Title 59 Ill. Adm. Code — Mental Health

59 Ill. Adm. Code 50.10 Definitions

For the purposes of this Part, the following terms are defined:

"Abuse". See definitions for "Physical Abuse, Sexual Abuse, and Mental Abuse".

"Access". Admission to a community agency or facility for the purpose of conducting imminent risk assessments, conducting investigations, monitoring compliance with a written response, or completing any other statutorily assigned duty, such as annual unannounced site visits, including but not limited to conducting interviews and obtaining and reviewing any documents or records that the Office of Inspector General (OIG) believes to be pertinent to an investigation.

"Act". The Department of Human Services Act [20 ILCS 1305].

"Administrative Action". An action taken by the community agency or the facility in response to an OIG report, an intake referral, or the direction of the DHS Secretary (see 20 ILCS 1305/1-17(p) & (q)) that protects individuals from abuse, neglect, financial exploitation, material obstruction of an investigation, or prevents recurrences of such abuse, neglect, financial exploitation, or material obstruction of an investigation.

"Agency". See the definition for community agency.

"Aggravating Circumstance". A factor that is attendant to a finding and that tends to compound or increase the culpability of the accused employee/facility/agency.

"Allegation". An assertion, complaint, suspicion, or incident involving any of the following conduct by an employee, facility, or agency against an individual or individuals: mental abuse, physical abuse, sexual abuse, neglect, financial exploitation, or material obstruction of an investigation.

"Authorized Representative". The administrative head or executive director of a community agency appointed by the community agency's governing body with overall responsibility for fiscal and programmatic management, or the facility director or hospital administrator of a Department facility. If this person is implicated in an investigation, the governing body of the community agency or the Secretary of the Department shall be deemed the authorized representative for that investigation.

"Bodily Harm". Any injury, damage, or impairment to an individual's physical condition, or making physical contact of an insulting or provoking nature with an individual.

"Community Agency" or "Agency". A community agency licensed, funded, or certified by the Department, but not licensed or certified by any other human services agency of the State, to provide mental health service or developmental disabilities service, or a program licensed, funded, or certified by the Department, but not licensed or certified by any other human services agency of the State, to provide mental health service or developmental disability service.

"Complainant". The person who reports a death or an allegation of abuse, neglect, financial exploitation, or material obstruction of an investigation directly to OIG and is not the required reporter.

"Complaint". A report of a death or an allegation of abuse, neglect, financial exploitation, or material obstruction of an investigation reported directly to the OIG Hotline.

"Completed Investigative Report". An investigative report approved for distribution by the Inspector General that summarizes the evidence obtained during the course of the investigation and that indicates whether the allegation of abuse, neglect, material obstruction of an investigation or financial exploitation is substantiated, unsubstantiated, or unfounded.

"Credible Evidence". Any evidence that relates to the allegation or incident and that is considered believable and reliable.

"Day". Working day, unless otherwise specified.

"Deflection". A situation in which an individual is presented for admission to a facility or agency and the facility staff or agency staff do not admit that individual. Deflection includes triage, redirection, and denial of admission.

"Department". The Department of Human Services.

"Egregious Neglect". A finding of neglect as determined by the Inspector General that represents a gross failure to adequately provide for, or a callous indifference to, the health, safety, or medical needs of an individual and results in an individual's death or other serious deterioration of an individual's physical condition or mental condition. See also "Neglect" definition.

"Employee". Any person who provides services at the facility or the community agency on or off site. The service relationship can be with the individual, the facility or agency. Also, "employee" includes any employee or contractual agent of the Department of Human Services or the community agency involved in providing or monitoring or administering mental health or developmental disability services. This includes but is not limited to, owners, operators, payroll personnel, contractors, subcontractors, and volunteers. For purposes of this Part, "employee" also includes someone who is no longer working for an agency or facility but is the subject of an ongoing investigation for which OIG has jurisdiction.

"Facility" or "State-operated facility". A mental health facility or developmental disabilities center operated by the Department.

"Final Investigative Report ". The version of the investigative report that is in place after the reconsideration and response period has ended.

"Financial Exploitation". Taking unjust advantage of an individual's assets, property or financial resources through deception, intimidation, or conversion for the employee's, facility's or agency's own advantage or benefit.

"Finding". The Office of Inspector General's determination regarding whether an allegation is substantiated, unsubstantiated or unfounded.

"Health Care Worker Registry" or "Registry". The Illinois Department of Public Health's Health Care Worker Registry created by the Nursing Home Care Act [210 ILCS 45].

"IDPH". The Illinois Department of Public Health.

"Imminent Danger". A preliminary determination of immediate, threatened, or impending risk of illness, mental injury, or physical injury or deterioration to an individual's health that requires immediate action.

"Individual". Any person receiving mental health services, developmental disabilities services, or both from a facility or agency, while either on-site or off-site.

"Insulting or provoking". Contact that offends a reasonable sense of personal dignity.

"Material Obstruction of an Investigation". The purposeful interference with an investigation of physical abuse, sexual abuse, neglect, or financial exploitation and includes, but is not limited to, the withholding or altering of documentation or recorded evidence; influencing, threatening, or impeding witness testimony; presenting untruthful information during an interview; failing to cooperate with an investigation conducted by OIG. If an employee, following a criminal investigation of physical abuse, sexual abuse, neglect, or financial exploitation, is convicted of an offense that is factually predicated on the employee presenting untruthful information during the course of the investigation, that offense constitutes material obstruction of an investigation. Material obstruction of an investigation does not include: an employee's lawful exercising of their constitutional right against self-incrimination, an employee invoking their lawful rights to union representation as provided by a collective bargaining agreement or the Illinois Public Labor Relations Act [5 ILCS 315], or a union representative's lawful activities providing representation under a collective bargaining agreement or the Illinois Public Labor Relations Act. Obstruction of an investigation is considered material when it could significantly impair an investigator's ability to gather all relevant facts. An employee shall not be placed on the Health Care Worker Registry for material obstruction of an investigation for presenting untruthful information during an interview conducted by the OIG, unless, prior to the interview, the employee was provided with any previous signed statements they made during the course of the investigation.

"Mental Abuse". The use of demeaning, intimidating or threatening words, signs, gestures, or other actions by an employee about an individual and in the presence of an individual or individuals that results in emotional distress or maladaptive behavior, or could have resulted in emotional distress or maladaptive behavior, for any individual present.

"Mitigating Circumstance". A condition that is attendant to a finding and does not excuse or justify the conduct in question but may be considered in evaluating the severity of the conduct, the culpability of the accused, or both the severity of the conduct and the culpability of the accused employee/facility/agency.

"Neglect". An employee's, agency's, or facility's failure to provide adequate medical care, personal care, or maintenance, and that, as a consequence, causes an individual pain, injury, or emotional distress, results in either an individual's maladaptive behavior or the deterioration of an individual's physical condition or mental condition, or places an individual's health or safety at substantial risk of possible injury, harm, or death. See also "Egregious Neglect" definition.

"OIG". The Office of Inspector General of the Department.

"OIG Liaison". The community agency or facility staff who has been appointed to act as OIG's investigative point of contact and who is responsible for coordinating the agency's or facility's initial incident response (see 59 Ill. Adm. Code 50.30(f)).

"Physical Abuse". An employee's non-accidental (i.e., occurring with volition or consciousness; not occurring by chance) and inappropriate contact with an individual that causes bodily harm. "Physical Abuse" includes actions that cause bodily harm as a result of an employee/facility/agency directing an individual or person to physically abuse another individual.

"Preponderance of the Evidence". Proof sufficient to persuade the finder of fact that a fact sought to be proved is more likely true than not true.

"Program". Any DHS-licensed, DHS-funded, or DHS-certified service provided to persons with either mental illness or developmental disabilities by a community agency or by a State-operated facility. Program includes, but is not limited to, day training, employment and workshop opportunities, and transportation services.

"Recommendation". An admonition rendered by OIG, separate from a finding, that requires action by the facility, agency, or Department to correct a systemic issue, problem, or deficiency identified during an investigation.

"Referral". OIG directing an OIG-received complaint to another entity for possible investigation or administrative action.

"Required Reporter". Any employee/facility/agency who suspects, witnesses, or is informed of an allegation of any one or more of the following: mental abuse, physical abuse, sexual abuse, neglect, financial exploitation, or material obstruction of an investigation.

"Routine Programmatic Operations". Refers to services provided as part of the individual's habilitation plan, treatment plan or as a regular or ongoing component of the community agency's or facility's general services or practices.

"Secretary". The leader of the Department.

"Sexual Abuse". Any sexual contact or intimate physical contact between an employee and an individual, including an employee's coercion or encouragement of an individual to engage in sexual behavior that results in sexual contact, intimate physical contact, sexual behavior, or intimate physical behavior. "Sexual Abuse" also includes:

an employee's actions that result in the sending or showing of sexually explicit images to an individual via computer, cellular phone, electronic mail, portable electronic device, or other media, with or without contact with the individual; or

an employee's posting of sexually explicit images of an individual online or elsewhere, whether or not there is contact with the individual. Sexual Abuse does not include allowing individuals to, of their volition, view movies or images of a sexual nature or read text containing sexual content unless the individual's guardian prohibits the viewing of those movies or images or reading of that material.

"Sexual Contact". Inappropriate sexual contact between an employee and an individual involving either an employee's genital area, anus, buttocks, or breasts or an individual's genital area, anus, buttocks, or breasts. "Sexual Contact" also includes sexual contact between individuals that is coerced or encouraged by an employee.

"Sexually Explicit Images". Includes, but is not limited to, any material that depicts nudity, sexual conduct, or sadomasochistic abuse, or that contains explicit and detailed verbal descriptions or narrative accounts of sexual excitement, sexual conduct, or sadomasochistic abuse. This does not include those images contained in sex education materials used by employees to educate individuals.

"Substantiated". A preponderance of the evidence supports the allegation.

"Unfounded". No credible evidence supports the allegation.

"Unsubstantiated". There is credible evidence, but less than a preponderance of the evidence, to support the allegation.

"Victim". An individual who has been subjected to alleged abuse, neglect, financial exploitation, or material obstruction of an investigation.

History

• Source: Amended at 50 Ill. Reg. 11451, effective July 24, 2026

59 Ill. Adm. Code 50.20 Reporting an Allegation of Abuse, Neglect, Financial Exploitation, or Material Obstruction of an Investigation and Death Reports

a) Reporting – by a Facility, Community Agency, or Employee

1. If an employee witnesses, is told of, or suspects an incident of physical abuse, sexual abuse, mental abuse, financial exploitation, neglect, material obstruction of an investigation, or a death has occurred, the employee, community agency, or facility shall report the allegation to the OIG Hotline according to the community agency's or facility's procedures. The employee, community agency, or facility shall report the allegation immediately, but no later than the time frames specified in subsections (a)(2) and (3). Such an employee or representative of a community agency or facility shall be deemed the "Required Reporter" for purposes of this Part. Such reporting shall additionally meet any requirements of 59 Ill. Adm. Code 115, 119 and 132 and Department administrative directives, as applicable.

2. Within four hours after the initial discovery of an incident of alleged physical abuse, sexual abuse, mental abuse, financial exploitation, neglect, or material obstruction of an investigation, the required reporter shall report the following allegations by phone to the OIG Hotline:

A) Any allegation of abuse by an employee;

B) Any allegation of neglect by an employee, community agency, or facility;

C) Any allegation of financial exploitation by an employee, community agency, or facility;

D) Any allegation of material obstruction by an employee; and

E) Any injury or death of an individual that occurs within a facility or community agency program when abuse or neglect may be suspected.

F) At a minimum, required reporters to the OIG Hotline shall provide details concerning:

i) Information about the victim, including name, date of birth, sex, disability, identification number, and/or social security number (if known);

ii) Information about the incident, including what happened, when it happened, where it happened, how it happened, and the identification of all witnesses;

iii) Information about the accused employee (if known), including name, contact information, and if the accused employee/facility/agency is presently working with or will be working with the victim; and

iv) Information about the person initiating the complaint, including name, contact information, relationship to the victim, and the need for anonymity (if applicable).

3. Within 24 hours after initial discovery of a death, the required reporter shall call the OIG Hotline and report (as described in Section 50.30):

A) Any death occurring within 14 calendar days after discharge or transfer of an individual from an agency residential program or facility;

B) Any death of an individual occurring within 24 hours after deflection from an agency residential program or facility;

C) Any other death of an individual occurring within an agency residential program or facility or at any other site licensed, funded, or certified by the Department even though not alleged to be a result of abuse or neglect.

4. Screening, delaying, or withholding reports of incidents or allegations of abuse, neglect, financial exploitation, or material obstruction of an investigation from OIG is strictly prohibited. Failure to report incidents or allegations of abuse, neglect, financial exploitation, or material obstruction of an investigation to OIG within the required timeframe is a Class A misdemeanor (see 20 ILCS 1305/1-17(k)(1)).

5. Retaliation

It is a violation of Section 1-17(k)(3) of the Act for any employee or administrator of an agency or facility to take retaliatory action against an employee who acts in good faith in conformance with the employee's duties as a required reporter.

6. Other Community Agency and Facility Requirements

A) Reporting to OIG shall not relieve the community agency or facility from any statutory or regulatory reporting requirements applicable to the community agency or facility. Authorized representatives are therefore not restricted or prohibited from taking action to protect residents or patients in accordance with or as required by IDPH to ensure compliance with Intermediate Care Facility Providers for Developmental Disability (ICF/DD) standards, including, but not limited to:

i) 42 CFR 483.420, Condition of participation: Client protections; and

ii) State Operations Manual Appendix J - Guidance to Surveyors: Intermediate Care Facilities for Individuals with Intellectual Disabilities, available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Qso18-16-ICFIID.

B) If the authorized representative, their designee, or the OIG Liaison reviews an agency's or facility's internal documents regarding an allegation of abuse, neglect, financial exploitation, material obstruction of an investigation, or the death of an individual at the respective community agency or facility, they shall not delete, delay, withhold, limit, or otherwise restrict any of the information contained in the documents. Information may be added by the authorized representative or their designee for clarification purposes only. Failure to report incidents or allegations of abuse, neglect, financial exploitation, or material obstruction of an investigation within the required timeframe is a Class A misdemeanor (see 20 ILCS 1305/1-17(k)(1)).

b) OIG Hotline

The OIG Hotline (#1-800-368-1463) shall be communicated to individuals and guardians at the time of admission and the number shall be posted in plain sight at each community agency and facility location where individuals receive services.

c) Material Obstruction of an Investigation

The OIG Hotline will document information received alleging material obstruction of an investigation pertaining to an allegation of abuse, neglect, financial exploitation, and death. If, after issuing the completed investigative report or final investigative report in an investigation of alleged abuse, neglect, or financial exploitation, OIG receives information alleging potential material obstruction of an investigation, OIG may reopen the related case or open a new case to investigate.

d) Other Reports of Allegations of Abuse, Neglect, Financial Exploitation, Material Obstruction of an Investigation and Deaths

1. Any other person, individual, family member, guardian or advocate who witnesses, is told of, or suspects an incident of alleged abuse, neglect, financial exploitation, material obstruction of an investigation, or a death of an individual has occurred, may report the incident to OIG by telephoning the OIG Hotline, or in writing by fax or other electronic reporting system offered by OIG to the OIG Hotline or mail at:

Department of Human Services

Office of Inspector General

901 Southwind Road

Springfield, Illinois 62703

2. Notifications

A) Within three working days after receipt of an allegation, OIG shall notify the authorized representative of the community agency or facility or their designee that an allegation has been received unless such notification compromises the integrity of the investigation, such as, an allegation involving the authorized representative or their designee.

B) Within 24 hours after notification of an allegation by their own staff or by OIG, the authorized representative of the community agency or facility shall notify the victim or guardian (if applicable) and the accused employee that an allegation has been received. All attempted and actual contacts by phone or in person shall be documented. In addition to the phone or in person notification, within 24 hours (or 72 hours if notified of the allegation on a Friday or Saturday or holiday) the community agency or facility shall also mail the victim or guardian and the accused a written letter of notification. If the victim no longer receives services at the community or facility, the letter shall be mailed to the victim's new address, if known, or to the guardian's last known address. If the accused is no longer employed at the facility or agency, the letter shall be mailed to the accused's last known address. A copy of the letters shall be maintained by the community agency or facility.

C) Immediately, but no later than within three working days after receipt of an allegation, OIG shall also contact the complainant regarding the allegation.

e) Training and Technical Assistance

1. Agencies and facilities shall have a policy detailing procedures for reporting allegations of abuse, neglect, financial exploitation, material obstruction of an investigation, and deaths as set forth in Sections 50.10 and 50.20.

2. All employees, as defined in Section 50.10, shall be trained in Part 50 requirements upon being hired and at least biennially thereafter.

3. Each facility and community agency is required to have an employee who is designated as the OIG Liaison.

4. Community agency or facility employees designated as OIG Liaisons or whose duties include completing the initial incident response as set forth in Section 50.30(f) are required to take OIG's Section 50.30(f) training.

5. Any employee, community agency, or facility may request training or technical assistance from OIG in identifying, reporting, investigating, and preventing abuse, neglect, financial exploitation, material obstruction of an investigation, reporting of deaths, or participation in applicable OIG-sponsored training as referenced in Section 1-17(h) of the Act.

f) Misleading Reports

Nothing in this Part protects persons who knowingly make false or misleading reports from disciplinary and other actions available to either the community agency or facility. Nothing in this Part prohibits OIG, other enforcement authorities, or any employee jeopardized by such reporting from pursuing any and all allowable remedies.

History

• Source: Amended at 50 Ill. Reg. 11451, effective July 24, 2026

59 Ill. Adm. Code 50.30 Responsibilities of OIG for Intake Assessment

a) Availability of OIG

OIG shall be available 24 hours a day to assess reports of allegations of abuse, neglect, financial exploitation, material obstruction of an investigation, or the death of an individual and provide any technical assistance with making the report.

b) Responsibility of OIG for receiving the report

OIG staff receiving the report of the allegation are responsible for assessing, based on the information received at intake, whether the allegation could constitute abuse, neglect, financial exploitation, or material obstruction of an investigation, and whether OIG has the authority to investigate in accordance with the Act. Absent extenuating circumstances, OIG shall make these assessments within one day after receiving the report.

c) Reports involving routine programmatic, licensure or certification matters

1. OIG shall have no supervision over or involvement in routine programmatic, licensure, or certification operations of the department. (Section 1-17(f) of the Act)

2. If the reported allegation relates to licensure or certification standards or routine programmatic operations and is deemed not to be abuse, neglect, financial exploitation, or material obstruction of an investigation, OIG shall refer the allegation to the appropriate agency or unit of government.

d) Investigations by two or more State agencies

When two or more State agencies could investigate an allegation of abuse or neglect at a community agency or facility, OIG shall not conduct an investigation that is redundant to an investigation conducted by another State agency (see Section 1-17(f) of the Act) unless requested in writing by another State agency in accordance with Section 1-17(e) of the Act.

e) Referrals to the Illinois State Police/Local Law Enforcement

In certain instances, it is appropriate or required for OIG to refer allegations to other entities.

1. Section 1-17(l) of the Act requires OIG to refer an allegation to the Illinois State Police or ensure that notification is made to the respective local law enforcement entity for investigation within 24 hours after determining that there is credible evidence indicating that a criminal act may have been committed in connection with an allegation of abuse, neglect, financial exploitation, material obstruction of an investigation, or death of an individual served by a facility or agency.

2. When an allegation concerns the actions of a community agency or facility employee, but the described conduct does not rise to the level of a reportable offense (e.g., an allegation that an employee was late to work), where appropriate, OIG shall forward the allegation to the appropriate authorized representative.

3. When an allegation does not concern the actions of either a community agency or facility employee, the intake investigator shall transfer or refer the caller to the appropriate local, State, or federal agency or organization, as appropriate.

4. When OIG has jurisdiction over an allegation, it may make a referral of that allegation to the involved facility or agency where, among other factors:

A) The primary facts relevant to the allegation have already been identified and additional investigative work by OIG would be of minimal value;

B) The agency or facility is better positioned to immediately address the allegation;

C) The allegation, if true, would be unlikely to result in a report to the Registry (e.g., mental abuse, non-egregious neglect); or

D) The allegation does not indicate an emergency situation or that an individual is in imminent danger.

f) Authorized Representative

If the allegation of abuse, neglect, material obstruction of an investigation, or financial exploitation is within the jurisdiction of OIG, the authorized representative of the involved community agency or facility or their designee shall:

1. Ensure the immediate health and safety of involved individuals and employees, including ordering medical examinations and healthcare, when applicable, and immediately contacting victim services, when applicable (a listing of victim services is available by contacting the OIG hotline); and

2. Remove accused employees from having contact with individuals at the facility or agency when there is credible evidence supporting the allegation of physical abuse, sexual abuse, financial exploitation when totaling a cumulate value of equal to or greater than $20, egregious neglect, or material obstruction of an investigation, pending the outcome of the OIG investigation, against the employee or until OIG independently determines that the allegation against the employee will be unsubstantiated or unfounded in OIG's final investigative report.

A) When, based upon credible evidence, an initial investigation of a reported allegation of abuse or neglect of a recipient of services indicates that it is reasonable to believe that an employee at a community agency or facility is the perpetrator of, at most, neglect, de minimis financial exploitation (such as financial exploitation totaling a cumulative value of less than $20), or mental abuse, the community agency or Department (for the facility) shall determine what appropriate steps should be taken as to the employee while the investigation of the Department of Human Services Office of Inspector General is pending. These steps by the community agency or Department (for the facility) may include, but not be limited to:

i) Training;

ii) Re-assignment away from and a bar from contact with the alleged victim;

iii) Being barred from any further contact with recipients of services of the community agency or facility; or

iv) Pursuing discipline for known conduct.

B) If further investigation reveals that the conduct rose to the level of physical abuse, sexual abuse, non-de minimis financial exploitation, egregious neglect, or material obstruction of an investigation, then the employee shall be barred from contact with recipients of services and shall remain barred, subject to the conditions detailed in this subsection(f)(2). [405 ILCS 5/3-210];

3. Ensure OIG is notified; and

4. Unless otherwise directed by OIG, initiate the preliminary steps of the investigation by a Section 50.30(f)-trained OIG liaison. The OIG liaison may not have a substantiated OIG finding in the last three years and may not be a witness or subject to the allegation for which they are performing preliminary steps. This may include the need to:

A) Secure the scene of the incident and preserve evidence, if applicable;

B) Identify and separate potential witnesses, and take initial statements immediately, but no longer than 72 hours from discovery of the incident. Potential witnesses shall not be allowed to communicate with one another or be in one another's presence until all initial statements have been taken and completed;

C) Identify and record the names of all persons at the scene at the time of the incident and, when relevant, those who had entered the scene prior to the scene being secured;

D) Secure all relevant documents and physical evidence, such as clothing, if applicable; and

E) Photograph the scene of the incident and the individual's injury, when applicable.

5. Employees taking initial statements pursuant to Section 50.30(f)(4)(B) shall not have a conflict of interest in the investigation such that there is a reasonable possibility that the employee may not exercise their investigative function in an impartial manner. Initial statements shall be taken of all individuals having knowledge of the incident.

A) At facilities, initial statements are an interview process where the OIG approved investigator asks the witness questions (and additional clarifying questions, as necessary), the answers to which are documented on a designated interview statement form.

B) At community agencies, the witness shall be directed to memorialize what happened during an incident, in their own words, and from their own perspective on a dedicated form. OIG will provide a model dedicated form that may be used. The employee shall conduct follow-up questioning as necessary to clarify the witness's statement.

g) OIG may determine what further action, if any, is necessary to protect the safety of any individual, secure the scene of the alleged incident, preserve the evidence, and maintain the integrity of the investigation. Such action may include immediate emergency referrals (such as medical or housing services), the notification of law enforcement officials, requesting hospital services or contacting the Department or other State agencies for assistance.

History

• Source: Amended at 50 Ill. Reg. 11451, effective July 24, 2026

59 Ill. Adm. Code 50.40 General Responsibilities

a) OIG shall notify the Authorized Representative when OIG opens an investigation and the Authorized Representative will then notify the victim or guardian (if applicable) and the accused employee, in writing, when an investigation will be opened.

b) If an OIG investigation results in a substantiated finding of physical abuse, sexual abuse, egregious neglect, material obstruction of an investigation, or financial exploitation by an employee, it shall result in the accused employee's identity and the OIG finding being reported to the Registry in accordance with Section 50.90.

c) OIG investigations may include, but are not limited to, site visits, telephone contacts, requests for written statements and responses from the community agency or the facility.

d) Nothing in this Part precludes a community agency or facility from taking immediate action that may include protecting the individuals from danger or harm, notifying appropriate law enforcement officials, or taking any other Administrative Action deemed necessary by the community agency or facility, unless otherwise directed by OIG. The agency shall request approval from OIG prior to conducting its own full investigation beyond what is outlined in Section 50.30(f)(4).

e) Each community agency must provide OIG with a valid (in working order) email which shall serve as the email address of record to receive confidential information securely transmitted to the community agency from OIG. Email transmitted by OIG is considered received by the community agency on the day it is transmitted. The community agency may receive intake information, reportable referred intakes, communications from the investigative bureaus, completed investigative reports, and written responses through the email address it has provided. Each community agency will provide OIG a current email address no later than October 1, 2026. Thereafter, the community agency will provide OIG with 10 business days advance notice of an email address change. The community agency email address (and subsequent changes) shall be emailed to DHS.OIG.Protocols@illinois.gov.

History

• Source: Amended at 50 Ill. Reg. 11451, effective July 24, 2026

Chapter I Department of Human Services

Part 50 Office of Inspector General Investigations of Alleged Abuse, Neglect, or Financial Exploitation in State-Operated Facilities and Community Agencies

59 Ill. Adm. Code 50.50 Conducting Investigations

a) In accordance with investigative best practice, OIG shall, when feasible, and to the extent these actions have not already been fully addressed by facility or agency staff:

1. Ensure that the victim is not in imminent danger;

2. Protect the integrity of the investigation at all times;

3. Secure the scene of the incident;

4. Identify and separate witnesses;

5. Preserve and secure all evidence;

6. Obtain statements from persons involved, including victims, accused employees, and witnesses through in-person interviews, by telephone, or by video; and

7. Obtain copies of pertinent documents relating to the investigation, i.e., progress notes, incident or injury reports, patient or resident records, photographs, etc.

b) Confidentiality

Any allegations or investigations of reports of abuse, neglect, financial exploitation, and material obstruction of an investigation shall remain confidential until a final report is completed (Section 1-17(m) of the Act). The identity of any person as a complainant shall remain confidential in accordance with the Freedom of Information Act [5 ILCS 140] or unless identification is authorized by the complainant. Information concerning diagnosis and treatment for substance use disorder shall be disclosed to OIG by community agencies only in accordance with federal regulations at 42 CFR 2. Information concerning tests for human immunodeficiency virus (HIV) and diagnosis and treatment for acquired immune deficiency syndrome (AIDS) shall be disclosed to OIG by community agencies only in accordance with the AIDS Confidentiality Act [410 ILCS 305]. All personal health related information contained in OIG investigative reports shall remain confidential in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (P.L. 104-191) (45 CFR 160, 162 and 164). All personal information concerning an employee or recipient shall be protected from disclosure in accordance with the Personal Information Protection Act [815 ILCS 530], except as necessary to complete reporting of an employee's name to the Registry or for other required reporting to investigatory, law enforcement, and/or licensing authorities.

c) All investigations shall be conducted in a manner that respects the dignity and human rights of all persons involved.

d) Every OIG Investigator authorized to conduct investigations shall receive ongoing training regarding OIG Investigations of alleged abuse, neglect, financial exploitation, and material obstruction of an investigation in State-Operated Facilities and Community Agencies (59 Ill. Adm. Code 50). Additionally, every OIG Investigator authorized to conduct investigations at community agencies shall receive ongoing training regarding Standards and Licensure Requirements for Community-Integrated Living Arrangements (59 Ill. Adm. Code 115); Administration of Medication in Community Settings (59 Ill. Adm. Code 116); and Minimum Standards for Certification of Developmental Training Programs (59 Ill. Adm. Code 119).

e) Representation during Interviews

An employee may request representation at an interview with OIG if the employee has reasonable grounds to believe that the interview may be used to support disciplinary action against them. If the investigator denies the request, the employee's statement may not be used in any subsequent disciplinary proceeding against that employee. No representative of the agency or facility that employs the interviewee may be present at an investigatory interview. Union representation for AFSCME employees, Council 31 (State-operated facilities), shall be granted in accordance with the applicable union contract.

f) No person shall interfere with or obstruct an OIG interview or investigation. Such conduct is a violation of Section 1-17(i)(2) of the Act and may result in a finding of material obstruction of an investigation.

g) OIG shall be granted access, for the purpose of investigating abuse, neglect, financial exploitation, or material obstruction of an investigation to any facility or program operated, funded, licensed, or certified by the Department that is subject to the provisions of Section 1-17 of the Act.

1. When advance notice to an authorized representative or their designee is not provided, OIG shall, on arrival at the community agency or facility site, request that an on-duty and on-site employee notify the authorized representative or their designee of OIG's arrival.

2. Facilities and community agencies shall obtain and provide OIG with all written statements and any requested documents in a timely manner.

h) If OIG determines that:

1. An individual's health or safety is in imminent danger, the Inspector General shall immediately notify the Secretary or their designee and the authorized representative of the community agency or facility or their designee.

2. There is reason to believe that a violation of an existing Department rule may have occurred, OIG shall notify the authorized representative of the community agency or their designee and the appropriate Department division.

History

• Source: Amended at 48 Ill. Reg. 14653, effective September 27, 2024

59 Ill. Adm. Code 50.60 Oig Procedures for Investigative Reports, Referrals, Reconsideration, and Clarification Requests

a) Processing Investigative Reports

1. When OIG determines that abuse, neglect, or financial exploitation of an individual or material obstruction of an investigation is substantiated against an employee, OIG shall note in the investigative report any aggravating or mitigating circumstances as those terms are defined in this Part.

2. When OIG substantiates neglect against an employee, OIG shall make a determination in the investigative report if the neglect is egregious neglect, as defined herein.

3. Finalizing Investigative Reports and Notifications to Community Agencies and Facilities

A) After determining the finding, for substantiated cases and unsubstantiated cases, as well as any case containing an OIG recommendation, OIG shall notify the authorized representative of the community agency or facility by submitting a copy of the investigative report to them. The authorized representative shall be responsible for maintaining the confidentiality of the investigative report consistent with State and federal law. For unfounded cases without recommendations, a letter of finding will be sent to the facility or agency.

B) The community agency or facility shall submit a written response when required as described in Section 50.80.

4. After OIG completes its investigative report, OIG shall notify, in addition to the facility or agency, the following parties of its finding:

A) the complainant;

B) the individual who was allegedly abused, neglected, financially exploited, or involved in a case alleging material obstruction of an investigation or their legal guardian (if applicable); and

C) the employee or employees alleged to have committed the act or acts.

5. The notice provided to the following parties shall identify the outcome of the investigation and include a statement of the right to request clarification or reconsideration of the finding:

A) the individual who was allegedly abused, neglected, financially exploited, or involved in a case alleging material obstruction of an investigation or their legal guardian (if applicable);

B) the employee or employees alleged to have committed the act or acts; and

C) the facility or agency.

6. In substantiated cases, OIG shall provide the employees found to have taken the substantiated action and the victim or guardian with a redacted copy of the investigative report.

b) Referrals

With respect to allegations within OIG's jurisdiction that OIG refers to a community agency or facility, after the community agency or facility has completed its inquiry, the agency or facility shall notify the following parties of the outcome:

1. the complainant;

2. the individual who was allegedly abused, neglected, or financially exploited, or their legal guardian (if applicable); and

3. the employee or employees alleged to have committed the act or acts.

c) Reconsideration and clarification requirements

Requests that OIG either clarify or reconsider its findings or recommendations must be submitted within 15 calendar days after receipt of the report or notification of the findings and/or recommendations.

1. All clarification and reconsideration requests must be in writing.

2. Community agency or facility clarification and reconsideration requests must be on letterhead signed by the authorized representative.

3. All clarification and reconsideration requests must clearly identify the nature of the request and reconsideration requests must clearly indicate the specific findings and/or specific recommendations to be considered.

4. Reconsideration requests shall be subject to a multi-layer review and shall include at least one reviewer who did not participate in the investigation or approval of the original investigative report.

5. If a reconsideration request is denied or after clarification has been provided, the community agency or facility shall submit a written response as set forth in Section 50.80.

6. If OIG determines further investigation is necessary based on the request for reconsideration or clarification of the findings, the investigation shall be reopened and an amended investigative report shall be issued.

History

• Source: Amended at 48 Ill. Reg. 14653, effective September 27, 2024

59 Ill. Adm. Code 50.70 Completed Investigations

a) OIG's investigation shall be considered final 30 calendar days after OIG provides notice to the facility or agency as required in Section 50.60(a)(3)(A), except where OIG has granted a request for clarification or reconsideration.

b) Distribution of Completed Investigative Reports

1. Within 10 calendar days after the transmittal of a completed investigative report substantiating an allegation, finding an allegation is unsubstantiated, or if a recommendation is made, OIG shall provide the investigative report to the Secretary and to the director of the facility or agency where the abuse, neglect, financial exploitation, or material obstruction of an investigation occurred. The director of the facility or agency shall be responsible for maintaining the confidentiality of the investigative report consistent with State and federal law. (Section 1-17(m) of the Act)

2. OIG shall provide copies of all completed investigative reports within 10 calendar days to the federally-mandated Protection and Advocacy System for the State of Illinois, and the Illinois Guardianship and Advocacy Commission.

3. OIG shall provide a completed investigative report of all substantiated cases from Department facilities serving individuals with developmental disabilities within 10 calendar days to IDPH and the Department's Division of Developmental Disabilities.

4. OIG shall provide a completed investigative report of all substantiated cases from Department facilities serving individuals with mental illness within 10 calendar days to the Department's Division of Mental Health.

5. If OIG substantiates abuse, neglect, financial exploitation, or material obstruction of an investigation at a community agency serving individuals with developmental disabilities or recommends administrative action, the completed investigative report shall be provided to the Department's Division of Developmental Disabilities within 10 calendar days.

6. If OIG substantiates abuse, neglect, financial exploitation, or material obstruction of an investigation at a community agency serving individuals with mental illness or recommends administrative action, the completed investigative report shall be provided to the Department's Division of Mental Health within 10 calendar days.

7. OIG shall provide a completed investigative report of all cases of abuse, neglect, financial exploitation, or material obstruction of an investigation in community agencies within 10 calendar days after closure to the Department's Bureau of Accreditation, Licensure and Certification.

8. OIG shall provide a completed investigative report in all cases substantiating abuse, neglect, financial exploitation, or material obstruction of an investigation against a Department employee within 10 calendar days to the Department's Bureau of Labor Relations.

9. OIG shall provide a completed investigative report substantiating abuse, neglect, financial exploitation, or material obstruction of an investigation within 10 calendar days to the Department's Office of General Counsel.

10. When an accused employee in a substantiated case is licensed by the Department of Financial and Professional Regulation, OIG shall provide a copy of the completed investigative report to that agency.

c) OIG shall inform the accused employee of the results of a reconsideration or clarification request or of any changes in the finding that resulted from such a request within 15 calendar days.

d) If the finding substantiates physical abuse, sexual abuse, egregious neglect, financial exploitation, or material obstruction of an investigation, OIG shall report the identity of the accused employee and its finding to IDPH's Registry. OIG shall notify the accused employee of the right to appeal the action that will report OIG's finding to the Registry as described in Section 50.90.

e) Release of Investigative Reports

1. All investigative reports prepared by OIG shall be considered confidential and shall not be released except as provided by the law of this State or as required under applicable federal law. (Section 1-17(m) of the Act)

2. Substantiated findings shall be released in accordance with the Act, the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110] and the Freedom of Information Act [5 ILCS 140].

3. Unsubstantiated and unfounded investigative reports shall not be disclosed except as allowed pursuant to Section 6 of the Abused and Neglected Long Term Care Facility Residents Reporting Act [210 ILCS 30] or pursuant to a valid court order. (Section 1-17(m) of the Act)

4. The identity of any person as a complainant shall remain confidential in accordance with the Freedom of Information Act [5 ILCS 140], or unless authorized by the complainant in writing. The identity of a required reporter shall only remain confidential under certain circumstances as determined by OIG on a case-by-case basis.

f) Release of Death Reports

Death reports where there was no allegation of abuse or neglect shall only be released to the Secretary, or the Secretary's designee, and to the director of the facility or agency when a recommendation is made and pursuant to applicable State or federal law or a valid court order. [20 ILCS 1305/1-17(m)]

g) Release of Unredacted Investigative Reports and Raw Data

1. Unredacted investigative reports, as well as raw data, may be shared, upon written request, with local law enforcement, state's attorney's offices, and coroner's offices;

2. Unredacted investigative reports, as well as raw data, may be shared with the Department of Financial and Professional Regulation when there is a substantiated finding against a person licensed by the Department of Financial and Professional Regulation who is within the Office of the Inspector General's jurisdiction, upon written request. If, during its investigation, the Office of the Inspector General found credible evidence of neglect by a person licensed by the Department of Financial and Professional Regulation who is not within the Office's jurisdiction, the Office may provide an unfounded or unsubstantiated investigative report or death report, as well as raw data, with the Department of Financial and Professional Regulation, upon written request. [20 ILCS 1305/1-17(m)]

h) Recommendations for Sanctions

1. The Inspector General may recommend to the Secretary of the Department of Human Services that sanctions be imposed against facilities or community agencies to protect residents, including:

A) appointment of on-site monitors or receivers;

B) transfer or relocation of an individual or individuals;

C) closure of units; and

D) termination of any one or more of the following:

i) Department licensing;

ii) Department funding; or

iii) Department certification.

2. The Inspector General may seek the assistance of the Attorney General of Illinois or the State's Attorney for imposing sanctions listed in subsection (g)(1). [20 ILCS 1305/1-17(r)]

History

• Source: Amended at 50 Ill. Reg. 11451, effective July 24, 2026

59 Ill. Adm. Code 50.80 Written Responses

There are multiple circumstances where OIG requires community agencies or facilities to provide a written response to an investigative report or referral:

a) If OIG substantiates abuse, neglect, financial exploitation, or material obstruction of an investigation, or makes one or more recommendations in its investigative report, the community agency or facility is required to submit a written response on a prescribed form to the respective DHS program division. The prescribed form will be sent to the community agency or facility.

1. The written response shall address the actions that it will take or has taken to protect individuals from abuse, neglect, financial exploitation, or material obstruction of an investigation, prevent recurrence, and eliminate problems. Each substantiated finding or recommendation shall be addressed separately.

2. The written response shall include the following information:

A) Investigative findings and/or recommendations by OIG;

B) Specific actions for each finding or recommendation, identifying the persons the actions address, if any;

C) Persons responsible for implementing each action;

D) For each action, the actual or anticipated completion date; and

E) Signature of the authorized representative or, if the authorized representative is named in the investigation, the President of the Board of Directors.

3. The written response shall be submitted to the respective Department program division within 30 calendar days after receiving the investigative report.

4. If a reconsideration request is received by OIG, the written response is due within 15 calendar days after the following:

A) The date the community agency or facility is notified that the reconsideration is denied;

B) The date the community agency or facility receives a revised cover letter based on a granted reconsideration indicating the finding remains substantiated, or there are recommendations.

5. If a reconsideration request is granted and the revised cover letter indicates the finding is unsubstantiated or unfounded and there are no recommendations, a written response is no longer required.

b) With respect to allegations within OIG's jurisdiction that OIG refers to a community agency or facility, the community agency or facility shall submit a written response on a prescribed form to the respective DHS program division within 45 calendar days after receipt of the referral. The prescribed form will be sent to the community agency or facility. The written response shall address any action that the community agency or facility took or will take to protect individuals from abuse, neglect, financial exploitation, or material obstruction of an investigation.

c) Division Responsibilities

1. The respective DHS program division shall promptly review the submitted written response and may require the community agency or facility to plan or take additional administrative actions in response to the findings and/or recommendations.

2. When the division agrees with the written response, the division's director, or designee, shall approve the written response by signing and dating the form. The actions listed on the written response do not need to be completed for the division to approve it.

3. To ensure timely implementation of identified actions, the division shall promptly do the following:

A) Notify the community agency, facility, and OIG of the approval; and

B) Send to OIG the approved written response and any documentation received that confirms implementation of the designated actions.

d) Implementation Status Reports

1. Community Agency or Facility

A) If the actions listed in a written response to an OIG investigative report have not been completed by the time the division notifies the community agency or facility that the written response is approved, the authorized representative shall send OIG an implementation status report within 30 calendar days of the date the written response was approved.

B) The implementation status report shall detail the status of each administrative action taken or planned, including the actual or anticipated completion date.

