Department prior to
implementation [405 ILCS 5/4-211].
b) The CILA agency shall remain responsible for ensuring the
quality of services it provides and the protection of the individual's rights
as enumerated in Section 115.250.
c) A QIDP shall be designated for each individual and shall, in
conjunction with the Provider Support Team:
1) Develop the initial Implementation Strategy, using Form
IL462-4470 provided by the Division, within 20 calendar days of the CILA
provider's dated signature on the Personal Plan and update the Implementation
Strategy at least annually as the Personal Plan is modified, or more often if
warranted by a change in functional status or at the request of the individual
or guardian;
2) Explain all rights enumerated in Section 115.250 and document
in the individual's record that this has been done upon the individual's entry
into a CILA;
3) Ensure that the services specified in the Implementation
Strategy are being provided;
4) Coordinate employees, other professionals, and any other
person, compensated or in a volunteer capacity, to implement the Implementation
Strategy;
5) Identify and address gaps in the Implementation Strategy;
6) Identify and inform the ISC agency of potential needed changes
to the Personal Plan;
7) Monitor the individual's status in relation to the Implementation
Strategy;
8) Advocate for the individual's rights and services;
9) Ensure that information specified by the Personal Plan is included
in the individual's record;
10) Ensure availability of a written Personal Plan and
Implementation Strategy to the Provider Support Team members; and
11) Work with the individual and/or guardian to address issues
that must be resolved or bought to the attention of the team by the individual
and/or guardian.
d) A mental health professional may provide all services
identified in subsections (b)(2) through (11) of this Section.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.225 ASSESSMENTS
Section 115.225 Assessments
The CILA agency shall ensure that each individual receives
an initial assessment and reassessments that shall be documented in the
individual's record, and the results shall be explained to the individual
and/or guardian. Valid assessments described in this Section and made
available from the ISC agency do not have to be duplicated.
a) Assessments
shall be performed by employees trained in the use of assessment instruments.
b) Through
the selection of the assessment instruments and the interpretation of results,
all assessments shall be sensitive to the individual's:
1) Racial,
ethnic, and cultural background;
2) Chronological
and developmental age;
3) Visual
and auditory impairments;
4) Language
preferences; and
5) Degree
of disability.
c) Initial
assessment for individuals with a developmental disability shall include:
1) A
physical and dental examination, both within the last 12 months, which shall
include a medical history;
2) Previous
and current adherence to medication regimen and the level of ability to
self-administer medications or participate in a self-administration of
medication training program;
3) A
screen for any health issues or risks. Each individual shall be assessed via a
web-based, electronic screening tool identified by the Department; A CILA
provider may make a request, along with justifications, to the Department to
complete the assessment on paper;
4) A
psycho-social assessment including legal status, personal and family history, a
history of mental illness or developmental disability and related services,
evaluation of possible substance abuse, and resource availability such as
income entitlements, health care benefits, subsidized housing, and social
services;
5) The Inventory for Client and Agency Planning
(ICAP);
6) A psychological assessment; in addition, a
psychiatric assessment must be conducted if the individual takes psychotropic
medications;
7) A
screening in vision, hearing, speech, and language; and
8) Other
assessments as required by the individual's disability, such as physical
therapy, occupational therapy, activity therapy, and sign language.
d) Annual
reassessments for individuals with a developmental disability shall include:
1) A
physical and dental examination, including a review of medications;
2) The
ICAP;
3) An
annual psychiatric examination for individuals with a mental illness;
4) An
annual assessment to screen individuals for any health issues or risks via a
web-based, electronic screening tool as identified by the Department. A CILA
provider may make a request, along with justifications, to the Department to
complete the assessment on paper.
(Source: Added at 47 Ill. Reg. 8485,
effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.230 PERSON-CENTERED PLANNING
Section 115.230 Person-Centered
Planning
a) CILA agencies licensed to provide CILA services shall comply
with Person-Centered Planning requirements as outlined in 42 CFR 441.301(c)(1)
through (c)(3) and in 59 Ill. Adm. Code 120.
b) CILA agencies licensed to provide CILA services shall
comprehensively address the needs of individuals through the development of an
Implementation Strategy for each individual as it relates to their Personal
Plan.
1) Within 20 calendar days of the provider's dated signature on
the Personal Plan, an Implementation Strategy using Form IL462-4470 provided by
the Division, shall be developed that:
A) Is based on the Personal Plan developed by the ISC agency and assessment
results;
B) Includes the participation of the individual and guardian and
the ISC as necessary;
C) Reflects the individual's and guardian's agreement as indicated
by a signature on the Implementation Strategy;
D) Addresses outcomes identified in the Personal Plan that the
CILA agency agreed to support; and
E) Identifies services and supports to be provided by the CILA
agency that agreed to support the individual to attain skills or achieve
outcomes identified in the Personal Plan.
2) The individual and guardian shall be given a copy of the Implementation
Strategy and subsequent updates.
3) The Implementation Strategy and subsequent updates shall
become a part of the individual's record.
4) At least monthly, the QIDP shall review the Implementation
Strategy and shall document in the individual's record whether:
A) Services are being implemented as identified in the
Implementation Strategy;
B) Services identified in the Implementation Strategy continue to
meet the individual's needs or require modification or change to better meet
the individual's needs;
C) Outcomes
are being supported as specified in the Personal Plan and Implementation
Strategy; and
D) Progress is being made toward outcomes as identified in the
Personal Plan and Implementation Strategy. If there is no progress made, CILA
agencies must document barriers and/or reasons why progress was not made.
5) The QIDP shall sign and date the monthly record.
6) Updates shall be made to the Implementation Strategy as the Personal
Plan is modified, or more often if warranted by a change in functional status
or at the request of the individual or guardian. CILA agencies must provide
the individual, guardian, and ISC with updated copies of the Implementation
Strategy.
7) All services specified in the Implementation Strategy, whether
provided by an employee of the licensed CILA agency, consultants, volunteers, or
sub-contractors, shall be provided by or under the supervision of a QIDP, as
appropriate, based on the individual's primary disability.
8) The CILA agency must ensure that current copies (digital or
paper) of individuals' Personal Plans and Implementation Strategies are kept at
the individuals' residences. The CILA agency must also ensure that DSPs
(including employees, contractual persons, volunteers and host family members)
are knowledgeable about the individuals' Personal Plans and Implementation
Strategies, are trained in their implementation, and maintain records regarding
the individuals' progress toward the outcomes identified in the Personal Plans
and Implementation Strategies.
9) The Provider Support Team, with concurrence by the ISC agency,
shall be responsible for determining an individual's ability to transition from
continuous supervision or support to an intermittent level of supervision or
support.
A) If a determination is made that the individual is appropriate
for a less restrictive environment, documentation shall be included in the
individual's Personal Plan identifying time frames for transition. The Implementation
Strategy shall be modified in accordance with the Personal Plan changes. The
QIDP shall be responsible for monitoring the individual's transition and for
documenting the individual's progress toward intermittent supervision and
supports.
B) If a determination is made that an individual with a
developmental disability is appropriate for intermittent supervision and
supports, the ISC agency in conjunction with the CILA agency must submit a
completed CILA rate determination packet to the Department for development of a
rate to support the intermittent supervision and supports.
10) An individual who requires continuous supervision or support,
as indicated by the Personal Plan and Implementation Strategy, may stay alone
or access the community independently under specific circumstances.
A) The provider support team must assess whether the individual
has the ability and desire to stay alone safely for brief periods of time, or
access specified locations in the community independently, or with supervision
and support other than that provided by CILA agency employees. This should
occur only as part of the individual’s needs and preferences and not to
accommodate staffing concerns or convenience.
B) The Implementation Strategy must state the periods of time and
restrictions on activities when at home, and locations and time frames for accessing
the community.
C) The CILA agency must document the results of the assessment regarding
the individual's skills necessary to ensure their safety, and this must be part
of the individual's record. The CILA provider shall also provide the assessment
results to the ISC responsible for updating the Personal Plan.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.240 MEDICAL SERVICES AND MEDICATIONS
Section 115.240 Medical Services
and Medications
When medical services and/or
medications are provided, or their administration is supervised, by employees
of the licensed CILA agency, the licensed CILA agency shall certify that they
are provided or their administration is supervised in accordance with the Mental
Health and Developmental Disabilities Administrative Act [20 ILCS 1705] and the
Illinois Nurse Practice Act [225 ILCS 65]. The licensed CILA agency must comply
with 59 Ill. Adm. Code 116. The CILA agency shall additionally document:
a) A licensed physician (MD or DO) shall be responsible for
medical services, including prescription of medications.
b) A physician shall perform an examination of the individual
prior to the initiation of psychotropic medications.
c) Screening, using the AIMS (Abnormal Involuntary Movement
Skills), for and documentation of abnormal involuntary movements, including
tardive dyskinesia, in individuals receiving prescribed psychotropics shall be
completed at least every six months by the prescribing clinician or employees
trained in performing this type of assessment.
d) A physician shall review the medications prescribed and shall
see the individual at least every six months, and more frequently if required
by a psychiatrist. Physician documentation within the individual's record shall
include, but is not limited to, the following:
1) Rationale for continuing current medications and/or initiating
new medications; and
2) Medication side effects.
e) A licensed medical professional must evaluate the ability of
the individual to self-administer medication. Ability to self-administer
medication must be reassessed at least annually. Individuals with
developmental disabilities must be evaluated using Department approved
screening and assessment tools, in accordance with 59 Ill. Adm. Code 116.
f) A medical professional who is licensed to prescribe
medications will either review psychotropic medications or be available for
consultation when psychotropic medications have been prescribed.
g) All medications shall be labeled.
h) A physician or pharmacist shall make available to the CILA
agency's nurse and administrative staff, and to the individual and family,
information on expected consequences, potential benefits, and side effects of
any prescribed medication.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.245 RESTRAINTS
Section 115.245 Restraints
a) The
following types of restraint are prohibited. If any of the following types of restraint
are utilized by a CILA agency employee, the incident must be reported via CIRAS
as well as reported to the Office of the Inspector General.
1) Prone
restraint (i.e., being restrained, face down against the floor or another
surface).
2) Supine
restraint (i.e., being restrained, face up).
3) Mechanical
restraint. Mechanical restraint does not include any restraint used to treat an
individual's medical needs; protect an individual known to be at risk of injury
resulting from lack of coordination or frequent loss of consciousness; provide
a supplementary aid or service or an accommodation, including, but not limited
to, assistive technology that provides proprioceptive input or aids in
self-regulation; or promote individual safety in vehicles used to transport
individuals.
4) Chemical
restraint is prohibited. Chemical restraint does not include medication that is
legally prescribed and administered as part of an individual’s regular medical
regimen including PRN medication, to manage behavioral symptoms and treat
medical symptoms.
b) Restraint
identified in the Personal Plan.
1) Restraint
shall be used only when:
A) The
individual’s behavior presents an immediate threat of serious physical harm to
the individual or others and other less restrictive and intrusive measures have
been tried and proven ineffective in stopping the immediate threat of serious
physical harm;
B) It is
included as a modification in an individual’s Personal Plan;
C) The
use of restraint has been discussed and approved for inclusion in the
individual’s Personal Plan by the individual or guardian and the Provider
Support Team;
D) It is
included in the individual’s behavior strategy;
E) The
use of restraint has gone through the Behavioral Management Committee/Human
Rights Committee for approval;
F) The
inclusion of restraint in the individual’s Personal Plan and behavior strategy
must include a plan to reduce and ultimately eliminate the use of restraint, as
appropriate;
G) The
staff applying the restraint have been trained in the use of restraint, as
described below, as well as the specific type of the restraint to be used on
the individual;
H) The
CILA agency has reviewed, determined, and documented that there are no known
medical or psychological limitations that contraindicate the use of the restraint;
and
I) The
CILA agency has included in the individual rights documentation, information on
the CILA agency’s policies and procedures for the use of restraint and this
information has been shared with the individual and guardian.
2) Restraint
shall not be used as discipline or punishment, convenience for staff,
retaliation, a substitute for appropriate physical or behavioral support, a
routine safety matter, or to prevent property damage in the absence of an
immediate threat of serious physical harm to the individual or others.
3) Restraint
must end immediately when:
A) The
immediate threat of serious physical harm ends;
B) The
individual indicates that they cannot breathe or staff supervising the
individual recognizes that they may be in respiratory distress; or
C) The
time period of 15 minutes has expired, unless approved in the individual’s
Personal Plan or a supervisor has approved the instance of the restraint going
beyond 15 minutes.
4) Restraint
must be implemented in the following manner:
A) CILA
agency staff must observe and monitor the individual being physically restrained
at all times during the use of restraint.
