Illinois Administrative Code › Title 59 - MENTAL HEALTH › Part 120 - MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Subpart A - GENERAL PROVISIONS › Section 120.10 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purposes of this Part, the following terms are
				  defined:
"Abuse." See full definitions for physical abuse, sexual
				  abuse, mental abuse, and financial exploitation in 59 Ill. Adm. Code
				  50.10.
"Adult." An individual aged eighteen (18) or older.
"Children's Group Home (CGH)." A residential service within
				  the DD Children's Residential Waiver, for children and adolescents (ages 3-21)
				  with developmental disabilities, that is designed to provide a structured
				  environment to children and adolescents who cannot reside in their own home.
				  These settings are licensed by DCFS under Title 89, Chapter III, Subchapter
				  e.
"Code." The Mental Health and Development Disabilities Code
				  [405 ILCS
				  5 ].
"Coercion." Occurs when an Individual, guardian, or family
				  member is compelled by force, intimidation, or threat to act in a manner
				  contrary to how that person would have acted if permitted to act in accordance
				  with their free and informed choice.
"Community Day Service (CDS)." A Home and Community-Based
				  certified day program that provides assistance with gaining, maintaining,
				  and/or improving skills and functioning to Individuals with developmental
				  disabilities. Services can reinforce skills or strategies taught in other
				  settings and may include training and supports to help prevent or slow the loss
				  of skills. CDS takes place in a non-residential setting, separate from the
				  participant's residential setting, whether individually-owned, controlled or
				  other. CDS can be provided in a site certified by the Department (site-based
				  CDS) or in community locations where members of the general community typically
				  congregate (non-site-based CDS). CDS activities shall promote greater
				  independence and support full access to the general community to the same
				  degree as persons not receiving HCBS Waiver services.
"Community Integrated Living Arrangement (CILA)."
A
				  living arrangement
certified by the Department
where
eight
or fewer
Individuals
with a developmental
				  disability reside
together in a home
under the supervision of
				  the agency
and are provided with an array of
				  services
.
[210 ILCS
				  135/3(d) ]
"Community living facility (CLF)." A transitional residential
				  setting licensed by the Department of Public Health (77 Ill. Adm. Code
				  370.240) that serves individuals
				  with developmental disabilities in skill training programs that provide
				  guidance, supervision, training and other assistance, with the goal of
				  eventually assisting individuals in moving to independent living. Individuals
				  are encouraged to participate in day activities, Community Day Services,
				  Supported Employment, or regular employment. A CLF shall not be a nursing or
				  medical facility and shall serve no more than 20 Individuals [210 ILCS
				  35/3 ]. CLFs that serve 16 or fewer Individuals are a
				  part of the Adults with Developmental Disabilities Waiver.
"Confidentiality Act." The Mental Health and Developmental
				  Disabilities Confidentiality Act [740 ILCS 110 ].
"Conflict of interest free case management." Separation of
				  entities that provide HCBS Waiver services and those that conduct activities
				  that include, but are not limited to determining eligibility for HCBS Waiver
				  services, helping individuals gain access to HCBS Waiver services, developing
				  and/or monitoring the person-centered plan (case management activities). Case
				  management activities cannot be conducted by a relative of the person served, a
				  direct provider of service, someone who has a financial interest in a provider
				  or who is employed by a provider (42 CFR
				  441.301(c)(1)(vi)).
"Day." A calendar day, unless otherwise indicated.
"Department." The Department of Human Services (DHS).
"Developmental disability (DD)." An intellectual disability
				  or other severe, chronic disability, other than mental illness, found to be
				  closely related to an intellectual disability (ID) because this condition
				  results in an 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 ID. In addition, a developmental disability
				  is manifested before the person 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 person'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.
"Division of Developmental Disabilities (DDD)" or "Division."
				  The Department's Division of Developmental Disabilities.
"Grant agreement." When fully executed the obligating
				  instrument providing the basis for Departmental financial participation in
				  grant-in-aid programs and which formalizes the written relationship between the
				  Department and the provider, indicating the amount of Department funds which
				  may be paid to the provider for the provision of services as described in the
				  grant agreement and the agency plan. Requirements for grant-in-aid funded
				  providers are contained in the Department's rules at 59 Ill. Adm. Code
				  103.
"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),
				  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." An effort directed toward
				  increasing
the
level of physical, mental, social or economic
				  functioning
of an Individual with a developmental disability.
				  Additionally, habilitation may include efforts to prevent loss of skills or to
				  decelerate loss of function.
Habilitation may
also
include, but is not limited to, diagnosis, evaluation, medical
				  services,
personal
care, day care, special living
				  arrangements, training, education,
employment-related
				  services
,
supported employment,
protective services,
				  counseling and other services provided to
Individuals
with
				  developmental
disabilities
by developmental
				  disabilities
programs. [405 ILCS 5/1-111 ]
"HFS." The Illinois Department of Healthcare and Family
				  Services.
"Home and Community-Based Services (HCBS) Waiver." A
				  federally-approved Medicaid program which allows services that support
				  Individuals to remain in their own homes or live in a community setting,
				  instead of an institution. HCBS is person-centered care which is delivered in
				  the home and community.
"Individual." A person with developmental disabilities who is
				  requesting, is receiving, or has received services under this Part.