C) An updated implementation status report must be sent to OIG every 60 calendar days thereafter until all administrative actions have been completed.

D) Upon completion of actions for which at least one implementation status report was submitted, the community agency or facility shall promptly do the following:

i) Notify OIG in writing of the completion date and the names of any persons who were the subject of the action; and

ii) Submit to OIG documentation confirming implementation of each of those actions.

2. OIG may review approved written responses and notify any community agency or facility when an implementation status report is overdue. Failure of the community agency or facility to comply with implementation status reports is a violation of the statute. [20 ILCS 1305/1-17(i)]

e) Compliance Reviews

1. OIG shall conduct a review of the following:

A) Any written response in which an action takes more than 120 calendar days after approval to complete;

B) A random sample of written responses to OIG investigative reports that have been approved by the division. The sample shall be chosen at least quarterly, shall be at least 10% of all written responses approved during that time period, and shall be proportionate by community agency and facility cases among the approved written responses; and

C) A random sample of written responses to OIG referrals that have been approved by the division. The sample shall be chosen at least quarterly, shall be at least 10% of all written responses approved during that time period, and shall be proportionate to the respective number of community agency and facility cases among the approved written responses.

2. OIG shall determine compliance with the completed action as approved, which may include, but not be limited to, written and verbal requests for documentation, phone contacts or site visits.

3. Community agencies and facilities shall fully cooperate with OIG during these compliance reviews, including providing access as defined in Section 50.10. Cooperation with compliance reviews additionally includes the following:

A) Arranging for interviews as requested and providing copies of any personnel action taken as a result of the findings or recommendations; and

B) Responding promptly to OIG requests for documentation and related information.

History

• Source: Amended at 50 Ill. Reg. 11451, effective July 24, 2026

Chapter I Department of Human Services

Part 50 Office of Inspector General Investigations of Alleged Abuse, Neglect, or Financial Exploitation in State-Operated Facilities and Community Agencies

59 Ill. Adm. Code 50.90 Reporting by the Inspector General to the Illinois Department of Public Health's Health Care Worker Registry

a) An employee's identity and the investigative finding will not be reported to the Registry when:

1. OIG has issued an amended investigative report, as a result of a reconsideration, that no longer contains a substantiated finding;

2. The Inspector General requests a stipulated disposition of the investigative report and the Secretary of the Department of Human Services agrees with the requested stipulated dismissal; or

3. The employee has notified OIG in writing, including any supporting documentation, that the employee is formally contesting an adverse employment action resulting from a substantiated finding by a complaint filed with the Illinois Civil Service Commission or has filed an action pursuant to any applicable collective bargaining agreement; or

4. The employee has requested a hearing to appeal the reporting of the employee's name to the Registry and the hearing has not been completed.

b) After OIG's investigative report becomes a final investigative report, OIG shall notify the employee against whom it has substantiated physical abuse, sexual abuse, egregious neglect, financial exploitation, or material obstruction of an investigation that the employee's identity and the investigative finding will be reported to the Registry maintained by IDPH.

c) The notification to the employee of the decision to report the employee's name and OIG's investigative finding to the Registry shall be provided to the last known address of the employee by certified mail and shall include:

1. A clear and concise statement of the grounds on which the report to the Registry is based.

2. Information on the opportunity to request a Registry hearing to contest the decision to report the employee's name and OIG's investigative finding to the Registry, or in lieu of a request for a hearing, the opportunity to submit a written response to the decision to report the employee's name and OIG's investigative finding to the Registry.

3. Explanation of the mechanism by which the employee can request a hearing.

d) If the employee requests a Registry hearing:

1. The employee and the Department may provide documentary, physical and oral evidence at the hearing.

2. The Department shall be required to establish by a preponderance of the evidence that the office of the inspector general's finding of physical abuse, sexual abuse, egregious neglect, financial exploitation, or material obstruction of an investigation warrants reporting to the Registry.

3. Hearings under this Section shall be conducted in accordance with the Department's rules on the conduct of hearings and appeals at 89 Ill. Adm. Code 508. In the event there is a conflict between 89 Ill. Adm. Code 508 and this Part, the provisions of this Part shall prevail.

4. If applicable, in addition to notice to OIG, the employee must give written notice to the Department's Division of Administrative Hearings, Department of Human Services, Office of the General Counsel, 69 W. Washington St., 4th Floor, Chicago IL 60602, that the employee's initiated the grievance or arbitration process and the date of initiation, or has filed an action with the Civil Service Commission. The notice must include a copy of the grievance or the filing with the Civil Service Commission.

5. The employee may request a hearing no later than 30 calendar days after receipt of the notice issued pursuant to Section 50.70(c). All notices sent to the employee's last known address via USPS certified mail will be deemed to be received on the 4th working day after mailing. The employee shall file an appeal by email at DHS.BAH@illinois.gov or in writing to the Division of Administrative Hearings, Department of Human Services, Office of the General Counsel, 69 W Washington St, 4th Floor, Chicago IL 60602, requesting a hearing and stating out the reasons why the proposed report to the Registry is not warranted.

6. If the employee requests an administrative hearing, the employee shall be granted an opportunity to appear before an administrative law judge to present reasons why the employee's name should not be reported to the Registry. The Department shall bear the burden of presenting evidence that establishes, by a preponderance of the evidence, that the substantiated finding warrants reporting to the Registry. After considering all the evidence presented, the administrative law judge shall make a recommendation to the Secretary as to whether the substantiated finding warrants reporting the name of the employee to the Registry. The Secretary shall render the final decision.

e) If the employee does not request a hearing or if the hearing results in a decision that the reporting of OIG's finding to the Registry is warranted, OIG shall report the name of the employee to the Registry maintained by IDPH and notify the employee of the report.

f) OIG's report to the Registry shall include:

1. The identity of the employee, including the employee's social security number, and identification of the substantiated finding that resulted OIG's reporting of the finding to the Registry;

2. The final decision from the Department's Registry hearing, if one was held; and

3. A brief statement from the reported employee if the employee chooses to make a statement.

History

• Source: Amended at 48 Ill. Reg. 14653, effective September 27, 2024

59 Ill. Adm. Code 50.100 Removal of an OIG Finding from the Illinois Department of Public Health's Health Care Worker Registry

a) Pursuant to 20 ILCS 1305/1-17s(5), if an action taken by an employer against an employee as a result of a finding of physical abuse, sexual abuse, egregious neglect, financial exploitation, or material obstruction of an investigation is overturned through an action filed with the Illinois Civil Service Commission or under any applicable collective bargaining agreement and if that employee's name has already been sent to the Registry, the employee's name shall be removed from the Registry.

b) An employee may petition, in writing, the Department of Human Services for removal of the finding against the employee at any time after OIG has reported the finding to the Registry, but not more than once in every 12 months.

c) The employee shall file the petition by email at DHS.BAH@illinois.gov or in writing to the Division of Administrative Hearings, Department of Human Services, Office of the General Counsel, 69 W Washington St, 4th Floor, Chicago IL 60602.

d) OIG shall conduct an investigation into the petition.

e) Following the investigation, the Department's Division of Administrative Hearings shall conduct a hearing in accordance with 89 Ill. Adm. Code 508 and inform the Department of its decision.

f) The parties may jointly request that the administrative law judge consider a stipulated disposition of the proceedings, and if the Secretary agrees with the stipulated disposition, a hearing need not take place.

g) At the hearing, the petitioner shall have the burden to demonstrate by a preponderance of evidence that removal of the finding against the employee from the Registry is in the public interest.

h) The hearing officer shall take into account, but not be limited to, the following considerations:

1. Statement of the nature of the physical abuse, sexual abuse, egregious neglect, financial exploitation, or material obstruction of an investigation for which the finding was placed on the Registry;

2. Evidence that the petitioner is now rehabilitated, trained, or educated and able to perform duties in the public interest;

3. Evidence of the petitioner's conduct since OIG's finding was reported to the Registry; and

4. Evidence of the petitioner's candor and forthrightness in presenting information in support of the petition.

i) The Inspector General shall, upon receiving the Department's hearing decision, request the Department of Public Health to remove its finding from the Registry when:

1. The hearing decision finds that it is in the public interest to do so; or

2. The parties have jointly requested the administrative law judge consider a stipulated disposition of the proceeding and the Secretary agrees with the stipulated disposition.

History

• Source: Amended at 48 Ill. Reg. 14653, effective September 27, 2024

Chapter I Department of Human Services

Part 101 Administration

59 Ill. Adm. Code 101.10 Illinois Department of Mental Health and Developmental Disabilities – Internal Organization (repealed)

History

• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984

59 Ill. Adm. Code 101.20 Service Recipients Activity Fund in State-Operated Mental Health and Developmental Centers

In accordance with Section 20 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/20], service recipients activity funds are established in the Department's mental health and developmental centers. The facility director/hospital administrator shall be responsible for receipts and expenditures from these funds in accordance with the following provisions:

a) Receipts to the fund shall include:

1. Profits from the operation of commissary stores, including vending machines;

2. Interest or dividend income derived from deposits in financial institutions or from investments of unrestricted cash funds in federal government securities or investments guaranteed or insured by the federal government for the principal amount of the investment. Unrestricted cash funds means those funds, gifts and donations as provided by Section 22 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/22], which are not restricted in their use for a specific purpose by the donor; and

3. Proceeds from the disposition of recipients' unclaimed personal property, including monetary assets in accordance with 59 Ill. Adm. Code 110.10 (Disposition of Unclaimed Personal Property).

b) Expenditures from the fund shall be for the pleasure, comfort, benefit and amusement of recipients except that expenditures from the fund shall be made in accordance with the Illinois Procurement Code [30 ILCS 500].

c) Expenditures from the fund shall not be made for the comfort, pleasure, benefit and amusement of Department employees.

History

• Source: Amended at 23 Ill. Reg. 11118, effective August 24, 1999

59 Ill. Adm. Code 101.30 Payments to the Account of Service Recipients

a) All payments made for the services charges for present or former Department recipients in accordance with 59 Ill. Adm. Code 106 (Services Charges) shall be in the form of check, draft or money order made payable to the Illinois Department of Human Services.

b) Such payments shall be mailed to the Department of Human Services, Bureau of Cash Management, 100 South Grand Avenue East, Springfield IL 62762.

c) The facility resource unit supervisor shall accept payments for services charges for recipients in the form specified in subsection (a) of this Section. On receipt of such payment, the facility resource unit supervisor shall forward a reminder to the payer that any future payments must be made to the Bureau of Cash Management as indicated in subsection (b) of this Section.

d) If cash payment is offered for services charges for recipients to a facility resource unit supervisor or Department attorney, the payer shall be instructed to obtain a money order, bank draft or check and forward the same as indicated in subsection (b). The facility resource unit supervisor may accept cash payments when the payer indicates that he or she cannot obtain an instrument of payment due to age, infirmity, or handicapping condition. Such cash payments shall be deposited in the trust fund account of the recipient for whom the payment was made, with the name of the payer entered in the trust fund records, if other than that of the recipient. The payer shall be given a receipt for cash received, a copy of which the facility shall retain. The payer shall be requested to submit future payments in accordance with subsection (b).

e) Department attorneys may receive checks, drafts, or money orders as payment toward or for a judgment entered by a court for transmittal to the Bureau of Cash Management as indicated in subsection (b).

f) Department employees shall not accept payments made or offered to recipients' accounts for purposes or reasons other than those specified in this Section.

History

• Source: Amended at 23 Ill. Reg. 11118, effective August 24, 1999

59 Ill. Adm. Code 101.60 Service Contracts (recodified)

History

• Source: Recodified to 44 Ill. Adm. Code 1250 at 8 Ill. Reg. 18490

59 Ill. Adm. Code 101.70 Conduct of Hearings and Appeals (repealed)

History

• Source: Repealed at 23 Ill. Reg. 11118, effective August 24, 1999

59 Ill. Adm. Code 101.75 Conduct of Hearings and Appeals for Bogard Et Al. V. Bradley Et Al. Consent Decree (88 C 2414, U.s.d.c., N.d. Il) (june 2, 1993)) Class Members

a) Applicability

This Section shall apply to decisions concerning the transfer and discharge from community residential settings of Bogard et al. v. Bradley et al. class members. If there is a conflict between this Section and 59 Ill. Adm. Code 115 and 59 Ill. Adm. Code 120 concerning discharge and transfer that apply to class members, this Section will govern.

b) Definitions

For the purposes of this Section, the following terms are defined:

"Administrative law judge (ALJ)." The person appointed by the Secretary to preside at the formal administrative hearing and is synonymous with any other term used to refer to the person conducting such hearings.

"Agency." An entity that operates a community residential setting.

"Appellant." The person who requests a hearing.

"Class members." All persons 18 years of age or older with developmental disabilities who, on or after March 23, 1986, resided in an intermediate care or skilled nursing facility in Illinois as a Medicaid recipient for a period of more than 120 days in the aggregate. No person shall be excluded from the class because he or she has a primary diagnosis that is not mental retardation or a related condition, provided that such person also has a condition which meets the definition of developmental disability. However, no person first admitted to a nursing facility on or after April 1, 1994, will be a member of the class.

"Community residential setting." One of a variety of living arrangements as long as no more than eight people reside together and the setting is designed to promote independence in daily living, community integration, and economic self-sufficiency. Community residential settings include existing categories such as community integrated living arrangements, community residential alternatives, assisted residential care, supported residential care and adult foster care and may also include newly developed settings which are consistent with these principles.

"Contested case." Has the meaning ascribed to it in Section 1-30 of the IAPA [5 ILCS 100/1-30].

"Days." Working days unless otherwise specified.

"Department". Department of Human Services.

"Developmental disability." A disability that is attributable to mental retardation, regardless of the need for specialized services or a related condition. A related condition meets all of the following conditions:

Is attributable to: cerebral palsy, epilepsy or autism, or any other condition (other than mental illness) found to be closely related to mental retardation because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of individuals with mental retardation and requires treatment or services similar to those required for such individuals;

Is manifested before the person reaches the age of 22;

Is likely to continue indefinitely; and

Results in substantial functional limitations in three or more of the following areas of major life activity: self-care, language, learning, mobility, self-direction, or capacity for independent living.

"Discharge." The termination of all services provided to an individual in the community residential setting in which the individual resides.

"IAPA." The Illinois Administrative Procedure Act [5 ILCS 100].

"Individual services coordinator." A person employed by a pre-admission screening and annual resident review agent, who is a qualified mental retardation professional, as defined in the Department's rules at 59 Ill. Adm. Code 103, and who acts as an agent of the State in assuring that each class member has an appropriate individualized service plan and that the service plan is implemented.

"Intermediate care facility." Any long-term facility licensed by the Illinois Department of Public Health under the Nursing Home Care Act [210 ILCS 45] as an intermediate care facility.

"Medicaid." The medical benefits program administered by the Illinois Department of Public Aid pursuant to Title XIX of the Social Security Act. (42 USC 1396a (1998))

"OBRA Management Unit." A group of individuals charged with coordinating implementation activities under the Bogard et al. v. Bradley et al. consent decree. There is one person designated from each of the Department's Offices of Developmental Disabilities and Rehabilitation Services and one person designated from each of the Departments of Public Aid, Aging and Public Health to serve on the Unit.

"Omnibus Budget Reconciliation Acts of 1987 and 1990 (OBRA) (42 USC 1396n (1998))." Federal law requiring that an individual with a mental illness or developmental disability have pre-admission screening before placement in a nursing facility. The law also requires an initial and annual assessment of all nursing facility residents having a mental illness or developmental disability to determine if they require the level of care provided by a nursing facility and whether they require specialized services related to their disability.

"Pre-admission screening." A two-phase process of assessing individuals seeking admission to nursing facilities. The first phase identifies individuals suspected of a possible severe mental illness or developmental disability. The second phase requires an assessment and determination of the individual's need for the level of services provided by a nursing facility and need for specialized services.

"Pre-admission screening/annual resident review (PASARR) agents." Entities selected by the Department to carry out the pre-admission screening and resident review services required by OBRA.

"Resident review." A two-phase process to assess individuals residing in nursing facilities. The first phase identifies individuals suspected of a possible mental illness or developmental disability. The second phase requires an assessment and determination of the need of the individual with severe mental illness or a developmental disability for the level of services provided by a nursing facility and the need for specialized services.

"Secretary." The Secretary of the Department of Human Services.

"Skilled nursing facility." Any long-term facility licensed by the Illinois Department of Public Health under the Nursing Home Care Act as a skilled nursing facility.

"Specialized services." A continuous program for each individual. These services include aggressive, consistent implementation of a program of specialized and generic training, treatment health services and related services that are directed toward the acquisition of behaviors necessary for the individual to function physically, intellectually, socially, and vocationally with as much self-determination and independence as possible; and the prevention or deceleration of regression. Specialized services does not include services to maintain generally independent individuals who are able to function with little supervision or in the absence or a continuous specialized services program.

"Substantial evidence." Such evidence as a reasonable person can accept as adequate to support a conclusion.

"Transfer." When an individual ceases to be served by one agency and begins to be served by another agency under the same community residential setting without interruption of services.

c) Decisions subject to appeal

Decisions by agencies to discharge or transfer class members shall be appealable pursuant to this Section, except when the agency ceases to provide a particular type of community residential setting.

d) Representation

The appellant and the agency may be represented during the hearing and appeals process by an attorney or any other person who the appellant or agency chooses. The appellant may also represent him or herself; the agency may represent itself.

e) Notice

1. Notice of an agency decision to discharge or transfer a class member shall be given not less than 30 calendar days before the proposed date of the transfer or discharge. The notice of the decision shall contain:

A) A statement of the reason for the transfer or discharge;

B) The effective date of the proposed transfer or discharge;

C) A statement which reads: "You have a right to appeal the agency's decision. If you think you should not have to leave this program, you must ask the agency to reconsider its decision. If the agency does not change its decision, you may file a request for a hearing with the Department of Human Services within 20 days after receiving this notice. You should send a letter saying why you shouldn't leave the program and asking for a hearing to: Bureau of Administrative Hearings, 100 South Grand Avenue East, Springfield IL 62762. If you request a hearing, you will not be transferred or discharged while the appeal is going on unless the individual services coordinator decides that a delay in transfer or discharge would imminently imperil you or others. If you have any questions, call the Department of Human Services, Bureau of Administrative Hearings."

D) The name, address and telephone number of the person charged with the responsibility of supervising the transfer or discharge.

2. The notice of the hearing sent by the Department shall contain:

A) A statement of the nature of the hearing;

B) A statement of the time and place of the hearing or if a pre-hearing conference is scheduled by the Department, the time and place of the conference;

C) A reference to the particular Sections of the statute and rules involved;

D) A statement of the legal authority under which the hearing is held;

E) A concise statement of the matters asserted;

F) A statement of the consequences of failing to respond to the notice;

G) The official file number;

H) The names and addresses of the administrative law judge and the parties involved; and

I) A statement of the right to be represented by the person of the appellant's choice, at his or her expense.

3. All notices under this Section shall be served either personally or by certified mail on the class member and guardian, if any, the class member's individual service coordinator and the agency. If the agency knows that the class member cannot read English, the notice shall be explained to him or her orally in his or her primary language, including sign language.

4. The Department shall send a notice of hearing and notice of pre-hearing conference within five days after receipt of the request for a hearing. The administrative law judge shall schedule the hearing to be held no later than 10 days from the date of the notice.

f) Exhaustion of agency remedies

The class member shall use any agency procedure for appealing the decision before requesting a hearing from the Department.

g) Transfer or discharge pending a hearing

No transfer or discharge shall proceed pending the Secretary's decision, except as provided for in subsection (h) of this Section.

h) Emergency discharges

When the physical safety of the class member or others is imminently imperiled and appropriate services are not available at the agency, the class member shall be discharged as soon as arrangements can be made for admission to another facility only if the individual service coordinator, after reviewing the class member's record, gathering the necessary clinical information, and meeting with the class member, determines that a delay in discharge would imminently imperil the physical safety of the class member or others and has documented that in the class member's record. In that case notice shall be given in accordance with subsection (e) of this Section as soon as possible but in no case later than 48 hours after the discharge. The hearing shall be held within the time specified in subsection (e)(4) of this Section at the receiving facility, unless the administrative law judge determines that either of the parties would not be able to completely present its case at the receiving facility within the specified time. The discharging facility shall hold the class member's bed open until the appeal is resolved.

i) Qualifications of administrative law judge

Administrative law judges shall meet the qualifications set out in the Department's rules at 89 Ill. Adm. Code 508.

j) Disqualification of administrative law judge

At any time prior to the issuance of the hearing officer's recommended decision, the appellant or the agency may move to disqualify the administrative law judge on the grounds of bias or conflict of interest. Such a motion shall be made in writing to the Secretary, with a copy to the administrative law judge, setting out the specific instances of bias or conflict of interest. An adverse decision or ruling, in and of itself, is not grounds for disqualification. The administrative law judge's employment or contract as an administrative law judge by the Department is not, in and of itself, a conflict of interest. The appeal shall be suspended until the Secretary rules on the motion. The Secretary may decline to disqualify the administrative law judge, appoint another administrative law judge to hear the case or decide that the appeal should be granted.

k) Pre-hearing conferences

1. The administrative law judge may schedule a pre-hearing conference at his or her discretion. This conference shall be held prior to the hearing and shall be for the purpose of considering:

A) A clarification of the issues;

B) The possibility of obtaining admissions of fact and of documents that would avoid unneccessary proof or testimony;

C) The possibility of a resolution of the case without a hearing; and

D) Any other matters that may aid in the disposition of the appeal.

2. The administrative law judge shall invite the class member, the class member's guardian, if any, and a representative of the agency to attend the pre-hearing conference. Other persons may attend at the discretion of the administrative law judge. If the class member's guardian or the agency's representative invite other persons, they shall notify the administrative law judge of the invitee's identity at least 24 hours before the pre-hearing conference.

3. If the pre-hearing conference results in a resolution of the appeal by agreement of the parties, the administrative law judge shall issue an order reciting the agreement and dismissing the appeal. Copies of the order shall be sent to the appellant, the agency and the Department's representative from the OBRA Management Unit. The appellant's and agency's copies shall be sent by certified mail.

l) Discovery

1. Discovery such as interrogatories and depositions as provided for in the Rules of the Illinois Supreme Court (S. Ct. Rule 1 et seq.) is at the discretion of the administrative law judge. Requests to take discovery shall be made in writing to the administrative law judge with notice to all parties. Discovery may only be taken with the prior permission of the administrative law judge and is subject to the provisions of the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

2. Each party shall, on request by another party or the administrative law judge, serve on all other parties a list of potential witnesses who may be called on to testify at the hearing. Such list shall include the address or place of employment of each witness and shall be served within seven days after the receipt of the request.

3. The appellant shall, on request, be allowed to inspect and copy any documents which the agency intends to submit at the hearing. Such request shall be made at least two days before the hearing.

m) Conduct of hearings

1. All hearings shall be closed to the public. However, individuals who request to attend a hearing may do so with the appellant's consent.

2. The administrative law judge:

A) Shall regulate the course of the hearing;

B) Shall dispose of procedural requests;

C) May continue the hearing from time-to-time when necessary;

D) May examine witnesses; and

E) Shall rule on the relevancy of evidence.

3. At the hearing, both parties may present written and oral evidence. The agency shall have the burden of proving that there was substantial evidence to support its decision. After the agency's presentation, the appellant may present written and oral evidence. Written opening or closing arguments, legal memoranda, trial briefs or similar documents shall be permitted on motion granted or if the parties so stipulate. This requirement shall not prohibit the administrative law judge, sua sponte, from requesting that certain issues be briefed by the parties.

4. Standards

A) A class member may not be transferred unless the transfer is consistent with the class member's service needs.

B) A class member may not be discharged unless the discharge is consistent with the class member's service needs or unless the class member does not meet the program's eligibility criteria.

5. Evidence

A) The rules of evidence and privileges as applied in the circuit courts of this State shall apply in these hearings. However, evidence not admissible under such rules shall be admitted if it is of a type commonly relied on by reasonably prudent persons in the conduct of their affairs. Irrelevant, immaterial or unduly repetitious evidence shall be excluded.

B) A party may conduct cross-examination of a witness subject to the evidentiary requirements in subsection (m)(5)(A) of this Section.

C) Notice may be taken of matters of which the circuit court of this State may take judicial notice. In addition, notice may be taken of generally recognized scientific or technical facts within the Department's specialized knowledge. Parties shall be notified before or during the hearing of the material noticed and shall be given an opportunity to contest the material so noticed.

6. The hearing shall be either taped or stenographically recorded at the hearing officer's discretion. The Department shall retain the tape or a copy of the transcript. If the appellant or the agency appeals the Secretary's decision, a copy of the tape or the transcript shall be provided to the appellant and the agency on request.

n) Administrative law judge's recommended decision

Within 20 days after the hearing, the administrative law judge shall issue his or her recommended decision to the Secretary. The decision shall contain findings of fact, conclusions of law, the reasons for the decision and a recommended disposition of the case. Copies of the decision shall be sent to both parties by certified mail. A copy shall also be sent to the Department's representative from the OBRA Management Unit.

o) Post-hearing briefs

1. Both parties shall be given the opportunity to submit a brief to the Secretary in response to the administrative law judge's recommended decision. The appellant or the agency must notify the Secretary within five days after receipt of the recommended decision if the appellant or the agency intends to submit a brief. Briefs shall be submitted no later than 20 days after receipt of the recommended decision, unless the administrative law judge grants a party's request for additional time. Briefs shall be no longer than 10 pages unless the administrative law judge grants a party's request to submit a longer brief. A copy of the brief shall be sent to the other party.

2. If either party submits a brief, the other party may submit a reply brief to the Secretary. The appellant or the agency must notify the Secretary in writing within five days after receipt of the brief if it intends to submit a reply brief. Reply briefs shall be submitted no later than 10 days after receipt of the brief.

p) The record

The record for a hearing shall include:

1. All notices, motions and rulings;

2. All evidence received and admitted;

3. A statement of matters officially noticed;

4. Any offers of proof, objections and rulings;

5. The administrative law judge's recommended decision; and

6. Any ex parte communication prohibited by Section 10-60 of the IAPA [5 ILCS 100/10-60].

q) Secretary's decision

1. The Secretary shall be provided with the record and all briefs, if any. Within 20 days after receipt of the record or the post-hearing brief (if any), whichever is later, the Secretary shall issue a final decision adopting, modifying or reversing the recommended decision. The decision shall include findings of facts and conclusions of law. The Secretary shall adopt the recommended decision if he or she determines that the recommended decision was supported by substantial evidence. Copies of the final decision shall be sent to the appellant, the agency, the Department's representative from the OBRA Management Unit, and the administrative law judge. The appellant's and agency's copies shall be sent by certified mail.

2. The Secretary's decision shall constitute a final administrative decision in accordance with the Administrative Review Law [735 ILCS 5/Art. III] and shall include a statement to that effect.

r) Miscellaneous

1. Ex parte communications

Unless all parties are given notice and an opportunity to participate, the administrative law judge or the Secretary shall not, after notice of hearings or other on-the-record proceeding, communicate directly or indirectly, in connection with any other issues, with:

A) Any party;

B) His or her representative; or

C) Any other person interested in the outcome of the proceeding.

2. Intra-Departmental communications

A Department employee may communicate with other employees of the Department, and the administrative law judge or Secretary may have the aid and advice of one or more personal assistants.

3. Waiver

Compliance with this Section or with any or all provisions of the IAPA regarding contested cases [5 ILCS 100/10-25] may be waived by written stipulation of all parties.

History

• Source: Amended at 23 Ill. Reg. 11118, effective August 24, 1999

59 Ill. Adm. Code 101.80 Conflict of Interest

a) The Department of Human Services has various statutory responsibilities regarding persons placed in nursing homes and sheltered-care homes which are subject to State licensure. The Department's statutory duties include monitoring of the levels of care given by the homes and input into the licensing process on such matters as staffing and program. It is, therefore, mandatory that no employee of the Department shall have any connection whatsoever with nursing homes or sheltered care homes which may be considered a conflict of interest or which may give rise to an inference that this connection may in any way influence the Department in carrying out its statutory duties in the selection and monitoring of homes for placement purposes. It is, therefore, Department policy that:

1. No employee of the Department whose job classification is at the professional level (salary grade 12 and above) shall serve in any capacity or have any connection as a full-time or part-time employee of any nursing home or sheltered-care home whether or not the Department is presently using that home for placement.

2. No employee shall act as a consultant, either paid or unpaid, for any nursing home or sheltered-care home if such consultation enables the home to meet its licensing requirements or to secure Department approval for program or staffing.

3. No employee who has any connection whatsoever with placement, follow-up care or program monitoring in nursing homes or sheltered-care homes, shall accept any employment or act as a consultant, either paid or unpaid, in any such facilities.

b) As the Department has an extensive grant and purchase care program which funds community-based agencies, it is Department policy that:

1. No employee shall serve on the board of directors or professional advisory committee paid or unpaid of any agency or facility which receives funds from the Department by any mechanism, including grants, purchase of care arrangements or contracts. If the regional administrator believes that in an individual case, it would be to the advantage of the Department or in the public interest to have an employee serve in an unpaid position on a board of directors or professional advisory committee, he or she shall document the facts and submit them to the Secretary who may make an exception.

2. No employee shall hold an economic interest of any character, nature or amount in any nursing home, sheltered-care home or community agency or facility which receives State funds, whether by grant, purchase of care, contract or any other mechanism. Employees presently holding any such economic interest in such agencies shall promptly divest themselves of their interest. Economic interest for the purpose of this Section does not include a contract for teaching services at a public or private college, community college or university.

3. No employee, the employee's spouse or any minor child of an employee, may own stock, bonds, debentures, shares or any other ownership or debt interest in any nursing home, sheltered-care home or community facility that receives State funds, whether by grant, purchase of care, contract or other mechanism.

4. No employee's spouse or minor child may hold a position with a nursing home or intermediate care facility or sheltered-care home which receives service recipients placed by the Department if the employee is involved in placement or monitoring.

c) The Illinois Procurement Code [30 ILCS 505] provides that no State employee may have any contract for personal services with any entity which may be satisfied in whole or in part by State funds. The Governor may grant exemptions for employees whose service to the State is important enough to outweigh the public policy expressed in the law. Any employee planning to work for any agency or facility which receives State funds must apply for and receive an exemption from the Illinois Procurement Code prior to accepting employment. The Office of Legal Services shall be contacted if an exemption is desired. The Illinois Purchasing Act does not apply to contracts between an employee and any State-aided school district, community college district, State university or any institution under the Board of Higher Education. The Illinois Procurement Code also includes monies received on behalf of public aid recipients in the definition of "State funds". Strict compliance with these provisions is mandatory.

d) The Department is required by Section 6 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/6] to have information on every executive level employee (pay grade 20 step 7 and above) who has any outside employment of any nature whatever and to share this information with the Department of Central Management Services. Questionnaires will be distributed once each year to collect this information. Full and complete disclosure of this information is mandatory.

e) Required disclosure and compliance

1. Section 4A-101 of the Illinois Governmental Ethics Act [5 ILCS 420/4A-101] identifies those State employees who are required to disclose certain economic interests. Strict compliance with this law is mandatory.

2. The Department may require any employee who is in violation of the foregoing policies to report to the Department in such reasonable detail as the Department may provide as to the fact of such violation and the action taken by the employee to comply with this Section.

3. Violation of these policies shall be cause for suspension or dismissal of employees.

f) Department's statutory, clinical and legal responsibilities

1. The Department has extensive statutory, clinical and legal responsibilities toward those persons it serves as recipients of those services. The provision of these services require that staff make, on a daily basis, decisions about the care, treatment and well-being of those recipients. One of the decisions staff may be called upon to make is the proper placement of a recipient in a foster home.

2. The Department also has various monitoring responsibilities regarding persons placed in foster homes, including the level of care and input into the continuation of the foster placement. At various times, Department staff may be called upon to appear and testify in court as to the appropriateness of the foster placement.

3. In view of these responsibilities, it is mandatory that no Department employee become a foster parent of a present or former recipient served in any facility wherein the employee is employed. To do so would place the employee in the position of making clinical decisions as an employee which directly affect the employee's position as a foster parent. Moreover, the recipient may be subject to unequal treatment as an inpatient by the employee due to his or her status as the employee's foster child. This situation creates both a conflict of interest as to the provision of services by the employee and the receipt of services by the recipient.

4. This provision shall have prospective application from the date of its promulgation. Exceptions to the foregoing provision may be granted, upon proper application, by the Secretary, if sufficient clinical bases exist to support such action.

History

• Source: Amended at 23 Ill. Reg. 11118, effective August 24, 1999

59 Ill. Adm. Code 101.90 Specialized Living Centers

A specialized living center shall be considered to be in compliance with Section 3.06 of the Specialized Living Centers Act [405 ILCS 25/3.06] for the conduct, maintenance and operation of a specialized living center so long as it is licensed by the Illinois Department of Public Health as an intermediate care facility for the developmentally disabled and is in conformance with the Department of Public Health's rules at 77 Ill. Adm. Code 350.

History

• Source: Amended at 23 Ill. Reg. 11118, effective August 24, 1999

59 Ill. Adm. Code 101.100 Community Mental Health and Developmental Disabilities Service Provider Participation Fee Trust Fund

a) Definitions

For the purposes of this Section, the following terms are defined:

"Actual payments." The absolute amount of Medicaid payments received by a provider from the Department, per written agreement, for the delivery of Medicaid-reimbursable services during the fee year.

"Applicable provider" or "provider." A community agency from which the Department purchases services through payments that are matched by federal funds under Medicaid and that the Department has determined to be subject to the provider participation fee.

"Days." Calendar days, unless otherwise specified.

"Department." The Department of Human Services.

"Fee." A fee that each applicable provider shall submit to the community mental health and developmental disabilities services provider participation fee trust fund.

"Fee year." The fiscal year beginning July 1 and ending June 30 for which the fee amount applies.

"Fund." The community mental health and developmental disabilities services provider participation fee trust fund comprising the fees submitted by applicable providers, the interest accrued on the fees, and the related federal Medicaid matching funds.

"Medicaid." Medical assistance issued by the Illinois Department of Public Aid, under the provisions of Title XIX of the Social Security Act (42 USCA 1396 (1998)), for eligible recipients, including Aid to the Aged, Blind and Disabled (AABD), Temporary Assistance to Needy Families (TANF), Medical Assistance No Grant (MANG), and Refugee Repatriate Program (RRP) recipients as well as Title XIX eligible Department of Children and Family Services (DCFS) wards.

"Medicaid payments." Payments made by the Department for services covered under Medicaid for which the State receives federal matching funds.

"Medicaid reimbursed services." A service provided by a provider under an agreement with the Department for which the State receives reimbursement from the Medicaid program and which is subject to the fee process.

"Projected payments." The estimated amount of Medicaid payments to be received by a provider from the Department, per written agreement, for the delivery of Medicaid-reimbursable services during the fee year.

b) Fees

1. Calculation of projected fees

Each year the Department shall calculate a fee which shall be paid by applicable providers. The fee amounts due to the fund by applicable providers shall be based on the projected amount of Medicaid payments to be made by the Department to the provider for the year taking into consideration:

A) The unit rates for services;

B) The units of service billed by the assessed provider for the year prior to the fee year; and

C) Any other factors which will influence a change in the number of units of service to be billed during the fee year.

2. Differential fee collection schedule

A) The Department shall establish a differential fee collection schedule for any provider whose projected Medicaid payments during the current fee year exceeds the actual Medicaid payments for the year prior to the fee year by more than 20 percent.

B) The Department shall establish a differential fee collection schedule for such providers which reflects the increasing payments for the current fee year.

C) The differential fee collection schedules for these providers will require lesser fee submittals during the first quarter with gradually increasing fee submittals according to the providers' projected growth in Medicaid receipts.

3. Adjustment of inaccurate projections

A) If the Department determines that any fee amount assessed a provider was incorrect, the Department will correct the fee error.

i) The Department will issue a revised fee amount for the quarter.

ii) The Department will adjust the fee amounts due for subsequent quarters of the fee year.

B) The Department shall monitor quarterly the ratio of actual to projected total gross payments for those assessed providers whose estimated increase in gross total payment for the fee year is expected to exceed 20 percent.

i) When the accumulated actual fees due to the fund by the assessed provider differ by more than 10 percent from the accumulated projected fees, the Department shall issue a revised fee amount for the immediate calendar quarter and a revised collection schedule for the remainder of the fee year. When this occurs, the provider shall submit the revised fee amount within 30 days after the date of postmark on the Department's written notification of the change.

ii) When the accumulated actual fees due to the fund by an assessed provider are less than the accumulated projected fee amounts, the Department shall return to the provider the appropriate share of overpaid fees.

4. Calculation of provider participation fees

The Department shall multiply the projected Medicaid payments for services which it has determined to be subject to the provider participation fee for the fee year of individual providers by any amount not greater than 15 percent to determine the fee amount owed to the fund.

5. Notification of fee due date

The Department shall notify each assessed provider, in writing, of the amount of the fee 30 days prior to the required fee due date. The Department may modify the notification timeframes and extend the required fee due date for good cause shown.

6. Provider submission of fees

A) Each provider shall submit the specified fee in equal quarterly amounts on or before the first business day of each calendar quarter.

B) Due dates for provider submission of quarterly fee payments shall be January 2, April 1, July 1, and October 1, or, if these dates are on weekends or holidays, the first business day immediately following.

7. Delayed fee collection schedules

A) The Secretary of the Department is authorized to establish delayed fee collection schedules for providers that are unable to make timely payments due to financial difficulties.

B) Delayed fee collection schedules shall be granted only under extraordinary circumstances to qualified providers that meet all of the requirements in subsections (b)(7)(C) and (D).

C) Denial of an application to borrow provider participation fee funds from a financial institution or other lending entity.

D) A signed written agreement with the Department specifying the terms and conditions of the delayed fee collection schedule, which shall contain the following provisions:

i) Specific reason(s) for the establishment of the delayed fee collection schedule;

ii) Specific dates on which submission of the fees will be received by the Department and the amount of the fees which will be received on each specified date described;

iii) The interest that shall be due from the provider as a result of the establishment of the delayed fee collection schedule;

iv) A certification stating that, should the provider entity be sold, the new owners shall be made aware of the liability and shall assume responsibility for repaying the debt to the Department in accordance with the original agreement;

v) A certification stating that all information forwarded to the Department in support of the establishment of the delayed fee collection schedule request is true and accurate to the best of the signatory's knowledge; and

vi) Such other terms and conditions that may be required by the Department.

E) In order to receive consideration for delayed fee collection schedules, providers shall forward their requests in writing (telefax requests are acceptable) to the Department. Requests must be received within five working days after the date of the Department's notification of the provider participation fee due for the subject quarter. All telefax requests must be followed-up with original written requests. All requests shall include:

i) An explanation of the circumstances creating the need for the delayed fee collection schedule;

ii) Supportive documentation to substantiate the emergency nature of the request and risk of irreparable harm to the provider's clients;

iii) Specification of the arrangements being requested by the provider.

F) The Department shall notify the provider, in writing, of its decision with regard to the request for the establishment of a delayed fee collection schedule. An agreement shall be issued to the provider for all approved requests. The agreement shall be signed by the provider's administrator, owner, chief executive officer, or other authorized representative and must be received by the Department before the first scheduled fee submittal date listed in the delayed fee collection schedule.

i) The Department shall waive the penalties for delinquent and/or deficient fee submittal upon the approval of the provider's request for establishment of a delayed fee collection schedule. When a provider's request for establishment of a delayed fee collection schedule is approved and the Department receives the signed agreement in accordance with this subsection, such penalties shall be permanently waived for the subject quarter unless the provider reneges on the conditions of the agreement. When the provider reneges on the conditions of the agreement, the agreement shall be considered null and void and such penalties shall be fully reinstated.

ii) The delayed fee collection schedule shall include interest at a rate not to exceed the State's borrowing rate. The applicable interest rate shall be identified in the agreement described in subsection (b)(7)(E).

iii) When a provider has requested and received Department approval for a delayed fee collection schedule, the provider shall not receive approval for subsequent delayed fee collection schedules until such time as the terms and conditions of any current delayed fee collection agreement has been satisfied. The waiver of penalties described in subsection (b)(7)(F)(i) shall not apply to a provider that has not satisfied the terms and conditions of any current delayed fee collection agreement.

8. Penalty for delinquent or deficient fees

Any provider that fails to submit the fee when due, or submits less than the full amount due, shall be assessed a penalty of 10 percent of the delinquency or deficiency for each month, or fraction thereof, computed on the full amount of the delinquency or deficiency, which includes any penalty accrued and not paid, from the time the fee was due.

9. Notification to comptroller

A) The Secretary may take action to notify the Office of the Comptroller to collect any amount of monies owed by the provider to the fund.