B) The
staff involved in physically restraining an individual must halt the restraint
every 5 minutes to evaluate if the immediate threat of serious physical harm
continues to exist. If the immediate threat of serious physical harm continues
to exist, staff may continue to use the restraint and the continued use may not
be considered a separate instance of restraint so long as the total time period
of the restraint does not exceed 15 minutes.
C) An
individual shall be released from the restraint immediately upon a
determination by the staff member administering the restraint that the
individual is no longer an immediate threat of causing serious physical harm to
themselves or others.
D) The restraint
shall not impair an individual’s ability to breathe or communicate normally,
obstruct an individual’s airway, or interfere with an individual’s ability to
speak. If the restraint is imposed upon an individual whose primary mode of
communication is sign language or an augmentative mode, the individual shall be
permitted to have their hands free of restraint for brief periods, unless the
supervising staff determines that this freedom appears likely to result in harm
to the individual or others.
5) Reporting
requirements. When restraints are used, the CILA agency shall:
A) Create
a report specifying why and how the restraint was used. The report shall be
included in the individual’s file and be available for assessment by the Bureau
of Quality Management during a CILA agency’s review.
B) Review
the use of any incident of restraint via the Human Rights Committee.
C) Report
the incident to the CILA agency Executive Director/Chief Executive Officer.
D) Notify
the individual’s guardian no later than 24 hours after any incident of restraint
occurs.
c) Restraint
not identified in the Personal Plan.
1) Restraint
not identified in the Personal Plan occurs when the requirements of subsection
(a) are not in place prior to the use of restraint. Restraint not identified
in the Personal Plan:
A) Shall
be used only when the individual’s behavior presents an immediate threat of
serious physical harm to the individual or others, the CILA agency deems the
situation an emergency, and other less restrictive and intrusive interventions
have been tried and proven ineffective in stopping the immediate threat of
serious physical harm.
B) Shall
not be used as discipline or punishment, convenience for staff, retaliation, a
substitute for appropriate physical or behavioral support, a routine safety
matter, or to prevent property damage in the absence of immediate threat of
serious physical harm to the individual or others.
2) The
use of restraint not identified in the Personal Plan shall be subject to the
following requirements and limitations:
A) Restraint
not identified in the Personal Plan may only be employed when:
i) The
staff applying the restraint not identified in the Personal Plan have been
trained in the use of restraint;
ii) The
CILA agency assessed the medical and psychological welfare of the person and there
are no known medical or psychological limitations that contraindicate the use
of the restraint; and
iii) The
CILA agency has included, in the individual rights documentation, information
on the CILA agency’s policies and procedures for the use of restraint and this
information has been shared with the individual and guardian.
B) Restraint
not identified in the Personal Plan must end immediately when:
i) The
immediate threat of serious physical harm ends;
ii) The
individual indicates that they cannot breathe or staff supervising the
individual recognizes that they may be in respiratory distress; or
iii) The
time period of 15 minutes has expired, unless a supervisor has approved the
instance of the restraint going beyond 15 minutes.
C) Restraint
not identified in the Personal Plan must be employed as follows:
i) CILA
agency staff must observe and monitor the individual being physically restrained
at all times during the use of restraint.
ii) The
staff involved in physically restraining an individual must halt the restraint
every 5 minutes to evaluate if the immediate threat of serious physical harm
continues to exist. If the immediate threat of serious physical harm continues
to exist, staff may continue to use the restraint not identified in the
Personal Plan and the continued use may not be considered a separate instance
of restraint not identified in the Personal Plan so long as the total time
period of the restraint not identified in the Personal Plan does not exceed 15
minutes.
iii) An
individual shall be released from the restraint not identified in the Personal
Plan immediately upon a determination by the staff member administering the restraint
not identified in the Personal Plan that the individual is no longer an
immediate threat of causing serious physical harm to themselves or others.
iv) The restraint
not identified in the Personal Plan shall not impair an individual’s ability to
breathe or communicate normally, obstruct an individual’s airway, or interfere
with an individual’s ability to speak. If the restraint not identified in the
Personal Plan is imposed upon an individual whose primary mode of communication
is sign language or an augmentative mode, the individual shall be permitted to
have their hands free of restraint for brief periods, unless the supervising
staff determines that this freedom appears likely to result in harm to the
individual or others.
v) After
restraint not identified in the Personal Plan has been used, the CILA agency
shall work with the ISC to determine whether restraint should be included in
the individual’s Personal Plan and behavior strategy moving forward.
D) Reporting
requirements. In incidents of restraint not identified in the Personal Plan,
the CILA agency shall:
i) Create
a report on the use of restraint not identified in the Personal Plan. The
Report shall be included in the individual’s file and be available for
assessment by the Bureau of Quality Management during a CILA agency’s review.
ii) Review
any use of restraint via the Human Rights Committee.
iii) Report
the incident to the CILA agency Executive Director/Chief Executive Officer.
iv) Send
a report of each incident of restraint not identified in the Personal Plan via
a report from the Critical Incident Reporting and Analysis System (CIRAS). BQM
will send all incidents of restraint not identified in the Personal Plan to the
Director of DDD or their designee.
v) Notify
the individual’s guardian no later than 24 hours after any incident of restraint
not identified in the Personal Plan occurs.
d) All
CILA agency employees are required to receive the following:
1) Developmentally
appropriate training at hire and annually thereafter, that shall include, but
not be limited to:
A) Crisis
de-escalation;
B) Trauma-informed
practices;
C) Behavior
management practices; and
D) Alternatives
to the use of restraint.
2) If
the CILA agency is utilizing restraint, the CILA staff should receive
developmentally appropriate training at hire and annually thereafter, that
shall include, but not be limited to:
A) Restraint
techniques;
B) Restrictive
interventions;
C) Restorative
practices; and
D) Identifying
signs of distress during restraint.
3) If
CILA agency staff are involved in restraint not identified in the Personal
Plan, the CILA agency may require them to complete remediation training on restraint.
4) A
copy of the CILA agency’s policies on the use of restraint.
e) Any
individual, guardian, organization, or advocate may file a signed, written
complaint with the Director of the Division of Developmental Disabilities,
alleging that the CILA agency serving the individual has violated this Section.
(Source: Added at 47 Ill. Reg. 8485,
effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.250 INDIVIDUAL RIGHTS AND CONFIDENTIALITY
Section 115.250 Individual Rights
and Confidentiality
a) The CILA agency shall share a copy and explain the contents of
the most current Rights of Individuals form (IL 462-1201) with the individual
and/or guardian when an individual enters the CILA and annually thereafter.
1) The rights of individuals shall be protected in accordance
with Chapter II of the Code except that the use of seclusion will not be
permitted.
2) The right of individuals to confidentiality shall be governed
by the Mental Health and Developmental Disabilities Confidentiality Act.
3) Every individual and/or guardian has the right to:
A) Remain in a CILA unless the individuals voluntarily withdraw or
meet the criteria set forth in Section 115.215;
B) Contact the Guardianship and Advocacy Commission, Equip for
Equality, Inc., the Department's Office of Inspector General, the CILA agency's
human rights committee and the Department. Employees shall offer assistance to
individuals in contacting these groups giving each individual the address and
telephone number of the Guardianship and Advocacy Commission, the Department's
Office of Inspector General, the Department, and Equip for Equality, Inc.;
C) Be free from abuse, neglect, exploitation, coercion, and restraint.
Restraint is not permitted unless it follows the requirements specified in
Section 115.245. Seclusion, time-out, aversive procedures, or any similar
actions are prohibited.
4) Individuals or guardians shall be permitted to purchase and
use the services of private physicians and other mental health and
developmental disabilities professionals of their choice, which shall be
documented in the plan.
b) Provider advisement of the individual's rights and
justification for any restriction of individual rights shall be documented in
the individual's record. For individuals in the Medicaid HCBS Waiver, any
modification of additional conditions that restrict an individual’s rights related
to provider-owned or controlled living arrangement must be supported by a
specific assessed need, be justified in the Personal Plan, and be documented in
the Personal Plan as specified in subsection 115.200(c)(7)(F)(i) through
(viii).
c) Individuals or guardians shall be permitted to present
grievances and to appeal adverse decisions of the CILA agency and other service
providers up to and including the authorized CILA agency representative. The CILA
agency representative's decision on the grievance shall be subject to review in
accordance with the Administrative Review Law [735 ILCS 5/Art. III]. For all
individuals enrolled in the DDD Medicaid HCBS Waiver, their rights to notices
of action, appeals and fair hearings are detailed in 59 Ill. Adm. Code 120.
d) Individuals shall not be denied, suspended, or terminated from
services or have services reduced for exercising any of their rights.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
SUBPART C: GENERAL AGENCY REQUIREMENTS
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.300 ENVIRONMENTAL MANAGEMENT OF LIVING ARRANGEMENTS
Section 115.300
Environmental Management of Living Arrangements
a) For individuals who receive intermittent supervision and
supports and choose to reside with their families or in living arrangements
owned or leased by the individuals living there, the licensed CILA agency shall
assist individuals in obtaining and maintaining CILAs which afford safety and
basic comfort. This assistance shall include, but is not limited to:
1) Performing visual inspections;
2) Purchasing and maintaining in working order safety devices (e.g.,
smoke and carbon monoxide detectors, first aid kits, door locks), when needed;
3) Encouraging landlords to comply with applicable building and
safety codes; and
4) Providing education and information on fire safety and
disaster preparedness procedures.
b) For individuals who choose to reside in a provider-owned or
controlled CILA, the licensed CILA agency shall ensure that buildings
containing owned or leased living arrangements shall comply with locally
adopted building codes (including those for attic spaces and impractical
evacuation capability) as enforced by local authorities; the applicable editions
and chapters of the NFPA 101, Life Safety Code (National Fire Protection
Association, 2015), as cited in the rules of the Office of the State Fire
Marshal (OSFM) at 41 Ill. Adm. Code 100; and any local fire codes that are more
stringent than the NFPA as enforced by local authorities or OSFM. A CILA
agency shall make available the report of an inspection by the local
authorities or OSFM prior to providing services to any individual in any CILA
site. Non-compliance may be shown by evidence of administrative or judicial
action taken against the owners of a building for violations of the applicable
housing code within the previous two months, or a letter indicating
non-compliance with NFPA requirements from the local authorities or OSFM.
c) Each living arrangement shall meet the most current standards
as identified in local life/safety and building codes. Living arrangements
specified in subsection (b) shall also meet the following additional standards:
1) Each living arrangement shall have a smoke detection system
which complies with the Smoke Detector Act [425 ILCS 60].
2) Each living arrangement shall have a carbon monoxide alarm
which complies with the Carbon Monoxide Alarm Detector Act [430 ILCS 135].
3) No more than eight individuals shall be served in any site.
4) There shall be documentation completed and maintained at the
CILA agency, verifying that living arrangements are inspected quarterly by the
licensed CILA agency to ensure safety, basic comfort, and compliance with this
Part.
5) Bath and toilet rooms
A) At least one bathroom shall be provided for each four
individuals. A bathroom shall include a toilet, lavatory, and tub or shower.
B) Bathrooms shall be located and equipped to facilitate
independence. When needed by the individual, special assistance or devices
shall be provided.
C) Bathing and toilet facilities shall provide privacy.
6) Bedrooms
A) Each single individual bedroom shall have at least 75 square
feet of net floor area, not including space for closets, wardrobes, bathrooms,
and clearly definable entryway areas.
B) Each multiple bedroom shall accommodate no more than two
individuals and each bedroom for two individuals shall have at least 55 square
feet of net floor area per individual, not including space for closets,
wardrobes, bathrooms, and clearly definable entryway areas.
C) Storage space for clothing and other personal belongings shall
be provided for each individual.
D) Each bedroom shall have:
i) Walls that extend from floor to ceiling;
ii) A mattress and box spring that is suitable to the size of the
individual which provides support and comfort, if beds are provided by the CILA
agency;
iii) At least one outside window; and
iv) Electrical light sufficient for reading.
E) Bedrooms shall maintain a dry and comfortable environment.
F) In living arrangements where more than one individual resides,
traffic to and from any room shall not be through an individual's bedroom.
G) In a provider-owned or controlled CILA, in addition to the qualities
at 42 CFR 441.301(c)(4)(i) through (iv), the following additional
conditions must be met concerning an individual's bedroom:
i) Each individual has privacy in their bedroom;
ii) Bedrooms have entrance doors that are lockable by the
individual from inside the room, with only the individual and appropriate staff
having keys to doors;
iii) Individuals sharing bedrooms have a choice of whom to share a
bedroom with;
iv) Individuals have the freedom to furnish and decorate their
bedroom within the lease or other agreement; and
v) The bedroom is physically accessible to the individual.