"Implementation Strategy." A document developed by a licensed
				  or certified provider agency, in conjunction with the Individual and 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 provider 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 provider agency's responsibility. The document
				  must describe how the provider agency will support the Individual to pursue the
				  outcomes included in the Personal Plan and be approved by the Individual and/or
				  guardian.
"Independent Service Coordination (ISC) agency." An entity
				  designated by DDD to carry out 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 DD 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.
"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.
"Intellectual disability." A disorder with onset during the
				  developmental period (before the person reaches age 22), that includes both
				  intellectual and adaptive deficits in conceptual, social, and practical
				  domains. The following three criteria must be present:
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 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.
"Intermediate care facility for individuals with Intellectual
				  Disabilities (ICF/DD)." A facility that meets the standards specified in
				  42 CFR
				  483, Subpart I.
"Modification." Altering or limiting the conditions in a
				  provider-owned or -controlled residential setting as specified in
				  42 CFR
				  441.301(c)(2) (xiii) and
				  Section 120.70(d)(6)(A) through
				  (E). Modifications must be supported by a
				  specific assessed need and justified in the Personal Plan.
"Natural supports." Unpaid assistance provided to a person
				  with a mental illness or developmental disability, typically by a person who
				  has some type of friendship, kinship, or other relationship (e.g., co-worker,
				  member of the same social group) with the person, whom the person accepts into
				  their life and with whom the person has chosen to spend time. A natural support
				  includes an informal agreement to assist in a particular way for some duration
				  of time and not just a one-time action done out of courtesy.
"Neglect." See full definition of neglect found in 59 Ill.
				  Adm. Code 50.10.
"Person-centered planning." A process that addresses health
				  and long-term services and support needs in a manner that reflects Individual
				  preferences and outcomes. The planning process, and the resulting Personal
				  Plan, will assist the Individual in achieving personally-defined outcomes in
				  the most integrated community setting, ensure delivery of services in a manner
				  that reflects personal preferences and choices, and contribute to the assurance
				  of health and welfare.
"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 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.
"Program." The Medicaid Home and Community-Based Services
				  Waiver Programs implemented in this Part.
"Provider." A community developmental services organization
				  in accordance with Chapter 805 of the Illinois Compiled Statutes, that is under
				  an agreement with the Department to provide HCBS Waiver services for
				  Individuals with a developmental disability.
"Provider-owned or -controlled." A physical setting in which
				  the Individual resides that is owned, co-owned, leased, or rented by a provider
				  of HCBS or is owned, co-owned, leased, or rented by a third party that has a
				  direct or indirect financial relationship with a provider of HCBS.
"PUNS." A database of Illinois children, adolescents, and
				  adults who are presumed to have a developmental disability and want or need
				  services in a developmental disability Home and Community Based Services Waiver
				  program.
"Qualified Intellectual Disabilities Professional (QIDP)." A
				  QIDP must have at least one year of experience working directly with
				  Individuals with intellectual disabilities or other developmental disabilities
				  (including individuals who are dually diagnosed with an ID/DD and mental
				  illness or other diagnosis) and be one of the following:
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 (Illinois Occupational Therapy Practice Act [225 ILCS 75
				  ]).
A physical therapist certified by the American Physical
				  Therapy Association or other comparable body (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 (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
				  (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 who meets the education requirements for licensure and is in the process of
				  accumulating the supervised experience required for licensure (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 dietitian registered with the Commission on
				  Dietetic Registration (Dietitian Nutritionist Practice Act [225 ILCS
				  30 ]); 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, or psychology.
"Quality assurance review." The Division's Bureau of Quality
				  Management's (BQM) process to determine the degree of compliance with quality
				  assurance requirements in this Part that a provider agency has maintained. This
				  can include reviewer observation and an on-site examination, 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 standard indicators to interview Individuals
				  and employees. Observation of a sample of Individuals, drawn from across
				  provider agency sites statewide, is also a part of the review.
"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 a recipient from completing an act that would result in
				  potential physical harm to themselves or another shall not constitute
				  restraint, but shall be documented in the Individual's record [405 ILCS
				  5/1-125 ]
"Restriction." Altering or limiting an Individual's rights
				  outlined in Section 120.100.
"Seclusion." Sequestration by placement of an Individual
				  alone in a room from which the Individual has no means of leaving; seclusion is
				  prohibited. [405 ILCS 5/1-126 ]
"Secretary." The Secretary of the Department of Human
				  Services or their designee.
"Service coordination." The coordination and monitoring of
				  supports to assist an Individual in planning and evaluating necessary services
				  to ensure a comprehensive array of supports and services to meet an
				  Individual's needs, personal goals, and choices, as defined in the Individual's
				  Personal Plan.
"Supported employment program (SEP)." Intensive supports
				  provided to Individuals with developmental disabilities to obtain and sustain
				  full-time or part-time paid work (at or above minimum wage) in an integrated
				  business, industry, or community setting. Individuals participating in SEP
				  shall be provided opportunities for advancement similar to those employees
				  without disabilities who have similar positions. Supports shall occur at
				  locations where the Individual interacts with employees without disabilities,
				  as well as regular interaction with persons who are not paid caregivers or
				  service providers. Supports may be provided individually or in group settings
				  of no more than six Individuals with disabilities. Individuals in SEP shall not
				  be isolated from individuals who do not have disabilities.