B) The Secretary may take action against providers failing to submit any delinquent or deficient fee or penalty including:

i) Suspension of payments;

ii) Cancellation of the provider contract or agreement; and

iii) Refusal to issue, extend, or reinstate the provider contract or agreement.

c) Local government funds certification

Providers may use local government funds as a source to meet their obligated, quarterly assessed fee amount in part or in whole.

1. If local government funds are used, the provider shall certify the planned spending of these local funds for the specified services in lieu of actual cash payment to the fund by providing a statement from each local government funder stating the intent of that funder to contribute the applicable portion of the fee amount, signed by the chairperson of the local government funder taxing authority.

2. If the certification process is used, the provider shall submit to the Department, by October 31 of the year following the fee year, an annual audit statement from a certified public accounting firm which demonstrates that the local government funds were spent for the intended service and in the amounts required according to the fee amount.

3. Expenditure of funds on Medicaid Services

A) If the local government funds were not spent for the Medicaid service as required:

i) The provider shall submit to the State by October 31 of the year following the fee year the amount of the fee which was not spent;

ii) A fine equal to 25 percent of the amount of the fee not properly covered by the local government funds certification process.

B) This payment shall be submitted to the State Treasury by October 31 of the year following the fee year.

d) Deposit of revenue

Deposits to the fund shall consist of:

1. Federal revenues received under Title XIX of the Social Security Act as a result of the increased rates paid by the Department to providers of Medicaid-reimbursable services;

2. The fees paid by providers of Medicaid-reimbursable services under agreement with the Department which are eligible for reimbursement from Medicaid and which are subject to the fee process;

3. The interest earned on the deposits to the fund; and

4. The revenues generated from fines and penalties levied by the Department on providers in accordance with subsection (c)(3).

e) Protection from reduction

1. The moneys in the fund shall be exempt from any State budget reduction Acts.

2. The funds shall not be used to replace any funds otherwise appropriated to the Medicaid program by the Illinois General Assembly.

f) Administration of contingency reserves

1. Moneys paid from the fund shall be used first to:

A) Pay for the administrative expenses incurred by the Department in performing the duties authorized by Section 18.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/18.1];

B) Pay any amounts reimbursable to the federal government, which are required to be paid by State warrant.

2. Disbursements from the fund shall be by warrants drawn by the State Comptroller upon receipt of vouchers duly executed and certified by the Department.

3. The Department shall establish a contingency reserve not to exceed three percent in any fee year of the total amount of the revenues described in subsection (d).

g) Fund expenditures

The Department shall spend 100 percent of the moneys in the fund during the fee year from which the monies were collected to reimburse providers for the delivery of Medicaid services less:

1. The administrative expenses incurred in performing the duties authorized by Section 18.1 of the Mental Health and Developmental Disabilities Administrative Act; and

2. A maximum of three percent of the total deposits made to the fund in any fee year for the contingency reserve.

h) Provider assurance

1. In the aggregate, providers under contract with the Department to provide Medicaid reimbursable services that are subject to the fee payment process are entitled to a return of 100 percent of the fee amount paid during any fee year:

A) Plus the federal funding portion;

B) Less the administration expenses incurred by the Department in performing the activities authorized; and

C) Less the allowed three percent contingency reserve.

2. No provider shall receive back less than the amount required as a fee for any given fee year.

i) Department records

The Department shall maintain records showing the amount of money paid by each provider into the fund and the amount of money that has been paid from the fund to each provider for each fee year.

j) Annual audit

1. The Department shall conduct an annual audit of the fund to determine that:

A) Receipts were appropriate and accurate;

B) Disbursements were appropriate and accurate;

C) Delayed fee collection schedules were justified and approved;

D) Interest and penalties were properly calculated and imposed;

E) Local government funds were properly certified;

F) Contingency reserves were accurately calculated;

G) Records were appropriate, complete and correct.

2. Any errors or deficiencies identified as a result of such audit shall be corrected on a timely basis.

k) Fee correction and recovery

If the Department's annual audit identifies erroneous fee or reimbursable payment amounts, then it shall:

1. Correct the fee payment amount and any related fine and notify the provider;

2. Correct the reimbursable payment amount to the provider; or

3. Take the action necessary to recover the required fee or reimbursed payment amount from the provider.

l) Applicability of provider participation fees

1. The Department shall determine which services and which providers will be subject to the provider participation fees.

2. The Department may choose to terminate or revise its policies concerning the computation and/or collection of provider participation fees if laws or regulations are implemented affecting state financing of Medicaid services with mandatory provider participation fees.

3. If the Department terminates the collection of provider participation fees and a positive balance remains in the fund, the Department shall expend the balance as follows:

A) Refund to each provider any portion of the annual fees the provider had submitted, but for which the provider had not yet been reimbursed.

B) Expend whatever is required for any outstanding costs related to the administration of the provider participation fee initiative or to its termination.

C) Distribute any remaining balance among contributing providers proportionally to each provider's contributions to the fund during the 12-month period prior to termination.

m) Appeals procedure

1. Appealable decisions – A provider may request a hearing on the following issues:

A) The initial assessment or change in the amount of the required payment;

B) An audit finding that a provider is required to reimburse the Department for a fee or payment.

2. Notice of appeal rights – The Department shall inform the provider of the right to appeal and the appeal procedure whenever the provider is notified of the initial assessment or change in the amount of the required payment, or of an audit finding that a provider is required to reimburse the Department for a fee or payment.

3. Request for hearing – A provider may appeal the Department's decision by requesting a hearing in writing within 10 days after receipt of the decision. The request shall be sent to:

Bureau of Administrative Hearings

Department of Human Services

100 South Grand Avenue East

Springfield IL 62762

4. Stay of proceedings – The request for an appeal shall stay any proceedings or decision taken concerning the provider until the resolution of the appeal.

5. Upon request of the provider at any time prior to the scheduled hearing, the provider may request an informal conference with the Division of Disability and Behavorial Health Services to determine the facts and issues and to resolve any conflicts as amicably as possible.

6. Hearing officer – The hearing shall be conducted by a hearing officer appointed by the Secretary.

7. Scheduling and notice of hearings – Within 60 days after the receipt after the appeal, the hearing officer shall schedule a hearing, to be held in the Department's central offices or a place agreed to by the hearing officer, the Department staff involved and the provider. The hearing officer shall send written notice of the hearing to the provider via certified mail. The notice shall contain:

A) A statement of the nature of the hearing;

B) A statement of the time and place of the hearing;

C) A statement of the right to be represented by an attorney at the provider's expense.

8. Continuances – The hearing officer may, upon good cause shown, grant a continuance requested by the provider.

9. Conduct of hearings

A) The hearing officer shall regulate the course of the hearings; hold informal conferences for the purpose of resolving the case; dispose of procedural issues; continue the hearing from time to time when necessary; examine witnesses and rule upon the relevancy of evidence.

B) At the hearing, the provider and the Department may present written and oral evidence. The Department shall have the burden of proving by substantial evidence that the decision was made in accordance with the statutes and this Section. Upon conclusion of the Department's presentation, the provider may present written and oral evidence.

C) The common law rules of evidence shall not be enforced in the hearing. The hearing officer shall conduct the hearing in a manner that allows participants to present their evidence fully and freely. Either party may ask questions of each other or any witness, and the hearing officer may ask questions of either party or any witness. Questions impeaching the witness' character or credentials shall be improper.

D) The hearing shall be taped or stenographically recorded. The tape or a copy of the transcript shall be retained by the Department. If the provider appeals the hearing officer's decision, a copy of the record shall be provided to the provider upon request.

10. Standard of review – In all appeals, the hearing officer shall decide whether there was substantial evidence showing that the Department's decision was made in accordance with statute and this Section.

11. Decision – Within 10 working days after the hearing, the hearing officer shall issue a written decision that upholds, modifies or reverses the Department's decision. The decision shall contain the reasons for the hearing officer's action. The hearing officer shall mail copies to the provider and the Department via certified mail. The decision shall be accompanied by a letter that informs the provider of the right to appeal the decision and state the procedure for requesting an appeal.

12. Appeal of the hearing officer's decision

A) The provider may request a review of the hearing officer's decision by the Secretary or his or her designee no more than 20 days after the receipt of the hearing officer's decision.

B) Upon receipt of the request for review, the Secretary or designee shall review the hearing officer's decision and copies of all documents considered at the hearing. Within 20 working days after receipt of the request for review, the Secretary or his or her designee shall issue a decision upholding, modifying or reversing the hearing officer's decision. The Secretary or his and her designee shall uphold the decision if he or she determines that the decision was supported by substantial evidence. Copies of the decision shall be sent to the provider, the Department and the hearing officer.

C) The Secretary's decision shall constitute a final administrative decision in accordance with Section 3-101 of the Administrative Review Law [735 ILCS 5/3-101].

History

• Source: Amended at 23 Ill. Reg. 11118, effective August 24, 1999

59 Ill. Adm. Code 101.110 Hearings and Appeals Under Sections 7 and 8 of the Illinois Grant Funds Recovery Act [30 Ilcs 705/7 and 8] (repealed)

History

• Source: Repealed at 24 Ill. Reg. 17120, effective November 3, 2000

59 Ill. Adm. Code 101.APPENDIX A Organization Charts (repealed)

Section 101.ILLUSTRATION A Illinois Department of Mental Health and Developmental Disabilities (Repealed)

Section 101.ILLUSTRATION B Associate Director (Repealed)

Section 101.ILLUSTRATION C Division of Developmental Disabilities (Repealed)

Section 101.ILLUSTRATION D Division of Alcoholism (Repealed)

Section 101.ILLUSTRATION E Division of Management Services (Repealed)

Section 101.ILLUSTRATION F Division of Community Services and Interagency Affairs (Repealed)

Section 101.ILLUSTRATION G Region 1A Office (Repealed)

Section 101.ILLUSTRATION H Region 1B Office (Repealed)

Section 101.ILLUSTRATION I Region 2 Office (Repealed)

Section 101.ILLUSTRATION J Region 2 Developmental Disabilities (Repealed)

Section 101.ILLUSTRATION K Region 3A Office (Repealed)

Section 101.ILLUSTRATION L Region 3B Office (Repealed)

Section 101.ILLUSTRATION M Region 4 Office (Repealed)

Section 101.ILLUSTRATION N Region 5 Office (Repealed)

History

• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984
• Source: Repealed at 8 Ill. Reg. 12265, effective July 1, 1984

Part 102 Department Campuses and Property

59 Ill. Adm. Code 102.5 Applicability

This Part pertains to the use and regulation of the Department's State-operated mental health and developmental disability centers and programs.

History

• Source: Added at 26 Ill. Reg. 8520, effective May 30, 2002

59 Ill. Adm. Code 102.6 Definitions

For the purposes of this Part, the following terms are defined:

"Administrator" means the chief administrator of a State-operated mental health center.

"Assistant Associate Director" means the Assistant Associate Director for Mental Health or Assistant Associate Director for State-operated Developmental Center (SODC) Operations, as appropriate for the center/program.

"Center/program" means a State-operated developmental disabilities facility or a State-operated mental health facility as defined by Sections 1-107 and 1-114 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/1-107 and 1-114].

"Director" means the chief administrator of a State-operated developmental disabilities facility or program.

"Individual" means a recipient of services as defined in Section 1-123 of Mental Health and Developmental Disabilities Code [405 ILCS 5/1-123].

"Voluntary organization" or "organization" means private or not-for-profit organizations that have, as a purpose, the review or promotion of treatment or habilitation services to persons with mental disabilities. Voluntary organization does not include organizations or agencies authorized to have access to centers/programs pursuant to either the Guardianship and Advocacy Act [20 ILCS 3955] or the Protection and Advocacy for Developmentally Disabled Persons Act [405 ILCS 40].

History

• Source: Added at 26 Ill. Reg. 8520, effective May 30, 2002

59 Ill. Adm. Code 102.10 Use of Department Campuses and Property

a) Site visitations

1. The Department may provide visiting privileges to voluntary organizations that wish to review living conditions and the nature of publicly-sponsored services.

2. Voluntary organizations shall request authorization for visiting privileges in writing. The request shall be made to the Assistant Associate Director of the Office of Mental Health or the Assistant Associate Director of SODC Operations, as appropriate and shall specify the center/program to be visited. If the organization agrees to the conditions set out in subsection (a)(2)(A) of this Section, the request shall contain those agreements.

A) The Assistant Associate Director shall authorize an organization to make visits to one or more centers/programs for a period of one year if:

i) The organization agrees that its visits will not interfere with the center's/program's treatment or habilitation programs;

ii) The organization agrees to abide by the provisions of the Mental Health and Developmental Disabilities Confidentiality Act (Confidentiality Act) [740 ILCS 110] concerning records and communications of individuals served; and

iii) The organization provides evidence that volunteers have received training on the topics specified in subsection (a)(3) of this Section within 12 months prior to the date of the application for authorization. Such evidence shall, at a minimum, include a list of the training sessions and instructors and any documents distributed as part of the training session.

B) The Assistant Associate Director shall revoke his or her authorization or not renew the authorization if he or she has information that the organization has not abided by the conditions set out in subsection (a)(2)(A) or complied with the requirements of this Section. Any person having information that the organization has not abided by the conditions or complied with the requirements shall submit that information in writing to the appropriate Assistant Associate Director's office. Within 30 calendar days after the receipt of such information, the Assistant Associate Director shall decide whether to revoke or renew the authorization.

C) When the Assistant Associate Director denies, revokes or does not renew an authorization, he or she shall send written notice of the decision to the agency within 30 calendar days after receipt of the application or receipt of information as set out in subsection (a)(2)(B) of this Section. The notice shall include the appeal procedure and time in which the agency must appeal.

D) Any organization whose authorization has been revoked or not renewed may appeal the decision within 30 calendar days after receiving the notice. The organization must submit its request for review in writing to the Secretary, and may submit any other documents in support of its appeal with the request for review. The Secretary shall review the decision and the documents and accept or reverse the decision within 30 calendar days. The Secretary shall uphold the decision if he or she finds that the organization has not abided by the agreements as set out in subsection (a)(2)(A) of this Section or complied with the requirements of subsection (a) of this Section.

3. Organization site visits shall be conducted in a manner that is consistent with center/program operating needs in compliance with the Confidentiality Act and be authorized by the Assistant Associate Director of the Office of Mental Health or the Assistant Associate Director of SODC Operations, as appropriate to the center/program. Disruption of individuals and their programs shall be minimized. Except as set by prior agreement with the appropriate Assistant Associate Director, visitation groups shall not exceed five persons on a given unit on any one day. The Assistant Associate Director shall allow more than five persons on a unit if, after consulting with the Director or Administrator, he or she determines that the proposed number of visitors would not interfere with the center's/program's treatment or habilitation plans and would not violate the individuals' privacy. Directors or Administrators who receive requests for visitation privileges shall either forward them to the Assistant Associate Director or advise the organization to send a written request to the Assistant Associate Director. The purpose of the authorization process is to ensure that organization members have received training and orientation concerning the Department's service delivery system with a focus on mental health services and/or developmental disability services, advocacy services, and legal issues such as the rights of individuals and confidentiality. The Assistant Associate Director shall distribute to centers/programs a listing of organizations that are authorized to conduct site visits. Although visitation privileges shall be authorized annually, organizations meeting the standards of this subsection (a) (3) may be included in the listing at any time during the year.

4. Site visits shall be announced 48 hours in advance to the Director or Administrator and shall occur between 9:00 a.m. and 9:00 p.m. Following two scheduled visits to any center/program, voluntary organizations may make unannounced visits to any center/program.

5. Before conducting any site visit, organization visitors shall report their presence to the Director or Administrator or the unit administrator on duty, who shall confirm the visitors' identity and authorization and make available a staff member to escort the visitors. All organization visitor's must produce a valid photo identification, such as a driver's license, passport, identification card issued by the Secretary of State to non-drivers, student identification or identification card issued by the visitor's organization or employer before the visitor will be permitted to enter the unit.

6. All visitation activities shall conform to the Confidentiality Act. Clinical records of individuals shall be examined during site visits only in accordance with the Confidentiality Act. During the visit, visitors may request and receive verbal authorization from individuals for interviews with the individuals. If center/program staff are to be included in the interviews or are to be questioned separately in regard to a specific individual, a written consent for release of information shall be obtained from that individual prior to or during the visit. The release shall be filed in the individual's clinical record. Unless a release is obtained, center/program staff shall not participate in the interview or respond to such questions.

7. Authorized visitors shall be permitted access to individuals' living units and program areas, except when, in the Director's, Administrator's or Unit Administrator's clinical judgment, such access poses a threat to their or the individuals' security, or constitutes an interference with individuals' programming. Before visitors are permitted access to living units or program areas, the Director or Administrator shall give individuals advance notice. Before inspecting an individual's room, visitors shall obtain the individual's written or verbal permission. The center/program staff member shall document the verbal permission or receive the written permission and file it in the individual's clinical record.

8. The organization shall provide a written report of its findings to the Director or Administrator within 14 calendar days after the visit. If no negative findings were noted during the visit, the organization should document this finding. The Director or Administrator shall provide the Assistant Associate Director, the Associate Director and the Department Secretary with a copy of all written reports within 48 hours and shall provide a written response to all exit reports within five working days after receipt to the visitors with a copy to the Assistant Associate Director, the Associate Director and the Department Secretary. If the organization has not received a response 15 working days after it submitted its report, it shall notify the Assistant Associate Director, who shall inform the Director or Administrator.

b) Sales or solicitation

The Director or Administrator shall not permit organizations or individuals to solicit funds or memberships, other than union memberships, nor sell or take orders for goods or services from employees in the buildings or on the campuses or property of Department centers/programs without the Secretary's prior approval. The Secretary may approve these activities if they do not interfere with the employees' job duties and if the activities are not directed toward individuals.

c) Game preserve

1. All Department center/program campuses and property shall be closed as game reservations and posted accordingly. The Director or Administrator may, however, grant fishing privileges to individuals at centers/programs where fishing is possible.

2. No hunting or trapping shall be permitted on the campuses or property of any Department center/program.

d) Liquor, controlled substances, cannabis, firearms and other weapons

1. Sale or gift of alcoholic beverages, liquor, controlled substances or cannabis to employees or individuals on center/program campuses or property is prohibited. Visitors or employees who show signs of intoxication or a drug-induced state shall not be admitted to center/program campuses or property.

2. Firearms or other weapons such as bludgeons, metal knuckles, tear gas, broken bottles or glass, knives, hatchets or bombs of any sort shall not be brought or permitted on center/program campuses or property. Armed law enforcement officials are allowed on the center/program campus or property when responding to an emergency situation. An emergency occurs when there is a threat of bodily harm that could result in the death or serious injury of individuals served or center/program staff. The delivery of an individual by a law enforcement official to a center/program for admission does not constitute an emergency. The Director or Administrator shall request that law enforcement officials secure their weapons in a locked squad car or store their weapons in a locked safe upon arrival at the center/program except during an emergency.

e) Center/program access

Only persons on official business, such as employees, authorized visitors, persons providing required goods and services shall have access to center/program campuses and property.

f) Identification of employees and visitors

The Director or Administrator shall develop and implement written policies and procedures to ensure that employees and visitors are properly identified at all times while they are on the center/program campus or property. Employees shall have on their person an employee identification card. All visitors must produce a photo identification as described in subsection (a)(5), and shall have on their person a visitor identification card. No Department employee shall wear a badge such as those issued to sworn law enforcement officials. The requirement of identification shall not hinder or preclude unannounced visits by voluntary organizations pursuant to this Section.

g) Traffic rules

All persons driving on center/program campuses or property shall operate their vehicles consistent with the Illinois Vehicle Code [625 ILCS 5] and shall observe the traffic rules established by the Director or Administrator that include, but are not limited to, the use of designated parking areas, observance of posted stop signs, speed limits, reckless driving, failure to yield to individuals, employees, and other persons crossing roadways, failure to display a decal, and leaving unattended vehicles unlocked. The Director or Administrator may bar vehicles from the center/program campus or property after notice is given for three violations of this subsection. Traffic rules shall be prominently posted.

History

• Source: Amended at 26 Ill. Reg. 8520, effective May 30, 2002

59 Ill. Adm. Code 102.30 Fire Protection in Department Centers/Programs

The Department adopts the rules of the Office of the State Fire Marshal at 41 Ill. Adm. Code 100 (Fire Prevention and Safety), 41 Ill. Adm. Code 140 (Policy and Procedures Manual for Fire Protection Personnel), 41 Ill. Adm. Code 160 (Storage, Transportation, Sale and Use of Gasoline and Volatile Oils: Rules and Regulations Relating to General Storage), 41 Ill. Adm. Code 170 (Storage, Transportation, Sale and Use of Petroleum and Other Regulated Substances), 41 Ill. Adm. Code 180 (Storage, Transportation, Sale and Use of Gasoline and Volatile Oils), 41 Ill. Adm. Code 200 (Storage, Transportation, Sale and Use of Liquified Petroleum Gas), 41 Ill. Adm. Code 250 (Fire Equipment Distributor and Employee Standards), and 41 Ill. Adm. Code 300 (Furniture Fire Safety Regulations).

a) General provisions

Each Department center/program shall have a master fire plan that shall include, at a minimum, that:

1. fire regulations are posted and communicated;

2. sprinkler systems, fire hoses, fire detection and alarm devices, and other fire safety equipment, are maintained in a fully functional condition at all times;

3. fire detection and protection systems are inspected, tested and serviced as required for compliance with the standards of the Office of the State Fire Marshal and the Illinois Department of Public Health;

4. interim life safety measures are implementing to compensate for the temporary interruption of fire safety systems and installations during periods of system failure and construction;

5. evacuation procedures protect the safety and well-being of all persons at all times;

6. employees are instructed in fire notification procedures and the use of alarm and signal systems;

7. situations when employees are to attempt to contain fires are identified;

8. there is advance planning for evacuation of non-ambulatory individuals in a prompt and safe manner; and

9. there is a displacement plan for the temporary housing of individuals and staff in the event there is a fire that hinders the center's/program's ability to provide for safe occupancy in any portion of the center/program.

b) Training

All employees shall be trained in:

1. Procedures to be followed in the master fire plan.

2. The general principles of portable fire extinguisher use and the hazards involved with incipient stage fire fighting.

c) Evacuation

1. Fire exiting drills shall be held at intervals to be set by the Director or Administrator, but shall be conducted at least once per shift, quarterly. Fire exiting drills do not require building evacuation.

2. Primary and secondary evacuation routes and the location of fire alarm activation stations and portable fire extinguishers shall be posted in all occupied structures.

3. In the event of fire or other emergencies, employees who serve non-ambulatory individuals shall be assisted by employees from other units who have been assigned to provide evacuation assistance.

4. Security staff and local law enforcement authorities, if requested, shall assist in the evacuation of individuals who present a risk of unauthorized absence or serious harm to others.

d) Prevention

1. Smoking shall not be permitted in areas other than those designated as smoking areas by the Director or Administrator.

2. The burning of candles, incense, and similar items with open flames/embers shall not be permitted inside buildings where centers/programs are located. This does not prohibit the use of such items as part of religious services.

e) Hazard surveillance

1. Every center/program shall develop a system of self-inspections to identify and eliminate fire hazards.

2. Employees shall report to their supervisors any potential fire hazards they identify. Information regarding the identified hazard shall be provided to the center/program safety officer or other person designated to act on such findings.

3. The center/program safety officer or other designated person shall conduct regularly scheduled inspections of all areas of the center/program.

4. In addition to life safety inspections conducted by other State agencies, the Department's environmental health and safety manager is responsible for conducting periodic hazard surveillance rounds of treatment and sleeping areas.

f) Reporting

1. The center/program shall maintain records and reports of fire safety inspections, fire drills and fire evacuations. The center/program shall document specific actions taken to correct deficiencies noted in these reports. Inspection reports from external sources and the plan for correcting the reported deficiencies shall be forwarded to the Department's Office of Environmental Health and Safety on the same date it is submitted to the inspecting agency.

2. Each center/program shall prepare, within 24 hours after each fire-related incident or injury, a fire incident report form, provided by the State Fire Marshal, and shall submit the form the 15th day of the following month to the Deputy State Fire Marshal for Fire Prevention of the Office of the State Fire Marshal and the Department's Office of Environmental Health and Safety.

3. Each center/program shall prepare an annual narrative report of the fires at the center/program during the previous calendar year. This summary report shall contain such information as the total number of fires by unit, total dollar amount of damages, any injuries or deaths that occurred, the primary cause of the fires, and any steps taken to reduce the number of fires or to increase fire safety. The Director or Administrator shall forward these reports to the Department's Office of Environmental Health and Safety.

History

• Source: Amended at 26 Ill. Reg. 8520, effective May 30, 2002

59 Ill. Adm. Code 102.40 Emergency/Disaster Response Plans

In the event of an emergency or disaster, such as an earthquake, tornado, flood, fire or man-made occurrence that threatens the safety and well-being of individuals, centers/programs shall comply with their emergency/disaster response plans.

History

• Source: Added at 26 Ill. Reg. 8520, effective May 30, 2002

Part 103 Grants

59 Ill. Adm. Code 103.10 Purpose

In accordance with the Community Services Act [405 ILCS 30], this Part establishes the Department's policies and procedures which are necessary to fund community agencies and programs which are eligible to receive grant-in-aid funding.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.11 Definitions

For the purpose of this Part, the following terms are defined:

"Accreditation." A process establishing that a program complies with nationally recognized standards of care as set by one of the following:

1997 Hospital Accreditation Standards (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996);

1997 Standards for Behavioral Health Care (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996);

1996 Comprehensive Accreditation Manual for Health Care Networks (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996);

Council on Accreditation 1997 Standards for Behavioral Health Care Services and Community Support and Education Services (Council on Accreditation of Services for Families and Children (COA), 120 Wall Street, 11th Floor, New York, New York 10005, 1996);

Outcome Based Performance Measures (The Council, 100 West Road, Suite 406, Towson, Maryland 21204, 1993);

Standards Manual and Interpretive Guidelines for Behavioral Health (Commission on Accreditation of Rehabilitation Facilities (CARF), 4891 East Grant Road, Tucson, Arizona 85711, 1996);

Standards Manual and Interpretive Guidelines for Employment and Community Support Services (Commission on Accreditation of Rehabilitation Facilities (CARF), 4891 East Grant Road, Tucson, Arizona 85711, 1996); or

Education Standards (National Accreditation Council for Agencies Serving the Blind and Visually Handicapped, 15 West 65th Street, New York, New York 10023, 1994).

"Agency plan." A part of the grant agreement which identifies the services to be provided, the target population and the geographic areas to be served. It identifies how the services will be financed and through what budget items and funding sources.

"Authorized agency representative." The administrative head of an agency appointed by the agency's governing body with overall responsibility for fiscal and programmatic management.

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Community agency" or "agency." Local government or not-for-profit corporation under contract with the Department to provide services.

"Confidentiality Act." The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

"Control." For a not-for-profit corporation, control is indicated if current members of the governing body (or staff) of the agency comprise 50 percent or more of the governing body of the controlled entity or the governing body of the agency can select 50 percent or more of the controlled entity, or any combination of seats and selection that results in influencing 50 percent or more of the seats of the controlled entity. For a for-profit corporation, control is indicated if the agency owns or controls, by options or trust, 50 percent or more of the voting stock of the corporation, or has control over the selection of over 50 percent of the governing body of the for-profit corporation, or the hiring of its management. For a partnership, control is being a general partner in a limited partnership, or being a partner with more than 50 percent of the invested equity in a general partnership. For a sole proprietorship, control exists if the proprietor is a full or part-time employee of the grantee.

"Controlled entity." Any corporation, partnership or sole proprietorship that is controlled by the agency's governing body.

"Day mode." An administrative designation quantifying service activities which are delivered during any substantial and regularly scheduled portion of a specific 24-hour time period.

"Days." Calendar days unless otherwise specified.

"Department." The Department of Human Services.

"Deemed status." If an agency has been accredited by an approved accrediting body as identified in the definition of "accreditation" in this Section, the Department shall deem the agency to be in compliance with specific Sections of this Part. Deemed status, however, may be nullified by a finding by the Department that the agency is in substantial non-compliance with one or more of the designated Sections.

"Event mode." An administrative designation quantifying service activities which are delivered in short, time-limited segments.

"Fair market value." The prevailing rate at which similar business is contracted in the agency's community, including the following specific criteria:

Fair market rent means up to plus 10 percent from the average of two estimates of appropriate rental costs from two local appraisers, which the agency is responsible for securing. If the appropriate rental cost is unclear, the Department and the agency shall establish a fair and appropriate fee.

Fair market fees for personnel means, whenever possible, the like prevailing rates in the community on a per day or per hour basis.

"Geographic service area." A geographic division for the purpose of providing locally-operated networks of services. The Department's programs are funded through a structure of service areas.

"Governing body." The policy-making authority of an agency which establishes policies concerning the agency's operation and the welfare of individuals; provides for the agency's administration by appointing an authorized agency representative to implement its policies, and exercises general oversight of the agency's operation, its fiscal affairs and programmatic content to implement the agency's mission.

"Grant agreement." When fully executed, the obligating instrument providing the basis for Departmental financial participation in grant-in-aid programs, and which formalizes the contractual relationship between the Department and the agency indicating the amount of Department funds which will be paid to the agency for the provision of services as described in the grant agreement and the agency plan.

"Individual" or "individuals." A person or persons who receives or receive mental health or developmental disability services.

"Lapse." Grant funds not expensed at the expiration of the grant agreement, due to allowable expenses not meeting revenue for Department grant funds awarded, by program.

"Lapse notice." A notification that the Department has determined potential lapsed funds, when the Department revenue by program exceeds allowable expense, by Department-funded program.

"Linkage." Person-to-person contact to assure that the supports and services needed by the individual and specified in the individual services plan are obtained. The qualified mental retardation professional, qualified mental health professional or staff under their supervision shall be responsible for assuring linkage.

"Medicaid." Medical assistance issued by the Illinois Department of Public Aid under the provisions of Title XIX of the Social Security Act (42 U.S.C.A. 1396 et seq. (1996)), for eligible recipients including Aid to the Aged, Blind and Disabled (AABD), Temporary Assistance to Needy Families (TANF), Medical Assistance No Grant (MANG), Refugee Repatriate Program (RRP) recipients, as well as Title XIX eligible Department of Children and Family Services (DCFS) wards.

"Network of services." A network which is developed and maintained by service providers, community residents (including consumers and consumer representatives), mental health authorities and the Department (including State-operated facilities), and which is planned, organized and coordinated for the delivery of mental disabilities services. Such a network will emphasize continuity, accessibility, appropriateness and comprehensiveness.

"Operating fund." A term inclusive of funds an agency may have in its accounting records, except those in a capital fund(s).

"Performance indicator." A qualitative and/or quantitative measure that can be included: in the assessment of how well the mental health and developmental disabilities service system is functioning; in evaluating both outcomes and system processes; and in assessing all levels of the system, including the system as a whole, the geographic service area, the agency, the State-operated facility, and the individual receiving mental health or developmental disabilities services.

"Preliminary evaluation." The use of a system to evaluate the physical, social, developmental, behavioral and psychosocial aspects of an individual.

"Redistribution." A change in the distribution of the agency's total award between two or more individual program awards, involving an intra-agency transfer of funds; therefore, the increases to individual programs are always balanced by the decreases to other programs, but not changing the agency total.

"Reduction." A decrease in the level of funding to a program currently receiving grant funds as well as a decrease to the agency total.

"Residential mode." An administrative designation quantifying service activities which are delivered in a specified living environment.

"Secretary." The Secretary of the Department of Human Services or his or her designee.

"Services" or "mental health or developmental disability services." Any treatment or habilitation events or products as contracted for through the grant agreement and as specified in the agency plan.

"Supplemental." For a program currently receiving grant funds, a supplemental represents an increase to both the individual program award and the agency total. For a new program, a supplemental represents both the addition of a specific program award, and an increase to the agency total.

"Umbrella agencies." Those organizations which have overall legal, administrative, planning, and funding responsibility for delivery of services in more than one geographic service area.

History

• Source: Amended at 21 Ill. Reg. 8282, effective June 25, 1997

59 Ill. Adm. Code 103.15 Incorporation by Reference

Any rules of any 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.

History

• Source: Added at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.20 Geographic Service Area

Agency plans shall be developed, presented, and reviewed in the context of the needs and resources within the geographic service area(s) to be served. The objectives stated in the plan shall be integrated into the development of the objectives of a community-based delivery system which is serving individuals through services or a network of services.

a) The agency shall define and describe the specific geographic area to be served by each program. Agencies are required to provide services in the grant-funded programs, up to the program's capacity and capability, for individuals in the target group who need such services.

b) All persons requesting services from any Department-funded agency shall receive a preliminary evaluation and be provided with immediate crisis intervention, if needed, regardless of their home area. The agency receiving the request for services shall, if funded for these services, provide the services. If the agency is not funded to provide these services, an immediate referral shall be made to an agency nearby which is funded to provide such services. The agency receiving the referral shall, then, provide the services as requested. Pursuant to the individual's consent in accordance with the Confidentiality Act, linkage to the individual's home area must be undertaken with an agency most suitable for responding to the individual's treatment and training needs.

c) Agencies receiving federal Community Mental Health Services (CMHS) Block Grant funds (42 U.S.C.A. 300x et seq. (1996), Subpart I and III, Part B, Title XIX, Public Health Services Act, 45 CFR 96 (1996)) through State financing shall assure that individuals admitted to Department facilities are screened and determined appropriate for that level of care or provide other treatment alternatives within the local community.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.25 Agency Governance (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.30 Conflict of Interest (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.40 Community Operation of Programs (repealed)

History

• Source: Repealed at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.50 General Program Requirements

Agencies funded by the Department shall meet the following general program requirements for all funded services:

a) Service setting

Services shall be provided in the setting most appropriate to the needs of the individual. This may include the individual's home, the agency, or the community. All settings shall be used innovatively in order to reach the target populations.

b) Recordkeeping

1. Cumulative case records including an individualized service plan shall be maintained for each person.

2. The individualized service plan shall state the goals for each individual. The individual shall be afforded the opportunity and encouraged to participate in goal/objective selection. Goals/objectives shall include timeframes specified by the agency's professional staff, in consultation with the individual and relevant collaterals.

"Individualized service plan", as used herein, refers to and is equivalent to "individual treatment plan" and "individual habilitation plan".

c) Behavior management and human rights review

Each agency is required to establish or ensure a process for the periodic review of behavior intervention and human rights issues involved in the individual's treatment and/or habilitation. Agencies required to have behavior intervention and human rights review policies and procedures under licensure or certification standards shall continue to comply with those standards.

d) Abuse and neglect

Each agency shall have and use a process for reporting and handling instances of abuse and neglect in accordance with applicable standards, regulations and laws.

e) Admission to programming

1. Grant agencies shall not discriminate in the admission to and provision of needed services to individuals on the basis of race, color, sex, religion, national origin, ancestry, or disability.

2. Admission policies and procedures shall be set forth in writing and be available for review.

f) 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.

g) Personnel requirements

1. A licensed physician (MD or DO) shall assume medical and legal responsibility for medical services offered in any program, including prescription of medications.

2. All services shall be provided by appropriately trained staff, operating under the supervision of qualified clinical professionals.

h) Mandated services

1. Mandated services shall be provided according to the requirements as stated in the Department's rules at 59 Ill. Adm. Code 125, Recipient Discharge/Linkage/Aftercare.

2. The Department shall monitor the provision of mandated follow-up monitoring services as outlined in 59 Ill. Adm. Code 125.

i) Utilization review

Utilization review is the ongoing review of services delivered, their intensity and their duration, to determine adherence to generally accepted guidelines or standards regarding the individual's assessment, eligibility for service and appropriateness of services rendered. Agencies shall engage in a utilization review process for all program services.

j) Compliance with 89 Ill. Adm. Code 509

Each agency shall comply with the Department of Human Services Fiscal/Administrative Recordkeeping and Requirements (89 Ill. Adm. Code 509).

History

• Source: Amended at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.60 Fiscal Management (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.65 Programs Eligible for Grants

a) Mental health services

The following services, and others that may not be listed herein, are eligible for State support in whole, or in part, by the Department for the provision of community-based mental health services for eligible clients.

1. Outpatient mental health services;

2. Screening, assessment and support services (SASS);

3. Community integrated living arrangements (CILA);

4. Day mental health services; or

5. Residential mental health services.

b) Developmental disabilities services

The following services, and others that may not be listed herein, are eligible for State support in whole, or in part, by the Department for the provision of community-based developmental disabilities services for eligible clients.

1. Diagnosis and evaluation;

2. Client and family support;

3. Epilepsy services;

4. Developmental training;

5. Vocational development;

6. Early intervention;

7. Regular work;

8. Supported employment;

9. Community integrated living arrangements (CILA);

10. Case coordination;

11. Pre-admission screening;

12. Group day respite services;

13. Limited use programs;

A) Dental services;

B) Leisure time services;

C) Additional support for residential respite services;

D) Demonstration projects;

E) Program start-up;

F) Administration; or

G) Transportation.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.70 Special Organizational Structures

a) Comprehensive community mental health centers

1. As a part of the Public Health Services Act, Title XIX, Part B (42 U.S.C.A. 300x (1996)) the CMHS Block Grant funds services provided to persons with mental illness by comprehensive community mental health centers.

2. Comprehensive community mental health centers receiving CMHS funds shall provide specialized outpatient services, 24-hour a day emergency care, day treatment or other partial hospitalization, screening to determine the appropriateness of admissions to State mental health facilities and consultation and education services. Agencies receiving block grant funds shall also provide services to individuals residing in a defined geographic area, with special attention to persons with severe and persistent mental illness, regardless of ability to pay, current or past health condition, or any other factor. These services shall be available and accessible promptly and in a manner which preserves human dignity and assures continuity and high quality care.

3. CMHS Block Grant funds shall not be used to: provide inpatient services; purchase or improve land, purchase, construct or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment; satisfy any requirements for the expenditures of non-federal funds as a condition for the receipt of federal funds; provide financial assistance to any entity other than a public or nonprofit private entity; or make cash payments to intended individuals.

b) Community mental health (708) boards

1. As required by the Community Mental Health Act [405 ILCS 20], community mental health boards (708) shall develop and submit a comprehensive plan for mental health and developmental disabilities programs in their geographic area by October 1 of each year for the ensuing 12-month and 3-year periods. Such plans shall be submitted annually for the ensuing 12 months to the Department.

2. When there is more than one 708 board within the geographic service area, the Department encourages the development of a single plan and a single delivery system for the entire geographic service area.

3. Pursuant to Section 3e(h) of the Community Mental Health Act, the Department will not make grant awards without consideration to the review and comments submitted by the 708 boards.

4. Programs operated by a 708 board are eligible for grant funding for no more than two fiscal years and must fully meet the requirements of this Part.

5. The Department will not participate in the costs of a 708 board which are attributable to the administration of local funds, duties and responsibilities. However, the Department may participate in the administrative costs of a 708 board which are directly attributable to the cost of administering Departmental duties and responsibilities.

6. Authorized agency representatives and staff of agencies funded by both 708 boards and the Department may not serve concurrently as a member or as staff of the 708 board. Individual exceptions to this provision must be justified in writing and require the written approval of the Secretary. Reasons for exceptions may include but are not necessarily limited to rural areas with limited numbers of mental health professionals.

c) Public health departments

1. County, multiple county, and municipal public health departments established by either referendum or resolution have the option to provide mental health and developmental disabilities services (see the Department of Public Health's rules at 77 Ill. Adm. Code 615 (Local Health Departments Program Standards Code)). Those public health departments which opt to provide these services are eligible agencies for grant funds, whether they provide services directly or by contract with existing providers of services (either within or outside the geographic service area).

2. Administrative costs of non-Department funded programs within a public health department are not eligible for funding by the Department.

3. A mental health and developmental disabilities services advisory committee must be appointed by the health department board.

4. Department-funded local health departments shall be in compliance with 77 Ill. Adm. Code 615.

d) Umbrella agencies

A plan for providing community input to the operation of units of the umbrella agency shall be developed for use by the umbrella agency. This plan shall be available for review by Department staff.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.80 Monitoring and Evaluation

The agency shall agree to participate in a monitoring and evaluation system as described in the grant agreement.

a) Evaluation methodologies

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 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 agency's compliance with contractual obligations, applicable administrative rules and legislation and insuring that Departmental funds are spent appropriately for services as specified in the grant agreement. Monitoring may include desk review and site review of agency performance.

c) Performance indicators

Performance indicators shall be established for each agency as a part of the annual grant negotiation process. Performance indicator data shall be routinely distributed to the agency as part of the monitoring process. Previous data on performance indicators shall be included in this distribution to allow for analysis of change in functioning over time.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.90 Fiscal Requirements (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.95 Grant Negotiation Process

A number of factors enter into the grant negotiation process, including, but not limited to:

a) A review of program expenses for the budget year and the past year;

b) Whether the agency provided the level of services budgeted for in prior years;

c) Number of individuals to be served;

d) Characteristics of individuals to be served (such as, disability or severity);

e) Cost per unit of service;

f) Other funding sources (such as, other State agencies, local governmental units, third party payors or individual fees);

g) Services proposed to be funded versus those outlined in the Department's annual plan;

h) The agency's current financial status;

i) The agency's ability to meet its own established goals;

j) Impact of recent Department audit findings or independent audit report conditions on the agency's operation;

k) Maintenance of effort needs; and

l) Performance indicators.