H) Any modification of the additional conditions, under subsection
(c)(6)(G), must be addressed according to Section 115.200(c)(7)(F)(i) through
(viii).
I) Pursuant to 210 ILCS 165, and as
outlined by DDD, a CILA provider shall permit individuals who reside in
a CILA to conduct authorized electronic monitoring of their bedroom through
the use of electronic monitoring devices placed in the room.
i) CILA agencies shall not intentionally retaliate or
discriminate against an individual for consenting to authorized
electronic monitoring under the Authorized Electronic Monitoring in Community
Integrated Living Arrangements and Developmental Disability Facilities Act
[210 ILCS 135/14.5(b)(1)].
ii) CILA agencies shall not prevent the installation or
use of an electronic monitoring device by an individual who resides
in a developmental disability CILA and has provided the staff of the CILA
with notice and consent as required by 210 ILCS 165/20 [210 ILCS 135/14.5(b)(2)].
7) The CILA agency shall ensure that:
A) Each living arrangement will be physically accessible and
accommodate other forms of accessibility if required by the needs of any
individual served in the setting.
B) Each living arrangement shall be safe and clean.
C) Each living arrangement shall be free from vermin.
D) Waste and garbage shall be stored with a proper fitting lid,
transferred, and disposed of (both interior and exterior) in a manner that does
not permit the transmission of diseases.
E) Following a snowfall, freezing rain, or sleet,
snow and ice must be cleared from sidewalks, ramps, and driveways of the living
arrangement to provide safe and accessible passage.
F) Each living arrangement must maintain vegetative
growth (including grass, bushes, trees) on the premises, not allowing it
or weeds to become overgrown and/or hazardous.
G) Private water systems shall comply with 77 Ill. Adm. Code 900
(Drinking Water Systems Code).
H) Each living arrangement shall evaluate the quality of the food
prior to its consumption. Manufacturers provide dating to help consumers and
retailers decide when food is of best quality. Each CILA site should have a
written policy on fresh, frozen, and pantry foods with acceptable dates. Food
should be dated when frozen, opened, etc. to determine whether it is safe to
consume.
I) Copies of inspections when performed by local and State
inspectors in regard to health, sanitation and environment shall be maintained.
8) The CILA agency shall develop, implement, and maintain a
disaster preparedness plan which shall include disasters and/or public health
crises, be reviewed annually and revised as necessary, and ensure that:
A) Records and reports of fire and disaster training are made
available to DDD and BALC while at the CILA site;
B) A record of actions taken to correct noted deficiencies in
disaster drills or inspections is maintained;
C) Employees and any other person, compensated or in a volunteer
capacity, with responsibility for individuals served know how to react to fire,
severe weather, missing persons, psychiatric and medical emergencies, poison
control and deaths;
D) Individuals know how to react to situations identified in
subsection (c)(8)(C) of this Section or are receiving training;
E) Employees and any other person, compensated or in a volunteer
capacity, with responsibility for individuals served are trained in the
location of fire-extinguishers, first aid kits, evacuation routes and
procedures; and
F) An operational telephone that is accessible to individuals and
staff, is available with a list stating the telephone number of the CILA site,
the nearest poison control center, the local police, the local fire department,
the Department's Office of Inspector General (OIG), and emergency medical
personnel or an indication that 911 is the appropriate number to call.
9) The CILA agency shall implement procedures for evacuation
which ensure that:
A) Drills are conducted at a frequency determined by the CILA agency
to be appropriate, based on the needs and abilities of individuals served by
the particular living arrangement, but no less than annually on each shift,
including overnight. Individuals who are new to the home must be trained
within 30 days of moving into the home. One of these drills shall be during
sleeping hours.
B) Evacuation drills must be conducted in a safe manner. Using
windows as a second means of egress is prohibited above the first floor unless
using a semi-permanent fixture.
C) Special provisions shall be made for those individuals who
cannot evacuate the building without assistance, including those with physical
disabilities and individuals who are deaf and/or blind.
D) All employees are trained to carry out and properly document their
assigned evacuation tasks.
E) Inefficiency or problems identified during an evacuation drill
shall result in specific corrective action.
F) Evacuation drills shall include actual evacuation of
individuals to designated safe areas.
10) At least one approved fire extinguisher shall be available in
the residence, with tags verifying annual inspection and recharged when
necessary.
11) First aid kits that meet the basic American Red Cross standards
shall be available in the CILA home. First aid kits shall be monitored quarterly
and replenished as needed by the CILA agency.
d) For individuals who receive continuous supervision and support
and choose to reside with their families or in living arrangements owned or
leased by the individuals living there, the licensed CILA agency shall ensure
that the living arrangements comply with all the requirements of subsection (c)
except subsections (c)(5)(A) and (C), (c)(6)(A), (C), and (D), and (c)(8)(B)
and (E). Employees and any other persons compensated or in a volunteer
capacity who have responsibility for individuals served shall be trained in the
location of a fire extinguisher, first aid supplies, evacuation routes, and
procedures. CILA agencies shall support the individual to ensure the residence
is maintained and complies with local building codes as enforced by local
authorities.
e) Prior to a new site owned or leased by the CILA agency being
occupied and prior to a host family site accepting individuals receiving
services, the site must be inspected by BALC and determined to be in compliance
with this Part. Site inspections will be completed within 15 working days after
all necessary documentation has been received, e.g., current fire clearances.
All sites as described in this subsection will be inspected at least once
during the two year period of licensure to determine on-going compliance with
this Part.
f) The CILA provider shall cooperate with BALC to visit and
inspect any home in which individuals enrolled in the CILA program are residing,
regardless of whether it provides continuous or intermittent supervision or is individual
or provider-owned or leased.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.310 GEOGRAPHIC LOCATION OF COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
Section 115.310 Geographic Location
of Community-Integrated Living Arrangements
a) Provider-owned or controlled CILA sites shall be located to
enable individuals to participate in and be integrated into their community and
neighborhood. Homes shall be typical of homes in the community and residential
neighborhood and their inclusion should not appreciably alter the characteristics
of the neighborhood.
b) Provider-owned or controlled CILA sites shall be located to
promote integration of individuals with developmental disabilities within the
range of communities throughout the State.
c) Provider-owned or controlled CILA sites
shall operate according to 42 CFR 441.301(c)(4) and related CMS guidance.
d) CILAs owned or controlled by a CILA agency and funded by the
Department shall comply with all of the following requirements:
1) Current provider-owned or controlled CILAs shall
be reviewed and evaluated for isolating characteristics. The provider-owned or
controlled CILA shall not have the effect of isolating individuals receiving
Medicaid HCBS Waiver services from the broader community of individuals not
receiving Medicaid HCBS Waiver services.
2) Any provider-owned or controlled CILA for
individuals in the Medicaid DDD Waiver that has the effect of isolating
individuals receiving Medicaid HCBS service and is operational during the
transition period established by the federal government shall be designated by
the Department for a heightened scrutiny review to determine whether it meets
the qualities of home and community-based settings listed in 42 CFR
441.301(c)(4). The Department may perform heightened scrutiny reviews in
accordance with federal rules and related guidance. The following factors
shall be taken into account in determining whether a setting may have the
effect of isolating individuals receiving Medicaid HCBS from the broader
community of individuals not receiving HCBS:
A) Due to
the design or model of service provision in the setting, individuals have
limited, if any, opportunities for interaction in and with the broader
community, including with individuals not receiving Medicaid-funded HCBS. Such
opportunities, as well as identified supports to provide access to and
participation in the broader community, should be reflected in both
individuals’ person-centered plans and the policies and practices of the
setting;
B) The
setting restricts individual choice to receive services or to engage in
activities outside of the setting; or
C) The
setting is physically located separate and apart from the broader community and
does not facilitate individual opportunity to access the broader community and
participate in community services, consistent with an individual’s
person-centered plan.
3) Settings must be validated by the State
as in compliance with federal settings rules by March 17, 2023. Ongoing
compliance with the Settings Rules will be incorporated into ongoing reviews
and surveys.
e) When CILA providers own or control units in a multi-unit
building, CILA providers should recognize and
consider the number of CILA and non-CILA residents located in the same building
and, in order to meet the right of individuals with disabilities to live in the
most integrated environment possible, strive to have an integrated grouping of
people in any building composed of a mix of both CILA and non-CILA residents.
No more than 25% of the total units in each building are CILAs funded by
the Department and owned or controlled by CILA providers. Each unit must meet
the requirements for a CILA as defined in Section 115.300.
f) Any new provider-owned or controlled CILA site
for individuals in the DDD Medicaid HCBS Waiver must comply with the federal
settings rules’ requirements and shall only be eligible for funding from the
Department if:
1) Subject
to the proximity waiver process in subsection (j), it is not adjacent to (next
to, across, or diagonal from or immediately behind) any Medicaid HCBS
waiver-funded residential or day program site or property owned or controlled
by the same CILA provider;
2) It is
not located in a building that is also a publicly or privately-operated
facility that provides inpatient institutional treatment;
3) It is
not located in a building on the grounds of, or adjacent to, a publicly or
privately-operated facility that provides inpatient institutional treatment; or
4) It is
not any of the settings defined in 42 CFR 441.301(c)(5).
g) New provider-owned or controlled CILAs must be in
compliance with the settings rules when they are licensed.
h) Individuals in individually owned or controlled homes and
apartments in which the individual receiving Medicaid HCBS Waiver services
lives independently or with family members, friends, or roommates are presumed
to be in compliance with the regulatory criteria of a home and community-based
setting. Settings where the individual lives in a private residence owned by
an unrelated caregiver (who is paid for providing HCBS to the individual) are
considered provider-owned or controlled settings and will be evaluated as such.
i) A proximity waiver can be requested
from DDD for HCBS adult waiver funded residential sites converting to CILA
sites.
j) Provider agencies can request a proximity waiver from DDD
from the provisions in subsection (f)(1) for a potential provider-owned or
controlled CILA site. The provider shall present to DDD its rationale for the
waiver request, including evidence of efforts to comply with subsection
(f)(1). The request must be submitted before the agency leases, purchases, or
takes possession of the property to be used as a CILA, or in the case of any
agency having possession of the property, before the property is used as a CILA
site. DDD shall grant the waiver for the duration of the CILA, if it
determines that the granting of the waiver would meet the criteria described in
42 CFR 441.301(c)(5)(v) and related federal CMS guidance, including, but not
limited to:
1) The Centers for Medicare & Medicaid Services Home and
Community-Based Settings Regulation - Heightened Scrutiny, March 22, 2019
(available at
https://www.medicaid.gov/federal-policy-guidance/downloads/smd19001.pdf);
2) Center for Medicaid and CHIP Services, SUBJECT: Heightened
Scrutiny Review of Newly Constructed Presumptively Institutional Settings,
August 2, 2019 (available at
https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/cib080219_124.pdf);
and
3) CMS Technical Guidance on Settings that Isolate to Inform
their Process for Identifying Prong 3 Settings (available at:
https://www.medicaid.gov/medicaid/hcbs/downloads/settings-that-isolate.pdf).
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.320 ADMINISTRATIVE REQUIREMENTS
Section 115.320
Administrative Requirements
a) Governing body
1) Each CILA provider which is owned or operated by any
corporation, association, or unit of local government shall have a governing
body in which is vested authority and responsibility for the organization,
management, control, and operation of the CILA agency and all programs,
services, facilities, and residences it administers.
2) Each CILA provider shall have provisions for obtaining input
from individuals served, guardians and/or individual's representatives to the
governing body.
b) Staffing
1) Mental health and developmental disabilities employees shall
be licensed or certified as required by Illinois laws.
2) When paraprofessional, non-professional contractual workers or
volunteers are used in direct services, they shall be supervised in the
provision of services by professional employees.
3) A CILA provider shall not employ an individual (including
contractual workers, volunteers, or practitioners who have the responsibility
of caring for individuals) in any capacity, until the CILA provider has conducted
the following registry checks concerning the potential employee,
contractor/subcontractor, volunteer, or practitioner:
A) Department of Public Health (DPH) Health Care
Worker Registry
B) Department
of Children and Family Services (DCFS) State
Central Register/Child Abuse and Neglect Tracking System (CANTS)
C) Illinois
Sex Offender Registry
D) Illinois Department of Healthcare and Family Services (HFS)
Sanctions List (maintained at the HFS Office of Inspector General website,
https://www.illinois.gov/hfs/oig/Pages/SanctionsList.aspx)
4) A CILA provider shall not employ an individual
(including contractual workers, volunteers, or practitioners who have the
responsibility of caring for individuals) in any capacity until the CILA
provider has inquired of and received the results from the applicable registry
or list concerning the potential employee, contractor/subcontractor, volunteer,
or practitioner. Inquiries shall not occur more than 30 calendar days prior to
the first day of employment.
5) If
the DPH, DCFS, or Illinois Sex Offender registries contain information
concerning the potential employee, contractor/subcontractor, volunteer, or
practitioner that indicates a finding of physical or sexual abuse or egregious
neglect, a substantiated case of child abuse or neglect, a sex offense, or a
disqualifying criminal conviction from which there is no waiver, the CILA
provider shall not employ that person in any capacity. If the HFS Sanctions
List indicates that the potential employee, contractor/subcontractor,
volunteer, or practitioner has been terminated, suspended, barred, or otherwise
excluded from the Illinois Medical Assistance Program, the CILA provider shall
confirm that person or entity's status with the HFS OIG.
6) CILA
providers shall make annual inquiries to the DPH, DCFS, and Illinois Sex
Offender registries and the HFS Sanctions List concerning each current
employee, volunteer, contractual worker, subcontractor, or licensed
practitioner. If the annual check discloses that the individual or entity's
name has been placed on the registry or list, that individual or entity must be
terminated. The CILA provider must establish a schedule that results in
completion of checks every full year (365 calendar days), which can be
accomplished by:
A) Repeating
the check on the anniversary of the employee’s, contractor’s/subcontractor’s,
volunteer’s, or practitioner’s hiring;
B) Repeating
the check when the employee’s, contractor’s/subcontractor’s, volunteer’s, or
practitioner’s annual performance evaluation is due; or
C) Creating
a specific schedule of checks to ensure timely completion.
7) The
CILA provider must comply with the Health Care Worker Background Check Act [225
ILCS 46]. A CILA provider shall not knowingly hire or retain any person
outside of the provisions of the Health Care Worker Background Check Act.
8) A
person listed on the Health Care Worker Registry may request a waiver of the
prohibition against employment by completing an application on a form
prescribed by DPH in accordance with the Health Care Worker Background Check
Act.
9) A
waiver of an indication on the CANTS Register may be requested by completing an
application per the guidelines issued and published by the Department.
c) General program requirements
CILA agencies
funded by the Department shall meet the following general program requirements
for all funded services:
1) Recordkeeping
Cumulative
case records including a Personal Plan and Implementation Strategy shall be
maintained for each individual.
2) Behavior management and human rights review
A) Each CILA agency is required to have a Human Rights Committee
that will establish or ensure a process for the periodic review of human rights
issues involved in the individual's services and supports. A program which
uses behavioral interventions as specified in Section 115.214 for managing
maladaptive behavior shall also establish a Behavior Management Committee.
Each Committee must have at least five members. Members shall not be shared
between committees with the exception of a physician, advanced practice
registered nurse, registered professional nurse, or nurse
practitioner/physician assistant.
B) The Human Rights Committee shall:
ii) Review
at least every six months practices which restrict a specific individual's
rights;
iii) Inform
the CILA agency of any complaints involving an individual's rights, deficiencies,
and any corrective actions;
iv) Ensure
that individuals, guardians, and natural supports as desired by the individual
are included in the meetings in which their services and supports are
discussed. The Committee shall also ensure that individuals are assisted to
have meaningful interactions and are accommodated as necessary during the
meetings; and
v) Maintain minutes, including attendance, and a
record of decisions made per individual including justification of decisions
and intended outcomes. When the committee approves restrictive interventions,
the minutes must include the next review date.
C) The
Human Rights Committee shall include:
i) At
least 5 members.
ii) At
least one person receiving services from the agency and/or the individual's
family member or guardian.
iii) At
least one-third of the members cannot be former employees of the CILA provider,
individuals receiving services or guardians of individuals formerly served by
the CILA provider, a vendor providing products or services to the CILA
provider, or employees from other CILA providers or DD programs.
D) A
Behavior Management Committee shall:
i) Approve
behavior interventions prior to their implementation and review those
interventions at least every six months;
ii) Review all behavior strategies at least
annually and determine if a rights restriction exists. Plans that are found to
have a rights restriction must also be reviewed by the CILA agency’s Human
Rights Committee;
iii) Maintain
minutes, including attendance and a record of decisions made; and
iv) Seek
input from individuals, guardians, and natural supports as desired by the
individual whose services and supports are discussed. The Committee shall also
ensure that individuals are assisted to have meaningful input and are
accommodated as necessary.
E) A
Behavior Management Committee shall be comprised in the following manner:
i) Members
shall include persons qualified to evaluate the appropriateness of the proposed
behavior management interventions.
ii) When
drugs to manage behavior are used, a licensed professional qualified to
evaluate their use shall be a member of the committee.
iii) At
least one member shall be from outside the CILA agency.
3) Abuse, neglect, and exploitation
A) Each CILA agency shall have and use a process for reporting and
handling instances of abuse, neglect, and exploitation in accordance with
applicable standards, regulations and laws that shall include notification of
the individual allegedly abused, neglected, or exploited and their guardian or
parent of the allegation within 24 hours after receiving the allegation.
B) In addition to abuse, neglect, and exploitation, each CILA
agency shall have and use a process for reporting and handling complaints
regarding individual rights. The CILA agency shall share a copy of the Rights
of Individuals form [IL 462-1201] with the individual and/or guardian when an
individual enters the CILA program (see Section 115.250(a)).
4) Admission requirements
A) CILA agencies shall not discriminate in the admission to and
provision of needed services to individuals on the basis of race, color, sex,
religion (creed), gender identity, gender expression, age, national origin
(ancestry), ethnicity, disability, marital status, sexual orientation or
military status in any of their activities or operations.
B) Admission policies and procedures shall be set forth in writing
and be available for review.
5) Compliance with life safety standards and requirements
All program
facilities shall be in compliance with applicable State licensure requirements
and local ordinances with regard to fire, building, zoning, sanitation, health,
and safety requirements.
6) Visits to programs
The CILA agency
shall ensure that Department-authorized individual protection and advocacy interest
groups shall be permitted, with the consent of the individual or guardian, to
visit provider-owned or controlled living arrangements.
7) Remote Monitoring and Supports
CILA agencies
may provide remote monitoring and support services in community-integrated
living arrangements pursuant to 305 ILCS 5/12-21.21, as determined by DDD. Remote monitoring and supports (i.e., video, web-cameras,
or other interactive technology) may be provided to increase independence and daily living skills of an
individual and address an individual's needs and outcomes identified in their
personal plan. Remote supports and services must be based on an assessment
which shall, at a minimum, identify risks
important in considering whether remote monitoring and supports are appropriate
for the individual.
d) Training
1) Direct service professionals and any other persons (paraprofessional,
contractual workers, or volunteers) with responsibility for direct care of
individuals served shall demonstrate competence in training areas listed in
subsections (d)(1)(A) through (M) as a part of an orientation program. Anyone
specified in this subsection (d)(1) without previous experience in direct
service to individuals shall receive training and demonstrate competence prior
to unsupervised responsibility for direct service unless trained employees are
on site and available for on-the-job training. Direct service professionals
and other persons as specified above who have completed training in the below
mentioned areas, and demonstrated competence as documented in their personnel records,
shall not be required to repeat that training as part of their orientation.
Anyone specified in this subsection (d)(1) who has not demonstrated competence
shall receive training until the person can demonstrate competence in the
following areas, as recorded in their records. All direct service employees
and any other compensated persons, regardless of staffing model, shall receive
training and demonstrate competence as documented in employee records in the
following training areas:
A) Cardiopulmonary resuscitation (CPR), back blows/abdominal thrusts,
and first aid;
B) Concepts of habilitation and rehabilitation including behavior intervention
and management, age appropriateness and psycho-social rehabilitation depending
on the needs of the individuals served or to be served;
C) Safety and disaster procedures; public health emergencies; and
fire procedures and the use of fire equipment such as a fire extinguisher;
D) Abuse, neglect, exploitation, coercion and critical incident
prevention, handling and reporting to the DHS OIG (pursuant to 59 Ill. Adm.
Code 50);
E) Individual rights in accordance with Section 115.250 and
maintaining confidentiality in accordance with the Mental Health and
Developmental Disabilities Confidentiality Act [740 ILCS 100];
F) The purpose and content of the Personal Plan pursuant to 42
CFR 441.301(c)(2);
G) Development and implementation of an Implementation Strategy;
H) The type, dosage, characteristics, effects, and side effects of
medications prescribed for individuals. The CILA agency shall ensure that
there is sufficient training in this area to provide coverage during expected
and unexpected absences of caregivers by others who have been determined
competent;
I) Observation, using the AIMS (Abnormal Involuntary Movement
Skills), of involuntary muscular movement, which may be indicative of tardive
dyskinesia;
J) Documentation and recordkeeping requirements with reference to
the Personal Plan and Implementation Strategy;
K) Other training which relates specifically to the type of
disability or treatment and intervention techniques being used specific to
individuals living in CILAs, geared toward assisting employees to execute outcomes
stated in the Personal Plans and Implementation Strategies;
L) The techniques associated with monitoring and regulating hot
water temperatures prior to and during an individual's use to ensure safe
hand-washing, hair-washing, bathing, and showering procedures. Water
temperatures should be between 100 and 110 degrees to ensure safety; and
M) In CILA programs for individuals with developmental
disabilities, all unlicensed, direct care employees, prior to assuming
responsibility for supervising the self-administration of medication training
programs or for administration of medications for persons with developmental
disabilities, shall meet criteria set forth in 59 Ill. Adm. Code 116.40(c)
including, but not limited to, successful completion of a Department approved
training program provided by a CILA agency Nurse-Trainer. Authorized direct
care staff shall be re-evaluated by a Nurse-Trainer at least annually or more
frequently at the discretion of the registered professional nurse. Any
retraining shall be to the extent that is necessary to ensure competency of the
authorized direct care staff to administer medication (see 59 Ill. Adm. Code
116.40).
2) After completion of training specified in subsection (d)(1),
each direct service employee shall participate in ongoing employee development
activities as outlined in the CILA agency's employee development plan.
3) All training shall be documented and shall be readily
available for review by BALC and DDD.
4) The CILA agency shall implement a written training plan which
lists training to be offered to meet the requirements of this Part, the methods
used for completion of any required training, and the process used to determine
competency.
e) Volunteer training
The CILA agency
shall provide an orientation and training program for volunteers specific to
volunteer duties and shall provide supervision as necessary. Volunteers with
responsibility for care of individuals served must complete and demonstrate
competency in the training areas specified in subsection (d).
f) Quality assurance
1) There shall be a written quality assurance plan and ongoing
activities designed to review and evaluate services to individuals and
operation of programs and to resolve identified problems.
2) The CILA agency's quality assurance program shall be the basis
for determining under its license that individuals are receiving appropriate
community-based services consistent with their Personal Plans and
Implementation Strategies and, that all programs and services are supervised by
the CILA agency and comply with this Part.
A) If a certified CILA does not continue to meet standards, the CILA
agency shall correct deficiencies within 30 days.
B) If deficiencies in a certified CILA cannot be corrected within
30 days, the CILA agency shall withdraw certification of the CILA program in
question and notify the Department. The CILA agency shall remain responsible
for those individuals who live in or lived in the affected CILA until the
individuals have transitioned to other settings.
g) Critical incidents
1) The CILA agency shall have written policies and procedures for
handling, investigating, reporting, tracking, and analyzing critical incidents
through the CILA agency's management structure, up to and including the
authorized CILA agency representative. The CILA agency shall ensure that
employees demonstrate their knowledge of, and follow, such policies and
procedures.
2) Within 24 hours of occurrence the CILA agency shall report any
incident which is subject to the Criminal Code of 2012 [720 ILCS 5] to the
local law enforcement agencies.
3) The CILA agency shall ensure that suspected instances of abuse,
neglect or exploitation against individuals in programs which are licensed by
the Department are reported to the Office of Inspector General (Section 1.17 of
the Department of Human Services Act [20 ILCS 1305/1-17(k)(1)]) within four
hours of discovery.
4) Incidents other than those required to be reported to the
Office of Inspector General shall be electronically reported to the
Department’s Division of Developmental Disabilities through its Critical
Incident Reporting and Analysis System (CIRAS) (http://www.dhs.state.il.us/page.aspx?item=97101).
Incidents to be reported are specified in Section 115.120 under Critical
Incidents.
h) Individuals' records
1) The CILA agency shall ensure the confidentiality of
individuals' records in accordance with the Act and shall ensure safekeeping of
all records against loss or destruction.
2) The CILA agency shall maintain a chronological record for each
individual. Records shall be accessible at the program site at which
individuals are being served.