History

• Source: Added at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.100 Accounting Requirements (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.110 Allowable/Non-Allowable Expenses (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.120 Audits

a) Each agency receiving a grant from the Department shall have an annual independent audit as of the close of its fiscal year. This audit shall be performed in accordance with Section 89 Ill. Adm. Code 507.

History

• Source: Amended at 22 Ill. Reg. 22390, effective December 8, 1998

59 Ill. Adm. Code 103.130 Department Review and Hearing Process

In order to assure that agencies have input and recourse to fiscal and programmatic decisions which directly affect them, a Department review and hearing process is established and available to each Department-funded agency:

a) Grant award re-evaluation process

1. An agency may request a review of the following decisions of the Department concerning an award of funds:

A) Differences or changes in the elements considered in the funding negotiations with the Department as specified in Section 103.90; or

B) Decisions which countermand previous commitments made to the agency.

2. The request shall be submitted in writing to the associate director of the appropriate program division within 45 days after the date of an executed or amended grant agreement and shall include the basis for the request.

3. Program division staff shall review the request and may request the agency to submit additional material. The program division staff shall render a written decision with 45 days after the date of the receipt of the request or of the additional material. The decision shall be mailed to the agency within 15 days after the completion of the review.

4. Program division staff may meet with the agency representatives for purposes of clarifying issues, seeking additional information, or attempting to resolve the matter.

b) Grant award hearing process

1. Agencies may submit a written request to the Department for a formal hearing only when resolution of the issues specified in subsection (a) of this Section is not in accordance with this Part.

2. A hearing may be requested by an agency not later than 30 days after the postmark date of the letter from the Department's program divisions informing the agency of the outcome of the review. The written request for a formal hearing must state specifically how the outcome was not in accordance with this Part.

3. Notice of hearing proceedings shall be in accordance with Section 10-25 of the Illinois Administrative Procedure Act [5 ILCS 100/10-25].

4. The hearing shall be conducted by a Department hearing committee, appointed by the Secretary, and composed of an agency representative selected from a roster of authorized agency representatives and who is not objectionable to the appealing agency, the associate director for the applicable program division or his or her designee(s) and the Associate Director of Administrative Services or his or her designee, who shall chair the committee.

A) At the hearing, Department staff shall present written and oral evidence concerning the Department's decision. The agency may then present written or oral evidence.

B) The Department shall have the burden of proving that its decision was made in accordance with this Part.

C) The hearing officer shall uphold the Department's decision if he or she finds that the decision was supported by substantial evidence. Substantial evidence is such evidence as a reasonable person can accept as adequate to support a conclusion.

5. The hearing shall be held not later than 45 days after receipt of the agency's request.

6. The finding(s) and decision of the hearing committee shall be made not later than 10 working days following the conclusion of the hearing proceedings and shall be sent to the agency via certified mail.

c) Secretary's review

1. If the agency is not satisfied with the committee's decision, it may request a review of the decision by the Secretary or his or her designee. Such request shall be made in writing to the Secretary within 20 days after receipt of the decision.

2. After receiving the request for review, the Secretary or his or her designee shall review the committee's decision and copies of all documents considered at the hearing. Within 20 working days after receipt of the request for review, the Secretary or his or her designee shall issue a written decision upholding, revising or modifying the committee's decision. Copies of the decision shall be sent to the Department and the agency.

3. The Secretary's or designee's decision shall constitute a final administrative decision, which is appealable in accordance with the Administrative Review Law [735 ILCS 5/Art. III].

d) Grant issue resolution process – for adjustments during the year.

1. Issues other than those directly related to the annual grant award process and not an exception to this Part are to be resolved within the Department's existing program division structure.

2. An agency may request a review related to a specific issue once an impasse has been reached in its negotiations with that program division level of the Department to which it relates on a regular basis.

3. If the program division and the agency are unable to resolve the issue, the agency may submit a written request to the Secretary for review. The agency shall send a copy of this request to the relevant program division. The Secretary shall not act on a review request unless the program division review process previously described has been exhausted.

e) The Department and the agency shall comply with all timeframes for submission of information, response to submission of information, notice, review or hearing as outlined in this Section regarding audits. The agency may appeal the Department's failure to respond to timelines as outlined in this Section.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.140 Budget Application (repealed)

History

• Source: Repealed at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.150 Agency Plan

a) The agency shall submit an agency continuation application prior to the beginning of the fiscal year. The purpose of the continuation application is to provide documentation of service and service contracting in order to permit continuation of grant payment into the new fiscal year. A complete agency plan shall be submitted after the beginning of the fiscal year.

b) All agencies are required to submit their data on forms prescribed by the Department.

c) Hereafter, in this Section and other Sections of this Part, " agency plan" shall refer to the currently approved program service and funding plan.

d) The agency plan when fully executed as part of the grant agreement, serves as the formal statement of mutual expectations between the Department and the agency regarding contracted levels of service, costs and funding levels. The agency plan is a combination service plan and budget. It identifies what services will be provided, to what target group and the geographical area to be served. In addition, it identifies how the services will be financed, and through what budget items and funding sources. It becomes formalized documentation of the agreement between the Department and the agency through mutual execution of the grant agreement.

e) An agency not funded by the Department or whose funding has been canceled pursuant to Section 103.190(e) shall submit verification of status as a not-for-profit organization, a complete agency plan on forms prescribed by the Department and shall execute a signed grant agreement prior to commencement of funding.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.160 Grant Agreement and Addenda

a) Definition of grant agreement

When fully executed, the grant agreement is the obligating instrument providing the basis for the Departmental financial participation in grant-in-aid programs, and which formalizes the contractual relationship between the Department and the agency, indicating the amount of Department funds which will be paid to the agency for the provision of services as described in the grant agreement and the agency plan.

b) Contents of grant agreement

The grant agreement shall specify the general services to be provided, the general terms and conditions of the agreement and may specify additional terms and conditions for specific services provided by the agency.

c) Preparation responsibilities

The Department is responsible for preparing the grant agreement, designating the appropriate addenda, and forwarding it to the agency. The agency shall sign the grant agreement and return it to the Department. The Department agent's signature shall be affixed thereby approving the grant agreement. An approved and executed copy shall be returned to the agency.

d) Provisions of the grant agreement

Provisions, as referenced in the grant agreement when applicable, and as described below become part of the grant agreement.

1. Non-discrimination

A) The agency agrees to comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C.A. 2000d (1996)) and all requirements imposed by or pursuant to the regulation of the U.S. Department of Health and Human Services (45 CFR 80 (1996)) issued pursuant to that Title, to the end that, in accordance with Title VI of that Act and the regulation, no person in the United States shall, on the grounds of sex, race, color, or national origin be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the grantee receives federal or State financial assistance from the grantor. Grantee hereby gives assurance that it will immediately take any measures necessary to effectuate this grant agreement.

B) The agency agrees to comply with Title VII of the Civil Rights Act of 1964 (42 U.S.C.A. 2000e (1996)) and not discriminate in the hiring or employment of staff on the basis of race, color, national origin, age, disability or sex.

C) The agency agrees to comply with the Americans With Disabilities Act of 1990 (42 U.S.C. 12101-12213 (1996) and 47 U.S.C. 225 and 611 (1996)) and all requirements imposed by or pursuant to the regulations of the U.S. Department of Health and Human Services issued pursuant to that statute, to the end that no otherwise qualified individual shall be discriminated against on the basis of handicap in the provision of services.

2. Drug-free workplace

The agency agrees to comply with the Drug-Free Workplace Act [30 ILCS 580]. Agency employees are prohibited from the unlawful manufacture, dispensing, possession or use of a controlled substance or alcohol in the workplace while performing their duties.

3. Mandated follow-up monitoring services

A) The agency shall comply with Section 15 of the Mental Health and Developmental Disabilities Administrative Act and the Department's rules at 59 Ill. Adm. Code 125 (Recipient Discharge/Linkage/Aftercare), which requires mandatory follow-up monitoring services to individuals placed in licensed nursing homes, sheltered care homes and homes for the aged in accordance with the Nursing Home Care Act [210 ILCS 45], and this Part.

B) The agency shall comply with the provisions of 59 Ill. Adm. Code 101.80 (Conflict of interest) in relation to its activities with licensed long-term care facilities. In essence, no employee of the agency shall serve as an employee or consultant either paid or unpaid to any licensed facility in the State of Illinois. Additionally, the agency itself shall not be in a financial relationship with a licensed facility in such a way which results in, or appears to result in, a conflict of interest with its monitoring functions under the grant. This shall include, at the very least, a situation where the agency is purchasing or receiving services from the same facility it monitors under this grant. The Secretary may issue approvals for exceptions which have been requested in writing to this subsection under circumstances including but not necessarily limited to those where the only developmental disabilities or mental health expertise available in a rural area is part of a current grant or of a governmental agency.

C) The Department shall monitor the agency's performance of the mandated follow-up monitoring function and maintain final responsibility for the provision of this service if the grant agreement is violated.

4. Adjustments addendum

This addendum is used for corrections, a redistribution, a supplemental award or a reduction in award.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.165 Accreditation (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.170 Agency Plan Compliance

a) The principles and procedures in subsections (c) through (e) of this Section do not replace any of the Departmental accountability standards and procedures currently in effect; rather, they are intended to clarify responsibilities for assuring compliance with all Departmental policy as it relates to the agency plan.

b) Principles

1. All agencies are accountable for the performance levels specified in their agency plans. Variances between the agency plan and an agency's actual performance as submitted to the reporting system shall be reviewed by the Department staff. Services shall be reported as event mode, day mode, residential mode services or other mutually negotiated measurements. An agency must be able to explain these variances to the Department's request.

2. The analysis of financial and statistical variances is not, in itself, an exercise in quality assessment. Variances are principally quantitative measures which should be used as an administrative guide in reviewing program performance.

3. The delivery of human services is not always predictably quantifiable in precise terms; variances, therefore, are not always meaningful measures.

4. All negative variances of 15% or greater in contracted units of service (direct service staff hours, direct service individual (client) hours, and days of care) shall be reviewed. Documentation shall be provided to the Department by the agency identifying the variance, the reason for the variance and action which the agency shall take to correct the variance.

5. The variance levels described in subsection (b) (4) of this Section are not intended to define an acceptable level of service but serve only as a "management flag" identifying the point beyond which formal documentation is required for Department review.

6. In applying these principles, it is important for the mutual expectations between the Department and the agency to be clearly established and for discussions regarding these expectations to be ongoing.

c) Procedures for Department review

1. During the grant year, events occur that may result in variations between the agency plan and the agency's actual performance, either statistically or financially. These variances in performance may be either temporary or permanent.

A) A temporary variance is a difference between the agency plan and actual performance that is caused by a short-lived event or circumstance that will not adversely impact a program's ability to perform as outlined in the agency plan, except in the short term. Best estimates of the program's future financial and service activity would indicate the correctness of staying with the current agency plan rather than changing it to meet the unusual and temporary circumstances. In other words, the causes of temporary variance are, by their nature, not sufficient reason to change the approved agency plan.

B) A permanent variance is a difference between the agency plan and actual performance that is caused by an event or circumstances that significantly alter expectations about the future financial or service activity in terms of a program's ability to perform as outlined in the approved agency plan. The causes of a permanent variance are such that a new agency plan will have to be negotiated between the agency and the Department.

2. It is the Department's responsibility to exercise a review function for all funded agencies assuring accountability for the service levels and costs established in all agency plans. To effectively perform this role, all statistical and financial variances from agency plans shall be reviewed semiannually (at a minimum). In addition, the Department may schedule site visits to agencies as part of this review process.

d) Identifying statistical variances

1. As administrative guide in conducting reviews, Department staff will focus on the following measures which are based on service projections included in the agency plan. These measures indicate the total units of service delivered by a program:

A) Either direct service staff hours, direct service individual (client) hours or total program participant hours, or as appropriate, total individual days of service.

B) For all programs with a variance in one of the above measures, written explanations are required if the variance exceeds minus 15%. For any variance identified in this manner, documentation is required at least semiannually. (Explanations, however, must addresses the variance for each month within the period.)

2. Variances requiring documentation

Those statistical variances which require documentation are identified in reports generated from the Department's reporting system. Variances will be determined according to the service modality of the program.

e) Audits

Documentation of variances and the records of renegotiated agency plans form the basis for any after-the-fact review of an agency's relationship with the Department.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.180 Prerequisites for Disbursement of Funds

a) Agencies are required to submit a continuation application for the forthcoming year prior to commencement of the fiscal year, within timeframes as established by and using forms prescribed by the Department.

b) Agencies are further required to submit a full agency plan for the Department's review and approval within timeframes as established by and using forms prescribed by the Department.

History

• Source: Amended at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.190 Interruption of Disbursement and Grant Cancellation (repealed)

History

• Source: Repealed at 24 Ill. Reg. 18160, effective November 30, 2000

59 Ill. Adm. Code 103.200 Revenue/Expense Reports (repealed)

History

• Source: Repealed at 17 Ill. Reg. 10282, effective July 1, 1993

59 Ill. Adm. Code 103.210 Reallocation

Reallocation of funds

Agencies may transfer funds between programs within the agency plan guidelines distributed by the Department. Agencies desiring to reallocate funds in excess of agency plan guidelines must request this reallocation in writing prior to the expiration of the grant agreement. Authorization to transfer these funds within the agency plan guidelines distributed by the Department will be allowable, with justification, unless the Department indicates to the contrary within 30 days after notification. The agency must request this reallocation by registered mail prior to the end of the fiscal year.

History

• Source: Amended at 24 Ill. Reg. 18160, effective November 30, 2000

Part 106 Services Charges

59 Ill. Adm. Code 106.10 Estates of Recipients Admitted to State Hospitals (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.15 Definitions

"Allowable reserve." An amount set by the Department in accordance with Section 106.45(g) which is exempt from services charges.

"Annual income." Adjusted gross income as defined by Section 2-203 of the Illinois Income Tax Act [35 ILCS 5/203].

"Average per capita cost." Amount calculated for the daily average per capita cost of operation of all Department facilities for the fiscal year immediately preceding the period of State care for which the rate is being calculated [405 ILCS 5/5-106].

"Board of Reimbursement Appeals." Board appointed by the Governor consisting of 3 persons whose duties are to review decisions of the Department under Sections 5-105 through 5-115 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-105 through 5-115].

"Department." The Department of Human Services.

"Estate of recipient." All income and assets, including real property.

"Ill-1, Financial Questionnaire." A designation assigned to a set of schedules developed for the purpose of collecting financial data on recipients of services and their statutorily responsible relations.

"Legal dependents." Those persons dependent upon the recipient for more than one-half of their support and shown as dependent on the recipient's U.S. Individual Income Tax Return.

"Medical costs." Services for the diagnosis and treatment of conditions, other than the recipient's handicapping condition, which are provided by a hospital.

"Notice of determination." Notification sent to an individual when charges have been established for recipient services [405 ILCS 5/5-111].

"Recipient of services" or "recipient." A person who has received or is receiving services partially or wholly supported by the Department [405 ILCS 5/1-123].

"Responsible relative." Spouse of a recipient or parent of a recipient under age 18 [405 ILCS 5/1-124 and 5-105].

"Secretary." The Secretary of the Department of Human Services or his or her designee.

"Services." Services which are rendered and are partially or wholly supported by the Department.

History

• Source: Amended at 13 Ill. Reg. 3821, effective March 14, 1989

59 Ill. Adm. Code 106.20 Maximum Charges for Treatment (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.25 Charges for Services

a) The maximum charge for services to be assessed against a recipient, or the estate of a recipient in a Department-operated facility, shall be 55% of the average per capita cost commencing January 1, 1985; 65% of the average per capita cost commencing January 1, 1986; 75% of the average per capita cost commencing January 1, 1987; 85% of the average per capita cost commencing January 1, 1988; 95% of the average per capita cost commencing January 1, 1989; and 100% of the average per capita cost commencing January 1, 1990 and each January 1 thereafter to be recalculated annually.

b) The standard authorized by Section 5-116 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-116] by which the Department will set the rate for responsible relatives to provide support will be based on a percentage of annual income, considering the number of dependents. Section 106.Table A, found at the end of this Part, is used for determining the support obligation of a responsible relative.

c) The maximum rate to be used when filing claims for benefits under Title XVIII of the Social Security Act (Medicare) (42 U.S.C.A. 1395b-1 (1996)), Title XIX of the Social Security Act (Medicaid) (42 U.S.C.A. 1396a (1996)) Veteran's Administration benefits (38 U.S.C.A. 521, 541, 542 (1996)), Champus/Champva (38 U.S.C.A. 601 (1996)) and active military, is not to exceed the rate set by the Department of Public Aid, or as approved each year for the respective program. Payments received from a benefit or federal insurance program shall be credited on a dollar for dollar basis for each covered day up to the maximum per capita cost for which the recipient has a liability or the contracted rate established by the provider, whichever is less. Responsible relatives cannot be assessed a charge during periods such coverage is received.

d) All payments received from private hospitalization insurance shall be credited against the recipient's liability on a dollar for dollar basis up to the prevailing maximum charge for recipients as established in this Section.

e) All payments on behalf of recipients from any source shall be credited against Medicaid (42 U.S.C.A. 1396a (1996)) billings if for the same period of service.

f) If a spouse who is a legal dependent of a recipient is designated as payee of the recipient's benefits and is using such benefits as his/her income, charges shall be established on the total combined income in accordance with the schedule in Section 106.Table A as provided for in Section 5-116 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-116].

g) Voluntary payments in excess of required amounts will be accepted from the recipient and from responsible relatives as well as from persons not legally responsible.

History

• Source: Amended at 15 Ill. Reg. 1555, effective January 22, 1991

59 Ill. Adm. Code 106.30 Liability for Treatment Charges (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.35 Liability for Services Charges

a) A recipient of services in Department facilities and the estate of such recipient has the primary liability for payment of sums representing charges for services at the prevailing maximum rate as determined by the Department. If a recipient is unable to pay such rate, or the estate of the recipient is insufficient for payment, the responsible relatives are severally liable for payment of the balance due according to the rates prescribed in Section 106.Table A of this Part. The liability of each responsible relative for payment of services charges ceases when payments on the basis of financial ability have been made for a total of 12 years. (Section 5-105 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-105])

b) The responsibility for liability for services charges shall be established in the following order:

1. Recipient of services or the estate of the recipient

A) The recipient of services or the estate of the recipient has a liability as long as there are unpaid services charges.

B) Income accruing from a trust estate of a recipient shall be charged the same as other assets. If the income from such trust is not sufficient to meet the maximum cost of services to the recipient, the Department shall, in those cases where the trust agreement specifically states that the principal, if needed, may be used, establish charges against both the income and the corpus of the trust.

2. Responsible relatives

A) A spouse is liable for services charges unless the other spouse willfully failed to contribute to the spouse's support for a period of five years preceding admission. Any spouse claiming exemption from liability for charges, due to willful failure to support for five or more years, shall be required to furnish the Department with clear and convincing evidence substantiating such claim. (Section 5-105 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-105]) Such evidence may consist of a judgment of legal separation or other evidence of lack of support for the five year period. A spouse ceases to be liable for services charges for the other spouse on the effective date of a divorce unless financial liability is established by the marriage dissolution or maintenance decree.

B) Parents, natural or adoptive (Instruments Regarding Adopted Children Act [760 ILCS 30]), are severally liable whether living together or apart unless a court order pursuant to a marriage dissolution under the Illinois Marriage and Dissolution of Marriage Act [750 ILCS 5] provides otherwise. No parent shall be personally liable for services charges incurred by a child after such child reaches the age of majority (18), except under a type of insurance arrangement which provides coverage for the recipient.

c) Charges for services shall not be made for recipients committed by the court to the Department of Corrections and then admitted to a Department facility for observation, diagnosis and treatment/habilitation for any period that the recipient is still under commitment to the Department of Corrections.

d) Charges for services shall be established against the estate and income of recipients in Department facilities whom the court has determined as being legally unfit to stand trial or not guilty by reason of insanity, but no services charges shall be assessed against the relatives of such recipients.

e) Charges for services for a recipient under the age of 18 shall be limited to the lesser of the cost of medical care provided, which are unrelated to the individual's handicapping condition, or the amount indicated on the responsible relative schedule for a responsible relative (see Section 106.Table A of this Part); or individual liability as determined by Section 106.45 for an individual payee.

f) Charges for a recipient between the ages of 18 and 21 are limited to the provisions of subsection (e) of this Section if the individual is receiving services under the Education for the Handicapped Act (20 U.S.C.A. 1400 (1996)). For a recipient between the ages of 18 and 21, who is not receiving services under the Education for the Handicapped Act (20 U.S.C.A. 1400 (1996)), the provisions of subsections (a) through (d) of this Section apply.

g) When a recipient of services under the age of 22 receives benefits from a federal government agency, which are to provide for the individual's care and maintenance needs, such funds, less the applicable personal allowance of $40 per month, shall be applied toward the State's cost of providing such care.

h) If the recipient is also a Medicaid recipient and receives benefits from a federal government agency, such funds, less the applicable personal allowance as specified in 89 Ill. Adm. Code 113.247, must be applied toward such Medicaid charges in accordance with 42 CFR 435.732 (1996). Claims submitted by the Department to the Illinois Department of Public Aid (IDPA) shall be reduced by the amount of these net benefits.

History

• Source: Amended at 12 Ill. Reg. 10472, effective June 7, 1988

59 Ill. Adm. Code 106.40 Determination of Ability to Pay Treatment Charges (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.45 Determination of Ability to Pay Services Charges

a) The Department, in determining the ability of the responsible person (recipient, responsible relative, guardian, trustee and/or payee) to pay services charges, shall assemble any necessary information pertaining to his or her financial status and shall then set the amount for which the responsible person shall be held liable. Recipients and all responsible persons must furnish financial information on admission or as soon thereafter as possible to enable the Department to make a proper determination of the sources available for the cost of services charges. The liability for payment of services charges shall be based on information available at the time of determination. (Such data may include savings, trusts, wills, evidence of indebtedness, evidence of court-ordered payments, and the like.) Each person for whom a determination has been made shall be issued a form DMHDD-612, Notice of Determination, notifying the person of his or her liability. Such notice shall be issued even when current determined liability is $0.00.

b) When there is a demonstrated ability to pay, payment for services is an obligation established by Sections 5-100 through 5-117 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-100 through 5-117] against the recipient, responsible relatives, guardians, trustees and/or payees.

c) If the responsible person fails to submit financial information as requested, the Department may assess services charges at the maximum rate of charge as provided in Section 106.25 until such information is supplied and an actual assessment can be determined. In the absence of billing during the period covered in such instances, the Department may consider that notices and requests for information as previously sent shall constitute ample notice of liability and indebtedness for such period. However, in subsequent review or annual redetermination involving responsible relatives, no services charges shall be retroactively established prior to the date of contact for financial information.

d) Subsequent review could be initiated by the recipient of services prior to the annual redetermination due to changes in ability to pay or as a result of an administrative hearing or by the Board of Reimbursement Appeals. Recipients and responsible relatives have a responsibility to inform the Department of any changes.

e) Liability of responsible relatives shall be reviewed annually and such responsible relatives shall be requested to submit copies of their most recent U.S. Individual Income Tax Return. This information will be used as a basis for determining services charges in accordance with this Part and the schedule of charges in Section 106.Table A of this Part.

f) The determination by the Department of the liability of a responsible person to pay an amount up to the maximum rate as established in Sections 106.25 and 106.25(b) shall continue in force until the Department determines a different amount on the basis of changes in circumstances surrounding the person's ability to pay, or until a change has been made in the standards of ability to pay set forth in Sections 106.25 and 106.25(b) or until a release from or a modification of services charges is granted upon a hearing on the petition of a person liable in accordance with Section 106.75 and Section 5-111 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-111].

g) The determination of the ability to pay and amount of liability of the recipient for services charges, up to the prevailing maximum rate established for recipients in Section 106.25, shall be based on all assets and income of the recipient. After considering the recipient's legal dependent's financial needs as covered in subsection (k) of this Section, all resources and assets are reduced to the allowable reserve exemption in accordance with subsection (h) of this Section.

h) The allowable reserve exemption, as provided for in Section 5-106 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-106], is determined by the amount of assets owned at the time of the recipient's admission except that the allowable reserve exemption from all sources cannot exceed that established by the Illinois Department of Public Aid at 89 Ill. Adm. Code 120.382. The recipient's allowable reserve exemption can only be increased by the unused portions of the monthly personal and clothing allowance or unspent workshop or other monetary incentive funds , such as living skills program funds. Payments to be paid by the recipient for services charges may not be deferred to build a reserve up to the maximum amount allowed.

i) If the recipient becomes eligible and is approved for Medicaid (42 U.S.C.A. 1396a (1996)), 42 CFR 430 (1996) and the Department of Public Aid's rules at 89 Ill. Adm. Code 120.40 and 120.382 govern the allowable reserve and personal and clothing allowance.

j) The Department shall allow deductions from income for a community spouse maintenance needs allowance and a family maintenance needs allowance for each dependent family member who does not have enough income to meet his or her needs. Family members include dependent children under age 21, dependent adult children, dependent parents or dependent siblings of either spouse who are living with the community spouse. To determine the amount of the deduction:

1. The deduction for the community spouse maintenance needs allowance, as set forth in the Department of Public Aid's rule at 89 Ill. Adm. Code 120.61(d), is equal to the community spouse maintenance needs standard less any non-exempt monthly income of the community spouse. The deduction is allowed only to the extent that income of the spouse who is receiving services at a Department-operated facility is contributed to the community spouse. However, the deduction for the community spouse maintenance needs allowance shall not be less than the amount ordered by the court for support of the community spouse or the amount determined as the result of the fair hearing.

2. The deduction for the family maintenance needs allowance for each dependent family member is equal to one-third of the difference between the family maintenance needs standard and any non-exempt income of the family member as set forth in the Department of Public Aid's rule at 89 Ill. Adm. Code 120.61(d).

k) Prior to the assessment of services charges against a recipient of services, the Department shall review the financial needs of the recipient's legal dependents. The financial needs of these legal dependents shall be based on amounts expended up to an amount equal to the minimum yearly income for which a responsible relative would be subject to a charge as shown in Section 106.Table A. Any amounts as allowed which are not expended for support of legal dependents claimed on the recipient's U.S Individual Income Tax Return, shall be subject to services charges.

l) When it is necessary for the Department to disclose information in order to collect services charges, such disclosure shall be limited to information needed to pursue collection, and the information so disclosed shall not be used for any other purpose nor shall it be redisclosed except in connection with such collection activities. (See Section 11 of the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110/11])

History

• Source: Amended at 18 Ill. Reg. 15606, effective October 5, 1994

59 Ill. Adm. Code 106.50 Standards for Ability to Pay Treatment Charges (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.60 Allowances for Unusual Expenses or Circumstances in Determining Ability to Pay Treatment Charges (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.65 Allowances for Unusual Expenses and/or Exceptional Circumstances in Determining Ability to Pay Services Charges

a) If an examination or re-examination reveals unusual and/or exceptional circumstances which indicate that the responsible relative's adjusted gross income as reported on his/her most recent U.S. Individual Income Tax Return or the recipient's income and assets as reported on schedules B and C of the I11-I, Financial Questionnaire is not an adequate measure to determine ability to pay services charges in accordance with Sections 106.25 and 106.45, allowances for the unusual and/or exceptional circumstances listed below shall be made in the application of the schedule of charges in Section 106.Table A of this Part.

1. Unemployment;

2. Provable reduction in income;

3. Additional dependents;

4. Medical and related costs over the amounts covered by insurance;

5. Unforeseen catastrophic expenses.

6. Undue hardship created by excessive increase in liability is limited to 100% prior year assessment applicable only to those assessed prior to July 1, 1984.

b) All individuals requesting allowance due to subsection (a) of this Section must furnish proof of the unusual and/or exceptional circumstances.

History

• Source: Amended at 12 Ill. Reg. 18158, effective October 31, 1988

59 Ill. Adm. Code 106.70 Petition for Release from or Modification of Treatment Charges (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.75 Petition for Release from or Modification of Services Charges

a) Any person who has been issued a form DMHDD-612, Notice of Determination, of sums due as service charges may petition the Department for a review of such determination. The petition must be in writing and filed with the Department, 401 Stratton Building, Springfield, Illinois 62765 within 90 calendar days from the date of the form DMHDD-612, Notice of Determination. [405 ILCS 5/5-111]

b) On the basis of the grievances presented in the petition, the Department shall review the record and shall make corrections for errors prior to a formal hearing. If such corrections do not resolve the issue raised, the Department shall provide for a hearing to be held on the services charges for the period covered by the petition. Pre-hearing conferences may be arranged by the Department prior to scheduling of formal hearing to develop factors not included in the Department's master file record, which could result in resolution of the issues raised.

c) A notice stating the date, time, and place of the hearing shall be sent by certified mail to the address given on the petition of the person entering the petition not less than 10 calendar days in advance of the date of such hearing. Hearings will be scheduled at a time and place to be determined by the Department. The place selected will be an appropriate location, with a view to geographic grouping of the cases to be heard, to keep travel at a minimum for all parties.

d) The person petitioning the Department shall appear personally and may bring such witnesses as may be deemed necessary and may be represented by a person of his or her own choice.

e) A hearing officer duly authorized by the Secretary of the Department shall conduct the hearing as follows:

1. The hearing is officially opened when the purpose of same has been stated and governing authorities have been cited.

2. Presentation of the hearing's examiner credentials. Leave to substitute a copy for incorporation in the record shall be sought, in order to retain the original in the Department's master file.

3. Swearing in of those who are to testify as witnesses, petitioner and others appearing on his or her behalf, the Department's representative or representatives, etc. Identification for the record by name and title. The hearing officer shall have the authority to subpoena witnesses and to compel the production of books and records (see 20 ILCS 1705/17).

4. The petitioner is given preference as to the order of appearances by agreement as to the format of the hearing, as a result of a preliminary conference between both parties. If agreeable, the Department's case is the first to be recited into the record for the purpose of developing a basis for the hearing. All documents, in support of such testimony, are numbered and offered into evidence as the Department's exhibits. Leave to substitute copies of such documents is sought so the originals may be retained in the Department's master file.

5. Upon completion of the Department's case, cross examination of the Department may be held if desired, either by the petitioner, or his or her attorney, if so represented.

6. The petitioner then states, either directly, or upon examination by the counsel, the reason for requesting a modification or release from charges, and submits documents to substantiate allegations made by him or her, or as a rebuttal of the Department's allegations. These exhibits are numbered and identified for record purposes as petitioner's exhibits. The presiding hearing's examiner has complete authority for determining what testimony or evidence is relevant and admissible into the record, either by the Department or the petitioner.

7. After all direct testimony has been completed, and all evidence by both the Department and the petitioner is in, cross-examination may again be held, if so desired.

8. When there is no further testimony or evidence to be offered by either party, the hearing is to be considered adjourned with the explanation that no decision will be rendered on the testimony and evidence submitted, inasmuch as the complete record will be reviewed and a full report, with recommendations will be submitted to the Secretary of the Department who will ultimately review the findings and recommendations and render a final decision as to whether the determination is subject to change, and so notify the petitioner.

9. If the findings of the hearing indicate that an error has been made in the original determination, or new or additional information indicates supplemental allowances are in order, an independent redetermination shall be made by the hearings examiner responsible for preparation of the report to conform.

10. Within 30 days, but no later than 60 days subsequent to the hearing, a copy of the Department's letter of decision, bearing the Secretary's signature, noted as to the date of the signature, along with a copy of the findings and recommendations shall be issued to the petitioner.

f) The common law rules of evidence shall not be enforced in the conduct of the hearing (see 5 ILCS 100/10-40). The hearing officer may ask and receive answers to such questions as are pertinent and proper for a fair determination of the case. Exhibits may be received as part of the evidence and shall be numbered in order according to whether they are the Department's or the petitioner's exhibits.

g) The hearing officer shall make a recommendation on the basis of statutory guidelines (see 405 ILCS 5 and 20 ILCS 1705), rules of the Department (59 Ill. Adm. Code) and the testimony and evidence presented. The Secretary shall review the record and the recommendation of the hearing officer shall become final only upon receiving the Secretary's signature indicating his or her assent thereto.

h) The Department is not authorized or empowered by the Mental Health and Developmental Disabilities Code [405 ILCS 5] to hold a subsequent hearing based on the same set of facts existing at the time the Departments final order was entered.

i) The Department shall keep a certified true copy of the record of the hearing and shall furnish such record to any court reviewing its decision or to the Board of Reimbursement Appeals (see 735 ILCS 5/3-101). The record shall be forwarded to a petitioner or to a person authorized by the petitioner to examine the record subject to costs as outlined in Section 5-111 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-111].

j) Any person aggrieved by the decision of the Department upon such hearing may, within 30 days thereafter, file a petition with the Department for review of such decision by the Board of Reimbursement Appeals. Upon receiving a petition for review by the Board of Reimbursement Appeals (the Board), the Department shall notify the Board, which shall render its decision on the petition within 30 days after it is filed and certify its decision to the Department. Concurrence of the majority of the Board is necessary in any such decision. The Board of Reimbursement Appeals may approve action taken by the Department or may remand the case to the Secretary with recommendation for redetermination of charges. [405 ILCS 5/5-111 and 5-113]

k) Any person affected by such a final administrative decision of the Department or the Board of Reimbursement Appeals may have such decision reviewed only under and in accordance with the Administrative Review Law [735 ILCS 5/Art. III]. [405 ILCS 5/6-101]

History

• Source: Added at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.80 Computing Costs of Hospitalization of Recipients (repealed)

History

• Source: Repealed at 8 Ill. Reg. 22555, effective November 7, 1984

59 Ill. Adm. Code 106.85 Computing Monthly Costs of Recipient Services Charges

The liability of recipients, the estates of recipients and that of responsible relatives for services charges in Department facilities shall be computed in the following manner:

a) Monthly liability established against recipients of services is determined by multiplying the per diem rate by the number of actual days of service received by the recipient during the month.

b) Monthly liability established against responsible relatives is determined by:

1. The full month's assessed charge whenever the service recipient's stay at the facility is continuous for the month, or

2. Multiplying the per diem equivalent by the number of actual service days whenever the recipient's stay is less than the full month.

History

• Source: Amended at 12 Ill. Reg. 18158, effective October 31, 1988

59 Ill. Adm. Code 106.90 Partial Payment of Cost of Maintenance for Certain Mentally Retarded Persons in Licensed Private Facilities (repealed)

History

• Source: Repealed at 6 Ill. reg. 879, effective January 15, 1982

59 Ill. Adm. Code 106.100 Partial Payment of Cost of Maintenance for Certain Mentally Ill Children in Licensed Private Facilities (repealed)

History

• Source: Repealed at 6 Ill. Reg. 879, effective January 15, 1982

59 Ill. Adm. Code 106.TABLE A Responsible Relative Liability

TABLE A

Responsible Relative Liability

Number in Family (including recipient)

Annual Income

Family Size

Range

2

3

4

5

6

7

$ 7,000

$ 7,500

$ 5

7,501

8,000

10

8,001

8,500

15

8,501

9,000

20

$ 5

9,001

9,500

25

10

9,501

10,000

30

15

10,001

10,500

35

20

$ 5

10,501

11,000

40

25

10

11,001

11,500

45

30

15

11,501

12,000

50

35

20

$ 5

12,001

12,500

55

40

25

10

12,501

13,000

60

45

30

15

13,001

13,500

65

50

35

20

$ 5

13,501

14,000

70

55

40

25

10

14,001

14,500

75

60

45

30

15

14,501

15,000

80

65

50

35

20

$ 5

15,001

15,500

85

70

55

40

25

10

15,501

16,000

90

75

60

45

30

15

16,001

16,500

95

80

65

50

35

20

16,501

17,000

100

85

70

55

40

25

17,001

17,500

105

90

75

60

45

30

17,501

18,000

110

95

80

65

50

35

18,001

18,500

115

100

85

70

55

40

18,501

19,000

120

105

90

75

60

45

19,001

19,500

125

110

95

80

65

50

19,501

20,000

130

115

100

85

70

55

20,001

20,500

135

120

105

90

75

60

20,501

21,000

140

125

110

95

80

65

21,001

21,500

145

130

115

100

85

70

21,501

22,000

150

135

120

105

90

75

22,001

22,500

155

140

125

110

95

80

22,501

23,000

160

145

130

115

100

85

23,001

23,500

165

150

135

120

105

90

23,501

24,000

170

155

140

125

110

95

24,001

24,500

175

160

145

130

115

100

24,501

25,000

180

165

150

135

120

105

Annual Income

Family Size

Range

2

3

4

5

6

7

25,001

25,500

185

170

155

140

125

110

25,501

26,000

190

175

160

145

130

115

26,001

26,500

195

180

165

150

135

120

26,501

27,000

200

185

170

155

140

125

27,001

27,500

205

190

175

160

145

130

27,501

28,000

210

195

180

165

150

135

28,001

28,500

215

200

185

170

155

140

28,501

29,000

220

205

190

175

160

145

29,001

29,500

225

210

195

180

165

150

29,501

30,000

230

215

200

185

170

155

30,001

30,500

235

220

205

190

175

160

30,501

31,000

240

225

210

195

180

165

31,001

31,500

245

230

215

200

185

170

31,501

32,000

250

235

220

205

190

175

32,001

32,500

255

240

225

210

195

180

32,501

33,000

260

245

230

215

200

185

33,001

33,500

265

250

235

220

205

190

33,501

34,000

270

255

240

225

210

195

34,001

34,500

275

260

245

230

215

200

34,501

35,000

280

265

250

235

220

205

35,001

35,500

285

270

255

240

225

210

35,501

36,000

290

275

260

245

230

215

36,001

36,500

295

280

265

250

235

220

36,501

37,000

300

285

270

255

240

225

37,001

37,500

305

290

275

260

245

230

37,501

38,000

310

295

280

265

250

235

38,001

38,500

315

300

285

270

255

240

38,501

39,000

320

305

290

275

260

245

39,001

39,500

325

310

295

280

265

250

39,501

40,000

330

315

300

285

270

255

40,001

40,500

335

320

305

290

275

260

40,501

41,000

340

325

310

295

280

265

41,001

41,500

345

330

315

300

285

270

41,501

42,000

350

335

320

305

290

275

42,001

42,500

355

340

325

310

295

280

42,501

43,000

360

345

330

315

300

285

43,001

43,500

365

350

335

320

305

290

43,501

44,000

370

355

340

325

310

295

44,001

44,500

375

360

345

330

315

300

44,501

45,000

380

365

350

335

320

305

45,001

45,500

385

370

355

340

325

310

45,501

46,000

390

375

360

345

330

315

46,001

46,500

395

380

365

350

335

320

Annual Income

Family Size

Range

2

3

4

5

6

7

46,501

47,000

400

385

370

355

340

325

47,001

47,500

405

390

375

360

345

330

47,501

48,000

410

395

380

365

350

335

48,001

48,500

415

400

385

370

355

340

48,501

49,000

420

405

390

375

360

345

49,001

49,500

425

410

395

380

365

350

49,501

50,000

430

415

400

385

370

355

50,001 & over (continues at $5.00 increments)

More than 7 in family (continues at $5.00 increments)

Annual income shall be adjusted gross income as defined in Section 2-203 of the Income Tax Act, (Ill. Rev. Stat. 1983, ch. 120, par. 2-203)

History

• Source: Added at 8 Ill. Reg. 22555, effective November 7, 1984

Part 108 Education and Training

59 Ill. Adm. Code 108.10 Definitions

For the purposes of this Part, the following terms are defined:

"Act." The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

"Adapted physical education." A diversified program of developmental activities, games, sports and rhythms, suited to the interests, capacities, and limitations of recipients who may be unable to safely or successfully engage in unrestricted participation in the activities of a general physical education program.

"Adaptive behavior." Standards of personal independence and social responsibility expected of the recipient's age-appropriate and cultural group.

"Approval." A written notification issued by the Illinois State Board of Education to an individual attesting that he or she has met the requirements set forth at 23 Ill. Adm. Code 226 for one or more categories of special education personnel.

"Certificate." A license issued pursuant to Sections 21-1 et seq. of the School Code [105 ILCS 5/21-1] authorizing an individual to be employed in an Illinois public school as a teacher, school service personnel or an administrator.