A) Each entry shall be legible, dated and authenticated by the
signature and title of the person making the entry.
B) Corrections shall be initialed and made in such a way as to
leave the original incorrect entry legible.
C) When symbols or abbreviations are used, the CILA agency shall
provide a legend to explain them which shall be standardized throughout the CILA
agency.
3) On an individual's entry into the CILA agency, the following
information shall be obtained, recorded, and updated as necessary in the
individual's record:
A) Identifying information including name, date of birth, sex,
race, a copy of state ID, Medicaid number, birth certificate, when available,
current photograph (if the individual consents to having their picture taken), social
security number (this may be stored separately from the record if necessary to
protect against identity theft), and legal status;
B) If applicable, the court appointed guardianship order;
C) The name, address and telephone number of the legal guardian or
the person to be notified in case of an emergency;
D) The language spoken or understood by the individual including,
in the case of an individual who is deaf or hard of hearing, the individual's
preferred mode of communication, e.g., American sign language, signed English,
aural, oral, or tactile communications device;
E) Prescribed medications, reactions and side effects to
medications, allergies to foods, other medications, and substances;
F) Physical and dental examinations, and medical history;
G) Consent to receive emergency medical services; and
H) Copies of the authorization for release of information.
4) The following shall be entered in the individual's record
during the period of service:
A) Written informed consent by the individual or guardian to
participate in a CILA;
B) Prior service history;
C) Personal Plan and Implementation Strategy as specified in
Section 115.230;
D) Assessments and reassessments as specified in Section 115.225;
E) Documentation of approval to use special procedures and the
results of their use; and
F) Monthly documentation of the individual's progress towards the
outcomes recorded in the Personal Plan and reflected in the Implementation
Strategy. The documentation must be signed and dated by the QIDP.
5) Electronic signature or computer-generated signature codes are
acceptable as authentication of record content.
A) In order for a CILA agency to employ electronic signatures or
computer-generated signature codes for authentication purposes, the CILA agency
must adopt a policy that permits authentication by electronic or
computer-generated signature.
B) At a minimum, the policy shall include adequate safeguards to
ensure confidentiality of the codes, including, but not limited to, the
following:
i) Each user must be assigned a unique identifier that is
generated through a confidential access code.
ii) The CILA agency must certify in writing that each identifier
is kept strictly confidential. This certification must include a commitment to
terminate a user's use of a particular identifier if it is found that the
identifier has been misused. "Misused" shall mean that the user has
allowed another person or persons to use their personally assigned identifier,
or that the identifier has otherwise been inappropriately used.
iii) The user must certify in writing that the user is the only
person with user access to the identifier and the only person authorized to use
the signature code.
iv) The CILA agency must monitor the use of identifiers
periodically and take corrective action as needed. The process by which the CILA
agency will conduct monitoring shall be described in the policy.
C) A system employing the use of electronic signatures or computer-generated
signature codes for authentication shall include a verification process to
ensure that the content of authenticated entries is accurate. The verification
process shall include, at a minimum, the following provisions:
i) The system shall require completion of certain designated
fields for each type of document before the document may be authenticated, with
no blanks, gaps or obvious contradictory statements appearing within those
designated fields. The system shall also require that correction or
supplementation of previously authenticated entries shall be made by additional
entries, separately authenticated, and made subsequent in time to the original
entry.
ii) The system must make an opportunity available to the user to
verify that the document is accurate and the signature has been properly
recorded.
iii) The CILA agency must periodically sample records generated by
the system to verify the accuracy and integrity of the system.
D) Each report generated by a user must be separately
authenticated.
i) Financial and operational requirements
Agencies
licensed to provide CILA services shall comply with Department rules regulating
their contractual and financial relationship with the Department.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.321 APPLICATION FOR WAIVER OF THE PROHIBITION AGAINST EMPLOYMENT
Section 115.321 Application
for Waiver of the Prohibition Against Employment
a) Hiring of direct care professionals
A CILA agency
shall not knowingly hire or retain any person after January 1,
1998 in a full-time, part-time, volunteer or contractual direct care position
if that person has been convicted of committing or attempting to commit one
or more of the offenses outlined in Section 25 of the Health Care
Worker Background Check Act [225 ILCS 46] unless the applicant or employee
obtains a waiver pursuant to subsection (b).
b) Health Care Worker Registry request for waiver
1) An applicant, employee, or nurse aide may request a waiver
of the prohibition against employment. [225 ILCS 46/40]
2) CILA agency employees may assist the applicant, employee, or
nurse aide in completing the application.
3) The outcome of the waiver request shall be determined by the
Illinois Department of Public Health pursuant to Section 40 of the Health Care
Worker Background Check Act and 77 Ill. Adm. Code 955.
c) DCFS
State Central Register/Child Abuse and Neglect Tracking System (CANTS)
1) The
Community-Integrated Living Arrangements Licensure and Certification Act
directs that the Department of Human Services establish a waiver process
from the prohibition of employment or termination of employment for any
applicant or employee listed on the DCFS’ State Central Register seeking to be
hired or maintain his or her employment with a community developmental services
agency [210 ILCS 135/13].
2) The
CILA agency must comply with 59 Ill. Adm. Code 115.320(b)(3)(B).
3) Application
for waiver
A) Waiver requests with all required and any supplemental materials should be
submitted via email at DHS.CANTSDDWaiver@illinois.gov to the
Department's Division of Developmental Disabilities (DDD). Waiver
requests and supporting materials should be submitted via email; however, requests may be faxed to (217) 782-9444, or mailed to Division of
Developmental Disabilities, Bureau of Quality Management, 600 East Ash,
Building 400, Mail Stop 2 North, Springfield, IL 62703. Faxed and mailed
waiver requests must be clearly marked as "DCFS CANTS Waiver
Request." Waiver requests submitted by telephone will not be
considered.
B) The
CILA provider or the individual listed on the DCFS' State
Central Register (or their authorized representative) may submit waiver
requests to DDD.
C) If
a CILA provider submits a waiver request for more than one
employee or prospective employee at the same time, each request must be a
separate submission.
D) Upon
receipt, DDD will review submitted materials and advise the waiver applicant, authorized
representative or CILA provider, in writing, if any
additional information is required.
E) DDD
will provide a response in writing to each waiver request within 30 calendar
days after receipt and review of all applicable materials and responses from
waiver applicant and/or CILA provider. DDD's review will
include, but is not limited to, DCFS' investigative reports and DHS Office of
the Inspector General's intake and investigative reports.
F) Delays
in receiving requested materials from the waiver applicant or CILA provider that exceed 30 calendar days and are without good cause will
result in DDD issuing a denial of the waiver request. Waiver requests denied
for waiver applicant or CILA provider delays may be
resubmitted for consideration.
G) If
a waiver request is approved, it will be specific to a position and CILA
provider.
H) If
a waiver request is approved, it will be automatically revoked upon notice to CILA
provider of another listing of the waivered individual on the
DCFS' State Central Register.
I) All
decisions by DDD regarding waiver requests will be final.
4) A
waiver request must include the following information concerning the waiver
applicant:
A) First,
full middle, and last names;
B) Address
(street and mailing, if different);
C) City,
state, and zip code;
D) Maiden
name, if applicable, and other names used;
E) Telephone
number;
F) Date of
birth;
G) Social
Security Number;
H) CANTS
finding from the DCFS' CANTS Background Check Information Form;
I) Name,
address, phone, email and contact for CILA provider where
position is sought or sought to be continued;
J) Position
held or sought;
K) Work
history, including current position;
L) Correspondence
from CILA provider where position is sought or sought to
be continued on CILA provider's letterhead which includes:
i) A signed statement of support for the waiver request from the CILA
provider's chief executive officer;
ii) The
length of time the individual has been employed by the CILA provider;
iii) Information
regarding previous employment by the provider in residential and day programs
for people with intellectual/developmental disabilities;
iv) Applicable
information regarding the individual's work history with the CILA provider organization, e.g., evaluations, any past disciplinary action
(or lack thereof), positive recognition for work well done, etc.; and
M) Any
additional information the individual would like to provide regarding the
waiver request.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.325 MONITORING AND EVALUATION
Section 115.325 Monitoring
and Evaluation
The CILA agency shall agree to
participate in a monitoring and evaluation system as described in the
contractual agreement between the Department and the CILA agency. Information
regarding CILA provider compliance scores from licensure and certification
surveys and quality assurance reviews, status of administration actions with
CILA providers, as well as substantiated DHS OIG findings of abuse, egregious
neglect and exploitation is available on the Department's website at
http://www.dhs.state.il.us/page.aspx?item=65616.
a) Evaluation methodologies
CILA agencies
shall develop evaluation methodologies that address the issues of the effective
and efficient use of program resources; for example, quality assurance,
utilization review, and professional services review organization. The CILA agency
shall also provide documentation of the implementation of these evaluation
methodologies and demonstrate how the information gained through evaluation
efforts is used in the planning process. The Department shall review and provide
consultation in this evaluation effort.
b) Monitoring
Monitoring is
the review of the CILA agency's compliance with contractual obligations,
applicable statutes and administrative rules ensuring that Departmental funds
are spent appropriately for services as specified in the contractual
agreement. Monitoring may include desk review and site review of CILA agency
performance.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.326 MONITORS AND RECEIVERSHIPS
Section 115.326 Monitors and Receiverships
a) The
Department shall engage the provider and initiate a review of a CILA agency's
service agreement for funding if it determines that issues including, but not
limited to, substantiated cases of abuse and neglect and quality review status
warrant such action. The review will be initiated by the Director of DDD, or
their designee, and will commence on a date as determined by the Director or
designee, but no later than 30 days after the decision has been made to
initiate a review. A review shall be based on, but not limited to, any of the
following:
1) a
disproportionate number or percentage of complaints regarding licensure issues;
2) a
disproportionate number or percentage of substantiated cases of abuse, neglect
or exploitation involving a CILA agency;
3) an
apparent unnatural death of an individual served by a CILA agency;
4) any
egregious or life-threatening abuse or neglect within a CILA agency; or
5) any
other significant event as determined by the Department.
b) Section
115.326(a) does not limit the Department's authority to take necessary action
through its own or other State staff.
c) When
determined necessary by the Department, the Department shall inform the CILA
agency that an independent monitor, who may be an individual or an employee or
contractor with a business entity but shall not be staff of the Department or
any other State agency, has been assigned to the CILA agency. Instead of, or in
addition to, requesting an independent monitor, the Department may petition the
circuit court for appointment of an independent receiver, who shall not be
staff of the Department or any other State agency.
1) Assigned
Independent Monitor
A) If
other action, such as re-locating individuals to another CILA agency, is not
indicated, the Department may assign an independent monitor to the CILA agency
when any of the following conditions exist:
i) The
CILA agency is operating without a license. The Department shall establish a schedule
for closing the CILA agency and the monitor shall work with the CILA provider
to transition the individuals.
ii) The
Department has suspended, revoked, or refused to renew the existing license of
the CILA agency. The Department shall establish a schedule for closing the
CILA agency and the monitor shall work with the provider to transition the
individuals.
iii) The
Department has issued a notice to terminate or not renew its provider agreement
with the CILA agency.
iv) The
CILA agency is closing or has informed the Department that it intends to close
and adequate arrangements for transition of individuals have not been made at
least 30 days prior to closure.
v) The
Department determines that an emergency exists and the CILA agency is unwilling
or unable to remedy the emergency. As used in this subsection,
"emergency" means a threat to the health, safety, or welfare of
individuals.
vi) The
Department, with the concurrence of HFS, terminates the CILA provider's
participation in the federal reimbursement program under Title XIX (Medicaid)
of the Social Security Act (42 U.S.C. 7).
B) The
Department shall ensure that the assigned monitor meets the following minimum
requirements:
i) Is
able to travel to various locations throughout Illinois in order to conduct
on-site visits (see Section 115.326(c)(1)(C)(i));
ii) Has
an understanding of the needs of individuals with developmental disabilities,
as evidenced by no less than two years of full-time cumulative experience in
working with individuals with developmental disabilities in programs such as
developmental training, residential services, or advocacy;
iii) Has
a clear and thorough understanding of the applicable licensure or certification
standards which are the subject of the monitor's duties, as evidenced in a
personal interview of the candidate;
iv) Is
not related to the owners/operators of the involved CILA agency either through
blood, marriage, or common ownership of real or personal property, except
ownership of stock that is traded on a stock exchange;
v) Is
certified as a QIDP or provides evidence of education and experience equivalent
to or greater than that of a QIDP; and
vi) Does
not have any other conflicting professional relationship with the CILA agency
or an ISC agency and is not employed by or contracted with any other entity
currently providing direct services to individuals with developmental
disabilities.