"Clinical psychologist." A psychologist registered with the Illinois Department of Professional Regulation who either has a doctoral degree from a regionally accredited university, college, or professional school, and has two years of supervised experience in health services of which at least one year is post doctoral and one year is in an organized health service program, or has a graduate degree in psychology from a regionally accredited university or college, and has not less than six years of experience as a psychologist with at least two years of supervised experience in health services. (Section 1-103 of the Code)

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Consent." The recipient's parent(s) or guardian has been informed of all necessary information including a description of the activity for which consent is sought and the risks associated with allowing or disallowing the activity. He or she understands and agrees, in writing, to carry out the activity for which consent is sought; understands that the granting of consent is voluntary on his or her part and may be revoked at any time; and is informed of the consequences of withholding consent.

"Day." A calendar day unless otherwise specified.

"Department." The Department of Human Services.

"Developmental disability." Disability which is attributable to mental retardation, cerebral palsy, epilepsy or autism, or to any other condition which results in impairment similar to that caused by mental retardation and which requires services similar to those required by mentally retarded persons. Such disability must originate before the age of 18 years, be expected to continue indefinitely, and constitute a substantial handicap. (Section 1-106 of the Code).

"Educational component of the individual treatment or habilitation plan." A written statement for a recipient that provides at least a statement of:

The recipient's present levels of educational performance, annual goals and short-term instructional objectives;

Specific special education services;

The extent of participation in a regular education program;

The projected dates for initiation of services;

Anticipated duration of services;

Appropriate objective criteria and evaluation procedures;

A schedule for annual determination of short-term objectives; and

A description of the intervention modalities.

This statement may be contained in the written treatment or habilitation plan or may be referenced therein and maintained elsewhere for ultimate inclusion in the clinical record.

"Endorsement." Refers to a statement on the face of an administrative special, school service personnel, provisional vocations, temporary provisional, vocational or general certificate limiting the holder to the functions, special area or service area specified.

"Evaluation." Any one or more parts of a diagnostic assessment or evaluation as delineated in Section 108.90.

"Hearing impaired." A hearing loss which ranges from mild to profound, and prevents full awareness of environmental sounds and spoken languages, limiting normal language acquisition and learning achievement.

"Individual treatment or habilitation plan." A written plan, which includes an educational component for special education, prepared within a specified number of days after admission, consistent with the recipient's diagnosis and needs pursuant to Section 3-209 (mentally ill) or Section 4-309 of the Code. The plan must be reviewed and updated at least every 30 days. A qualified professional shall be responsible for overseeing the implementation of such plan.

"Instructional programs." Those activities which provide the principal elements of the recipient's educational development at any given time. These activities may include any or all of the following:

Evaluation of the nature of the recipient's educational needs;

Amelioration of and compensation for visual, auditory, physical, speech or other impairments;

Development of language concepts and communication skills;

Educational experiences which are adjusted in content, emphasis, rate, or location; and

Modification of social skills or emotional adjustment in the classroom setting.

For the purposes of this Part, an instructional program shall be considered as one in which the recipient spends 50% or more of his or her school day.

"Intervention modalities." The developmental, corrective, and other supportive services discussed in Section 108.50 which are required for a recipient according to his or her individual treatment or habilitation plan. Many, but not all, of these services would be designated as related services in the public school special education setting.

"Language use pattern." Verbal or nonverbal language or combination of languages which the recipient uses to conceptualize and communicate those conceptualizations.

"Mental impairment." Markedly delayed intellectual development, adaptive behavior, and academic achievement. Such mental impairment may be mild, moderate, severe, or profound.

"Multiple impairment." Two or more impairments, severe in nature or total impact, which significantly affect a recipient's ability to benefit from a standard educational program.

"Parent." The natural or adoptive parent, a guardian, a person acting as a parent of a minor recipient. Guardian means the plenary or limited guardian appointed by the court for a person over age 18 so long as the limited guardian's duties encompass educational concerns. For recipients over 18 years of age without court-appointed guardians, parents may be informed or participate only with the consent of the adult recipient. Parent also includes a person acting as a parent for educational purposes such as a surrogate parent appointed by the Illinois State Board of Education.

"Parent counseling and training." Procedures used in assisting parents in understanding the special needs of their child and providing parents with information about child development.

"Physical or health impairment." A physical or health disability, either temporary or permanent, ranging from mild to profound, which adversely affects a recipient's educational performance and requires adaptation of the physical plant or the use of supplementary aids and services.

"Provisional certificate." Refers to a credential valid for up to two years entitling the holder to teach at grades kindergarten-nine – provisional elementary (type 30), six-12 – provisional high school (type 31), or kindergarten-12 – provisional special (type 33), in compliance with Sections 21-1 et seq. of the School Code and based on the individual's meeting the requirements for a regular certificate of the same type in another state.

"Psychological evaluation." An individual evaluation of the child's functioning in cognitive, social, emotional and academic achievement or aptitude areas using appropriately validated formal and informal tests and evaluation material.

"Qualified professional." Those professional personnel who meet either the certification or approval requirements described in Sections 108.40(d), 108.40(g), 108.40(h), and 108.40(i), exclusive of interns and aides.

"Recipient of services" or "recipient." A person who has received or is receiving treatment or habilitation (Section 1-123 of the Code).

"Re-evaluation." A series of diagnostic procedures which are performed in accordance with Section 108.90 for the purpose of determining a recipient's continued eligibility for special education programming.

"Resource programs." Specialized educational instructional services which are provided to the recipient for less than 50% of his or her school day.

"School days." Those days on which school is officially conducted during the regularly established school year in accordance with Section 10-19 of the School Code [105 ILCS 5/10-19].

"School psychologist." An individual certified as such by the State Board of Education in accordance with Section 21-25 of the School Code [105 ILCS 5/21-25].

"Secretary." The Secretary of the Department of Human Services or his or her designee.

"Social developmental study." A compilation and analysis of information concerning those life experiences of the recipient, both past and present, which pertain to the recipient's problems and/or to the possible alleviation of those problems.

"Special education." Those instructional and resource programs, unique materials, physical plant adjustments, and other special educational facilities provided by the facility to meet the unique needs of recipients, which modify, supplement, support, or are in the place of the standard educational program of the public school. The term includes speech pathology and vocational education.

"Specific learning disability." The recipient exhibits a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. This term includes such conditions as perceptual handicap, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include recipients who have learning problems which are primarily the result of visual, hearing, or motor handicaps, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage. Such disorder may range from mild to profound.

"Speech or language impairment." Deviations of speech and language processes which are outside the range of acceptable deviation within a given environment and which prevent full social or educational development. Such impairment may range from mild to profound.

"Standard certificate." Refers to a credential valid for four years issued pursuant to Article 21 of the School Code [105 ILCS 5/Art. 21], entitling the holder to teach at grades kindergarten-nine – standard elementary (type 03), six-12 – standard high school (type 09), or kindergarten-12 – standard special (type 10) levels.

"Standard educational program." The educational program similar to that offered by the local school district to its non-handicapped students.

"Standard special certificate." Refers to a credential (type 10) issued to individuals completing the requirements set forth at 23 Ill. Adm. Code 25.40, 25.43 and 25.45, which is endorsed for one of the following: educable mentally handicapped, learning disabilities, social, emotional disorders, trainable mentally handicapped, blind and partially seeing, deaf and hard of hearing, physically handicapped or speech and language impaired.

"State-operated facility" or "facility." A mental health and/or developmental center operated by the State of Illinois, under the jurisdiction of the Department, which provides treatment or habilitation services for recipients who are mentally ill or developmentally disabled or who are a danger to themselves or others.

"Visual impairment." Vision is such that the recipient cannot develop his or her educational potential without special services and materials. Such impairment may range from mild to profound.

"Vocational education." Organized educational programs which are directly related to the preparation of individuals for paid or unpaid employment, or for additional preparation for a career requiring other than a baccalaureate or higher degree.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.20 Educational Standards for Department Facilities

a) The Department shall be responsible for providing appropriate and effective educational programs, at no cost to the recipient's parents, for all exceptional persons aged 3 to 21 who are admitted, committed or transferred into state-operated facilities in accordance with the Code.

b) Each facility shall provide a comprehensive program of special education for recipients who are aged 3 to 21 years old. A comprehensive program shall include:

1. Systematic procedures for identifying and evaluating the need for special education and intervention modalities.

2. A continuum of program options which incorporate appropriate instructional programs and resource programs.

3. Qualified personnel, who can provide:

A) Supervisory services;

B) Instructional programs;

C) Resource programs; and

D) Intervention modalities.

4. Appropriate and adequate facilities, equipment and materials.

5. Functional relationships with other public or private agencies necessary to provide comprehensive programming and avoid duplicity of services. For example, some not-for-profit organizations may loan a recipient some needed adaptive equipment; others may provide services which are not available to the Department.

6. Interaction with parents, and with other concerned persons, which facilitates the educational development of recipients.

7. Procedures for internal evaluation of the special education programs and services.

8. Continuous planning for program growth and development based on internal and external evaluation.

c) Special education shall be established and conducted as an identifiable component of the total treatment and habilitation effort.

d) The Department shall be responsible for ensuring that those recipients who require special education services enjoy rights and privileges equal to those of all other persons who are 3 to 21 years old.

1. No recipient between the ages of 3 and 21 may be permanently excluded from the educational program, either by direct action by the facility, by indication of the facility's inability to provide an educational program or by an informal agreement between the parents and the facility to allow the recipient not to participate in an educational program.

2. No recipient whose individual treatment or habilitation plan includes special education instructional or resource programs shall be excluded from that program.

3. Any absence from a prescribed educational program must arise from medical limitation.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.30 The Establishment and Administration of Special Education

a) Each facility shall establish and maintain special education instructional and resource programs and intervention modalities, which meet the educational needs of recipients with the following exceptional characteristics, if such recipients are admitted to the facility:

1. Deficits in intellectual development and mental capacity;

2. Adaptive behavior which restricts effective functioning;

3. Deficits in the essential learning processes of perception, conceptualization, memory, attention, or motor control;

4. Auditory, visual, physical, or health impairment; or

5. Speech or language impairment.

b) Special education instructional and resource programs shall range along a continuum based on the nature and degree of the intervention. This continuum of program options shall include, but not be limited to:

1. Special instructional program

The recipient receives most of his or her basic educational experiences through an instructional program in a special class, which is largely self-contained, or in a special school.

2. Cooperative program

The recipient receives most of his or her educational experience through either the standard or the special program of the public or non-public school. However, this is supplemented through work experience programs or facility programs.

c) Special education instructional and resource programs, including diagnostic services, shall be available to recipients who are aged 3 to 21 years.

1. When a recipient becomes three years old, the recipient shall be eligible for special education services.

2. A recipient who requires continued educational experience to facilitate his or her integration into society shall be considered eligible for such services to age 21 or upon successful completion of the secondary program. The recipient who becomes 21 during the school year shall be allowed to complete that year.

d) The physical plant used for special education programs and services, i.e., size and location as well as the amount of equipment and materials depend on the individual recipient's needs. For example, the size of the room and furniture depends upon the physical size and ability of the recipients located in the room. The equipment and materials depend on factors such as the recipient's developmental ability level, safety features, and the recipients' mobility needs. Such physical plant shall, as far as feasible, approximate settings in public schools for similar students.

e) Methods by which information regarding a recipient is collected, recorded, protected and maintained shall be in compliance with the Code and the Act.

f) Within each facility, the facility director or designee shall, in cooperation with special education personnel, facilitate the functioning of special education instructional and resource programs as an integral part of the facility program.

g) The specific responsibilities of special education personnel in relation to special education instructional and resource programs shall be delineated in writing and made known to all persons involved.

h) General supervision by the Illinois State Board of Education of all special education programs shall be facilitated by the facility director.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.40 School Schedule and Staff Requirements

a) Each facility shall operate its special education program five days per week unless a regularly scheduled day falls on a legal holiday and shall ensure recipient attendance throughout the period of admission as specified in the educational component of the individual treatment or habilitation plan.

b) Each facility shall develop a school calendar specifying the days on which special education programs will operate; the calendar shall specify a minimum of at least 185 days.

c) Each facility shall provide or assure for each recipient a full program of five clock hours of group or individual instruction on days specified as school days, except as delineated in Section 108.70.

d) In all facilities, all newly hired professional teachers and administrators shall be properly certified in accordance with Section 14-9.01 and Article 21 of the School Code [105 ILCS 5/14-9.01 and Art. 21].

1. In all programs serving recipients who are mentally ill, proper certification may be construed to mean personnel certified as regular education personnel, where such are teamed with or regularly consult with certified special educators as needed in accordance with the recipient's individual treatment plan.

2. In all programs serving recipients who are developmentally disabled, proper certification in the most nearly appropriate special education areas shall be required.

3. All professional personnel, supervisors, and administrators who were employed to provide special education services for persons who are developmentally disabled at the facilities on or before July 1, 1983 shall be exempt from the requirements of this Section until July 1, 1988.

e) Facilities may also employ non-teaching personnel or use volunteer personnel for non-teaching duties not requiring instructional judgment or evaluation of students. Facilities may use volunteer or non-certified personnel to assist in the instruction of recipients under the immediate supervision of an educator who holds an appropriate certification.

f) All teacher aides shall hold an approval form issued by the Illinois State Teacher Certification Board. Approval is based on 30 semester hours of college training or completion of an approved teacher aide program as at 23 Ill. Adm. Code 25.Subpart G).

g) Psychologists shall be registered clinical psychologists or certified school psychologists or be a clinical or school psychology intern functioning under the general supervision of such a person. A clinical psychology intern must be at the doctoral level in his or her training. A school psychology intern must be in a master's degree program in school psychology. All testing and reports must be reviewed by the supervising clinical or certified school psychologist.

h) Social workers shall have graduated from a school of social work which has been approved by the Council on Social Work Education and shall possess the master in social work degree and a type 73 certificate issued in accordance with 23 Ill. Adm. Code 226 or hold a bachelor's degree or function as a social work intern under the general supervision of such a person.

i) Other professional providers of direct service, such as medical services personnel, including nurses and physicians and physical therapists, all of whom must be registered with the Illinois Department of Professional Regulation in accordance with the Illinois Nursing Act of 1987 [225 ILCS 65], the Medical Practice Act of 1987 [225 ILCS 60] and the Illinois Physical Therapy Act [225 ILCS 90]; occupational therapists who must hold certification with the American Occupational Therapy Association (Illinois Occupational Therapy Practice Act [225 ILCS 75]); and licensed audiologists and licensed speech-language-pathologists and those who function under their supervision who shall be available in numbers adequate to meet the needs of recipients as specified in the educational component of their individual treatment or habilitation plans (Illinois Speech-Language Pathology and Audiology Practice Act [225 ILCS 110]).

j) General supervision of a recipient's individual treatment or habilitation plan may be provided by a qualified professional or by a regularly scheduled consultant who provides technical assistance, supervision and consultation to each professional functioning under his or her direction and supervision on a weekly basis. Additional consultation or supervision must be provided if required by a recipient's individual treatment or habilitation plan.

k) The principal determinants of the number of recipients served in each instructional group shall be the age of the recipients, the nature and severity of their exceptional characteristics, and the degree of intervention necessary. Exceptions to the following instructional group size limitations shall require the prior written approval of the Illinois State Board of Education.

1. Early childhood instructional groups shall have a ratio of one qualified teacher to five recipients in attendance at any one given time.

2. Instructional groups which primarily serve recipients whose exceptional characteristics are either profound in degree or multiple in nature shall have a maximum of five recipients to one qualified teacher at any one given time.

3. Instructional groups which primarily serve recipients whose principal exceptional characteristics are mild to severe mental impairments or severe behavioral disorders shall have a ratio of one qualified teacher to eight students at any one given time.

4. In the instructional programs above, no qualified teacher shall have a total roster of more than two times the number of students allowed per instructional group.

5. A facility may increase the instructional group size by a maximum of five additional recipients when the class is provided with a full-time non-certified assistant.

l) The age range of recipients within an instructional group shall not exceed four years.

History

• Source: Amended at 15 Ill. Rev. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.50 Intervention Modalities

a) Treatment and habilitation intervention modalities which shall be provided by the facility are those activities required by the individual treatment or habilitation plan. They are in addition to the individual education plan and serve to facilitate the recipient's development. The activities include evaluation, therapeutic or consultation services. The intervention modalities to be provided are:

1. Speech and language services for all recipients with speech and/or language impairments which interfere with their educational or social development.

A) Speech and language services shall include, but not be limited to:

i) Screening and diagnosis of recipients;

ii) Planning and developing the clinical program;

iii) Therapy for recipients with impairments of oral language comprehension, production, or usage, including disorders of fluency, phonation, resonance, articulation and oral language formation;

iv) Parent counseling;

v) Referrals and follow-up; and

vi) Consultative and resource services to other personnel.

B) The number of recipients served by a speech and language clinician shall be based on the nature of the speech and language needs of the individual recipients but in no case shall be greater than 60 per clinician.

2. Psychological services to and on behalf of recipients who require psychological evaluation and assistance in their behavioral or educational adjustment.

A) Psychological services shall include, but not be limited to:

i) Screening of recipients to identify recipients who should be referred for individual study;

ii) Individual psychological examination and interpretation of those findings and recommendations which will lead to meaningful educational experiences for the recipient;

iii) Counseling and performing psychological remedial measures as appropriate to the needs of recipients, individually or in groups;

iv) Participating in parent education and the development of parent understanding; and

v) Consulting with teachers and other personnel in relation to behavior management and learning problems, and consulting in program development.

B) Psychological services shall be used to assist in the process of developing an educational climate conducive to the optimum development of all recipients. Emphasis shall be placed on prevention as well as rehabilitation; on indirect as well as direct services.

3. Social work services to and on behalf of recipients whose behavioral or educational development is restricted due to social or emotional considerations, family circumstances, or problems of the environment.

A) Social work services shall include, but not be limited to:

i) Consultation service to personnel on behalf of recipients;

ii) Providing consultation and inservice training experiences to facility personnel;

iii) Identification of recipients in need of services;

iv) Providing the social developmental study in a diagnostic evaluation and participating in the identification of those recipients who require social work intervention;

v) Direct services to recipients;

vi) Service to parents on behalf of recipients;

vii) Serving as a liaison between the home and the facility and providing parental education;

viii) Counseling as appropriate in relation to the recipient's problem;

ix) Utilization of community resources; and

x) Assisting in developing services which are needed but unavailable.

B) Social work services shall be used to assist in the process of developing an educational climate conducive to optimum development of all recipients. Emphasis shall be placed on prevention as well as rehabilitation; on indirect as well as direct services.

4. Special reader services, braillists, typists, and interpreters shall be provided as required by the recipient's individual treatment or habilitation plan.

5. Therapy services shall be provided for recipients as indicated by the individual treatment or habilitation plan.

A) Physical and/or occupational therapy shall be provided for recipients whose physical impairments require appropriate therapeutic attention if the recipients are to receive full benefit from the program provided them. Such therapy shall be provided to individual recipients in accordance with the recommendation and prescription of a physician licensed to practice medicine in all of its branches in accordance with the Medical Practice Act of 1987.

B) Other therapeutic services such as recreation shall be provided as required in the individual treatment or habilitation plan to facilitate the education and development of recipients.

6. Audiology services for all recipients with hearing impairments that interfere with their education or social development. Audiology services shall include, but not be limited to:

A) Administering diagnostic hearing tests to evaluate audiological abilities;

B) Assessing the recipient's need for amplification;

C) Providing rehabilitative services for hearing disorders;

D) Instructing other health team personnel and family members in methods of assisting the recipient in improving communication skills; and

E) Recording and reporting to the recipient's physician the recipient's response to rehabilitative intervention.

7. Consultation services shall be provided as required by the recipient's individual treatment or habilitation plan.

b) The facility shall provide other services including health, medical, psychiatric, nursing and pharmacy services, or transportation, arranged-for counseling services and parent counseling or training when the multi-disciplinary conference determines that such services are necessary to facilitate the treatment, habilitation or educational development of the recipient.

c) Recipient-based objectives shall be determined for each intervention modality.

d) Specific objectives shall be established for each recipient who receives a particular intervention modality.

e) Intervention modalities delivered to or on behalf of the recipient shall be sufficient to be therapeutically or educationally adequate, as determined by evaluation of the recipient's needs.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.60 Vocational Program

a) A vocational program consisting of organized instructional experiences, training, and resource programs shall be provided to recipients in accordance with their needs and as determined by the educational component of the individual treatment or habilitation plan.

b) Provision of a vocational program to individual recipients shall be determined at the treatment or habilitation multi-disciplinary conference, or at a subsequent conference convened for this specific purpose.

c) A vocational plan indicating specific vocational objectives, the training required, service personnel required, and the length of the proposed program shall be developed for each recipient determined to require a vocational program. This plan shall be developed in cooperation with the recipient and his or her parents, shall be adapted to the recipient's interests and aptitudes, and shall be incorporated into the educational component of the individual treatment or habilitation plan.

d) Community work experiences which are part of the recipient's vocational plan shall occur during the school day, unless this is precluded by the nature of the experience.

e) No recipient shall spend more than one-half of the established school day participating in community work experiences or in local rehabilitation facilities.

f) The recipient's primary special education teacher works with the vocational instructor responsible for all community work experiences which are provided by the facility as part of the vocational plan and for which the recipient receives educational credit.

g) Vocational programs serving recipients shall be coordinated with other vocational programs of the local school district, or other public, private, and state agencies or organizations.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.70 Medically-Limited Educational Program

a) The medically-limited educational program shall consist of appropriate special education services in accordance with the individual treatment or habilitation plan which are provided by the facility to a recipient who is unable, due to either a mental or physical medical condition, to participate in a full special education program.

b) The medically-limited educational program shall be provided to any recipient who has a health, physical or psychiatric impairment which, in the opinion of a physician, will cause an absence from his or her regularly prescribed educational program for more than two consecutive weeks.

c) Medically-limited educational services shall begin as soon as eligibility has been established and the recipient's physical and mental health permit.

d) The amount of instructional service time provided shall be determined in relation to each recipient's educational needs, as well as physical and mental health.

1. A recipient who requires a medically-limited educational program on a temporary basis shall be provided with instructional services sufficient to enable the recipient to return to the regular program with a minimum of difficulty. Instructional time shall not be less than five hours per week, unless the physician orders a more restricted program.

2. A recipient who requires the medically-limited educational program for an extended time shall be provided with instructional services sufficient to appropriately advance his or her basic educational development, as determined by the multi-disciplinary team every 30 days.

e) The facility shall not use the medically-limited educational program to avoid responsibilities to maintain a more normalized program nor to eliminate recipients from any educational program.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.80 Referrals to Other Special Education Facilities from State-Operated Facility Programs

a) If a treatment or habilitation conference determines that a recipient would benefit significantly from sustained interaction with non-handicapped peers, the facility may recommend educational placement in a public school or non-public special education facility in cooperation with the public school. Placement shall be recommended unless the recipient poses a physical threat to him (her) self or his or her non-handicapped peers. If, for any reason, the recommended placement cannot be immediately implemented, the facility shall provide as appropriate a placement as possible consistent with Section 108.90. Such placement shall be detailed in the recipient's clinical record.

b) The availability of community resources including non-public programs in no way relieves the facility of its responsibility to assure a comprehensive program of special education nor its responsibility to the individual recipient.

c) When a treatment or habilitation conference determines that a recipient cannot be provided with an appropriate education by the facility, the multi-disciplinary team shall meet with the recipient's parents, representative(s) of the school district of parental residency and the potential provider public school or non-public special education facility, to develop an individualized program in accordance with this Part prior to placement. If any of the representatives cannot attend, the facility shall use other methods to insure participation and document such efforts in the recipient's clinical record.

d) The facility shall be responsible for locating an appropriate public school or non-public special education facility and for facilitating the referral to that program. An appropriate program is one which will provide the recipient with special education experiences, in accordance with the recipient's individual treatment or habilitation plan.

e) Any recipient determined eligible under subsection (a) of this Section for placement in a public school or non-public special education facility shall, with the consent of the parent and the local school district, be enrolled by the facility in the local school district where that facility is located. If the local school district does not consent, the Department will provide the educational component of the individual treatment or habilitation plan.

f) The facility shall maintain a record of supportive data on each recipient placed in a public school or non-public special education facility. This data will include:

1. A summary of the recipient's diagnostic profile on which placement is based;

2. A description of the program as required by the educational component of the recipient's individual treatment or habilitation plan;

3. An explanation of why the recipient's needs cannot be met by the facility;

4. A description of the special education program offered by the provider school;

5. Conference report and periodic progress reports submitted by the provider school to the facility; and

6. An annual reassessment of the need for continued placement in a provider school.

g) The facility shall be expected to follow the progress of those recipients placed in a public school or non-public special education facility.

h) Facility personnel shall communicate, with the consent of the parent, no less than every 30 days with the provider school personnel to evaluate the recipient's progress and appropriateness of placement.

i) Staff of the provider program shall direct communications regarding the recipient's educational program to facility staff with the parent's consent.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.90 Identification, Evaluation and Education of Recipients

a) Each facility shall develop and implement procedures for creating public awareness of the facility's programs and for advising the public of the rights of recipients.

1. All such procedures shall assure that information regarding programs and the rights of recipients is made available in the community in phrases which will be understandable to parents, regardless of ethnic or cultural background or hearing or visual abilities.

2. Procedures developed by the facility to create public awareness of programs, and for advising the public of the rights of recipients shall include, but not be limited to:

A) Annual notification to all parents of recipients regarding the special education programs and services available in or through the facility and of their right to receive, on request, a copy of this Part.

B) An annual dissemination of information to the community served by the facility regarding the program and services available in or through the facility and the rights of recipients.

b) After admission, the multi-disciplinary team shall perform the educational diagnosis and evaluation in accordance with subsections (e) and (g) of this Section so that the educational component of the individual treatment or habilitation plan can be developed in accordance with the time frames in the definition of the individual treatment or habilitation plan in Section 108.10. The educational component shall be developed in accordance with subsection (n).

c) Parents of the recipient must be notified, in writing, when the facility proposes to initiate or change the educational identification, evaluation or placement of a recipient.

1. The notice shall be:

A) Written in language understandable to the general public, and

B) Written in the native language of the parent or provided in another mode of communication used by the parent, unless it is clearly not feasible to do so, such as when the parents' native language is not a written language or is one in which the dialect is not commonly known to an interpreter of that language.

C) If the language or other mode of communication of the parent is not a written language, the facility shall insure that the notice is translated orally or by other means to the parent in his or her native language or other mode of communication; that the parent understands the content of the notice, and that there is written evidence on file that these requirements have been met.

2. The notice shall contain:

A) A full explanation of all the procedural safeguards regarding education available to parents, including the availability, on request, of a list of free or low cost legal and other relevant services available locally to assist parents in initiating an impartial due process hearing regarding educational issues.

B) A description of the educational action proposed or refused by the facility, an explanation of why that facility proposed or refused to take the action, and a description of any options that the facility considered and the reasons why those options were rejected.

C) A description of each educational evaluation procedure, test, record, or report that the facility used as a basis for the proposal or refusal.

D) A description of any other factors which are relevant to that facility's proposal or refusal, and

E) Inclusion of parental consent for evaluation and placement into a program.

d) When a recipient is given an evaluation, the facility shall be responsible for determining the recipient's language and cultural background.

1. Determination shall be made by determining the language(s) spoken in the recipient's home and the language(s) used most comfortably and frequently by the recipient.

2. Determination of the recipient's mode of communication shall be made by assessing the extent to which the recipient uses expressive language and the use he or she makes of other modes of communication (e.g., gestures, signing, unstructured sounds) as a substitute for expressive language.

3. The recipient's language use pattern, proficiency in English, mode of communication and cultural background shall be noted in the recipient's individual treatment or habilitation plan.

e) The recipient shall be given an educational evaluation.

1. For the recipient who requires temporary hospitalization estimated to last 90 days or less, a respite services evaluation shall be conducted, and an individual habilitation plan developed. This evaluation shall include, but not be limited to:

A) Evaluation of the physical health impairment by a physician, for diagnostic and evaluation purposes;

B) Estimation by the physician of the time the recipient will require respite services; and

C) A review of the recipient's current educational status and academic needs.

2. The individual education plan from the recipient's former school becomes the working individual plan for the respite admission.

3. A comprehensive evaluation shall be conducted for all other recipients. This evaluation shall include, but not be limited to:

A) An interview with the recipient;

B) Consultation with the recipient's parents;

C) A social developmental study, including an assessment of the recipient's adaptive behavior and cultural background;

D) A report regarding the recipient's medical history and current health status;

E) A vision and hearing screening, completed at the time of the evaluation or within the previous six months;

F) A review of the recipient's academic history and current educational functioning;

G) An educational evaluation of the recipient's learning processes and level of educational achievement; and

H) A psychological evaluation.

4. If a psychologist has not provided the evaluation on which admission was based, the recipient shall be evaluated by the psychologist as part of the comprehensive evaluation.

A) The psychologist shall conduct direct personal observation of the recipient and shall administer such tests as the individual's situation requires; shall review the tests administered by school district personnel and/or the results of recent externally administered evaluations, and analysis of the learning environment and learning processes; and shall participate in the multi-disciplinary conference and such other procedures as deemed necessary.

B) An appropriate medical examination by a physician shall be obtained for all recipients and the expense borne by the Department. Nothing herein shall be construed to require any recipient to undergo any physical examination or medical treatment whose parents object thereto on the grounds that such examination or treatment conflicts with his or her religious beliefs, pursuant to the provisions of Sections 2-102 (b), 2-107, 2-110 and 2-111 of the Code.

5. Other specialized evaluations appropriate to the nature of the recipients' problems shall be provided for all recipients. When specialized evaluation procedures not usually provided by the facility are required to provide a better understanding of the recipient's educational or educationally-related problems, the facility recommending such evaluation procedures shall be responsible for locating and using appropriate local and/or state resources. Consideration shall be given to resources of other state agencies or third party payers. The recipient may not be prohibited from receiving a special education program or service because the recipient is financially or otherwise unable to obtain specialized evaluation procedures.

6. If the parent disagrees with an educational evaluation completed by the facility, the facility shall inform the parents of the opportunity to obtain an independent evaluation at public expense.

A) In such cases, the facility may initiate an impartial due process hearing prior to such independent evaluation to demonstrate that the facility's evaluation is appropriate.

B) If the final decision is that the facility's evaluation is appropriate, the parent shall have the right to an independent evaluation, but not at public expense.

f) If all requirements for educational evaluation cannot be fulfilled, due to lack of parental involvement, religious convictions of the family, or the inability of the recipient to participate in an evaluation procedure, the facility shall note the missing component(s) in the recipient's individual treatment or habilitation plan.

g) Each educational evaluation shall be conducted so as to assure that it is linguistically, culturally, racially, and sexually non-discriminatory.

1. The language(s) used to evaluate a recipient shall be consistent with the recipient's language pattern. If the language use pattern involves two or more languages, the recipient shall be evaluated using each of the languages used by the recipient.

2. Psychological evaluation of a recipient shall be performed by a clinical or certified school psychologist who has demonstrated competencies in, and knowledge of, the language and culture of the recipient. The facility, having exhausted all other alternatives and not securing the services of a clinical or certified school psychologist who has demonstrated competencies in, and knowledge of, the language and culture of the recipient, the psychologist regularly employed by the facility shall conduct assessment procedures which do not depend on language, or use the services of an interpreter. Any educational programming resulting from such alternative procedures shall be reviewed at least every 30 days until the recipient acquires a predominately English language use pattern which will assure that a psychological evaluation given by a clinical or certified school psychologist will not be discriminatory.

3. Tests given to a recipient whose primary language is other than English shall be relevant, to the maximum extent possible, to his or her culture.

4. If the recipient's receptive and/or expressive communication skills are impaired due to hearing and/or language deficits, the examiners shall use instruments and procedures which do not stress spoken language and one of the following:

A) Visual communication techniques in addition to auditory techniques;

B) An interpreter to assist the evaluating personnel with testing.

5. Each facility shall insure that testing and evaluation material and procedures used for educational evaluation be selected and administered so as not to be racially or culturally discriminatory.

6. Each facility shall insure that:

A) Tests and other evaluation materials are provided and administered in the recipient's native language or other mode of communication, unless it is clearly not feasible to do so; have been validated for the specific purpose for which they are used, and are administered by a clinical or certified school psychologist in conformance with the instructions provided by their producer.

B) Tests and other educational evaluation materials include those tailored to assess specific areas of educational need and not merely those which are designed to provide a single general intelligence quotient.

C) When tests are administered to a recipient with impaired sensory, motor or communication skills, tests shall be selected and administered to insure that the results accurately reflect the recipient's aptitude or achievement level rather than reflecting the recipient's impaired sensory, motor or communication skills except when those skills are the factors which the test(s) purports to measure.

D) No single procedure is used as the sole criterion for determining an appropriate educational program for a recipient.

E) The educational evaluation is made by a multi-disciplinary team, including at least one teacher or other specialist with knowledge in the area of the suspected disability.

F) The recipient is assessed in all areas related to the suspected disability, including, when appropriate, health, vision, hearing, social and emotional status, general intelligence, academic performances, communicative status, and motor abilities.

h) In those instances in which a recipient has been evaluated by a clinical or certified school psychologist outside the facility, that evaluation shall be considered and may be used in determining educational programming.

i) Upon completion of a respite service educational evaluation and program, the recipient will resume his or her educational programming consistent with the recipient's regular placement. A report regarding respite recommendations and all recommendations upon which they were based shall be placed in the recipient's education record and shared, with the sending agency or school district, with appropriate consents, in accordance with the Act.

j) Upon completion of a comprehensive educational evaluation, one or more conferences shall be convened for the purpose of formulating educational program and service options, and developing the educational component of the individual treatment or habilitation plan. This may be the conference at which the individual treatment or habilitation plan as required by Sections 3-209 and 4-309 of the Code is developed. If not, an additional meeting is to be held to develop the educational component of the individual treatment or habilitation plan.

1. Participants in the conference who formulate the educational component shall include:

A) Representatives of the recipient's local district of residence as determined by the local district;

B) The facility director, special education director, or unit educator who is qualified, in accordance with Section 108.40(j), to provide or supervise the provision of educational programming;

C) All those personnel involved in the educational evaluation of the recipient;

D) The parent;

E) Other persons, such as the recipient's personal physician, a counselor seen by the recipient, social worker or psychologist, having significant information regarding the recipient;

F) Those persons who may become responsible for providing the educational program or service to the recipient; and

G) The recipient, if mentally able to participate, and other individuals at the discretion of the parent.

2. The purpose of the above conference shall be to:

A) Establish a composite understanding of the recipient's learning characteristics, sensory and motor skills, and behaviors;

B) Determine appropriate educational programs and/or other services;

C) Determine the recipient's unique educational needs and the extent to which these needs can be met;

D) Determine the nature and degree of educational intervention which is needed and recommend corresponding facility programming and/or community placement which is appropriate and is as unrestrictive of interaction with non-handicapped recipients as possible.

k) Recommendations made at the multi-disciplinary conference shall be determined by a consensus of facility participants and the parent(s) and the recipient, if mentally able.

l) Recommendations for educational programming shall be based on the following:

1. The recipient shall be placed in the educational program which is appropriate to the recipient's needs and least restrictive of interaction with non-handicapped or less handicapped recipients.

2. The educational programming must be based on the recipient's individual education plan, consistent with the findings obtained from the comprehensive educational evaluation.

3. Consideration must be given to any potentially harmful effects on the recipient, on the quality of services which the recipient needs, or that which impedes the education of other recipients.

m) A written report of the results and recommendations of the multi-disciplinary conference shall be prepared and entered into the recipient's clinical record.

1. The conference report shall be dated and list the names of all those in attendance.

2. The facility shall keep on file a copy of the conference report, together with all documentation upon which it is based. The parents shall be informed of their rights to access the report, pursuant to Section 4 of the Act.

n) If the initial multi-disciplinary conference was held only for the purpose of formulating program and service options, an additional meeting must be held for the purpose of developing the educational component of the individual treatment of habilitation plan for the recipient. The meeting at which a recipient's educational component is developed must be held within 60 days after the admission of the recipient.

1. Parents of a recipient must be notified of any meeting to develop, review, or revise the educational component of a recipient's individual treatment or habilitation plan. The facility must take steps to insure that a recipient's parents are present at each meeting or are afforded the opportunity to participate, including:

A) Notifying parents of the meeting early enough to insure that they will have an opportunity to attend;

B) Scheduling the meeting at a mutually agreed on time and place; and

C) Indicating in the notice the purpose, time, and location of the meeting and who will be in attendance.

2. The following participants must be invited to the meeting to develop, review or revise the educational component of the individual treatment or habilitation plan:

A) A representative of the district of parental residence who is qualified to provide or supervise the provision of special education (e.g., the State-approved special education director or designee);

B) The recipient's teacher; and

C) One or both of the recipient's parents. If neither can attend, the facility shall use other methods to insure parent participation, including individual or conference telephone calls. A meeting may be conducted without a parent in attendance if the facility is unable to convince the parents that they should attend. In this case, the facility must have a record of its attempts to arrange a mutually agreed on time such as detailed records of telephone calls made or attempted and the results of those calls, copies of correspondence sent to the parents and any response received, and detailed records of visits made at the parent's home or place of employment and the results of those visits.

D) The recipient if mentally able to participate; and

E) Other individuals at the discretion of the parent or facility.

3. Employee organization representatives may not attend without parental and facility consent.

4. The facility shall insure that a member of the evaluation team participates in the meeting or that some other person, who is knowledgeable about the procedures used with the recipient and who is familiar with the results of the evaluation, participates in the meeting, as well as an interpreter for the hearing impaired, if necessary.

o) Special education placement shall be made within four days after the recipient's educational component is developed in accordance with subsection (n) of this Section.

p) In addition to initial meetings, the educational status and continued special education placement of each recipient shall be reviewed at least annually in a conference attended by those professional persons working with the recipient, the parents, the recipient when mentally able to participate, the special education director or designee from the district of parental residence, who is a qualified professional, and other individuals at the discretion of the parent.

q) Notification to parents regarding continuation, change, re-evaluation, or termination of placement shall inform the parents of their right to object and of the procedures to be followed to make such an objection.

r) At least 10 days prior to any major change in the educational component of the recipient's individual treatment or habilitation plan, including those stated herein, the parents shall be given written notification of the proposed change, including the reasons for the change and a description of the proposed program.

1. If the parents request an impartial due process hearing regarding a proposed change in the educational placement of the recipient, the facility shall not change the placement until the matter is resolved.

2. If the parents agree to the proposed placement, then a meeting shall be held for the revision of the recipient's educational plan.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.100 Request for Hearing

a) After informal procedures have been exhausted, and there remain differences between the facility and the parents or the recipient regarding the educational component and intervention modalities aspect of the individual treatment or habilitation plan, an impartial due process hearing may be requested.

b) Differences over issues regarding services other than special education and intervention modalities to the recipient are resolved according to provisions of the Code.

c) A hearing may be requested by the parents, the recipient or the facility regarding, but not limited to, the following:

1. Objections to signing consent for a proposed educational diagnosis or evaluation or initial educational placement;

2. Failure of the facility, upon request of the parents or the recipient, to provide an educational diagnosis or evaluation;

3. Failure of a facility to consider evaluations completed by a qualified professional outside the facility;

4. Objection to a proposed individual education component, either an initial plan, a continuation of a previous plan, or a major change in the recipient's program;

5. Termination of an individual education plan;

6. Failure of the facility to provide an individual education plan consistent with the findings of the educational diagnosis or evaluation and the recommendation of the staff (24 day) conference;

7. Failure of the facility to provide or arrange for the least restrictive special education placement appropriate to the recipient's needs;

8. Provision of special education instructional or resource programs, in an amount insufficient to meet the recipient's needs;

9. An exclusion from educational services, except as provided by medical order, totaling individually or in aggregate 10 or more school days in a given school year of a recipient who has a special education instructional program or resource plan;

10. An exclusion from educational services, except as provided by medical order, totaling individually or in aggregate 10 or more school days in a given school year of a recipient who is eligible for a special education instructional program or resource service but who has not been placed in such a program or provided such a service;

11. Reasonable belief by the parents or the recipient, that the recipient's exclusion from educational services resulted from behavior or a condition symptomatic of an exceptional characteristic as defined herein;

12. Recommendation for the graduation of a recipient;

13. Failure of the facility to comply with this Part;

14. Failure of the facility to arrange for or provide a recipient with a free, appropriate public education.

d) The facility shall be responsible for informing the parents, in writing, of their right to a hearing and of the procedures to follow to make a request for such a hearing. The facility director shall assist the parents in taking whatever action is necessary to use the hearing process. The facility shall inform the parent of any free or low cost legal and other relevant services available in the area if the parent requests the information or if the parent facility initiates a hearing.

e) A request for a hearing shall be made, in writing, to the facility director of the facility in which the recipient resides. Such a request shall contain the reasons the hearing is being requested and all other information pertinent to the request.