C) The
assigned monitor shall be under the supervision of the Department and shall
accomplish the following actions:
i) Conduct
on-site visits to the agency as directed by the Department;
ii) Review
all records pertinent to the condition for the monitor's placement under
subsection (c)(1);
iii) Interview
individuals, their guardians, and with the consent of the individual and/or
guardian, family members regarding the services received and the needs of the
individuals;
iv) Provide
to the Department oral and written reports detailing the observed conditions of
the agency and its operations; and
v) Be
available as a witness for hearings involving the condition for placement as
monitor as directed by the Department.
D) All communications, including but not limited to,
data, memoranda, correspondence, records, and reports, shall be transmitted to
and become the property of the Department. In addition, findings and results
of the monitor's work performed under this Section shall be strictly
confidential and shall not be released without written authorization from the
Department, unless required by law or a court order.
E) The
assignment as monitor may be terminated at any time by the Department with or
without notice.
2) Section
115.326(c)(1) does not limit the Department's authority to take necessary
action through its own or other State staff.
3) Assigned
Independent Receiver
A) In the
event the Department determines an emergency situation exists that threatens
the health, safety, or welfare of individuals and the CILA agency is unwilling
or unable to remedy the situation, the Department may petition the circuit
court for appointment of an independent receiver. Through consultation with
developmental disability professional organizations and advocacy groups, the
Department shall maintain a list of independent receivers. Preference on the
list shall be given to CILA agencies possessing extensive experience with
individuals with developmental disabilities, and in financial and operations
management of residential settings. To be placed on the list, the Department
shall ensure the potential receiver meets the following minimum requirements:
i) Is
able to travel to various locations throughout Illinois in order to conduct
on-site visits;
ii) Has
an understanding of the needs of individuals with developmental disabilities
and the delivery of the highest possible quality of services, as evidenced by
no less than two years of full-time cumulative experience in working with
individuals with developmental disabilities in programs such as developmental
training, residential services, or advocacy;
iii) Has
a clear and thorough understanding and working knowledge of the applicable
licensure or certification, as evidenced in a personal interview of the
candidate;
iv) Is
not related to the owners/operators of the involved agency either through
blood, marriage, or common ownership of real or personal property, except
ownership of stock that is traded on a stock exchange;
v) Is
certified as a QIDP, or provides evidence of education and experience
equivalent to or greater than that of a QIDP; and
vi) Does
not have any other conflicting professional relationship with the CILA agency
or an ISC agency and is not employed by or contracted with any other entity
currently providing direct services to individuals with developmental
disabilities.
B) Upon
appointment of a receiver, the Department shall inform the individuals of all
legal proceedings to date which concern the agency.
C) In the
case of Department-ordered transition of individuals to alternative services
and supports, the Department shall establish a schedule for closing the agency
and the receiver shall work with the CILA provider to transition the
individuals. The receiver may also:
i) Assist
in providing for the orderly transition of any or all individuals served by the
agency to other qualified agencies and/or make other provisions for their
continued health and well-being;
ii) Assist
in providing for transportation of individuals, records, and belongings if
individuals are transitioned or discharged;
iii) Assist
in locating alternative services and supports;
iv) Assist
in preparing individuals for transition; and
v) Facilitate
the participation of individuals and individuals' guardians/families in the
selection of alternative services and supports.
4) Section
115.326(c)(3) does not limit the Department's authority to take necessary
action through its own or other State staff.
(Source: Added at 47 Ill. Reg. 8485,
effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.330 ACCREDITATION (REPEALED)
Section 115.330
Accreditation (Repealed)
(Source: Repealed at 47 Ill. Reg. 8485, effective May 31, 2023)
SUBPART D: LICENSURE REQUIREMENTS
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.400 APPLICABILITY
Section 115.400
Applicability
This Part shall apply to all
public or private CILA agencies, associations, sole proprietorships,
partnerships, corporations, or organizations which certify CILAs and provide
CILA services and are, therefore, subject to Department licensure.
(Source:
Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.410 LICENSE APPLICATION
Section 115.410 License Application
a) Forms
1) Agencies must fulfill new provider requirements for
prospective CILA providers within one of year of requesting a licensure
application. Upon verification of eligibility, agencies can obtain an
application by contacting:
The Bureau of Accreditation,
Licensure and Certification
Department of
Human Services
DHS.BALC@illinois.gov
2) The application shall require prospective CILA agencies to
certify that individuals being served and the programs and services to be provided
in CILAs comply with Section 4 of the Community-Integrated Living Arrangements
Licensure and Certification Act, the Mental Health and Developmental
Disabilities Confidentiality Act, and this Part. Agencies that will be
providing CILA services for individuals in the DDD Medicaid HCBS Waiver shall ensure:
A) Services to be provided comply with 59 Ill. Adm. Code 120 and
42 CFR 441.301(c)(1) through (c)(4), which specifies Person-Centered Planning
and Settings requirements for individuals receiving Medicaid HCBS Waiver
Services;
B) Settings
are not the type of settings described in 42 CFR 441.301(c)(5)(v); and
C) CILAs
that will be provider-owned or controlled also meet the additional conditions
set forth in 42 CFR 441.301(c)(4)(vi)(A) through (E).
3) The application shall request information including, but not
limited to:
A) The CILA agency, the type of business organization (per 805 ILCS
5 through 415), the names of all owners, partners, and stockholders;
B) The individuals being served or to be served in the CILAs
supervised by the agency, including their disabilities and diagnoses, any
special needs such as visual or hearing impairments or mobility issues, the
kind of supervision received, and whether individuals are in living
arrangements owned or leased by the agency;
C) The living arrangements used as CILA sites, including site
addresses and telephone numbers;
D) Policies and procedures of the agency; and
E) Organizational chart, staffing patterns, and staff
qualifications for the agency.
4) The authorized agency representative shall sign and date the
application forms.
b) Fees
The Department
shall charge a non-refundable licensure and renewal fee as provided by Section
4(d) of the Community-Integrated Living Arrangements Licensure and
Certification Act.
c) Renewal
On Department
notification, each licensed agency shall submit a signed and dated renewal
application at least 120 days prior to expiration of the license.
d) Change in Ownership
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.420 APPLICATION ACCEPTANCE AND VERIFICATION
Section 115.420 Application Acceptance
and Verification
a) Applications for licensure or licensure renewal shall be acknowledged
as received by the Department on the postmarked and/or electronic submission date.
b) An agency shall have 60 days after the Department has
responded to its application request to complete an application.
c) The application shall include signature and date.
d) The Department shall notify an agency of any error or omission
made in the submission of an application for licensure within 30 days. Failure
of the Department to respond shall not constitute a waiver of the requirements.
If the agency fails to respond to the letter of deficiency within 30 days of
the electronic submission date, the Department shall terminate the application
process and notify the agency within 30 days.
e) The Department shall either approve or disapprove a completed
application within 60 days after the Department has completed the application
process. If an application is incomplete, the Department shall notify the
applicant of the status.
f) The Department may verify information supplied in licensure
applications.
g) The Department will not accept an application for a period of
two years from an agency, or the principals of an agency now doing business
under another name, when the original agency license was revoked or services
were terminated while the agency was not in good standing.
(Source:
Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.430 ISSUING A LICENSE AND PERIOD OF LICENSURE
Section 115.430 Issuing a License
and Period of Licensure
a) Upon receipt of a completed application and verification of
the agency's compliance with this Part, the Department shall issue a license
which will authorize agencies to certify that programs provided in CILAs comply
with the Mental Health and Developmental Disabilities Confidentiality Act and
this Part.
b) The Department shall conduct surveys of licensed agencies and
their certified programs and services. The Department shall review the records
or premises, or both, as it deems appropriate for the purpose of determining
compliance with the Community-Integrated Living Arrangements Licensure and
Certification Act, the Mental Health and Developmental Disabilities Confidentiality
Act, and this Part. For agencies that will be providing CILA services for
individuals in the DDD Medicaid HCBS Waiver, the Department shall also
determine compliance with 59 Ill. Adm. Code 120 and 42 CFR 441.301(c)(1)
through (c)(4), as well as confirm the agencies do not have the characteristics
described in 42 CFR 441.301(c)(5)(v). For CILAs that will be provider-owned or
controlled, the Department shall review agency policies to confirm compliance
with additional conditions set forth in 42 CFR 441.301(c)(4)(vi)(A) through
(E).
1) The Department shall conduct unannounced surveys to determine
compliance at the time of license renewal as well as to investigate complaints,
health and safety inspections, and other concerns as deemed warranted by the
Department.
2) Determination of compliance with the service requirements
contained in Subpart B of this Part shall be based on a survey centered on the
individual which samples services being provided.
3) Determination of compliance with the general agency
requirements contained in Subpart C of this Part shall be based on a review of
agency records and observation of individuals and staff.
c) Upon completion of the application process the Department may
issue a provisional license to an applicant for up to one year and allow the
holder of this license to operate one CILA site, serving up to eight
individuals.
d) A license, other than the provisional license, shall be valid
for the time period set in statute unless revoked in accordance with Section
4(e) of the Community-Integrated Living Arrangements Licensure and
Certification Act.
e) CILA agencies found during a survey to be in substantial
compliance with this Part shall be relicensed.
(Source:
Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.440 LICENSE SANCTIONS AND REVOCATION
Section 115.440 License
Sanctions and Revocation
a) The Department may revoke a license at any time if the agency:
1) Fails to comply with the service requirements identified in
Subpart B of this Part;
2) Fails to comply with the general agency requirements
identified in Subpart C of this Part;
3) Fails to correct deficiencies identified as a result of an
on-site survey by the Department, or fails to submit a plan of correction
within 30 days after receipt of the notice of deficiency;
4) Submits false information either on Department forms, required
certifications, plans of correction or during an on-site inspection;
5) Refuses to permit or participate in a scheduled or unscheduled
survey; or
6) Willfully violates any rights of individuals being served as
identified in Chapter II of the Code or Section 115.250.
b) The Department shall refuse to license or relicense an agency
or shall deny or revoke a license if the owner and/or authorized agency
representative or licensee has been convicted of a felony, or a misdemeanor
involving moral turpitude, as shown by a certified copy of the court of
conviction.
c) CILA provider agencies, as a result of an on-site survey,
shall be recognized according to levels of compliance with standards as set
forth in this Part, as specifically defined in interpretive guidelines made
available to CILA agencies. CILA agencies with findings from Level 1 to Level
3 will be considered to be in good standing with the Department. Findings from
Level 3 to Level 5 will result in a notice of deficiency, a plan of correction
and defined sanctions. Findings resulting in Level 6 will result in a notice
of violations and license revocation based on the sanction standard defined in
this Section. The levels of compliance are:
1) Level 1 - Full compliance with CILA standards.
2) Level 2 - Acceptable compliance with CILA standards. No
written plan of correction will be required from the agency.
3) Level 3 - Partial compliance with CILA standards. An
administrative warning is issued. The agency shall submit a written plan of correction.
4) Level 4 - Minimal compliance with CILA standards. The agency
shall submit a written plan of correction, and the Department will issue a
probationary license. A re-survey shall occur within 90 days.
5) Level 5 - Unsatisfactory compliance with CILA standards. The
agency shall submit a written plan of correction, and the Department will issue
a restricted license. A re-survey shall occur within 60 days.
6) Level 6 - Revocation of the agency's license to provide CILA
services. Revocation shall occur as a result of an agency's consistent and
repeated failure to take necessary corrective actions to rectify documented deficiencies,
and/or the agency's failure to protect individuals from situations that produce
an imminent risk.
d) Prior to initiating formal action to sanction a CILA license, the
Department will allow an organization an opportunity to take corrective action
to eliminate or ameliorate a deficiency of this Part except in cases in which the
Department determines that emergency action is necessary to protect the public
or individual interest, safety, or welfare.
e) Subsequent to an on-site survey, the Department shall issue a
written notice to an agency/organization. The Department shall specify the
particular Sections of this Part, if any, with which the agency is not
compliant. The Department's notice shall require any corrective actions be
taken within a specified time period as required by this Part.
f) If the Department does not approve an agency for license
renewal or revokes a license, it shall notify the agency in writing of the
opportunity for a hearing per Section 115.470.
g) Sanctions will be imposed according to the following
definitions:
1) Administrative notice - A written notice issued by the
Department that specifies rule deficiencies requiring a written plan of
correction with time frames for corrections to be made and a notice that any
additional violation of this Part may result in a higher level sanction. (Level
3)
2) Probation - Compliance with standards is minimally acceptable
and necessitates immediate corrective action. Individuals' life safety or
quality of care are not in jeopardy. The probationary period is time limited
to 90 days. During the probationary period, the agency must make corrective
changes sufficient to bring the agency back into good standing with the
Department. Failure to make corrective changes within that given time frame may
result in a determination to initiate a higher level sanction. The admission
of new individuals shall be prohibited during the probationary period. (Level
4)
3) Restricted license - An agency is sanctioned for
unsatisfactory compliance. The admission of new individuals shall be
prohibited during the restricted licensure period. Corrective action sufficient
to bring the agency back into good standing with the Department must be taken
within 60 days. During the restricted licensure period a Division monitor will
be assigned to oversee the progress of the agency in taking corrective action.
Depending on the severity of the deficiencies, individuals may be moved to
another CILA site supervised by the same agency or a site supervised by another
agency. If individuals are moved to a site supervised by another agency,
funding for the services will also be moved. If corrective actions are not
taken, the agency will be subject to a higher level sanction. (Level 5)
4) Revocation - Revocation of the CILA license is withdrawal by
formal actions of the CILA license. The revocation shall be in effect until
such time that the CILA provider submits a re-application and the agency can
demonstrate its ability to operate in good standing with the Department. The
Department has the right not to reinstate a license. If revocation occurs as a
result of imminent risk, all individuals will be immediately relocated to
another agency and all CILA funding will be transferred. (Level 6)
5) Financial penalty - A financial penalty may be imposed upon
finding of deficiency in any one or combination of the provisions of this
Part. In determining an appropriate financial penalty, the Department may
consider the deterrent effect of the penalty on the organization and on other
providers, the nature of the deficiency, the degree to which the deficiency
resulted in a benefit to the organization and/or harm to the public and any
other relevant factor to be examined in mitigation or aggravation of the
organization's conduct. The financial penalty may be imposed in conjunction
with other sanctions or separately.
6) Targeted license - An agency with multiple CILA sites may be
sanctioned for non-compliance according to the performance of the respective
sites. Failure of one site to comply may result in a sanction-level
determination for the individual site and may not impact on the license of the
parent agency. One exception to the foregoing shall be an agency's continuous
administrative failure to implement corrective changes for a site in accordance
with a finding of deficiencies and stipulated time frames to come into
compliance. The CILA license of the agency may be subject to sanctions in
those cases.
7) Higher level sanctions may be imposed in situations where
there are repeat deficiencies.
(Source:
Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.450 NON-TRANSFERABILITY OF LICENSE
Section 115.450
Non-transferability of license
a) A license is not assignable or transferable.
b) Discontinuation of operations causes the license to be void.
c) License documents and all copies shall remain Department
property and shall be returned by the agency within 10 days after notifying the
Department of a change in ownership, or if the license is revoked or modified.
(Source:
Former Section 115.450 renumbered to Section 115.460 and former Section 115.440
renumbered to Section 115.450 at 23 Ill. Reg. 9791, effective August 13, 1999)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.460 CESSATION OF OPERATIONS
Section 115.460 Cessation of
Operations
a) If, at any time, an agency determines that it will terminate
operation as a licensed CILA agency, it shall notify the Department of its
decision at least 60 days prior to the date of termination. Agencies can only
cease operations in less than 60 days with written approval from the
Department.
b) Said notice shall be given to the Department, to service
providers working with all affected individuals, to any individual who must be
transferred or discharged, to the individual's guardian, and to a member of the
individual's family, when applicable.
c) The notice shall state the proposed date for cessation and the
reason.
d) The agency shall assist individuals in securing alternative
services and shall advise individuals on available alternatives.
e) The agency shall be responsible for services to individuals
until cessation of operation as a licensed CILA agency occurs and shall work
cooperatively with the Department and ISC agency in efforts to secure and
transition individuals to alternative services. This includes, but is not
limited to, supplying records and other documents, supplying the individual's
personal items, and conferencing with prospective agencies regarding
individual's care.
(Source:
Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.470 HEARINGS
Section 115.470 Hearings
a) If an agency contests the Department's decision regarding
licensure pursuant to subsection (a), (b), or (c), it can request a hearing by
submitting a written request within 20 working days to the Department's Bureau
of Hearings at the address stated in the notice. The Department shall notify
the agency of the time and place of the hearing not less than 14 days prior to
the hearing date.
b) A license may not be denied or revoked unless the agency is
given written notice of the grounds for the Department's action. Except when
revocation of a license is based on imminent risk, the agency whose license has
been revoked may operate and receive reimbursement for services during the
period preceding the hearing, until a final decision is made.
c) Hearings shall be conducted in accordance with the
Department's Administrative Hearings rules at 89 Ill. Adm. Code 508.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
SUBPART E: HOST FAMILY LIVING ARRANGEMENTS
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.500 PROGRAM DESCRIPTION
Section 115.500 Program
Description
a) This Subpart details those requirements specific to the Host
Family Living Arrangements Program (traditional care model and shared living
model) beyond the basic CILA requirements.
b) The Host Family Living Arrangement Program consists of two
major program components, the Traditional Care Model and the Shared Living
Model.
1) Traditional Care Model
Host family
living arrangements, traditional care models are 24-hour residential
alternatives to typical shift staff arrangements. The setting is the residence
for the person with a developmental disability and the full-time residence for
the paid caregivers. It is owned, leased, or rented by the paid caregivers.
In traditional care settings, 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 CILA agency to provide host family services.
2) Shared Living Model
Host family
living arrangements, shared living models are also 24-hour residential
alternatives to typical shift staff arrangements. The setting is the residence
for the person with a developmental disability and may house either full or
part-time caregivers in which more than 50 percent of the residential coverage
is provided by individuals other than shift employees. It is owned, leased, or
otherwise controlled by either the individual, the caregivers, or the agency.
In shared living models, host families consist of one or more persons who are
unrelated to the individual with a developmental disability and who are under
contract or employed by the CILA agency to provide host family services.
3) The difference between traditional care and shared living
models is that, in the shared living model, shift employees of the CILA agency
routinely share supervision, care and training responsibilities with the host
family caregivers who are providing services under contract.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.510 COMPLIANCE WITH THIS PART
Section 115.510 Compliance
with this Part
For purposes of clarification,
host family arrangements, whether traditional care or shared living models, are
subject to all provisions of this Part, including Subparts A through D. The CILA
agency shall ensure that host families are aware of and comply with all
requirements of this Part.
(Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.520 PROGRAM REQUIREMENTS
Section 115.520 Program Requirements
Maximum emphasis is to be placed
on the needs and requests of the individual with developmental disabilities who
is under consideration to receive host family services.
a) The CILA agency is responsible for assessing potential host
family caregivers' capabilities to provide appropriate services to individuals
with developmental disabilities.
b) The CILA agency shall ensure that all host family caregivers
are either employed by or have a signed contract with the licensed CILA agency.
c) The CILA agency shall ensure that the primary caregiver is at
least 21 years of age.
d) The CILA agency shall conduct criminal background checks on
all other persons living in the home of the host family who are age 16 or
older.
e) The CILA agency shall ensure that host family members are not
relatives or guardians of the individuals with developmental disabilities for
whom they provide services.
f) The CILA agency shall ensure that host families do not also
provide foster care services to children. Waivers may be requested for
long-standing relationships as children age out of DCFS programs. The intent of
such waivers is to provide uninterrupted services to successful, current family
arrangements. Waiver requests will be reviewed through on-site observations and
interviews to determine that both the site and the program meet requirements as
specified in this Part and are in the best interest of the person with
developmental disabilities. The Department reserves the right to deny any such
waiver requests.
g) The CILA agency shall ensure that at least one member of the
host family has a current driver's license with a safe driving record; a
vehicle to accommodate the needs of the person with developmental disabilities;
and automobile insurance with at least minimum coverage as required by the
State of Illinois. This requirement may be waived by the Department if the
family has access to and uses public transportation and public transportation
is appropriate for the individual.
h) The CILA agency shall ensure that persons under contract as
host family members who engage in additional employment or contract work commit
the resources necessary (including time and energy) to meet the requirements of
this Part in providing services and supports for individuals. In doing so, the
CILA agency must ensure that:
1) In situations where the host family encompasses only one
responsible adult, that adult may not engage in additional employment or
contract work without the knowledge of the CILA agency.
2) In situations where the host family encompasses more than one
responsible adult, the primary caregiver may not engage in additional
employment or contract work without the knowledge of the CILA agency.
3) The primary caregiver has demonstrated that he or she can be
available in the event an individual unexpectedly requires support, e.g.,
becomes ill, etc.
i) CILA agencies must ensure that caregivers who provide a
preponderance of care furnish services and supports that ensure the
individual's general welfare.
j) The CILA agency shall have a plan and arrangements for
providing relief for employees and contractual workers who have responsibility
more than eight consecutive hours or five consecutive days for individuals
receiving CILA services and shall have evidence of implementation of the plan
and arrangements. This plan shall comply with federal and State labor laws and
shall provide recognition of the need for relief in host family model settings.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.530 COMPATIBILITY OF INDIVIDUALS AND HOST FAMILIES
Section 115.530 Compatibility
of Individuals and Host Families
a) The following factors must be considered when determining the
compatibility of individuals with developmental disabilities and host family
members:
1) Smoking habits;
2) Waking and bedtimes;
3) Meal preferences;
4) Social interests;
5) Cultural needs;
6) Chores; and
7) Other unique needs.
b) Differences in preference and needs must be identified and
must be avoided or addressed in Personal Plans.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.540 DEPARTMENT APPROVAL OF HOST FAMILY SERVICES
Section 115.540 Department Approval
of Host Family Services
a) Any CILA agency desiring to provide host family services must
meet the following requirements:
1) Demonstrate knowledge and experience in the provision of such
services;
2) Provide shift-staff services under the CILA program for the
past two consecutive years;
3) Achieve a compliance Level of 1 or 2 during the most recent
CILA licensure survey process.
b) An interview and record review process may also be used to
determine the ability of the agency to provide host family services.
c) The CILA agency shall seek and obtain prior Department
approval for all host family arrangements before service implementation.
1) During this prior approval process, the CILA agency shall
submit materials and information regarding, but not limited to, the following:
A) Number and characteristics of individuals living in and
routinely visiting (as defined in Section 115.560(b) the residence;
B) Physical layout and other characteristics of the residence and
the surrounding neighborhood;
C) Legal address of the residence;
D) Description of the needs of the individuals to be served;
E) Personal Plans and Implementation Strategies;
F) Information as listed in Section 115.590(a)(4) through (a)(9)
and (a)(11); and
G) Proposed arrangements for relief services.
2) The CILA agency shall assist the Department as needed in
conducting site visits of each proposed host family residence during the prior
approval process.
d) Parents, other relatives, and legal guardians may not provide
host family services.
e) The CILA agency must report to DDD and BALC changes in the
host family arrangements that impact the lives of the individuals with
developmental disabilities. The CILA agency shall seek and obtain the
Department's approval to continue services in the event of such changes in host
family arrangements subsequent to service implementation. These changes may
include, but are not limited to:
1) Movement to a new residential location;
2) Changes in the makeup of the household;
3) Changes in the working arrangements of the host family; and
4) Significant changes in the needs of the individuals with
developmental disabilities.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.550 NUMBER OF INDIVIDUALS SERVED IN HOST FAMILY SETTINGS
Section 115.550 Number of Individuals
Served in Host Family Settings
a) No more than two individuals with developmental disabilities
may reside with any one host family.
b) The CILA agency is responsible for informing DDD and BALC, the
individual, and/or guardian in advance of any changes involving individuals
moving into or out of the home, as well as host family relocation to another
residence.
c) The CILA agency may request waiver of subsection (a) to allow
up to four persons with developmental disabilities to be served in the same residence.
The process for submission and review of waiver requests is as follows:
1) A request packet must be compiled by the licensed CILA agency
and submitted to the Department.
2) The Department will make final decisions on waiver requests.
3) The request packet must include a description of the waiver
being requested; information substantiating the appropriateness of the waiver;
and a proposed Implementation Strategy incorporating the waiver. If the waiver
impacts more than one individual served, a Personal Plan and an Implementation Strategy
must be included for each individual involved.
4) The request packet must be approved and signed by the
appropriate QIDP and executive director or Chief Executive Officer.
5) The CILA agency must complete and submit a standardized
application form for waiver requests as well as include supporting documents.
If an application is incomplete, the Department shall notify the applicant of
the status.
6) The Department will conduct a site visit or visits to review
the home, meet the host family, and meet and observe the individuals served
prior to the approval of any waiver of the requirements of subsection (a).
7) The Department will consider whether the requested waiver
provides for the individual's general well-being, safety, choices, and service
needs in making a determination of whether to grant the requested waiver.