1. A request for a hearing may be made at any time significantly different circumstances prevail. Otherwise a hearing may not be requested nor an appeal made more than once each calendar year.

2. Such a request shall be made in writing within 10 days after the parents' receipt of the written notification regarding the proposed placement. If the parents have not made a request within the 10-day period, the parents may request a hearing at a later date in accordance with the provisions of subsection (a) of this Section.

f) Within 48 hours of the receipt of a request for a hearing, the facility shall:

1. Send a certified letter to the Secretary, requesting the appointment of an impartial hearing officer. This letter shall include:

A) The name, address, and telephone number of the recipient, and of the parents and of the person(s) making the request for the hearing, if it is someone other than the recipient or parents;

B) The date on which the facility received the request for the hearing;

C) The nature of the controversy to be resolved;

D) The primary language spoken by the parents and the recipient.

2. Send to the person requesting the hearing, by certified mail, a copy of the letter sent to the Secretary.

3. If the hearing has been requested by someone other than the recipient's parents, the parents shall be informed of the request and invited to participate in the proceedings. Thereafter, unless the parents indicate that they do not wish to be informed and/or involved in the hearing process, all communications from the facility, the hearing officer, and the Secretary, and the Illinois State Board of Education shall be directed to both the person requesting the hearing and the parents.

g) If the facility decides not to honor the request for a hearing, the parents of the recipient shall be notified of this denial. Such notification shall be made, in writing, within five days of the receipt of the request and shall contain the reasons for the denial. A copy of the written denial shall be sent to the Illinois State Board of Education.

1. If the facility fails to notify the parents of their right to a hearing, as prescribed herein, or if the request for a hearing is denied either directly or by failure to provide such a hearing, the parent may appeal such a denial directly to the Secretary.

2. In the event of a direct appeal to the Secretary, the Secretary shall order that a hearing be conducted at the local level, or order the facility to perform such other measures as deemed necessary.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.110 Hearing Officers

a) Within five calendar days after receipt of the request from the facility, the Secretary shall provide a list of five prospective trained impartial hearing officers, one of whom shall be selected as the impartial hearing officer to conduct the local hearing. Criteria for the hearing officers are as follows:

1. Shall not be an employee of the Department, Illinois State Board of Education, the facility, any local school district, joint agreement or cooperative program with which the facility interacts, or any other agency or organization that is or has been directly involved in the diagnosis, education or care of the recipient.

2. Shall not be a resident of the school district in which the parent is a recipient or in which the facility is located.

3. Shall not be involved in the decisions already made about a recipient regarding identification, evaluation, or placement, and may not have a personal or professional interest which would conflict with his or her objectivity.

4. Shall possess knowledge, information acquired through training under the auspices of the Illinois State Board of Education and the Department about the nature and needs of the type of recipient. An awareness and understanding of the types and quality of programs available for the type of recipient is essential.

b) The Department shall pay expenses to the hearing officer for his or her services at the local hearing.

c) Selection of one hearing officer from the list shall occur within five calendar days after receipt of the list from the Secretary, and shall occur as follows:

1. The parents shall first strike a name from the list.

2. The facility shall next strike a name from the list.

3. Both parties shall continue striking from the list until one name remains; that person shall serve as the impartial hearing officer.

4. The facility shall notify the Secretary and the State Superintendent of Education, within five days after receipt of the list, the name of the person to be the impartial hearing officer.

5. This notification may be transmitted verbally to the Secretary, provided that the verbal notification is confirmed in writing, with verification by the facility and the parent, to the Secretary and the State Superintendent of Education within five days.

6. Upon receipt of the notification, the Secretary shall appoint the hearing officer selected by the facility and the parent(s) to convene the hearing. If the selected hearing officer is unable or unwilling to accept the appointment, the Secretary shall seek from the facility and parent a mutually acceptable alternate. If the facility and parent are unable to agree to a mutually acceptable alternate, the Secretary shall provide the facility and parent with an additional list of five prospective hearing officers. The facility and parent shall then repeat the selection process as detailed above.

7. The Illinois State Board of Education shall maintain a list of those persons who serve as hearing officers, along with their qualifications. From the list, the Secretary shall select a list of persons especially qualified in mental disabilities and offer further training to make them eligible to serve as Department educational hearing officers.

d) The hearing shall not be considered adversarial in nature, but shall be directed toward bringing out all facts necessary for the hearing officer to make a decision.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.120 Conduct of the Hearing

a) Within five days of his or her appointment, the hearing officer shall set the time and place for the hearing.

1. The hearing shall be held at a time and place reasonably convenient for both parties involved. However, it shall be scheduled not later than 15 days after the appointment of the hearing officer, unless the hearing officer permits an extension of time due to extenuating circumstances, not to exceed 15 days, unless both parties agree.

2. If the facility and parent cannot agree to a reasonably convenient time and place, the hearing officer shall make such a determination and proceed to schedule the hearing.

3. The Department shall inform the parents, by mail, no later than 10 days prior to the hearing, that:

A) Pursuant to Section 4 of the Act, they or their designated representative shall have an opportunity to inspect all records regarding the recipient and to obtain copies prior to the hearing, at their own expense.

B) They may request an independent evaluation of the recipient prior to the hearing, at their own expense. The hearing officer may consider this request an extenuating circumstance and thereby authorize an extension of time for the hearing date, not to exceed 30 days, unless both parties agree.

C) They may require the attendance at the hearing of any facility employee or any other person who may have information relevant to the recipient's needs and abilities. They may request the attendance of any other persons who may have such information. They must make all requests for attendance to the hearing officer as soon as possible but no later than five days prior to the scheduled date of the hearing. The hearing officer may issue subpoenaes requiring the attendance of witnesses and, at the request of the parent of facility, shall issue subpoenaes. The hearing officer may limit the number of witnesses whose attendance is subpoenaed or requested by either party to not more than 10. If a party refuses to answer a subpoena or refuses to honor a request to attend, the hearing officer shall note such in the record and contact the Illinois State Board of Education legal department. The hearing may be postponed for a specified period of time, as designated by the hearing officer in order to resolve questions of attendance.

D) They may bring representatives, including legal counsel, agency representatives, or others, to the hearings at their own expense. These persons shall be given an opportunity to participate in the hearing process according to the procedures established by the impartial hearing officer. The facility shall maintain on file a list of independent evaluation sites, legal and other relevant services available in the area, and shall provide parents with the above information, upon request.

E) The educational status of the recipient will not be changed, pending the completion of the due process proceedings, unless the facility director or designee decides that such change would be warranted due to immediate physical danger to the recipient or other persons. In such case, the facility shall be responsible for developing and implementing an appropriate interim educational plan. Any change in placement shall not exceed 10 days. A facility director must request a change in placement from the Secretary, in writing.

F) Any party to the hearing has the right to prohibit the introduction of any evidence which has not been disclosed to that party at least five days prior to the hearing.

G) Either party may request that an interpreter be made available.

b) Parents involved in such a hearing have the right to have the recipient who is the subject of the hearing present, and open the hearing to the public if the parents wish.

c) The hearing officer shall conduct the hearing in a fair, impartial, and orderly manner.

1. At all stages of the hearing, the hearing officer shall require that the facility make available interpreters for persons who are hearing impaired or for persons whose normally spoken language is other than English. The facility shall assume any costs for interpretation services.

2. At all stages of the hearing, the hearing officer shall assure that the parents are aware of and understand their rights and responsibilities in regard to this process.

3. The hearing officer shall have the authority to require additional information or evidence when he or she deems it necessary to make a complete record. The hearing officer may recess the hearing for a specified period in order to obtain the additional information necessary.

4. The hearing officer may order an independent evaluation at facility expense.

d) At any hearing which has been requested regarding the educational placement of a recipient, the hearing officer shall seek to establish the issues, allow the introduction of evidence which is relevant to those issues, and derive conclusions therefrom. These conclusions may include, but are not limited to the following:

1. Whether the recipient has needs which require special education intervention;

2. Whether the evaluation procedures used in determining the recipient's needs have been appropriate in nature and degree;

3. Whether the recipient's diagnostic profile on which the placement recommendation was based is substantially verified;

4. Whether the proposed educational placement is directly related to the recipient's needs;

5. Whether the recipient's rights have been fully observed.

e) A hearing which has been requested regarding any other controversy shall seek to establish the issues as perceived by the prospective parties and the facts on which these issues depend. To that end, the hearing officer may require from both parties to the hearing written statements of the issues to be resolved, prior to the convening of the hearing. Each party is entitled to a copy of the other party's statement at least five days prior to the hearing.

f) The facility shall present evidence that the special education needs of the recipient have been appropriately identified and that the special education services proposed to meet the needs of the recipient are adequate, appropriate and available.

g) The recipient's parents and the facility, or their respective representatives, shall have a right to present testimony, cross-examine, and confront all witnesses at the hearing.

h) The rules of evidence shall not apply to the hearing process.

i) The facility shall make a record of the hearing proceedings, either by a court reporter or by a tape recorder. The parents have a right to obtain a written or electronic verbatim record of the hearing and to obtain written findings of fact and decisions. Additionally, the record of the hearing shall be part of the recipient's education record, which is governed by the Act. The facility shall bear the cost for such record.

j) Within 10 days after the conclusion of the hearing, the hearing officer shall render his or her decision, by certified mail, to the facility, the parents, and the State Superintendent of Education and the Secretary.

1. The findings of fact and decision shall be in English and in the language normally spoken by the parents if it is other than English.

2. The State Superintendent of Education shall distribute the information in a non-personally identifiable form to the Advisory Counsel on Education of Handicapped Children.

3. The hearing officer's decision shall be binding upon the facility and the parent unless such decision is appealed, pursuant to Section 108.130.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.130 Appeal Process

a) Either party aggrieved by the decision of the impartial hearing officer may appeal that decision to the State Superintendent of Education. The request for appeal shall be submitted in writing to the State Superintendent of Education and shall include a statement of the specific reasons upon which the appeal is predicated. It shall be postmarked within 15 days after the receipt of the hearing officer's decision. A copy of the request for an appeal shall be sent also to the other party to the hearing and the Secretary. Upon initiating a request for appeal, or upon receipt of notice of a parental request for appeal, the facility shall immediately undertake the preparation and compilation of transcripts and documents for submission to the Superintendent of the Illinois State Board of Education for review.

1. If a tape recorder was used to record the hearing procedures, then the facility shall make a verbatim typewritten transcript within 15 days which shall be reviewed by the parents within 10 days after receipt of the transcript. Inaccuracies shall be recorded and the transcript signed by the parents and the facility director.

2. The typewritten transcript and tape recording of the hearing shall be subject to the Act.

b) In all appeals pursuant to subsection (a) of this Section, the facility shall send a completed appeal form provided by the Department and five copies each of the typewritten transcript of the local hearing, of all documents presented at the hearing and of the hearing officer's decision to the State Superintendent of Education. If there are disputes concerning the accuracy of the transcript of the tape recording, the facility shall also send a statement of the inaccuracies and the original tape recording and copies of all documents relevant to the case.

c) The facility shall provide a copy of the transcript, which is being sent to the State Superintendent of Education, to the parents.

d) Pending the completion of the due process hearing, and any appeal to the State Superintendent of Education, the facility shall postpone any proposed change in the recipient's educational services, unless the Secretary decides that the health and safety of the recipient or others would be endangered. In such a case, the facility shall be responsible for developing an appropriate interim educational plan. Any change in placement shall not exceed 10 days. A facility director must request a change in placement from the Secretary, in writing.

e) Upon receipt of a request for a State level review, the State Superintendent of Education or designee shall designate a trained impartial hearing panel of five members, composed of three qualified mental health professionals or educational employees of the Department and two comparable employees of the Illinois State Board of Education recommended by the State Superintendent of Education. The State Superintendent of Education or designee may issue subpoenas requiring the attendance of witnesses at the State level review.

f) The impartial review panel shall consider the appeal based upon a study of the entire hearing record. It is at the discretion of the reviewing panel whether to afford the parties an opportunity for additional testimony. If additional testimony is allowed or additional evidence is to be considered, a hearing shall be convened and all due process rights shall be afforded the parties. Additional testimony is allowed or additional evidence is considered if new information comes to the attention of either party, which neither had at the time of the hearing, or to hear a claim from either party that all the issues of disagreement were not resolved by the hearing officer at the local level.

g) A report of the reviewing panel, including its recommendations, shall be submitted to the State Superintendent of Education, who shall decide the appeal within 30 days of receipt of the entire hearing record of the appeal.

1. If a hearing is convened for the purpose of receiving additional testimony or considering additional evidence, the 30 day deadline for a final decision may be extended for a specific period of time, not exceeding 30 days. The Superintendent may issue subpoenas requiring the attendance of witnesses at the hearing.

2. The State Superintendent of Education may dismiss any appeal he or she deems lacking in substance. The Superintendent shall dismiss an appeal in which the parents refuse to cooperate or to provide additional information requested.

h) Copies of the decision of the State Superintendent of Education shall be sent by certified mail to the facility and to the parents. The decision shall be written in English and in the language normally spoken by the parents if it is other than English.

i) The decision of the State Superintendent of Education shall be binding on all parties. Such decision shall not be contrary to the statutory powers of the Secretary and shall not require expenditure of money except as appropriated by the General Assembly.

j) The decision of the State Superintendent of Education shall be immediately transmitted to the Secretary who shall be responsible for seeing that the facility implements the decision of the State Superintendent.

k) Either party to the hearing aggrieved by the decision of the State Superintendent of Education shall have the right to bring a civil action with respect to the complaint, filed with the education agency which may be brought in a State court of competent jurisdiction or in a district court of the United States.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.140 Determination of Fulfillment of Special Education Responsibilities

a) The extent to which the facility is fulfilling its special education responsibilities to recipients shall be determined by the Illinois State Board of Education.

b) Official representatives of the Illinois State Board of Education shall be authorized to examine all documentation which would facilitate such determination. Examination of recipient records can be conducted only pursuant to the provisions of the Act.

c) Evaluation by the Illinois State Board of Education shall focus on the facility's provision of special education services, according to this Part, 23 Ill. Adm. Code 226, P.L. 94-142 (the Education for the Handicapped Act, 20 U.S.C.A. 1400 et seq., 1981), and on community resources used by the facility for special education services.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.150 Bases for Evaluation of Special Education Programs and Services

a) The facility shall develop a special education services comprehensive plan which shall describe its provision of special education services, its plan for program involvement, and those factors unique to the facility which are considered in the evaluation. This plan shall be filed with the Illinois State Board of Education and revised at least tri-annually.

b) The facility shall develop and implement procedures which continuously assess the extent to which recipients are being adequately served and the effectiveness of each special education program and service.

c) A team representing the Illinois State Board of Education shall assess recognition criteria for special education through an indepth study conducted on site.

d) Records must be maintained to demonstrate compliance with assurances agreed to in the applications for state and federal funds. Staff of the State Board of Education will monitor these records.

History

• Source: Amended at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.160 Written Reports

Written reports of the results of the evaluation conducted by the Illinois State Board of Education and any subsequent recommendations or actions shall be provided to the facility director and the responsible Department associate director. Reports of the evaluation shall be considered in the public domain.

(Section: Amended at 15 Ill. Reg. 6122, effective April 15, 1991)

59 Ill. Adm. Code 108.200 Application Review

a) A program sponsor, as defined in 77 Ill. Adm. Code 395.100, shall submit to the Department of Public Health its application, including its proposed training program, for initial approval and annual renewal in accordance with 77 Ill. Adm. Code 395.110 and 77 Ill. Adm. Code 395.130.

b) When the proposed program involves developmental disabilities aide training, the Department shall evaluate the new program and shall re-evaluate such programs annually thereafter and make its recommendations to the Department of Public Health and the program sponsor. The Department must receive new proposed programs and annual program renewals 60 days in advance of the training period. The Department shall complete its programs evaluations within 30 working days after their receipt.

c) The Department shall also evaluate proposed program changes, which it must receive 30 days in advance of program delivery. The Department shall give its recommendations regarding program changes to the Department of Public Health and the program sponsor 15 working days after their receipt.

History

• Source: Added at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.210 Review Criteria

a) The Department shall evaluate developmental disabilities aide training programs using a check list (see Section 108.Appendix A of this Part), which contains the instructor qualifications and program requirements provided in 77 Ill. Adm. Code 395.150(b), 77 Ill. Adm. Code 395.310 and 77 Ill. Adm. Code 395.160(c). The Department shall recommend that the training program either be approved, conditionally approved, or disapproved.

b) The Department shall recommend conditional approval when revisions are needed to remedy any minor program deficiencies which would not prevent the program from being implemented, such as deficiencies in the number of course hours, which can be corrected by submitting a revised schedule or outline. The program sponsor shall submit such revisions to the Department within 10 days after the Department has given its recommendation. The Department shall, within 30 working days after their receipt, recommend approval providing the program complies with the Ill. Adm. Code provisions in subsection (a) of this Section.

c) Hearings and appeals regarding the denial, suspension and revocation of program approval shall be conducted by the Department of Public Health in accordance with 77 Ill. Adm. Code 395.190.

History

• Source: Added at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.300 Providing Staff Consultation to School Boards

In accordance with Section 10-22.6 of the School Code [105 ILCS 5/10-22.6], a school board may invite a representative designated by the Department to consult with the board whenever there is evidence that mental illness may be the cause of a student's expulsion or suspension. Facility directors who receive such an invitation shall contact the appropriate local community mental health agency in order to coordinate arrangements for an agency representative to work with the school board on this matter.

History

• Source: Added at 15 Ill. Reg. 6122, effective April 15, 1991

59 Ill. Adm. Code 108.APPENDIX A Developmental Aide Training Program Review Check List

DMHDD-1221i

Department of Mental Health & Developmental Disabilities

Rev. 03/91

IL462-0337

DEVELOPMENTAL DISABILITIES AIDE TRAINING PROGRAM REVIEW CHECK LIST

Facility/agency name:

Date:

Address:

Phone:

Program sponsor:*

Contact person:

DPH ID:

Reviewer:

Review date:

PROGRAM CLASSIFICATION

Licensed ICFD

Bed capacity

Community college

Certified ICFDD

No. DD clients

Area vocational college

Other

STATUS

Initial approval

Program change (must be submitted 30 days prior to implementation)

Annual renewal

(must include:

(1)

Master program schedule as outlined in 77 Ill. Adm. Code 395.110(c)(5);

(2)

any clinical site agreements as outlined in 77 Ill. Adm. Code 395.110(c)(7); and

(3)

any other information required in 77 Ill. Adm. Code 395.110(c) which

has been changed since initial approval or previous annual renewal.)

Reviewer

AIDE TRAINING PROGRAM OVERVIEW

Directions: Check reviewer box whenever the program does NOT meet the stated criteria.

TRAINING PROGRAM TITLE

I.

Program rationale (i.e., philosophy, purpose, sponsor, summary, cirriculum coordinator qualifications

A.

Philosophy

B.

Purpose

C.

Summary that identifies sponsoring agency

D.

Qualification(s) of curriculum coordinator (QMRP or at least two years' experience with DD & DMHDD approved)

E.

Other (identify)

COMMENTS:

*If the program sponsor is a private business or vocational school, a copy of the sponsor's certificate of approval issued by the State Board of Education must be included.

II.

Instructor qualifications shall meet one of the following (A-C):

A.

Verification of successful completion of a DMHDD-approved "train-the-

trainer" workshop

B.

DMHDD approved QMRP trainer

C.

At least one year's experience with DD programs & DMHDD approved

D.

Resume included

COMMENTS:

III.

Program Delivery

A.

Location(s) identified

B.

Scheduled projected dates given

C.

Evidence of agency agreements, as appropriate

COMMENTS:

Reviewer

TRAINING PROGRAM OVERVIEW

Directions: Check reviewer box whenever the program does NOT meet the stated criteria

TRAINING PROGRAM TITLE

IV.

Program Schedule

A.

Basic content presented in a minimum time frame of three (3) weeks, but not to exceed a maximum of 120 days. Educational institutions are exempt.

B.

If an educational institution, the term, semester or trimester courses submitted must include designated hours for OJT and evidence of any agency agreements.

COMMENTS:

V.

Academic Classroom Component (80 hours)

Outline including:

A.

Program and course title

B.

Behavioral objectives learner is expected to know or do

C.

Content outline

D.

Teaching methods

COMMENTS:

VI.

On-the-Job Training Component (40 hours)

A.

Has a completed itemization of written training tasks (analogous to behavioral objectives)

Tasks are identified and written specifying training behaviors trainee is required to perform.

Each task has the required steps for successful completion.

B.

Task-specified behaviors are taught by a qualified instructor.

COMMENTS:

VII.

Program Content

A.

Flows from stated objectives (not mandated)

B.

Reflects basic, current knowledge in personal care and skills as related

to the needs of developmentally disabled persons (not mandated)

C.

Curriculum review findings (pages 3-4)

D.

Explanation identifying:

Instructor(s) criteria for pass/fail of trainers (not mandated)

Methodology

E.

Audiovisual materials, trainee and trainer texts are identified by title

(not mandated)

F.

Training plan received 60 days prior to being implemented

COMMENTS:

VIII.

Program Hours

A.

120 hours minimum

B.

Exceeds minimum 120 hours with additional program content (not mandated)

C.

Ratio of one (1) hour of on-the-job training (including supervised clinical

practice to two (2) hours of (theory) classroom experience

COMMENTS:

IX.

Evaluation Tools

A.

Copy of evaluation tool(s) included

B.

Copy of student evaluation of instructor (not mandated)

C.

Has tools to evaluate:

Program objectives

Program content

On-the-job performance

a.

Evaluation of tasks by instructor's direct observation

b.

A recording form is used to indicate the date of successful completion of all OJT tasks; will be filled out and kept on file at the facility

Instructors (student evaluation of program instructor)

COMMENTS:

DEVELOPMENTAL DISABILITIES AIDE TRAINING CURRICULUM REVIEW

Directions: Designated reviewer should

Program Deficiencies

Anticipated Time

a.

Check Program Deficiencies whenever the program does not meet stated criteria

b.

As appropriate, indicate sponsor's Anticipated Time (i.e., hours, minutes) by the general or specific program title; you may also elect to use this space to identify if the time is for CI (classroom instruction) or OJT (on-the-job training)

c.

As appropriate, state instruction media used

PROGRAM TITLE

I.

Orientation

A.

Functions of long-term care facilities for the developmentally

disabled

B.

The health care professions, support services for the develop-

mentally disabled and community social service agencies

C.

Philosophy of residential care

D.

Role of the interdisciplinary team

E.

Job duties and responsibilities of the DD aide

COMMENTS:

II.

Introduction of the Residents

A.

Communication and interpersonal relationships with residents,

families and others

B.

Psychosocial needs of residents and their family

C.

The growth and development process

D.

Characteristics and types of developmental disabilities

E.

Resident's adjustment to death and dying

COMMENTS:

III.

Fundamentals of Habilitation Planning

A.

Philosophy of achieving independent living skills

B.

Introduction to the individual habilitation plan including the role

of the employee in the habilitation process

C.

Habilitation plan assessment procedures and goal planning

D.

The role of the employee in the admission, transfer and discharge processes

E.

The role of the employee in basic resident care planning & procedures

COMMENTS:

IV.

Techniques of Habilitation Planning and Implementation

The role of the employee in social habilitation include:

A.

Activities of daily living (ADL);

B.

Therapeutic and leisure time activities;

C.

Education;

D.

Community living adjustment;

E.

Behavior development;

F.

Behavior control;

G.

Effect of drugs in behavior management;

H.

Total communication;

I.

Pre-vocational and vocational training;

J.

Nutrition and fluid intake;

K.

Diets and therapeutic diets;

COMMENTS:

DEVELOPMENTAL DISABILITIES AIDE TRAINING CURRICULUM REVIEW

Program Deficiencies

Anticipated Time

PROGRAM TITLE

V.

Principals of Record Keeping

A.

History and use of facility records with special emphasis on the role of the employee in the record keeping process

B.

Content and organization of resident records

C.

Recording methods for progress notes, universal notes, ADC notes and habilitation news

D.

Writing effective progress notes

E.

Confidentiality

F.

Recording admission, transfer and discharge information

COMMENTS:

VI.

Safety

A.

Basic fire safety

B.

Emergency and disaster procedures

C.

Injury prevention techniques

D.

Household daily safety procedures including body mechanics

COMMENTS:

VII.

Facility Environment

A.

Creating normalized environment for daily activities

B.

Importance of cleanliness of the facility, use of equipment and supplies

COMMENTS:

VIII.

Principles of Disease Control

A.

Introduction to micro-organisms causing resident illness and disease

B.

Teaching of disinfection and sanitation

COMMENTS:

IX.

Emergency Medical Procedures

A.

CPR

B.

Seizures

C.

Drug reactions

D.

Traumas

E.

Heimlich maneuver

COMMENTS:

X.

Resident Rights

A.

Basic civil, human and legal rights of residents

B.

Protection of residents personal property

COMMENTS:

XI.

Bodily Functions

A.

Helping residents to understand their bodily functions

B.

Personal hygiene

C.

Human sexual behavior

COMMENTS:

DEVELOPMENTAL DISABILITIES AIDE TRAINING SUMMARY SHEET

Sponsor

Date

I.

Decision:

A.

Approved.

B.

Conditionally approved (contingent on the receipt of additional materials,

or revisions needed to remedy any minor deficiencies in the proposed

program). Additional materials or revisions requested are as follows:

C.

Denied for the following reasons:

II.

Additional comments or recommendations:

Title

Signature

Date

History

• Source: Added at 15 Ill. Reg. 6122, effective April 15, 1991

Part 109 Individuals Access to Services

59 Ill. Adm. Code 109.10 Definitions

“Computer programs” or “software” means instructions for the computer written generally in a machine language.

“CD-ROM” or “CD” means a compact computer memory storage device containing one or more computer programs that can be used by or installed onto a computer and which is removable.

“CPU” or “central processing unit” means the brains of the computer and physically consists of a large metal or plastic box.

“CRT” or “cathode ray tube” means one type of a computer monitor.

“Cyberstalking” means using electronic communication (such as a computer) to transmit a threat of bodily harm, sexual assault, confinement or restraint to a person, or place the person or his or her family member in reasonable apprehension of harm, sexual assault, confinement or restraint.

“EDP liaison” means the person designated by the facility to ensure computer software and hardware are compatible with DHS systems and requirements. The EDP liaison serves as the liaison between the facility and the Bureau of Management Information Systems.

“Educational purposes” means enrollment in a degree program from an accredited school or a class offered by an accredited school or adult learning center approved by the individual’s treatment or interdisciplinary team.

“Employee”, for the purposes of this Part only, means any person providing services at the direction of the Administrator or Director, or Department Secretary, on- or off-site. This includes payroll personnel, contractors, subcontractors, and volunteers.

“Facility” means a State-operated developmental disabilities or a State-operated mental health facility as defined by Sections 1-107 or 1-114 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/1-107 and 1-114].

“Facility director” means the chief administrator of a facility or his or her designee. At a mental health facility, the designee may be a hospital administrator, medical director, medical administrator, physician, clinical psychologist, clinical social worker, or registered nurse. At a developmental disabilities facility, the designee may be any member of the center’s executive staff or the EDP liaison coordinator.

“Inappropriate use” means the use of a computer in violation of this Part or facility policy or to harass or otherwise harm another person. Unless instructed otherwise by the court, it does not include using the computer to prepare for litigation to seek relief or against the Department.

“Individual” means a recipient of services as defined in Section 1-123 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/1-123].

“Internet” or “World-wide web” means a method whereby two or more computers can interact.

“Laptop computer” means a portable computer that has all of the functions of a larger desktop computer.

“LCD” means liquid crystal display.

“Modem” means a device used to connect one computer to another or to the internet through telephone lines, radio frequencies, cable connections, or other means.

“Peripheral” means any device that is used in conjunction with a computer and includes, but is not limited to, printers, scanners, and disk drives.

“Printer” means a device that will put the information from a computer program on paper.

“Restriction” means limiting the individual’s use of a computer or access to specified software, up to and including denial to use a computer.

“Treatment or Interdisciplinary team” means the facility employees responsible for developing, implementing, and evaluating an individual’s programs and services.

59 Ill. Adm. Code 109.20 Applicability

This Part shall apply to all facilities.

59 Ill. Adm. Code 109.30 Procedures

a) General Provisions

1. The facility director shall be responsible for implementing this Part. He or she may restrict the possession or use of computers, peripherals, modems, CDs, disks, software, or other equipment used with the computer for all individuals in a facility, when necessary to protect an individual or others from harm, provided that notice of such restriction shall be given to all individuals upon admission. If it becomes necessary to restrict individuals who did not receive notice of the restriction upon admission, the professional responsible for overseeing implementation of an individual's services plan may, with the approval of the facility director, restrict the right to property when necessary to protect the individual or others from harm.

2. Due to safety concerns raised by metal in the CPU or glass in the CRT monitors, the facility director may choose to limit the approved computers to laptop computers with LCD displays. If the facility director limits the type of equipment to be used, he or she will ensure that information concerning these limitations is included in notices to employees and individuals.

3. Except as provided in this Section, e-mail and internet use on State-owned computers by individuals is prohibited. Facilities are not required to provide individuals with e-mail or internet access on State-owned computers. Individuals may request to have e-mail and internet access for educational purposes only. No other e-mail and internet related uses of State-owned computers by individuals are permitted. The treatment or interdisciplinary team may deny the request if it determines that e-mail or internet access would be clinically inappropriate or that a restriction on e-mail or internet use is necessary to protect the individual or others from harm. Behaviors such as issuing written and verbal threats, obtaining personal information about other persons in order to intimidate or harass them, obtaining information about making bombs and other weapons, cyberstalking, and planning escapes from facilities will result in denial of e-mail and internet access.

4. If a facility prohibits possession of CDs by individuals while in the facility and an individual has an approved program on CD, the individual, under employee supervision, may load the program onto the computer after which the CD will be placed in personal storage until the individual is discharged. The facility shall not provide any equipment to convert any program from one format (CD) to another (disk) (see subsection (a)(1)).

5. The treatment or interdisciplinary team, with the approval of the facility director, may restrict an individual’s possession of computers, modems, or computer peripherals when necessary to protect the individual or others from harm. Individuals wishing to purchase or obtain computers, modems, or computer peripherals for personal use must have prior approval from their case managers and the treatment team at a mental health facility or the interdisciplinary team and the EDP liaison at a developmental disabilities facility. Individuals will be asked to sign the “Agreement for Use of Computers” form (IL 462-0190) documenting their understanding of the terms of use and their agreement to those terms. Those terms may include restricting the use of the computer and any peripheral to non-treatment or habilitation time periods. Any computer or computer peripheral received by an individual that has not been approved shall either be returned to the sender or placed in the individual’s personal property storage, at the individual’s choice. The individual may elect to seek approval for the computer or peripheral.

6. The treatment or interdisciplinary team, with the approval of the facility director, may restrict an individual’s possession or use of computer software when necessary to protect the individual or others from harm. Individuals wishing to purchase or obtain computer software for personal use must have prior approval from their case managers and the treatment team at a mental health facility or the interdisciplinary team and the EDP liaison at a developmental disabilities facility. Individuals will be asked to sign the “Agreement for Use of Computers” form (IL 462-0190) documenting their understanding of the terms of use and their agreement to those terms. Any computer software received by an individual that has not been approved shall either be returned to the sender or placed in the individual’s personal property storage, at the individual’s choice. The individual may elect to seek approval for the computer software.

b) Individual Use

1. If an individual wishes to use a computer and software, employees will inform the individual concerning the stipulations/terms under which a computer and software may be used. The individual must sign the form attesting that he or she understands the terms of use and agrees to those terms. If an individual has a guardian, the treatment or interdisciplinary team shall review the form with the individual and his or her guardian. The guardian will also be asked to sign the agreement. The treatment or interdisciplinary team may specify additional terms and conditions for use of a computer in the individual’s treatment or habilitation plan.

2. If an individual is approved to use a computer, software that is approved includes the following:

A) Operating system (i.e., DOS, Windows, OS2);

B) Utility programs (virus checkers, file managers, defragmenters, scan disk);

C) Word processing;

D) Accessories (calculators, paintbrush, print programs);

E) Games that the individual would be authorized to play on the unit, such as solitaire, card games, chess, checkers, various board games, or skills development games; and

F) The treatment or interdisciplinary team must approve any additional programs that the individual wishes to use. Any software in a factory-sealed container may be presumed to contain only the software that it indicates is included.

3. The individual’s use of the computer will be determined based on clinical review and assessment, as well as the availability of space, the number of electrical outlets, and electrical devices. No extension cords or devices that multiply the number of outlets, such as outlet strips, etc., are permitted.

4. If an individual at a mental health facility uses a computer, any peripheral, power cord and/or other associated part in an attack or assault on another individual, employee, or visitor, the computer and all accompanying devices and equipment shall be confiscated and placed in personal property storage. The “Notice Regarding Restricted Rights of Individuals” form (IL 462-2004M) will be completed according to facility procedure. If an individual at a developmental disabilities facility uses a computer related item to harm or attempt to harm another person, the computer will be removed from the individual until the interdisciplinary team meets (within 3 working days) to determine the programmatic action warranted. The “Notice Regarding Restriction of Rights of an Individual” form (IL 462-2004D) and SODC Operations “Supplemental Report On the Use of Restraints and/or Emergency Behavior Intervention Procedures” are to be completed if an individual’s computer is restricted and the forms processed in accordance with the developmental disabilities facility’s procedures for processing documents.

5. If an individual inappropriately uses a computer, the treatment or interdisciplinary team may restrict his or her use of the computer until the treatment or interdisciplinary team meets to determine the programmatic action warranted.

6. The treatment or interdisciplinary team shall keep a record of the equipment and software that each individual is authorized to use. At least annually, there shall be an inventory of all individuals’ rooms to ensure compliance. There may be random checks of what software is loaded onto each individual’s computer. Any unauthorized software programs shall be deleted. The continued presence of unauthorized software or providing software to other persons may result in the restriction of the use of the computer.

7. Computers are approved for the individual’s personal use. Allowing another individual to use a computer or using the computer to obtain personal gain from other individuals is a violation that can result in restrictions on the use of the computer.

c) Use of Disks

1. Individuals may purchase blank disks or software approved in accordance with subsections (b)(1) and (2) through a facility commissary or through the facility at a local store. If individuals are sent blank disks or software approved in accordance with subsections (b)(1) and (2), they must be in a factory sealed container. If they are not in a factory sealed container, they are to be treated as “computer disks from others” (see subsection (c)(3)).

2. When an individual has been approved to use a computer, he or she may wish to send and receive correspondence from his or her attorney on computer disk. The facility shall send a letter to the individual’s attorney explaining that correspondence may be sent to the individual on computer disk, provided the attorney certifies, with each computer disk, that it only contains documents relating to that legal representation.

3. Computer disks coming to the individual shall be examined (except for disks sent to or from the individual’s attorneys) and the documents on some or all of the disks will be reviewed. If unauthorized contraband material is present, those disks (and all other disks from that same person) could be restricted with the appropriate restriction of rights. Outgoing computer disks shall not be examined, impeded or censored unless the facility director makes an individual determination that it is necessary to protect the individual or others from harm, harassment or intimidation.

4. For security reasons, the facility director may restrict all disks coming to or from persons or organizations outside the facility, except for those disks coming to or from attorneys corresponding with individuals. The treatment or interdisciplinary team, with the facility director’s approval, may restrict disks coming to or from an individual when necessary to protect the individual or others from harm, except for those disks coming to or from the individual’s attorney.

59 Ill. Adm. Code 109.40 Department Access to E-Mails and Internet Communications

a) Personal Information on Department Computers – The privacy of materials kept in electronic data storage, internet use, and electronic mail when using Department computers is not a right, nor is it guaranteed. Most materials on Department systems are, by definition, public records. As such, they are subject to laws and policies that may compel the Department to disclose them.

b) Monitoring of Computer Use – The facility director shall ensure e-mail and internet use by individuals on all State-owned computers is monitored to ensure compliance with sanctioned uses. Individuals using State-owned computers for sanctioned uses shall be informed, prior to use, that such use shall be monitored. The Office of Management Information Systems (MIS) administers the Department’s information systems and data processing equipment. MIS may monitor computer use and system accesses by any individual or organizational entity in DHS. This includes the potential to monitor transaction executions, file accesses, communications such as e-mail and accesses of external resources such as the internet.

c) Contents of E-mail – The contents of electronic messages may be seen by a system administrator in the course of routine maintenance or in order to dispose of undeliverable messages. In addition, electronic mail systems store messages in files (e.g., the file containing a user’s inbound mail). These files are copied in the course of system backups and these backup copies may be kept long after original messages are deleted.

d) System Files and Logs – In the course of resolving system performance or security problems, system administrators may examine the contents of files that control the flow of tasks through the system or that grant unauthenticated access to other systems. This includes systems logs that document activities of users.

59 Ill. Adm. Code 110.5 Definitions

"Assessment of Individual Rights" means an assessment tool used to evaluate a person's capacity to exercise their rights and make informed decisions. It is performed at the time of admission and during the annual review and is designed to ensure that a person receiving services can exercise their rights as described under Article 1 of the Mental Health and Developmental Disabilities Code.

"Code" means the Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Contraband Items" or "Contraband" means items that are illegal for a recipient to have in their possession or that are legal but considered dangerous for recipients to have on units, in accordance with Section 110.30(a)(2) and (d). Such items shall be confiscated by staff of the Security Department and turned over to the proper authorities or destroyed.

"Department" or "DHS" means the Department of Human Services.

"Department Facility" means a State-operated mental health facility or a State-operated developmental disability facility as defined by the Mental Health and Developmental Disabilities Code [405 ILCS 5]. "Department facility" does not refer to a treatment and detention facility.

"Facility Resource Unit" means a facility entity commonly known as a Patient Resource Unit (PRU) or Resident Resource Unit (RRU) which operates under the oversight of the facility's Business Office.

"Guardian" or "guardian of the person or estate" means a court-appointed guardian of the person or estate as described in 755 ILCS 5/11a-3 with specific authority to make decisions concerning the recipient's financial transactions or their care.

"Human Rights Committee" means a committee established by each Department facility, consisting of at least five members, including at least one individual receiving services or their guardian. At least one-third of the members shall be persons not associated with the Department, and no more than half of the members may be employed by the Department. The committee is responsible for reviewing and monitoring restrictions of individual rights, ensuring informed consent, and promoting the protection and restoration of rights in accordance with State and federal law.

"Informed Consent" means permission voluntarily granted by the recipient or guardian of the person or estate for the release of information, for participation in the program services specified in the treatment plan, for the use of a specific procedure in the plan, or for designating the facility as representative payee, as applicable. Informed consent means full disclosure to the recipient or guardian of the information required for them to make the decision.

"Recipient" means a person who has received or is receiving treatment or habilitation at a Department facility.

"Restricted Items" means lawful items that may be returned to the recipient or their designee upon discharge but are restricted in accordance with Section 110.30 (a)(1). Such items shall be restricted from being in the possession of the recipient while a recipient is at the Department facility.

"Restriction of Rights" means the legal limitation or withdrawal of an individual's rights issued in accordance with Section 2-201 of the Mental Health and Developmental Disabilities Code.

"Treatment Team"

At State operated mental health facilities:

The treatment team at all State operated mental health facilities is comprised of an interdisciplinary team of clinicians who are responsible for developing individualized treatment plans for all recipients admitted into a State operated mental health facility. In addition, the treatment team is responsible for ensuring that all direct care staff are tasked with the implementation of goals developed by the treatment team for every recipient who requires psychiatric stabilization. Additionally, the treatment team identifies treatment issues, barriers, and makes recommendations towards each recipient's discharge planning process. Every treatment team is assembled at the facility level to ensure the specific individualized needs of every recipient are appropriately addressed.

At State operated developmental disability facilities:

The treatment team at all State operated developmental disability facilities is comprised of an interdisciplinary team consisting of clinicians, professionals, paraprofessionals, and non-professionals who possess the knowledge and expertise to assess and identify a recipient's strengths, needs, and preferences for the development and implementation of an Individualized Service Plan and related programming.

"Trust Fund" means a recipient's account which is established upon authorization by the recipient or their guardian of the person or estate to maintain personal funds.

History

• Source: Amended at 49 Ill. Reg. 14118, effective October 9, 2025

59 Ill. Adm. Code 110.10 Disposition of Unclaimed Personal Property

a) Personal property of recipients left unclaimed at a Department facility for two years, after due notification to the recipients or their representatives, shall be sold, and the money deposited in the service recipient activity fund as described in 59 Ill. Adm. Code 101.20 (also known as Other Special Trust Fund #1139) Service Recipients Activity Fund (see Section 20 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/20]).

b) Items that have a total estimated value of $1,000 or more shall be advertised for sale at least seven days prior to the time of being sold.

c) If no acceptable offers are received to the advertisement, the property will then be sold in a manner considered most advantageous to the facility.

d) Information regarding the sale of unclaimed items of personal property shall be recorded in the recipient's record, whenever possible.

History

• Source: Amended at 49 Ill. Reg. 14118, effective October 9, 2025

59 Ill. Adm. Code 110.20 Handling of Recipient's Personal Property Other Than Clothing

a) Introduction

1. When a recipient is admitted to a Department facility, such recipient or the recipient's guardian of the person or estate may authorize the facility to establish a trust fund account in accordance with Section 20 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/20], using form IL462-0623, Trust Fund Deposit Authorization. Any monetary assets in the recipient's possession at the time of admission may be deposited in such an account. The recipient shall be advised that:

A) The recipient may retain money and deposit it in a financial institution or use it as the recipient chooses, unless the recipient is a minor or is prohibited from doing so under a court guardianship order, in accordance with Section 2-105 of the Code.

B) The recipient may revoke the authorization for the trust fund account, using form IL462-0623C, Revocation of Authorization.

C) Any funds deposited in the trust fund shall earn interest based on the end of the month balance. If funds are withdrawn prior to the end of the month, no interest will be paid on withdrawn funds for the period.

2. Accounting records shall provide separate entries for those funds (checks) designated to the recipient and those funds (such as checks from the Social Security Administration, Railroad Retirement, or the Veterans' Administration) designated to the facility for cost of care charges on behalf of the recipient. Only qualified clinical personnel at the facility can make statements or answer questions on applications for a Center Director to be selected as payee of these benefits which relate to the recipient's ability to manage their own funds.

3. Except when a recipient or the guardian of the person or estate has given informed consent, no facility nor any of its employees shall be made representative payee for the recipient's Social Security pension, annuity, trust fund, or any other form of direct payment or assistance, as provided by Section 2-105 of the Code. When a facility is selected as representative payee, benefit checks are credited to the recipient's trust fund account. The amount which is allowed by the payor shall be set aside for the recipient's personal needs prior to establishing services charges pursuant to 59 Ill. Adm. Code 106.25.

4. The allowable reserve exemption, as defined in 59 Ill. Adm. Code 106.15 and clarified in 59 Ill. Adm. Code 106.45(g) and (h), shall not be used for services charges. The allowable reserve exemption from all sources cannot exceed that established by the Illinois Department of Healthcare and Family Services at 89 Ill. Adm. Code 120.382. The recipient's allowable reserve exemption can only be increased by the unused portions of the monthly personal clothing allowance or unspent workshop or other monetary incentive funds such as living skills program funds. Amounts exceeding those allocated for the recipient's personal use are applied to the services charges of the recipient. Payments to be paid by the recipient for services charges may not be deferred to build a reserve up to the maximum amount allowed. The reserve fund can be used by the recipient in support of discharge planning, or other needs as determined by the recipient or guardian of the person or estate, or in the case of a recipient still hospitalized at a State operated mental health facility at the time of death, for burial.

5. Recipients without guardians of the person or estate with trust funds shall be asked to sign form IL462-0623, Trust Fund Deposit Authorization. A guardian of the person or estate will be asked to sign form IL462-0623 for recipients.

6. The facility resource unit shall be notified immediately whenever any recipient or guardian of the person or estate refuses to sign form IL462-0623. If the recipient or guardian of the person or estate does not sign form IL462-0623, no funds from the recipient's trust fund made payable to the recipient may be used to defray services charges without a court order. Recipients without a guardian of the person or estate whose funds are payable to themselves shall be billed for services charges and collection shall proceed as provided by Section 5-113 of the Code and the Department's rules at 59 Ill. Adm. Code 106.

7. When a recipient is admitted to the Department facility, all personal property shall be deposited in the business office or a facility designated area for safekeeping if authorized by the recipient or guardian of the person or estate.

8. Vault access keys shall not be given to any person other than authorized Department staff. Bank vault property may be accessed by the recipient or guardian of the person or estate through standard operating procedures of each facility. If a person other than the guardian of the person or estate has obtained a court order for the release of bank vault property and presents this order to the facility director or designee, the authorized Department staff shall be immediately notified so that the bank vault property may be accessed. The business office shall report any physical document issued by a bank to a recipient indicating potential outside funds to the facility resource unit immediately upon possession or as soon thereafter as possible.

b) Discharge

For those recipients who have received Social Security benefits, the facility director or designee must notify the Social Security Administration within 10 working days after these recipients are discharged.

1. Recipients without a guardian of the person or guardian of the estate (including veterans)

A) Authorization must be secured in writing to expend monies or release property of recipients who do not have a guardian of the person or estate for any purpose, including services charges, except when the facility has been named payee by the Social Security Administration, Railroad Retirement Board, or named the legal custodian by the Veterans' Administration. The facility's authority to disburse funds from the trust fund without the recipient's or the recipient's guardian's authorization shall be limited to those funds made payable to the facility as a payee or agent of the recipient.

B) When discharge plans have been made, the facility director shall designate an employee to discuss with the recipient or the recipient's guardian of the person or estate the disposition of monies remaining in the trust fund account. The discussion must include the following information:

i) The recipient applying for or approved for assistance from the Department of Human Services or the Department of Healthcare and Family Services is subject to the rules of that agency depending on the amount of assets owned at the time of the recipient's admission.

ii) The recipient may take their funds with them to the place where the recipient will be living or may arrange for an alternative disposition of all or part of their money such as checking or savings accounts. The facility shall comply with the recipient's or the recipient's properly empowered guardian's wishes regarding the disposition of the recipient's funds, excluding those funds designated for the recipient's care at the Department facility.

iii) If there are amounts due for services charges, the recipient or the recipient's guardian of the person or estate can, at that time, authorize the release of funds for payment and, if payment from the trust fund is not authorized toward services charges due, the recipient will be billed and will be subject to collection procedures in accordance with Section 5-113 of the Code.

iv) Eligibility of the recipient for programs administered by the Department of Human Services and the Department of Healthcare and Family Services when applicable.

v) The amount of money appropriate for a person placed in a long-term care facility as defined by the Nursing Home Care Act [210 ILCS 45] or placed in a community-integrated living arrangement as defined by Section 3(d) of the Community-Integrated Living Arrangements Licensure and Certification Act [210 ILCS 135] and discussion of how best to handle that sum and any excess (see subsection (c)(1)(B)(ii) of this Section).

2. Legally disabled veterans and veterans' legally disabled beneficiaries (funds received from the Veterans' Administration)

An amount not to exceed that allowed by the Veteran's Administration (38 U.S.C. 521, 541 and 542 (1996)) may be released to the recipient, responsible relative, or guardian of the person or estate pending receipt of instructions from the Veterans' Administration by the facility regarding the trust fund balance of funds received from the Veterans' Administration. A copy of instructions received from the Veterans' Administration shall be sent to the facility resource unit.

3. Legally disabled recipients

A) If there is a court-appointed guardian of the person or estate, the guardian shall be notified regarding the trust fund balance and unpaid services charges and instructions shall be secured from the guardian. In such cases, any assets or personal effects released to the guardian of the person or estate, the date of discharge and amount of money or list of effects released, and the date of release shall be immediately reported to the facility resource unit.

B) If there is no guardian of the person or estate, the funding source shall be notified of the imminent discharge of the recipient with a request that the funding source name an appropriate representative payee. If the recipient is not eligible for public assistance, an attempt shall be made to restore the recipient to non-legally disabled status in the local court. If the facility believes that the recipient is non-restorable and in need of guardianship, the facility director or designee shall investigate guardianship alternatives. The facility resource unit shall be notified when any legally disabled recipient is to be discharged.

C) When the recipient is discharged, the facility director or designee shall advise the facility resource unit regarding the remaining balance in the trust fund account, source of funds, and other pertinent details such as disbursement restrictions, discharge needs, and location of bank accounts.

c) Death

1. The facility director or designee may authorize the arrangements for the burial of a recipient and the necessary expenses connected with such burial at a cost that is reasonable and necessary. The amount should take into consideration the average cost of a burial for the region as well as cultural or religious preferences and should subtract any federal or State benefits the recipient is entitled to and any pre-burial services the recipient has purchased, including, but not limited to, benefits from the Veterans' Administration, the Social Security Administration, and pre-paid burial plots and expenses. Plans for burial shall be arranged by the facility director or designee in situations when the recipient has no rightful heirs. Payments to funeral directors shall be made only on receipt of itemized statements and only for the amount authorized.

2. Facility staff shall determine if the recipient had life insurance, and shall report the amount of the policy, name of the beneficiary, name of the insurance company, and policy number or numbers to the facility resource unit.

3. Upon receipt of a certified copy of Letters of Administration, Letters Testamentary, or a properly executed Small Estates Affidavit, disbursement shall be made of the trust fund balances. Information regarding release of such funds shall be reported immediately to the facility resource unit.

4. Lump-sum benefits

A) Recipients of Social Security benefits who have wage records are entitled to lump-sum benefits for burial of three times the amount of the monthly benefit, except that the maximum lump-sum payment shall not exceed $255.00.

B) Relatives shall be advised of any lump-sum entitlement and shall be informed that they should make their own arrangements for the recipient's burial, and that they should request payment of the lump-sum benefit directly from the Social Security Administration. If the trust fund accumulation is used for burial, the facility director or designee shall make a claim to the Social Security Administration for the lump-sum benefit as trustee of the recipient's funds. The Social Security Administration will also reimburse the facility if the funeral expense is paid from a General Revenue Fund appropriation. The amount of the lump-sum death benefit shall be reported to the facility resource unit when received. When full charges for services have not been satisfied, billing shall be issued for any unpaid amount taking into account the balance in the trust fund. When balances are reported to the Social Security Administration, the amount of unpaid services charges should also be reported.

5. If the recipient's estate is not admitted to Probate, the facility resource unit shall issue billing against the trust fund account of the decedent for any balance remaining, up to the amount of unpaid balance, based on the maximum per capita services charges (59 Ill. Adm. Code 106.25).

d) Discharge to community placement

1. State-operated mental health facility responsibilities for discharge of a recipient to a community placement include the following:

A) In determining charges for the services of a recipient to be placed in the community placement program, consideration shall be given to the recipient's immediate needs and eligibility for public assistance based upon information available to the facility at the time of discharge preparation. Any financial information available shall, whenever possible, include real time data and the community agency shall obtain the most accurate financial accounting status on the online portal for the payor source (e.g., SSDI, HFS, etc.). A report shall be made for all recipients in the community placement program. A financial questionnaire for aftercare services will be provided to the community agency at the time of discharge from any Department facility.

B) If there is a trust fund balance, this information shall be sent to the facility resource unit. Recipients to be discharged and placed in nursing homes or sheltered-care homes may have the reserve funds from the trust fund used to pay for their care in the home if they are otherwise eligible for public assistance, except that the funds in the trust fund plus other liquid assets cannot exceed the amount set forth in Department of Healthcare and Family Services rules at 89 Ill. Adm. Code 120.382. Money from the trust fund may be so used only to the extent permitted by the Department of Human Services and the Department of Healthcare and Family Services to enable the recipient to receive public assistance on discharge from the facility.

2. State-operated developmental disability facility responsibilities for discharge of a recipient to a community placement include the following:

A) Each State-operated developmental disability facility shall have procedures in place which address accountability of a recipient's property. Each recipient being discharged to a community placement should transition with all of their personal property.

B) If there is a Recipient Trust Account balance, these funds and a summary detailing the amount and purpose of each sub-account will be released to the recipient, recipient's guardian, or the Community Service Provider, depending on the protocol guidelines associated with the discharge service type and setting. Any irrevocable funeral or death funds shall be reported under a sub-account. This release of funds will take place after the facility has ensured that all liabilities have been paid. Any federal benefit monies that are not payable to the State are returned to the Federal Payee source. Upon discharge of the recipient to the community, the facility will provide notice of pre-paid funeral and/or death benefits.

e) General − State-operated mental health facilities

1. All trust fund balances for discharged recipients shall be reported to the facility resource unit and shall show the net balance available for use in establishing charges for services. Facility claims for clothing shall be deducted before reporting this balance. Money credited on commissary cards shall be included in the balance.

2. All trust fund balances for deceased recipients shall be reported to the facility resource unit and shall show, in detail, all burial and death benefits.

3. Facilities shall not remit funds to pay services charges until receipt of an official billing statement. Funds may be remitted to pay services charges from recipient trust funds only if the recipient or the recipient's guardian of the person or estate, has consented.

History

• Source: Amended at 49 Ill. Reg. 14118, effective October 9, 2025

59 Ill. Adm. Code 110.30 Personal Property in Department Facilities

a) Recipients may possess a reasonable amount of personal property for personal use under the following conditions:

1. Possession and use of certain classes of property may be restricted by the facility director or designee when necessary to protect the recipient or others from harm, provided that notice of such restriction shall be given to all recipients upon admission so long as the restriction does not otherwise conflict with the rights provided in this Section.

2. Upon admission of a recipient to a Department facility, staff shall inform the recipient or guardian and confiscate any personal property identified as contraband and any personal property identified as restricted items. Upon arrival at the facility, the recipient's belongings will be inventoried and checked against the contraband and restricted items list. Items that are contraband/restricted will not be given to the recipient. Staff shall notify the recipient of the contraband and restricted items, shall dispose of any illegal contraband items, and shall determine whether other contraband or restricted items should be stored in a secure space or, with the recipient's permission, returned to the recipient's guardian of the person or estate, a family member, or friend.

3. Property must be approved by the facility director or designee prior to use pursuant to Section 2-104 of the Code. Any personal property that the facility director or designee determines, in the exercise of its professional judgment, may pose harm to the recipient or to others shall be restricted. Property shall not be restricted on political, philosophical or religious grounds. Property intended as a medically reasonable accommodation of a known disability shall not be restricted except when determined by the facility director or designee, in exercise of their professional judgment, that the accommodation may pose harm to the recipient or others. A restriction of rights shall be issued in accordance with the Mental Health and Developmental Disabilities Code [405 ILCS 5/2-201] within 48 hours. When the restriction of rights is issued, the treatment team member shall inform the recipient of their ability to request a review under subsection (a)(5). The recipient will have the option of placing the personal property in storage or returning it to its place of origin.

A) Personal property approved for usage by a recipient may not be shared with any other recipient unless the second recipient is approved for such usage in accordance with this Section. Violation of this subsection (a)(3)(A) may result in a restriction of rights, including loss of use of the shared property, as determined by the facility director or designee exercising its professional judgment.

B) Recipients may request prior approval from the facility director or designee, in accordance with subsection (a)(3), for any property the recipient intends to have sent to the facility or intends to receive during visits with family or friends, but are not required to seek prior approval. Property that has not been submitted for prior approval must nonetheless be subject to the approval process, in accordance with subsection (a)(3) and comply with all other Sections of this Part before a recipient may have access to it.

C) Once approved by the facility director or designee, personal property must be inspected by designated facility staff prior to entering the treatment or residential unit. Items approved for possession by a recipient may be indelibly marked or identified as belonging to that recipient prior to entering the unit.

D) Media and media storage devices, including but not limited to physical, print, digital, and electronic media, such as cell phones, hotspots, tablets, headphones, wireless equipment, tapes, DVDs, CDs, video games, digital music players (MP3 players, iPods, etc.), and related items, shall be considered personal property and are subject to this Section, except as noted in subsection (c).

E) Personal computers, laptops, peripherals, and related items are covered by 59 Ill. Adm. Code 109.

4. Property maintained in each recipient's room must fit within available storage space. In addition to the storage available in each recipient's room, each recipient will be permitted a designated amount of storage for personal property and for clothing. The facility may set limits on off-unit storage in accordance with the Mental Health and Developmental Disabilities Code [405 ILCS 5/2-104]. Additional space may be made available for storage of medically-approved reasonable accommodations for a known disability.

5. If a recipient residing in a State-operated mental health facility does not agree with the decision of the facility director or designee concerning the restriction of an item, the recipient may request a review of that decision. Decisions concerning contraband or items on the restricted list in subsection (a)(1) are not subject to review.

A) All such requests shall be forwarded to the facility director or designee, who shall assign a clinician, who did not take part in the original decision, to review the decision.

B) The recipient who requested the review shall have the opportunity to speak with the clinician performing the review before a recommendation is issued. The assigned clinician shall schedule to speak with the recipient requesting the review within 10 days after being assigned. If the recipient does not wish to speak, that position shall be noted in the recommendation.

C) Within two weeks after being assigned the request to review, the clinician shall issue a recommendation, with a copy going to the recipient who requested the review, another going to the treatment team, and a third going to the facility director. The facility director shall evaluate the recommendation of the clinician and make a final decision.

6. When a recipient admitted or residing in a State operated developmental disability facility has an "Assessment of Individual Rights" by the facility director or designee to determine any needed limitation or restriction of personal property due to the recipient's judgement or lack of skills:

A) The facility director or designee's decision regarding limitations or restrictions of the recipient's personal property must be documented in the Individual Support Plan (ISP) and must be reviewed and approved by the Human Rights Committee. The "Assessment of Individual Rights" shall be reflected in the ISP.

B) If the facility director or designee incorporates restriction of the recipient's personal property into a behavior intervention program (BIP), that program must have approval of the Behavior Intervention Committee and the Human Rights Committee and the recipient's or guardian's consent, as applicable, prior to initiation of the program.

C) Emergency Restriction of Personal Property: When a situation occurs where the use or continued use, or the manner in which personal property is used, may result in harm to the recipient or to others or may infringe on the rights of others, the restriction of personal property may be implemented in accordance with the facility guidelines.

b) Use and Possession of Recipient Money in Department Facilities

1. If a recipient chooses to keep personal funds for use, those funds shall be kept in accordance with Section 110.20. If a recipient's personal funds are deposited in a facility-created trust fund account, Quarterly Reports of Individual Trust Fund transactions that are issued will be forwarded directly to the recipient or the guardian of the person or estate when issued. Treatment team members may review trust fund transactions only upon good cause and the approval of the facility director or designee.

2. A recipient may use their personal funds as the recipient chooses, provided the use of any property purchased complies with subsection (a).

A) A facility may monitor the outgoing purchases a recipient makes only if that recipient is subject to a do not call/no contact list, an order of protection, or a relevant restriction of rights issued pursuant to the Mental Health and Developmental Disabilities Code [405 ILCS 5/2-201].

B) A recipient's access to personal funds shall only be restricted if the recipient's treatment team makes a professional clinical judgment that unrestricted access creates a harm to the recipient or others. If access is restricted, a restriction of rights notice shall be completed in accordance with the Mental Health and Developmental Disabilities Code [405 ILCS 5/2-201].

C) A recipient shall be required to fill out a withdrawal form before using their personal funds held within the trust fund. The facility staff may, and must if requested, advise the recipient if property the recipient intends to purchase is not likely to be approved for use in accordance with subsection (a)(3), but prior approval shall not be required before a recipient may use their personal funds.

D) If a recipient withdraws all, or substantially all, of the money in the trust fund at one time, the treatment team shall be immediately notified. The facility director or designee may establish a minimal amount that may be withdrawn at one time that will not require notice to the treatment team notwithstanding the notification requirement.

3. Recipients may use funds at facility vending machines and at commissaries, where available. Facilities may offer a debit card or other system for such purposes.

c) Media Usage

1. For the purpose of this Section, "media" means electronic and digital media (e.g., cell phones, tablets, televisions, etc.), print media (e.g., newspapers, magazines, books, etc.), audio media (e.g., records, cassette tapes, compact discs, etc.), visual media (e.g., video tapes, video games and associated paraphernalia, DVDs, blank media (blank tape cassettes, blank video tapes, blank compact disks, etc.), media storage devices (e.g., MP3 players, iPods, etc.), digital audio files (e.g., MP3 files, iTunes, etc.), and related items. Media is a type of property and subject to the provisions of this Section.

2. DVD/CD/Video Game Usage

A) Recipient Use: Personal property approved by the facility director or designee for usage by a recipient may not be shared with any other recipient unless the second recipient is approved for such usage in accordance with subsection (a)(3).

B) Group Use: Facility staff may allow DVD/CD usage for group display/usage. In such cases, the facility director or designee shall exercise their professional clinical judgment to determine appropriate DVD/CD usage, taking into account the risk of harm to all possible users.

C) DVDs or video tapes shall not be categorically restricted on the basis of their Motion Picture Association Rating. Recipients shall be able to possess DVDs with PG-13 and R-ratings without restriction unless an individualized professional clinical judgment is made in accordance with subsection (a)(3).

D) CDs with a "Parental Advisory" warning label on them shall not be categorically restricted. Recipients shall be able to possess CDs without restriction unless an individualized professional clinical judgment is made in accordance with subsection (a)(3).

E) Video games shall not be categorically restricted on the basis of their Entertainment Software Ratings Board (ESRB) rating. Recipients shall be able to possess video games without restriction unless an individualized professional clinical judgment is made in accordance with subsection (a)(3).

3. Facility staff may only inspect the contents of a recipient's media pursuant to subsection (a)(3).

A) CDs/DVDs can be restricted pursuant to 59 Ill. Adm. Code 109.30 only if there is a facility wide determination that CDs/DVDs are dangerous objects, irrespective of their content.

B) The facility may not impose an across-the-board restriction on the possession and use of media based on its content unless that content violates the law.

d) Contraband

Notwithstanding any other Section of this Part, any property that is determined to be contraband shall not be allowed in any Department facility.

1. Contraband includes: Alcoholic beverages, any drug not dispensed by the facility, firearms, explosives, and weapons.

2. Contraband items shall be confiscated by staff of the security department and turned over to the proper authorities or destroyed.

3. "Burned" CDs/DVDs and second-hand CDs/DVDs shall not be listed as contraband or restricted items, except as provided under subsection (a)(3) or (c)(3)(A). Recipients shall be allowed to possess such items in accordance with subsection (a)(3).

4. Sexually explicit material shall not be listed as a contraband item. A recipient's access to such materials may be restricted in accordance with subsection (a)(3). Public display or sharing of sexually explicit materials may result in the confiscation and restriction of those items as provided in subsection (a)(3).

e) Restrictions on a recipient's right to possess personal property shall not be imposed as punishment, in response to a recipient declining to take medication, or in response to a failure to undergo other treatment recommended by a recipient's treatment team. However, if a recipient's clinical situation changes, the recipient's facility director or designee may reconsider the possession of property in accordance with this Section.

f) This Section applies to all adult recipients admitted to a Department facility.

g) The facility shall conduct training on a frequency determined by facility administration on this Section and a written record of such training shall be made.

History

• Source: Amended at 49 Ill. Reg. 14118, effective October 9, 2025

Chapter I Department of Human Services

Part 111 Recipient Rights

59 Ill. Adm. Code 111.10 Nondiscrimination on the Basis of Handicap in the Delivery of Services Under Section 504 of the Rehabilitation Act of 1973 (29 Usca 701 Et Seq., 1982) (repealed)

History

• Source: Repealed at 24 Ill. Reg. 7730, effective May 12, 2000

59 Ill. Adm. Code 111.20 Services to Individuals Who Are Deaf, Hard-of-Hearing, Deaf-Blind, Deafened and/or Use Manual/Visual Communication

All individuals receiving services shall be provided with adequate and humane care and services pursuant to an individualized service (treatment or habilitation) plan in accordance with Sections 2-102(a), 3-209, and 4-309 of the Code. Individuals who are deaf, hard of hearing, deaf-blind, or deafened (i.e., experiencing hearing loss and/or using manual or visual communication) shall not be excluded from facility participation, be denied facility benefits, or be subjected to any form of discrimination [405 ILCS 5/2-102(a), 3-204, 3-205, and 4-205].

a) Definitions

For the purposes of this Section, the following terms are defined:

"Auxiliary Aids and Services." See definition for auxiliary aids and services in the Code of Federal Regulations (28 CFR 36.303) and the Americans with Disabilities Act (42 U.S.C. 12103(1)).

"CART (Computer Aided Realtime Translation) reporting services." The verbatim translation of the spoken word into a visually enhanced format from a stenotype machine to a computer.

"CART reporter." A certified shorthand reporter licensed by the Department of Financial and Professional Regulation under the Illinois Certified Shorthand Reporters Act of 1984 [225 ILCS 415] or a registered professional reporter licensed by the National Court Reporters Association.

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Communication facilitation." The means provided to overcome a barrier in communication created because an individual has a hearing loss and/or uses manual or visual communication, e.g., interpreter services, CART reporting services, or mental health or developmental disability services, and deafness professional services.

"Deaf." Any person with hearing loss as described in 225 ILCS 443/10.

"Deaf-blind." Any person with hearing loss as described in 225 ILCS 443/10 and a visual impairment with best corrected visual acuity of 20/70 or poorer in the better eye or a contraction of the visual field of 20 degrees or less in the better eye.

"Deafened." Any loss of hearing, occurring at any age after spoken language was acquired, that precludes processing of linguistic information through audition, with or without a hearing aid.

"Department." The Illinois Department of Human Services (DHS).

"Facility." Any mental health or developmental disability facility, as defined by Sections 1-107 and 1-114 of the Code.

"Hard-of-hearing." Any person with hearing loss as defined by 225 ILCS 443/10.

"Individual." A recipient of mental health or developmental disabilities services, as defined by Sections 1-111 and 1-128 of the Code.

"Interpreter." A sign language interpreter for the deaf or any person defined as an interpreter by Section 10 of the Interpreter for the Deaf Licensure Act of 2007 [225 ILCS 443].

"Manual or visual communication." Using the hands, body, or facial expressions as the primary modalities for communication, which may include and not be limited to American Sign Language, signed English, fingerspelling, pantomime, gestures, lip or speech reading, tactile fingerspelling or signs, reading, or writing.

"Mental health or developmental disability and deafness professionals." Mental health or developmental disability professionals, e.g., psychiatrists, psychologists, social workers, psychiatric nurses, speech and language pathologists, and other mental health or developmental disability professionals with intermediate or advanced expertise in manual or visual communication modes and languages and knowledge of culture and psychosocial aspects of individuals who have hearing loss.

"Preferred mode of communication." Any mode of visual or auditory communication used by an individual with hearing loss to express themselves or comprehend others' communication, such as American Sign Language or writing.

"Statewide Accessibility and Accommodation Coordinator." The Department's Statewide Accessibility and Accommodation Coordinator of Services for People who are Deaf, Hard of Hearing, or Deaf-Blind.

b) Services for individuals with hearing loss

1. Intake and admission

A) The intake staff shall conduct an initial assessment to ascertain whether an individual presenting for admission has a hearing loss. This assessment shall include identifying the type and degree of hearing loss based on the available information at the time and whether the individual requires manual or visual communication. This information shall be documented on the "Clinical Record Face Sheet" or the facility's intake form.

B) Each facility shall maintain a list of interpreters, CART reporters, and mental health or developmental disability deafness professionals employed by, or under contract to, the facility. The list shall have each interpreter's licensure level. The facility director shall be responsible for distributing the list to the appropriate facility staff and updating it at least annually. These lists shall be submitted to the Statewide Accessibility and Accommodation Coordinator.

C) Facility staff, with the assistance, if necessary, of family members or friends of the individual who use the individual's preferred mode of communication, shall inform the individual that an interpreter, CART reporters (to facilitate communication), and/or mental health or developmental disability and deafness professionals (to consult) have been contacted and the expected time of arrival. Facility staff (unless licensed under the Interpreter for the Deaf Licensure Act of 2007), family members, or friends of the individual shall not interpret. A qualified licensed interpreter or CART reporter shall be used during the individual's intake, assessment, and evaluation, when information is being conveyed to the individual regarding admission, discharge, transfer, or the right to object thereto, the explanation of the individual's rights, when being examined for involuntary admission or certification, while being interviewed or tested by a psychologist, psychiatrist, or physician, during therapy, or whenever necessary to provide effective treatment or habilitation services to the individual. Unless preferred by the individual, writing is not an acceptable substitute for an interpreter or CART reporter.

D) If communication facilitation is necessary in order to determine whether the individual meets the admission criteria, or to complete the admission, discharge, or transfer process, it shall be obtained preferably within 12 hours, but not later than the time limits prescribed by Sections 3-503, 3-504(f), 3-604, 3-607, 3-610, 3-704(a), 4-300, 4-402(a), and 4-405 of the Code. The services of an interpreter or CART reporter shall be available to the facility 24 hours per day, seven days per week. This requirement may be met by contracting with a person or agency for services, as needed. The facility shall pay for the cost of the interpreter or CART reporter.

E) The Statewide Accessibility and Accommodation Coordinator shall assist any facility, on request, in obtaining the services of an interpreter or a CART reporter.

2. Treatment or habilitation services

A) Interpreter services, CART reporting services, and/or the services of mental health or developmental disability and deafness professionals as determined by the interdisciplinary team, shall be made available to individuals or staff who have hearing loss and/or use manual or visual communication such as signed English or American Sign Language.

B) Facilities shall provide appropriate services and/or treatment to individuals who have hearing loss and/or use manual or visual communication and the appropriate auxiliary aids and services to allow such individuals to benefit from the services and/or treatment. The Statewide Accessibility and Accommodation Coordinator shall be contacted to provide assistance to facilities to develop and provide appropriate services for these individuals. Treatment or habilitation programs for individuals who have hearing loss and/or use manual or visual communication may include arrangements made by the facility with other facilities, private clinicians, or other community providers (e.g., hospitals, clinics, Department-funded agencies) that can meet the individual's treatment or habilitation needs.

C) Individuals who have hearing loss and/or use manual or visual communication shall be provided with, for example, video phones, captioned phones, phone amplifiers, and/or telebraille devices, whichever is appropriate, to ensure their right to private telephone communication as provided by Section 2-103 of the Code. Visual and tactile life-safety alerting devices including, but not limited to, wake-up alarms (lights and/or vibrators) and fire alarms (lights and/or vibrators) shall be installed or made available, where necessary.

D) As a part of the quality assessment and improvement program, facilities shall have a written compliance plan for individuals who have hearing loss and/or use manual or visual communication. This plan shall include, but not be limited to:

i) Designated staff responsible for implementing, monitoring, and evaluating the plan;

ii) A list of interpreters, CART reporters, and mental health or developmental disability and deafness professionals employed by, or contracted to, the facility, their skill level in American Sign Language, and any licenses or certifications they hold; and

iii) Training for staff on the unique aspects of providing services to individuals who have hearing loss and/or use manual or visual communication and procedures to assist the individual in filling out a complaint form.

3. Clinical records documentation. Provision of interpreters, CART reporters, mental health or developmental disability and deafness professionals, special equipment, and other support services shall be documented in the intake and treatment summaries.

History

• Source: Amended at 49 Ill. Reg. 8228, effective May 30, 2025

59 Ill. Adm. Code 111.25 Services to Individuals in Department Facilities Who Are Non-English or Limited-English Speaking

All individuals in Department facilities shall be provided with adequate and humane care and services pursuant to an individualized service (treatment or habilitation) plan in accordance with Sections 2-102(a), 3-209, and 4-309 of the Code. In accordance with Sections 2-102(a), 3-204, 3-205, and 4-305 of the Code, no individual shall, on the basis of an inability to communicate in the English language, be denied the benefits of, or be subjected to discrimination by, a Department facility.

a) Definitions

For the purposes of this Section, the following terms are described:

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Department." The Department of Human Services.

"Individual." A recipient of mental health or developmental disabilities services, as defined by Sections 1-111 and 1-128 of the Code.

"Interpreter." A person fluent in English and in the native language of the recipient who can accurately speak, read, and readily interpret the necessary second language. This interpreter shall be approved by the Department's Statewide Accessibility and Accommodation Coordinator of Services for People who are Non-English or Limited-English Speakers.

"Limited-English speaker." A person whose English vocabulary consists of 100 to 400 words. Such a person has usually mastered most expressions necessary to function marginally in an English speaking environment. However, words used to express feelings and other emotionally charged material are lacking.

"Non-English speaker." A person who has no command or understanding of the English language.

"Qualified staff." Mental health or developmental disability professionals, e.g., psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health or developmental disability paraprofessionals who meet the definition of interpreters, as defined in this subsection (a).

b) Service provision

1. Prior to admission or during the admission process, intake staff shall determine whether a person presenting for admission is a non-English or limited-English speaker and, if so, the person's native language. Intake staff shall document interpreter services required on the intake and treatment summaries. The provision of the interpreter services shall be defined as a part of active treatment.

2. Interpreter services in the individual's native language shall be available in accordance with Sections 3-204, 3-205, and 4-205 of the Code for the treatment or habilitation staff to provide services to non-English or limited-English speaking individuals. Staff shall document in the individual's clinical record that an interpreter was used to provide information.

3. Each facility shall maintain a list of interpreters employed by or under contract to the facility and what language(s) they speak. In addition, each facility shall maintain a list of community interpreter resources. The facility director shall be responsible for distributing the list to the appropriate staff and updating it at least annually.

4. Facilities shall provide interpreters during admission, when denying admission, during intake, or specifically during all assessments or evaluations while the individual is being interviewed or tested by a psychologist, psychiatrist, or physician. Additionally, interpreters are to be used during therapy, when care and treatment information is being conveyed, when information is being conveyed regarding the individual's discharge, transfer, objection to discharge or transfer, or the individual's rights, when the individual is being examined for involuntary admission or certification at the request of the individual's family or guardian, or whenever necessary to provide effective treatment or habilitative services to the individual.

5. Qualified staff who speak the individual's native language may be used as interpreters or the facility may contract for the services of interpreters. The facility shall pay for the cost of the interpreters. Family members of the individual shall not be used as interpreters. Family members may inform the individual that an interpreter has been contacted and the expected time of arrival. The family may participate in the intake and treatment process with the interpreter provided by the facility.

c) Facility plan

Facilities shall establish a written implementation, monitoring, and evaluation plan for interpreter services to non-English and limited-English speaking individuals. This plan, which shall be a part of the facility quality assessment and improvement program, shall include, but not be limited to, the following areas:

1. Designation of personnel within the facility responsible for implementing the plan, monitoring the provision of interpreter services, and conducting an annual evaluation of services provided;

2. Establishing a list of interpreters on the facility's staff or on contract from the community, the languages they speak, and their availability. In addition, ensure that postings that advise individuals and their families of the availability of interpreters, the procedures for obtaining interpreters, and the telephone number to call to file a complaint are posted in conspicuous places in the facility;

3. Defining an effective process to implement the Department's procedures for identifying the individual's level of functioning in English and the individual's native language and accurately recording this information in the individual's clinical record and the Department's data systems and based on new assessments or information updating them as indicated; and

4. Training facility staff in the unique aspects of providing services to individuals who are non-English or limited English-speaking and in procedures to assist the individual in submitting the complaint form.

History

• Source: Amended at 49 Ill. Reg. 8228, effective May 30, 2025

59 Ill. Adm. Code 111.30 Voter Registration for Service Applicants (repealed)

History

• Source: Repealed at 23 Ill. Reg. 7496, effective June 17, 1999

Part 112 Treatment and Habilitation Services

59 Ill. Adm. Code 112.5 Incorporation by Reference

Any rules or standards 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.

History

• Source: Added at 21 Ill. Reg. 2210, effective February 1, 1997

59 Ill. Adm. Code 112.10 Utilization Review Hearings

a) Utilization review hearings shall be conducted in accordance with Sections 3-207, 3-405, 3-903, 3-910, 4-209, 4-312, 4-704 and 4-709 of the Code. When a person who is evaluated as being mildly or moderately mentally retarded, resides in a Department mental health facility and objects to the facility director's certification of the treatment and habilitation plan or the appropriateness of the setting, a utilization review hearing shall be conducted in accordance with Section 112.20(g). b) Definitions

"Aftercare." The continuation of needed care and services of a recipient discharged from a state-operated facility within an appropriate setting with individualized follow-up services.

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Day." As used in this Section and in Section 112.20 means calendar day unless otherwise indicated.

"Department." The Department of Human Services.

"Discharge." The full release of any person admitted under the provisions of the Code, or transferred under the provisions of Sections 3-8-5, 3-8-6, 3-10-5 and 3-10-6 of the Unified Code of Corrections [730 ILCS 5/8-5, 8-6, 10-5 and 10-6] for treatment or habilitation.

"Facility Director." The director or hospital administrator of a mental health or developmental disabilities facility.

"Guardian." The plenary guardian of the person or limited guardian of the person with specific court authority to make mental health decisions on the person's behalf. (Section 11a-14 of the Probate Act of 1975 [755 ILCS 5/11a-14].) It does not include a guardian ad litem or person in loco parentis or with power of attorney.

"Guardian ad litem." A person appointed by the court to defend or represent the interests of a minor or alleged legally disabled during a guardianship proceeding or in other matters. This person has no right to interfere with the minor's or alleged legally disabled person or estate.

"In loco parentis." Any individual, other than a parent or legal guardian, who has the primary functional responsibility of providing food, shelter, medical care and education to a minor.

"Person subject to involuntary admission." A person who is mentally ill and who because of his or her illness:

is reasonably expected to inflict serious physical harm on him/herself or another in the near future; or

is unable to provide for his or her basic physical needs so as to guard himself or herself from serious harm. (Section 1-119 of the Code)

"Responsible relative." The spouse or, if the recipient is under 18 years of age, the parent of a recipient of services. (Section 1-124 of the Code)

"Secretary." The Secretary of the Department of Human Services or his or her designee, or the Manager of the Office of Clinical Services when applicable pursuant to Section 1-108 of the Code.

"Transfer." The movement of a recipient from one Department facility to another Department facility or to a Veterans' Administration facility. This does not include movement from a Department facility to a non-Department facility (other than to a Veterans' Administration facility) or movement between separate units or discrete portions of the same facility. It also does not include the discharge of a recipient.

c) Notice requirements

1. Notice of denial of admission

Whenever a person seeking admission to a Department facility is denied admission by the facility, the person shall be given within two hours written notice of his or her right to request a review of the denial of the facility's decision on the Notice of Denial of Admission and Right to Request Review form.

2. Notice of non-emergency transfer

A) Whenever a recipient who has been in a Department facility for more than seven days is to be transferred to another facility, the facility director shall give written notice of the proposed transfer on the "Notice of Transfer" form, to the persons identified in Sections 4-206 and 4-709 of the Code at least 14 days prior to the scheduled transfer.

B) Notice of transfer and the right to object shall be given to recipients being transferred to the Chester Mental Health Center even when such recipients have been in the Department facility for less than seven days and to the adult recipient's attorney, guardian, if any, and responsible relative and to the minor recipient's attorney, parent, guardian or person in loco parentis who executed the application for admission in accordance with Section 3-910 of the Code. Except in an emergency, as specified in subsection (c)(3) of this Section, no transfer shall proceed pending the facility director's decision or any administrative or judicial review of that decision which is permitted by law. (See subsection (e)(3) for waiver provisions.)

3. Notice of emergency transfer

In an emergency, when the health of the recipient or the physical safety of the recipient or others is imminently imperiled and appropriate care and services are not available where the recipient is located, a recipient shall be transferred to another facility as soon as transfer arrangements can be made, provided that notice is given in accordance with subsection (c)(2) of this Section, as soon as possible but not later than 48 hours after the transfer. If an emergency transfer cannot be effected within 48 hours after the decision to transfer, the transfer shall proceed only as a non-emergency transfer with prior written notice of the right to object as provided in Sections 3-910 and 4-709 of the Code and subsection (c)(2) of this Section.

4. Notice of discharge

A) Recipient in a mental health facility

i) Adult – Notice shall be given to the adult recipient, the recipient's attorney, and guardian, if any, on the "Notice of Discharge" form, at least seven days prior to the date of intended discharge.

ii) Minor – Notice shall be given to his or her attorney, his or her parent, guardian, or person in loco parentis who executed the application for admission, and to the minor if he or she is 12 years of age or older, on the "Notice of Discharge" form, at least seven days prior to the date of intended discharge.

B) Recipient in a developmental disabilities facility

i) Notice shall be given at least 14 days prior to the date of discharge.

ii) Notice shall be given on the "Notice of Discharge" form, to the recipient, if he or she is 12 years of age or older, to the recipient's attorney and guardian, if any, to the person who executed the application for admission and to the resident school district if the recipient is receiving educational services.

C) Discharge pending a hearing or review

No discharge shall proceed pending the facility director's decision or any administrative or judicial review of that decision which is permitted by law, except that persons temporarily admitted under Section 4-311 of the Code shall not stay beyond 30 days plus the additional time up to the hearing.

5. Notice contents

A) All notices for transfers or discharge shall include:

i) The reasons for the transfer or discharge;

ii) A statement of the right to object; and

iii) The address and telephone number of the Guardianship and Advocacy Commission.

B) All notices of denial of admission shall include:

i) A statement of the right to request a review of the denial; and

ii) The address and telephone number of the Guardianship and Advocacy Commission.