8) The request packet must be approved by an authorized Department
representative.
d) In the event of a denial of a waiver request involving
settings in existence prior to 2001, individuals whose services are funded by
the Department would be required to choose another residential setting if they
wish funding to continue.
e) The Department reserves the right to deny any waiver requests.
f) Complete requests for waivers will be responded to within 30 calendar
days after receipt by the Department. If an on-site visit is deemed necessary
prior to making a determination regarding the waiver request, the Department
will respond within 60 calendar days after receipt of the request.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.560 NUMBER OF INDIVIDUALS LIVING IN HOST FAMILY SETTINGS
Section 115.560 Number of Individuals
Living in Host Family Settings
a) No more than six persons, including members of the host family
and individuals with developmental disabilities, may reside in a single site.
b) This number shall include extended family members who
routinely and continually visit the home for support. Examples may include
preschool children such as grandchildren, nieces or nephews who stay during the
working hours of their parents/guardians, sons or daughters who routinely
return from college on weekends, and persons who move to the setting at a later
date.
c) The CILA agency may request a waiver of subsection (a) to
allow up to eight persons to reside in a single site, inclusive of the number
of individuals with developmental disabilities. The process for submission and
review of waiver requests is as follows:
1) A request packet must be compiled by the licensed CILA agency
and submitted to the appropriate Department representative.
2) The Department will make final decisions on waiver requests.
3) The request packet must include a description of the waiver
being requested; information substantiating the appropriateness of the waiver;
and a proposed Implementation Strategy incorporating the waiver. If the waiver
impacts more than one individual served, an Implementation Strategy must be
included for each individual involved.
4) The request packet must be approved and signed by the
appropriate QIDP and executive director, or by an authorized Department
representative.
5) The CILA provider must complete and submit a standardized
application form for waiver requests as well as include supporting documents.
If an application is incomplete, the Department shall notify the applicant of
the status.
6) The Department will conduct a site visit or visits to review
the home, meet the host family, and meet and observe the individuals served
prior to the approval of any waiver of the requirements of subsection (a).
7) The Department will consider whether the requested waiver
provides for the individual's general well-being, safety, choices, and service
needs in making a determination of whether to grant the requested waiver.
d) Completed requests for waivers will be responded to within 30 calendar
days after receipt by the Department. If an on-site visit is deemed necessary
prior to making a determination regarding the waiver request, the Department
will respond within 60 calendar days after receipt of the request.
e) The Department reserves the right to deny any waiver requests.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.570 CILA AGENCY REQUIREMENTS
Section 115.570 CILA Agency
Requirements
a) The CILA agency is responsible for adhering to Department of
Labor and Internal Revenue Service regulations. The agency is also responsible
for assuring compliance with DHS Division of Developmental Disabilities provider
agreement requirements, rules and procedures, and quality assurance
requirements, as applicable.
b) The CILA agency is responsible for informing the Department,
the individual and/or guardian in advance of any changes in host family
composition and of any changes in staffing, if possible.
c) The CILA agency is responsible for the training of caregivers
as described in Section 115.320(d).
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.580 24-HOUR SERVICE
Section 115.580 24-Hour Service
Individuals living in host
family arrangements are considered in need of 24-hour service. For this
reason, the CILA agency shall:
a) Ensure that, in accordance with Section 115.230(b)(9) and (b)(10),
host families do not leave the individuals they serve alone or in the care of
individuals providing natural supports, unless such action is specifically
called for in an individual's Personal Plan and Implementation Strategy to
support training initiatives to increase independence, and then only for the
duration specified in the Personal Plan and Implementation Strategy.
b) Ensure that individuals shall not be left alone for the
convenience of the host family or CILA agency. For example, individuals shall
not be left alone before or after day program hours while host family members
travel to and from work or school.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.590 MINIMUM CILA AGENCY/CAREGIVER CONTRACT REQUIREMENTS
Section 115.590 Minimum CILA
Agency/Caregiver Contract Requirements
a) All independent contractors or caregivers shall provide
services in compliance with a contract or signed agreement made with the CILA
agency. The contract or signed agreement shall include, at a minimum, the
following provisions:
1) Names of the caregivers and all other individuals residing in
the home.
2) Names of the individuals served.
3) Legal address and phone number of the residence.
4) Signed assurance of compliance with all applicable federal and
State rules and regulations.
5) Description and documentation of training of the primary
caregivers.
6) Detailed description of how the home will be monitored by the CILA
agency and related entities, including assurance of the host family's
compliance with investigations of the Department's Office of the Inspector
General, Centers for Medicare & Medicaid Services, Department of Healthcare
and Family Services, DHS, and the CILA agency.
7) Description of how the transportation needs of the individual
will be met.
8) Description of the expected daily schedule of the individuals
and caregivers.
9) Indication of participation in the development and/or review
of the individual's Personal Plan and Implementation Strategy and how ongoing
documentation of service delivery will occur.
10) Description of relief services, including number per month,
arrangements for relief services, requests for additional relief services, and
responsibility to take relief time.
11) How documentation of the individual's financial resources
will occur.
12) If the primary caregiver is employed outside the home,
information relative to the outside employment, including:
A) The CILA agency’s approval of outside employment for the
caregiver;
B) Employer's name, address, and phone number;
C) Employer's type of business;
D) Hours caregiver will be working in this employment;
E) Name, address, and phone number of the authorized substitute
caregiver who will provide care in the absence of the primary caregiver; and
F) Copy of the documentation of training of the substitute
caregiver.
13) Other information as determined by the individual receiving
services and their family/guardian, the host family caregiver, the CILA agency,
and the Department.
b) Additional staff support
1) In exceptional circumstances, the Department may require CILA
agencies to utilize shift staff support in addition to the services provided by
the host family. These exceptional circumstances may include, but are not
limited to, the following:
A) Residences serving more than two individuals, per approval of a
waiver by the Department;
B) Transitional periods during initial service implementation;
C) Circumstances in which individuals are experiencing serious
maladaptive behaviors;
D) Circumstances in which individuals are experiencing serious
medical issues;
E) Situations in which host families are experiencing transitional
or crisis periods; and
F) CILA agencies under sanction by the Department.
2) Other staff coverage may be determined by the agency, DHS, and
the contractor (as applicable), as guided by the individual's needs, and
following the agency's quality assurance plan for service delivery.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.600 RELIEF SERVICES
Section 115.600 Relief Services
a) Each host family shall develop and submit a plan for the
provision of relief services to the CILA agency for approval. The plan will be
controlled by the host family in accordance with Department of Labor rules and
regulations.
b) The CILA agency shall have a plan and arrangements for
providing relief for employees and contractual workers who have responsibility
more than eight consecutive hours or five consecutive days for individuals
receiving services and shall have evidence of implementation of the plan and
arrangements. This plan shall comply with federal and State labor laws and
shall provide recognition of the need for relief in host family model settings.
c) For each traditional care setting, the CILA agency shall
develop, maintain, and implement a plan to provide relief services.
1) The relief plan shall provide, at a minimum, an average of 20
hours of relief services monthly per individual served, and two weeks per year
of vacation/personal time for each caregiver.
2) Relief hours shall be documented by the CILA agency.
3) The CILA agency shall develop criteria and implement procedures
for host families to request more than the required minimum average hours of
relief based on an individual's needs. The CILA agency must submit this
criteria and procedures to the Department for prior review. The Department may
require changes based upon its review.
4) The CILA agency shall employ or contract with, train, and pay
all persons providing relief services to the host family. These functions
shall not be performed by the host family.
5) The CILA agency shall not allow for relief services for a host
family by a relative of the host family.
6) All relief workers must meet the same training requirements
and background checks as the host family.
7) The CILA agency shall ensure that host families do not leave
individuals in the care of untrained and/or unauthorized persons.
8) Individuals shall not be moved from their residence for
durations of overnight stays or longer for the sole purpose of providing relief
to host families. Overnight or absence from the host family arrangement for
the benefit of the individuals must be addressed in the Personal Plan and
Implementation Strategy.
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.610 CONFLICTS OF INTEREST
Section 115.610 Conflicts of
interest
In order to avoid conflicts of
interest or the appearance of conflicts of interest, the provider agency shall:
a) For host families of the traditional care model, observe and
include in the contract of host family caregivers policies including, but not limited
to, those identified in subsection (b).
b) For host families of the shared living model, inform and
ensure that host family caregivers are knowledgeable regarding policies
including, but not limited to, the following:
1) A host family relative may not provide agency administrative
direction and/or monitoring oversight of the host family;
2) A host family member may not serve in a supervisory or
administrative position within the provider agency's host family program;
3) Employees of provider agencies and members of host families
may not serve as guardians or representative payees of individuals for whom
they have direct care or supervisory responsibilities;
4) No provider agency administrator, Board of Directors member,
or officer shall serve as a host family member for the provider agency with
which he or she is affiliated; and
5) No person employed by or contracting with the provider agency
as a host family member shall enter into any independent financial relationship
or transaction with the agency or individuals served, including, but not
limited to, rental or lease arrangements, personal cash loans, or property
transactions (including sale, trade or transfer).
(Source: Added at 27 Ill.
Reg. 5376, effective March 17, 2003)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.620 QUALITY ASSURANCE PLAN
Section 115.620 Quality Assurance
Plan
In addition to general oversight
requirements stated or implied in other Sections of this Part, the CILA
agency's own quality assurance plans must ensure that additional monitoring
occurs through visits by the following staff:
a) A QIDP employed by the CILA agency will visit each individual
served in a host family setting a minimum of 1 time per month for a minimum of
1 hour. These face-to-face visits shall occur at the individual's residence
while the individual is present. Issues to monitor include, at a minimum:
1) Health of the individual;
2) Safety of the individual;
3) Provision of services as outlined in the individual's Implementation
Strategy;
4) The individual's satisfaction with level of service received;
and
5) The individual's integration into the living environment and
community outlined in the individual's Personal Plan and Implementation
Strategy.
b) Program management or professional services staff will visit
each individual two times per month for a minimum of one hour each visit. The
staff member shall be knowledgeable about the individual's Personal Plan and
Implementation Strategy and the applicable rules and regulations covering the
setting. These face-to-face visits shall occur at the individual's residence
while the individual is present. The Department reserves the right to require
additional visits if deemed necessary. At least one visit each month shall be unannounced.
Issues to monitor include, at a minimum, those identified in subsection (a).
(Source: Amended at 47 Ill.
Reg. 8485, effective May 31, 2023)
SUBPART F: REIMBURSEMENT RATE COMPONENTS
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.700 PURPOSE (REPEALED)
Section 115.700 Purpose
(Repealed)
(Source: Repealed at 47 Ill.
Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.710 RATE COMPONENTS (REPEALED)
Section 115.710 Rate Components
(Repealed)
(Source: Repealed at 47 Ill. Reg. 8485, effective May 31, 2023)
| TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115
STANDARDS AND LICENSURE REQUIREMENTS FOR
COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.APPENDIX A SPECIFIC LEVEL OF FUNCTIONING ASSESSMENT AND PHYSICAL HEALTH INVENTORY (REPEALED)
Section 115.APPENDIX A
Specific Level of Functioning Assessment and Physical Health Inventory
(Repealed)
(Source: Repealed at 23 Ill. Reg. 9791, effective August 13, 1999)
AUTHORITY: Implementing the Community-Integrated Living Arrangements Licensure and Certification Act [210 ILCS 135] and the Health Care Worker Background Check Act [225 ILCS 46], and authorized by Section 5-104 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-104] and Section 5 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/5].
SOURCE: Adopted at 14 Ill. Reg. 10865, effective July 1, 1990; emergency amendment at 14 Ill. Reg. 20550, effective December 5, 1990, for a maximum of 150 days; emergency expired May 18, 1991; amended at 15 Ill. Reg. 8560, effective May 24, 1991; emergency amendment at 16 Ill. Reg. 2676, effective February 1, 1992, for a maximum of 150 days; emergency expired on June 30, 1992; amended at 17 Ill. Reg. 21434, effective November 29, 1993; amended at 21 Ill. Reg. 2205, effective February 1, 1997; amended at 21 Ill. Reg. 6085, effective May 5, 1997; amended at 21 Ill. Reg. 8332, effective June 25, 1997; recodified from the Department of Mental Health and Developmental Disabilities to the Department of Human Services at 21 Ill. Reg. 9321; amended at 22 Ill. Reg. 8382, effective April 28, 1998; amended at 23 Ill. Reg. 9791, effective August 13, 1999; amended at 24 Ill. Reg. 16313, effective October 12, 2000; amended at 27 Ill. Reg. 5376, effective March 17, 2003; amended at 47 Ill. Reg. 8485, effective May 31, 2023.
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