C) If the recipient's or guardian's primary language is not English or if the recipient or guardian is hearing impaired and/or vision impaired, arrangements must be made to provide for an adequate explanation in the person's primary language in accordance with the Department's rule at 59 Ill. Adm. Code 111.20 or preferred method of communication of the recipient's right to request a review. Arrangements will be made to secure the services of an interpreter who is fluent in the recipient's or guardian's primary language to explain the notice to the recipient or guardian.

6. Manner of service of notices

All notices required by Sections 3-405(a), 3-903(a), 3-910, 4-312(a), 4-704(a) and 4-709 of the Code shall be served personally on the recipient and/or objector whenever possible. A copy of the notice, signed by the recipient in acknowledgment of service, shall be placed in the recipient's clinical record. When personal service is not possible, first class mail shall be used to serve notice on the recipient and/or objector and any other person entitled to receive notice.

7. Aftercare and case coordination

Aftercare and case coordination shall be provided to all discharged and conditionally discharged recipients in accordance with the Department's rules at 59 Ill. Adm. Code 125 (Recipient Discharge/Linkage/Aftercare).

d) Requests for review of denial of admission

1. To a mental health facility

A) Adult – A review of a denial of admission may be requested by the person seeking admission or, with the person's consent, by an interested person on his or her behalf.

B) Minor – The request may be made by the minor's attorney, by his or her parent, guardian or person in loco parentis who executed the application for admission, or by the minor if the minor is 16 years of age or older.

2. To a developmental disabilities facility

A review of the denial of admission may be requested by the person who executed the application for admission or by the attorney or guardian of the person for whom admission is sought.

3. Manner of requesting review

The request for review must be submitted, in writing, to the facility director of the facility to which admission was sought within 14 days after the denial. Facility staff shall notify the recipient or other persons requesting review that staff are available to assist in contacting the Guardianship and Advocacy Commission and to prepare a written request for review of a denial of admission.

4. Admission pending review

An individual requesting review of admission denial does not have a right to admission pending the outcome of the hearing and review.

e) Objection to a transfer or discharge

1. Transfer of a recipient

A) Adult recipient in a mental health facility

A recipient may object to his or her transfer or the recipient's attorney, guardian, or responsible relative may object on the recipient's behalf.

B) Minor recipient in a mental health facility

The minor's attorney, the person who executed the application for admission, or the minor, if the minor is 12 years of age or older, may object to the transfer.

C) Recipient in a developmental disabilities facility

A recipient may object to his or her transfer or any person entitled to receive notice under subsection (c)(2) of this Section, may object on the recipient's behalf.

D) Manner of making an objection

An objection to a transfer must be submitted, in writing, prior to the transfer or within 14 days after an emergency transfer to the facility director of the facility where the recipient is located. Facility staff shall notify the recipient or other persons objecting to a transfer that staff are available to assist in contacting the Guardianship and Advocacy Commission and to prepare a written objection to a transfer.

2. Discharge of a recipient

A) In a mental health facility

i) Adult – A recipient may object to his or her discharge or the recipient's attorney or guardian may object on the recipient's behalf.

ii) Minor – The minor's attorney, the person who executed the application for admission, or the minor, if the minor is 12 years of age or older, may object to the discharge.

B) In a developmental disabilities facility

The recipient, if he or she is 12 years of age or older, may object to the discharge or conditional discharge, or the recipient's attorney or guardian, or the person who executed the application for admission, may object on the recipient's behalf.

C) Manner of making an objection

All objections to a discharge must be submitted, in writing, to the facility director of the facility where the recipient is located prior to the discharge. Facility staff shall notify the recipient or other persons objecting to a discharge that staff are available to assist in contacting the Guardianship and Advocacy Commission and to prepare a written objection to a discharge.

3. Waiver of hearing

A) Any person entitled to request a hearing regarding a denial of admission, a discharge or a transfer may waive his or her hearing thereon. If a legally competent adult recipient or legal representative on the recipient's behalf waives his/her hearing, a request for a hearing made by another person will not be honored.

B) A waiver shall be deemed effective only if all of the following conditions are satisfied:

i) The person has been advised of his or her rights to object and to have a hearing;

ii) The person has been advised of and understands the consequences of waiving such hearing; and

iii) The person has expressed his or her waiver of the hearing in writing.

C) All waivers shall be filed in the recipient's medical record along with the notice. The record should:

i) Reflect that the recipient was advised and understood the consequences of the waiver; and

ii) Indicate who made the decision that the recipient understood the consequences of the waiver.

D) When a waiver of a hearing has been made in accordance with subsection (e)(3)(B)(iii) of this Section, the Department may proceed to implement its transfer or discharge.

E) If the person, or legal representative on that person's behalf, withdraws the waiver prior to the expiration of the 14-day period for transfer or the seven-day period for discharge, such action shall be considered a formal objection and a hearing shall be scheduled. The responsibility for the hearing shall be with the transferring or discharging facility.

f) The utilization review committee

Each Department facility director shall recommend individuals to serve on a utilization review committee(s) in accordance with Sections 3-207 and 4-209 of the Code to hear requests for review and objections received under the Code. The recommendations shall be sent to the Secretary or his or her designee for approval or denial.

1. The committee shall consist of at least three and not more than seven members, who shall represent at least two different professional clinical disciplines, trained and equipped to deal with the recipient's clinical and treatment needs (for persons with mental illness) or habilitation needs (for persons with developmental disabilities) or both types of needs for those persons with dual diagnosis in accordance with Section 112.20(g)(3). Clinical disciplines include psychiatry, psychology, medicine, nursing, social work, or the other disciplines that qualify a person to be a qualified mental retardation professional, as defined in Section 112.20(d).

A) The committee membership may be permanent or rotating, at the facility director's discretion and must be approved by the Secretary; or

B) The facility director shall not recommend himself/herself or designee, or any staff member involved in the decision to admit, transfer or discharge the recipient to be a committee member or to participate in the committee's decision on any request for review or objection.

2. The facility director, or at the facility director's discretion, the committee, shall appoint, from the committee's membership, a chairperson who shall have the duties and responsibilities as set forth in subsection (g)(2)(A) of this Section.

g) The utilization review hearing

1. General provisions

A) Scheduling the hearing

Upon receipt of a request for a review or an objection, the facility director shall schedule a hearing to be held at the facility within seven working days. If the hearing is to review an objection to a transfer, the hearing shall be held at the transferring facility. When an emergency transfer has taken place, the hearing will be held at the receiving facility, provided that the hearing may be held at the transferring facility when the facility director of the receiving facility finds that either of the parties would not be able to completely present witnesses or evidence at a hearing at the receiving facility within the specified time.

B) Notice of hearing

The recipient and objector, and the representative or attorney of each, shall be informed, in writing, of the time, place and date of the hearing either personally or by first class mail at least 72 hours before the hearing.

C) Continuances

The committee chairperson, at his or her sole discretion, may grant a continuance of the hearing at the request of the Department or the recipient or objector if he or she determines that a continuance would not adversely affect the rights of either of the parties to present evidence and witnesses.

D) Representative

The recipient and objector may be represented at the hearing by any person of his or her choice, subject to the provisions of subsection (g)(2)(A)(iv) of this Section.

E) Witnesses

The Department and the recipient and objector may present evidence orally and in writing and may present argument. The facility director or designee shall appoint one or more persons to present the Department's case at the hearing.

F) Right to be present

Unless waived by the recipient or his or her attorney, the recipient or the objector (if not the recipient) has the right to be present at the hearing as well as responsible relatives and other interested persons designated by the recipient.

2. Hearing procedures

A) Duties of the chairperson

The chairperson is responsible for the orderly conduct of the utilization review hearing. He or she shall conduct the hearing so that both the facility and the objector are allowed to present their evidence and arguments completely. To these ends, the chairperson has the following authorities and responsibilities, including, but not limited to:

i) Requiring the Department to present its evidence prior to hearing evidence from the recipient or objector;

ii) Prescribing the order of presentation within the Department's or objector's presentation to accommodate witnesses' schedules or respond to inquiries from committee members;

iii) Terminating the taking of testimony when the committee is satisfied that both parties have presented all relevant information related to the facility's decision;

iv) Declaring an individual ineligible to represent the recipient or objector due to his or her employment by the Department. If the chairperson declares an individual ineligible, he or she shall give the recipient an opportunity to secure a substitute within seven days. This shall not be used to prevent a Department employee from testifying on behalf of the recipient;

v) Taking official notice on the record of generally recognized technical, scientific or clinical facts within the Department's specialized knowledge;

vi) Insuring that a complete and accurate record of the hearing is made by an audio tape or stenographic recording;

vii) Insuring that the committee's findings of fact, conclusions and recommendations are in compliance with subsection (i)(2) of this Section.

B) Evidence

i) The committee shall not be bound by the rules of evidence or procedure, but shall conduct the proceedings in a manner that insures both parties are allowed to present their evidence and arguments completely.

ii) When the hearing will be expedited and the interests of the parties will not be prejudiced, all or any part of the evidence may be received in written form if disclosed to all other parties, at least two days, excluding weekends and holidays, prior to the hearing.

iii) Any party or representative may ask questions of any other party or witness, and the committee may ask questions of any party or witness. Questions impeaching the witnesses' character or credentials shall be prohibited.

iv) If the chairperson takes notice of any generally recognized technical, scientific, or clinical facts within the Department's specialized knowledge, he or she shall so inform the recipient and objector and shall afford them an opportunity to contest the material so noticed. The committee may use the Department's experience, technical competence and specialized knowledge in its evaluation of the evidence.

h) Standards

1. For denial of admission to a mental health facility

A) Informal and voluntary

The person may be denied admission if he or she is not clinically suitable for admission. This standard applies to all persons age 16 years or older who have executed their own application for admission. (See Sections 3-300(a), 3-400 and 3-502 of the Code.)

B) Application for a minor executed by his or her parent(s), guardian or person in loco parentis

The minor may be denied admission if the minor:

i) Does not have a mental illness or emotional disturbance; or

ii) Does not have a mental illness or emotional disturbance of such severity that hospitalization is necessary; or

iii) Has a mental illness or emotional disturbance of such severity that the minor's hospitalization is necessary but the minor is unlikely to benefit from inpatient treatment. (See Section 3-503(a) of the Code.)

C) Application for a minor is executed by another person 18 or older

The minor may be denied admission if those conditions listed in subsection (h)(1)(B) of this Section are present or if the minor is not in such condition that immediate hospitalization is necessary. (See Section 3-504(a) of the Code.)

2. For denial of admission to a developmental disabilities facility

A) Administrative admission

A person may be denied admission if he or she is not clinically suitable for admission. (See Section 4-302 of the Code.)

B) Temporary admission

A person may be denied admission if:

i) He or she is not developmentally disabled; or

ii) The parent or guardian will not benefit from respite care; or

iii) There is no crisis which necessitates immediate temporary residential services. (See Section 4-311 of the Code.)

3. For transfer from a mental health facility

A) All transfers occurring more than seven days after admission

The facility director may transfer a recipient if the transfer is clinically advisable and consistent with the recipient's treatment needs as defined by the recipient's individual treatment plan. (See Section 3-908 of the Code.)

B) Emergency transfers

A recipient may be transferred as soon as the transfer can be arranged when the health of the recipient or the physical safety of the recipient or others is imminently imperiled and appropriate care is not available at the facility where the recipient is located. (See Section 3-910(b) of the Code.) If an emergency transfer cannot be effected within 48 hours after the decision to transfer, the transfer shall proceed only as a non-emergency transfer with prior written notice of the right to object as provided in Section 3-910 of the Code and subsection (c)(2).

C) Transfer to a more restrictive facility

A recipient may be transferred if the transfer is clinically advisable and consistent with the recipient's treatment needs as defined by the recipient's individual treatment plan and is required for the safety of the recipient or others. (See Sections 3-908 and 3-910(d) of the Code.)

D) Transfer of minors to adult units

A minor recipient may be placed in the same unit with adult recipients if:

i) The placement is to a medical unit because of a physical illness; or

ii) The minor recipient is between 13 and 18 years of age and temporary security measures are needed. (See Section 7 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/7].)

4. For transfer from a developmental disabilities facility

A) All transfers occurring more than seven days after admission

The facility director may transfer a recipient if the transfer is appropriate and consistent with the recipient's habilitation needs as defined by the recipient's individual habilitation plan. A facility which is close to the recipient's place of residence shall be preferred unless the recipient requests otherwise or unless compelling reasons exist for preferring another facility. (See Section 4-707 of the Code.)

B) Emergency transfers

A recipient may be transferred as soon as the transfer can be arranged when the health of the recipient or the physical safety of the recipient or others is imminently imperiled and appropriate care and services are not available at the facility where the recipient is located. (See Section 4-709(a) of the Code.) If an emergency transfer cannot be effected within 48 hours after the decision to transfer, the transfer shall proceed only as a non-emergency transfer with prior written notice of the right to object and provided in Section 4-709 of the Code and subsection (c)(2) of this Section.

C) Transfers to a more restrictive facility

A recipient may be transferred if the transfer is appropriate and consistent with the recipient's habilitation needs as defined by the recipient's individual habilitation plan and the transfer is reasonably required for the safety of the recipient or others. (See Sections 4-707 and 4-709(c) of the Code.)

D) Transfer of minors to adult units

A minor recipient may be placed in the same unit with adult recipients if:

i) The placement is to a medical unit because of a physical illness; or

ii) The minor recipient is between 13 and 18 years of age and temporary security measures are needed. (See Section 7 of the Mental Health and Developmental Disabilities Administrative Act.)

5. For all discharges

For all discharges, the Department must not only prove by evidence offered at the hearing that the standards cited in subsections (f)(6) and(7) of this Section have been met, but must also determine and have in writing the determination that the recipient to be discharged is not currently in need of hospitalization and:

A) Is able to live independently in the community; or

B) Requires further oversight and supervisory care for which arrangements have been made with responsible relatives or a supervised residential program approved by the Department; or

C) Requires further personal care or general oversight as defined in the Nursing Home Care Act [210 ILCS 45], for which placement arrangements have been made with a family home or other licensed facility approved by the Department under Section 15 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15].

6. For discharges from a mental health facility

A) Voluntary, informal or minor admissions

The facility director may discharge any voluntary, informal or minor recipient who is clinically suitable for discharge. (See Section 3-902(a) of the Code.)

B) Involuntary admissions

The facility director shall discharge any recipient who is admitted on a court order for involuntary admission when the recipient is no longer subject to involuntary admission, unless voluntary admission is requested and the recipient is clinically suitable. (See Sections 1-119 and 3-902(b) of the Code.)

C) Transfers from Department of Corrections

The facility director shall release to the Department of Corrections any recipient transferred to the Department from the Department of Corrections under the provisions of Sections 3-8-5, or 3-10-5 of the Unified Code of Corrections when the recipient is no longer subject to involuntary admission, if he or she is 18 or older, or if the recipient no longer meets the standard for admission of a minor to a mental health facility if he or she is 17 or younger. (See Sections 3-8-6 or 3-10-6 of the Unified Code of Corrections.)

7. For discharges from a developmental disabilities facility

A) Administrative and temporary admissions

The facility director may discharge any recipient who is suitable for discharge. (See Section 4-701(a) of the Code.)

B) Conditional discharge

The facility director may grant a conditional discharge to a recipient when conditional discharge is appropriate and consistent with the recipient's habilitation needs. (See Section 4-702(a) of the Code.)

C) Judicial admissions

A recipient admitted to a facility upon court order for judicial admission may be discharged when the recipient no longer meets the standard for judicial admission, unless administrative admission is requested and the recipient is clinically suitable. (See Sections 4-500 and 4-701(b) of the Code.)

D) Transfers from Department of Corrections

The facility shall release to the Department of Corrections any recipient transferred to the Department from the Department of Corrections under the provisions of Sections 3-8-5, or 3-10-5 of the Unified Code of Corrections when the recipient no longer meets the standard for judicial admission, if he or she is 18 or older, or if the recipient is suitable for administrative admission to a developmental disability facility, if he or she is 17 or younger. (See Sections 3-8-6 or 3-10-6 of the Unified Code of Corrections.)

i) The committee's findings of fact, conclusions and recommendations

1. Within three working days after the conclusion of the utilization review hearing, the committee shall submit to the facility director its written findings of fact, conclusions and recommendations. The committee shall not consider or decide questions of law.

2. Findings of fact, conclusions and recommendations shall be separately stated and so labeled. Findings of fact shall be based exclusively on the evidence and on matters officially noticed. The Department has the burden of proof in all utilization review hearings.

A) Findings of fact

To conclude that the Department has sustained its burden of proof, the committee must find that the Department has established the facts by substantial evidence. Substantial evidence is such evidence as a reasonable person can accept as adequate to support a conclusion (i.e., consists of more than a scintilla of evidence but somewhat less than a preponderance).

B) Conclusions and recommendations

i) If the committee finds that the Department has established the facts by substantial evidence, it shall make its written conclusion that the decision was based on substantial evidence and shall recommend that the decision be upheld.

ii) The committee shall recommend that the decision be overturned if it concludes that the Department has not sustained its burden of proof.

C) Manner of service of the committee's recommendations

A copy of the committee's recommendations, with its factual findings and conclusions, shall be given to the recipient and objector at the time the recommendations are submitted to the facility director. Service may be made either personally or by certified first class mail.

j) Facility director decision

The facility director shall review the committee hearing record to determine if the evidence supports the committee's findings of fact, conclusions and recommendations. The facility director shall not consider or decide issues of law nor participate in reviewing the committee's recommendations in those instances in which the facility director made the original decision which was appealed. In such circumstances, the facility director shall appoint a designee to review the committee's findings, conclusions and recommendations.

1. Decision

Within seven days, excluding Saturdays, Sundays and holidays, after receipt of the committee's recommendations, the facility director shall either accept or reject the recommendations and shall state the reasons for accepting or rejecting the recommendations. The facility director shall provide a concise statement explaining the bases for his or her decision.

2. Manner of service of notice

The facility director shall give written notice using the "Notice of Facility Director's Decision" form, either by personal delivery or by certified first class mail, to the recipient and objector and their attorneys or representatives within the seven days specified in subsection (j)(1) of this Section.

3. Right to review

A) The facility director shall, in every case, advise the recipient and objector that if further review of his or her decision is desired, it may be obtained by requesting review by the Secretary, in writing to the facility director, within seven working days of receipt of the decision.

B) If the facility director rejects the committee's recommendations or if the recipient or objector requests a review of the facility director's decision, the facility director shall forward a copy of his or her decision, the committees' recommendations and the hearing record to the Secretary, within two working days.

k) Review by the Secretary

1. How requested

Whenever a recipient or objector requests that the Secretary review the facility director's decision, such request must be in writing, either to the facility director or the Secretary. The person submitting the request must state the reasons he or she believes that the facility director's decision is incorrect.

2. Time for request

The person submitting the request for review must submit it within seven days after receipt of the facility director's decision. If he or she does not submit a request for review within this period, the facility director's decision shall be deemed final and reviewable in accordance with the Administrative Review Law [735 ILCS 5/Art. III].

3. Scope of the review

The Secretary's review shall extend to all questions of law and of fact presented by the entire record of the utilization review hearing and the facility director's decision. The Secretary shall not consider any additional evidence. The committee's findings and conclusions on questions of fact shall be presumed to be true and correct.

4. The Secretary's authority

The Secretary shall, in reviewing any facility director's decision, have the authority, if he or she deems it necessary to reach a decision as to any question of fact or law based on the complete record:

A) To dismiss a request for review as moot or not ready for adjudication;

B) To approve or disapprove the facility director's decision in whole or in part;

C) To reverse and remand the facility director's decision in whole or in part and, in such case, to state the questions requiring further hearing or proceedings and to give such other instructions as deemed proper;

D) To remand the committee for the purpose of taking additional evidence when from the state of the record of the hearing, it shall appear that such is necessary to resolve the issues raised at the hearing.

5. Manner of service of decision

The Secretary's decision shall be served on the recipient and objector and their attorneys or representatives, either by personal delivery or by certified first class mail, addressed to the recipient and objector at his or her last known address no later than 30 days after the person has submitted the request for the review.

6. Final administrative decision

The Secretary's decision shall constitute the Department's final administrative decision and no application for rehearing will be entertained. The decision is then reviewable in accordance with the Administrative Review Law.

History

• Source: Amended at 23 Ill. Reg. 10327, effective August 10, 1999

59 Ill. Adm. Code 112.20 Admission, Treatment and Habilitation of Mentally Retarded Persons

Mentally retarded persons shall be admitted to Department facilities in accordance with the following procedures.

a) Admission

Persons shall be admitted to Department facilities based on an assessment of their current individual needs and not solely on the basis of inclusion in a particular diagnostic category, identification by a sub-average intelligence test score, or consideration of a past history of hospitalization or residential placement.

b) Treatment and habilitation plans

Treatment and habilitation plans formulated for persons in Department facilities shall be governed by and conform to the Sections 3-209 and 4-309 of the Code.

c) Classification

All diagnoses of retardation shall be defined according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) (American Psychiatric Association, 1987 with no later editions or amendments).

d) Definitions

"Developmental disability facility." A facility or section thereof licensed or operated by or under contract with the State or a political subdivision thereof and which admits persons with a developmental disability for residential or habilitation services (Section 1-107 of the Code).

"Mental health facility." Any facility operated by the Department or any unit within such a facility which is used for the treatment of persons who are mentally ill as provided in Chapter 3 of the Code.

"Mental retardation." Significantly subaverage intellectual functioning: an intelligence quotient (IQ) of 70 or below on an individually administered IQ test; concurrent deficits or impairments in adaptive behavior, the person's age being taken into consideration; onset before the age of 18. There are four subtypes based on IQ levels: mild mental retardation (50-55 to 70), moderate mental retardation (35-40 to 50-55) severe mental retardation (20-25 to 35-40) and profound mental retardation (below 20 or 25).

"Qualified mental retardation professional (QMRP)" (42 CFR 483 et seq., 1988, with no later editions or amendments). Any of the following persons who have specialized training in the following areas or one year experience working with or treating the mentally retarded:

An educator with a degree in education from an accredited program.

A physical therapist licensed in accordance with Section 2 of the Illinois Physical Therapy Act [225 ILCS 90/2].

An occupational therapist licensed pursuant to Section 3 of the Illinois Occupational Therapy Practice Act [225 ILCS 75/3].

A physician licensed by the State of Illinois to practice medicine or osteopathy pursuant to Section 3 of the Medical Practice Act of 1987 [225 ILCS 60/3].

A licensed psychologist with a doctorate from an accredited program pursuant to Section 10 of the Clinical Psychologist Licensing Act [225 ILCS 15/10].

A registered nurse with a valid current Illinois registration to practice as a registered professional nurse pursuant to Section 4 of the Illinois Nursing Act of 1987 [225 ILCS 65/4].

A speech-language pathologist or audiologist licensed pursuant to Section 7 of the Illinois Speech-Language Pathology and Audiology Practice Act [225 ILCS 110/7].

A licensed social worker or a licensed clinical social worker with at least a master's degree pursuant to Section 9A of the Clinical Social Work and Social Work Practice Act [225 ILCS 20/9A].

A therapeutic recreation specialist who is a graduate of an accredited program and eligible for certification by the National Council for Therapeutic Recreation Certification.

A rehabilitation counselor who is certified by the Commission on Rehabilitation Counselor Certification.

e) Severely or profoundly mentally retarded persons

1. Any person admitted to a Department mental health facility with an admitting diagnosis of severe or profound mental retardation shall be transferred to a developmental disabilities facility or unit within 72 hours after admission unless transfer is contra-indicated by the person's medical condition documented by the evaluating physician.

2. Any person who is diagnosed as severely or profoundly mentally retarded while in a Department mental health facility shall be transferred to a developmental disabilities facility or unit within 72 hours after such diagnosis unless the transfer is contra-indicated by the person's medical condition as documented by the evaluating physician.

f) Mildly or moderately mentally retarded persons

1. Any person admitted to a Department of mental health facility who may be mildly or moderately mentally retarded in the clinical judgment of facility staff, including those who are also mentally ill, shall be evaluated by a multi-disciplinary team which includes a qualified mental retardation professional as defined in subsection (d) of this Section. The evaluation shall be consistent with Section 4-300(b) of the Code and shall include:

A) A written assessment whether the person needs a habilitation plan consistent with Section 4-309 of the Code;

B) A written habilitation plan if the written assessment determines that such plan is required, and

C) A written determination whether the admitting facility is capable of providing the specified habilitation services.

2. This evaluation shall occur within a reasonable period of time, but in no case shall exceed 14 days after admission. In all events, a treatment plan shall be prepared for the person within three days after admission, and reviewed and updated every 30 days, consistent with Section 3-209 of the Code.

3. A mentally retarded person shall not reside in a Department mental health facility unless the person is evaluated and is determined to be mentally ill and the facility director determines that appropriate treatment and habilitation are available and will be provided to such person at the facility. In all such cases the mental health facility director shall certify in writing within 30 days of the completion of the evaluation and every 30 days thereafter, that the person has been appropriately evaluated, that services specified in the treatment and habilitation plans are being provided and that the setting in which services are being provided is appropriate to the person's needs. The certifications shall be filed in the recipient's record.

4. If the facility director determines that appropriate treatment and habilitation services are not available or that the setting in which services are provided are not appropriate to the recipient's needs, the facility director shall seek a placement for the recipient that is appropriate to his or her needs. Transfers and discharges shall be carried out in accordance with Section 112.20.

g) Utilization review

1. A person residing in a Department mental health facility who is evaluated as being mildly or moderately mentally retarded, an attorney or advocate representing the person, or a guardian of such person may object to the facility director's certification required in subsection (f)(3) of this Section, the treatment and habilitation plans, or the appropriateness or setting and request a utilization review as provided in Sections 3-207 and 4-209 of the Code.

2. Notice requirements

A) After evaluation

Within 24 hours after an evaluation as required by subsection (f)(1) of this Section or the certification(s) as required by subsection (f)(3) of this Section, the mental health facility director shall give written notice to each person evaluated as being mildly or moderately retarded, or to each person certified, the person's attorney and guardian, if any, or in the case of a minor to his or her attorney, to the parent, guardian or person in loco parentis and to the minor if he or she is 12 years of age or older, of his or her right to request a utilization review of the facility director's determination that such person is appropriately placed or is receiving appropriate services.

B) Notice contents

All notices given pursuant to this subsection shall provide the address and telephone number of the Chicago office of the Legal Advocacy Service of the Guardianship and Advocacy Commission and the instructions that the person or his or her guardian may contact that office for assistance. Facility staff shall notify the recipient or guardian that staff are available to assist in contacting the Legal Advocacy Service. If the recipient's or guardian's primary language is not English, arrangements must be made to provide an adequate explanation in the person's primary language of the nature of the recipient's right to request review. If a staff member is available who is fluent in the language required, he or she should be requested to explain the notice to the recipient or guardian.

3. The utilization review committee

The utilization review committee shall be appointed in accordance with Section 112.10(f), with the exception that the committee shall include as one of its members a qualified mental retardation professional as defined in subsection (d) of this Section. If all the qualified mental retardation professionals at the facility were involved in the decision on which the hearing will be held, the facility director shall request that the appropriate deputy director for facility operations assign a qualified mental retardation professional from another facility to the committee for that hearing.

4. The utilization review hearing

The utilization review hearing shall be conducted in accordance with Section 112.10(g).

5. Standards

The following standards shall be used by the committee in reaching its decision:

A) Certification as mildly or moderately mentally retarded

Whether there is substantial evidence to support the diagnosis of an individual as mildly or moderately mentally retarded.

B) Receiving appropriate services

Whether there is substantial evidence to support the conclusion that the person is receiving services that are called for in his or her treatment and habilitation plans, and that those services are appropriate and necessary in accordance with the person's treatment and habilitation goals and objectives.

C) Appropriate setting

Whether there is substantial evidence that the person is placed in a setting (unit or facility) that is appropriate to meet the person's treatment and habilitation needs, and that the individual's service needs can be met at the unit or facility.

6. The committee's findings of facts, conclusions and recommendations.

The committee's findings of facts, conclusions and recommendations shall be made in accordance with Section 112.10(i).

7. The facility director's decision

The facility director's decision shall be made in accordance with Section 112.10(j).

8. Review by the Secretary

Review of the facility director's decision by the Secretary shall be in accordance with Section 112.10(k).

9. Final administrative decision

The decision of the facility director or the decision of the Secretary shall be subject to review in accordance with the Administrative Review Law.

History

• Source: Added at 13 Ill. Reg. 20344, effective December 19, 1989

59 Ill. Adm. Code 112.30 Recipient Physical and Dental Examinations and Informed Consent for Services

To provide the highest possible quality of humane and rehabilitative care and treatment for all recipients in the care of the Department and to promote public health and safety, all recipients in Department facilities shall receive comprehensive physical and dental examinations.

a) Physical examination

1. Each person admitted to the Department in accordance with the Code [405 ILCS 5] shall have a thorough physical examination on admission and annually thereafter (see Section 1-119(2) of the Code). Persons with mental illness shall be examined within 24 hours in accordance with the Mental Health Standards (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60681, 1995) or the Accreditation Manual for Hospitals (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60681, 1996). In accordance with 77 Ill. Adm. Code 350 (Intermediate Care for the Developmentally Disabled Facilities Code) (ICFDD), persons with developmental disabilities shall be examined within 72 hours. This requirement may be waived in the judgment of the admitting physician only if such an examination was done within three days prior to admission and the results are received by the facility and are entered into the recipient's clinical record.

A) The examination shall include an evaluation of the recipient's condition, including height, weight, blood pressure and vital signs, diagnoses, plan of medical treatment, recommendations for care, including personal care needs, treatment orders, permission for participation in activity programs, as appropriate, and any other examinations that are required by the accrediting agencies cited in subsection (a)(1) of this Section, as well as the Standards for Services for People with Developmental Disabilities (Accreditation Council for Services for People with Developmental Disabilities (Council) 8100 Professional Place, Suite 204, Landover, Maryland 20785, 1990). The examination shall also include a visual check of the oral cavity, including lips, teeth, gums and tongue. Referral to a dental hygienist or dentist shall be completed if clinically indicated. Plans of medical treatment, recommendations for care and treatment orders shall be recorded in the recipient's individualized services plan as defined in Sections 3-209 and 4-309 of the Code.

B) The presence or absence of communicable or infectious diseases shall be noted by the examining physician with recommendations given for curing or controlling the disease, as applicable. Communicable or infectious diseases shall be reported in accordance with Department of Public Health rules:

i) 77 Ill. Adm. Code 690 (Control of Communicable Diseases Code);

ii) 77 Ill. Adm. Code 693 (Control of Sexually Transmissible Diseases Code); and

iii) 77 Ill. Adm. Code 697 (AIDS Confidentiality and Testing Code).

2. An electrocardiogram (EKG) shall be provided within three days after admission, excluding Saturdays, Sundays, and holidays, for any recipient age 40 or over, except that an admission EKG need not be repeated on readmission if one was provided within the previous 12 months during a prior admission, unless otherwise clinically indicated by the examining physician.

3. A Papanicolaou (Pap) smear uterine cytologic examination for cancer shall be offered to all female recipients admitted or readmitted to a Department facility who are 20 years of age and over, or under 20 years of age if sexually active, unless the examining physician considers the examination contraindicated, the examination has been performed within the previous year and the results were normal, or the examination is refused by the recipient on the counsel of the examining physician or on her own judgment. Results of tests performed outside the facility shall be obtained and entered into the recipient's clinical record. A Pap smear uterine cytologic examination shall be offered and recommended annually. The examining physician shall document in the recipient's clinical record the results of the Pap smear, whether or not the test was contraindicated, or that the recipient refused the examination.

4. In the event that the recipient's psychiatric, behavioral, or medical condition is such that the physical examination as described in subsection (a)(1)(A) of this Section cannot be completed within the times stated in subsection (a)(1) of this Section, the examining physician may extend the time frame until the recipient's condition has improved to allow the completion of the examination. Every 72 hours the examining physician shall record in the recipient's clinical record the condition preventing a complete physical examination and the continuation of the recipient's condition until the physical examination has been completed. If the recipient's physical examination is delayed in excess of 30 days, such delay shall require notice from the examining physician to the facility director, and a special conference of the treatment team to identify a course of action designed to protect the recipient from inappropriate treatment based on inadequate information.

b) Dental examination

1. Persons with developmental disabilities shall have a comprehensive diagnostic dental examination, including extra- and intra-oral examinations within 30 calendar days after admission, unless the admitting physician waives this requirement. The admitting physician shall record the reason for the waiver in the recipient's clinical record.

A) The examination report shall include an evaluation of the recipient's dental condition, diagnoses, plan of treatment, recommendations for oral health care and dental hygiene, and treatment orders.

B) The physician may extend the time for conduct of the dental examination; however, the physician must record the reason for the extension in the recipient's clinical record. If the recipient's dental examination is delayed in excess of 30 days, such delay shall require notice from the examining physician to the facility director, and a special conference of the treatment team to identify a course of action designed to protect the recipient from inappropriate treatment based on inadequate information.

2. Persons with mental illness shall have a comprehensive diagnostic dental examination, including extra- and intra-oral examinations, within six months after admission. If the recipient's condition is such that a dental examination is necessary less than six months after admission, a referral to a dentist or dental hygienist shall be made.

c) Schedule for examinations and treatment plan

1. Physical examinations shall be repeated annually. In accordance with Section 7 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/7], dental examinations shall be repeated every 18 months for recipients with mental illness while residing in Department facilities. In accordance with the Standards for Services for People with Developmental Disabilities (Accreditation Council for Services for People with Developmental Disabilities, 8100 Professional Place, Suite 204, Landover, Maryland 20785, 1990,) dental examinations shall be repeated annually for recipients with developmental disabilities while residing in Department facilities. These examinations shall be performed by a licensed dentist or a registered hygienist and shall be independent of periodic reviews such as the use of medications, blood levels of drugs and gingivitis checks.

2. If a recipient has been in the facility or is transferred from another facility, the receiving facility shall perform comprehensive diagnostic examinations if the individualized services plan does not provide a treatment plan for medical and dental services for the recipient.

3. On completion of the comprehensive diagnostic examinations, a treatment plan for any medical and dental services shall be established as part of the recipient's individualized services plan.

A) Such a plan will include procedures to address the special dental care needs of recipients who receive medication known to promote tooth decay or gum disease.

B) Such a plan will include a procedure to address the prevention and treatment of tardive dyskenesia.

d) Informed consent

Informed consent is defined as permission for a procedure freely granted by a person or persons authorized by law to give consent to services and treatment plans, i.e., the recipient, guardian (if the recipient is under guardianship) or parent (if the recipient is under age 18). Informed consent is based on the full disclosure to the authorized person of the information required to make the decision intelligently, including a description of the procedure, the possible benefits and the risks and the alternative(s) to the procedure.

1. For the purposes of this Section, the person(s) authorized to give consent shall be informed of the treatment plan for medical and dental services, and shall be provided with the information necessary to give informed consent. The documented agreement to the individualized services plan will obviate the need for specific agreement to the treatment plan for medical and dental services.

2. The person(s) authorized to give consent shall be informed of the method whereby he or she can exercise the right to refuse medical and dental services.

3. For services listed below, the person(s) authorized to give consent shall be informed that if an objection is not received prior to performance of services, consent shall be implied for the treatment plan:

A) Dental - preventive procedures (such as prophylaxis, topical fluoride, periodontal scaling, and gingival curettage,) and restorative procedures (such as, fillings and local anesthesia).

B) Medical - non-psychotropic medication, endoscopy not involving anesthesia, exercise regimens and sutures.

4. A written consent, signed by the person authorized to give consent, shall be required for all other procedures, including general anesthesia, surgery (both medical and dental) and radiation therapy. The written consent shall be specific to the procedure or course of therapy to be used and shall only apply to a particular procedure performed at a particular time or to a course of therapy of which the procedure is a part. An additional consent shall be obtained for each subsequent procedure. A consent authorizing a specific Department staff person to perform a procedure is specific to that staff person.

5. If consent is denied by the person authorized to consent, medical or dental procedures shall not be provided except pursuant to subsection (d)(6) of this Section. Such refusal shall be documented in the recipient's clinical record.

6. In accordance with Section 2-111 of the Code, when a medical or dental emergency exists, if the physician or licensed dentist who examines the recipient determines that the recipient is not capable of giving informed consent, essential medical or dental procedures may be provided without consent. No physician nor licensed dentist shall be liable for a non-negligent good faith determination that a medical or dental emergency exists. The nature of the emergency shall be documented in the recipient's clinical record and notice shall be given to the recipient, the legal guardian or parent(s).

e) Communicating examination findings

Significant or negative examination findings obtained from the recipient's physical examination results of laboratory tests as they become known shall be communicated to the recipient or, if the recipient is under guardianship, to the recipient's guardian, or, if the recipient is a minor to the recipient's parent or guardian. The fact that such findings were communicated to the recipient, parent or guardian shall be documented in the recipient's clinical record.

History

• Source: Amended at 21 Ill. Reg. 2210, effective February 1, 1997

59 Ill. Adm. Code 112.40 Release and Burial of Deceased Recipients

a) Burial of recipients in facility cemeteries and bodies removed from the facility require the services of a licensed funeral director. All records pertaining to the recipient's death must be completed as outlined in Section 18 of the Vital Records Act [410 ILCS 535/18].

b) Facility directors shall make every effort to have relatives, friends, conservators, or interested organizations assume charge of and the expense of burying bodies. Assets of the recipient or burial allowances to which he is entitled shall be used to the extent that they are available within limitations set forth in the Department's rule at 59 Ill. Adm. Code Section 110.20. If the family of a recipient requests burial of the recipient in a cemetery plot owned by or available to the recipient or his family, the facility may grant such request and pay all or part of the funeral expense, if the cost cannot be borne by the family or from the recipient's assets. The amounts paid by the facility in such cases shall not exceed the rate paid for State burials by that facility. The Department may accept partial payment of the cost of burials made at State expense from relatives or conservators of recipients who are unable to bear the total cost.

c) Recipients buried in facility cemeteries shall receive their last rites in keeping with their religious faith. The medical record librarian shall maintain an accurate record of all bodies placed in the facility cemeteries. All graves shall be plainly marked with number or name and number, and the cemeteries shall be kept in a tidy, presentable condition.

d) Unclaimed bodies required to be buried at State expense may be turned over to the Demonstrators Association as joint representative of the Illinois medical schools. Before the body is taken by this organization, an appropriate funeral service shall be held. The Demonstrators Association shall bear all expenses of removing and shipping such bodies. The clause on the death certificate in all such cases shall read "Surrendered to the Illinois Demonstrators Association" in lieu of place of burial.

History

• Source: Effective October 1, 1969

59 Ill. Adm. Code 112.50 Tuberculosis Control Program (repealed)

History

• Source: Repealed at 10 Ill. Reg. 11894, effective July 1, 1986.

59 Ill. Adm. Code 112.70 Protection of Human Subjects

a) The purpose of this Section is to safeguard the rights and welfare of human subjects participating in research, development, demonstration, clinical trials or other such activities.

b) Persons who conduct any activity which may place a human subject at risk must adhere to the Departmental Guidelines on the Protection of Human Subjects, under any or all of the following conditions:

1. The activity is conducted by a Department employee;

2. The activity involves the participation of Department service recipients or personnel as subjects, regardless of the person conducting it; or

3. The activity takes place in a Department facility, regardless of the person conducting it or the subjects participating.

History

• Source: Effective October 15, 1973

59 Ill. Adm. Code 112.80 Use of Narcotics and Psychotropic Medications in Department Facilities

a) In accordance with Section 5.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/5.1], a listing of medication with maximum dosages shall be issued yearly by the Mental Health and Developmental Disabilities Services Pharmacy and Therapeutics Committee. This list of narcotics and psychotropic medications shall represent the official listing of such medications authorized for use in Department facilities.

1. For the purposes of this Section, "psychotropic medications" refers to medications:

A) used for antipsychotic, antidepressant, antimanic and/or antianxiety purposes as listed in the American Hospital Formulary Service (AHFS) Drug Information Manual (American Society of Health-System Pharmacists, 7272 Wisconsin Avenue, Bethesda, Maryland 20814 (2000) (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 (2000) (AGENCY NOTE: this document is published annually)); and the Drug Facts and Comparisons (Facts and Comparisons, 111 West Port Plaza, Suite 300, St. Louis, Missouri 63146-3098) (2001) (AGENCY NOTE: this document is published annually and updated monthly)); or

B) where there is a body of peer reviewed medical literature supporting its use.

2. "Narcotics" refers to those medications listed as narcotics in the references in subsection (a)(1)(A).

b) The Department shall establish a Pharmacy and Therapeutics Committee under the auspices of Mental Health and Developmental Disabilities Services, which shall serve as the vehicle for compliance with 20 ILCS 1705/5.1 as it relates to the establishment of medications that may be utilized within Departmental institutions. The Pharmacy and Therapeutics Committee shall consist of the Administrator of Mental Health and Developmental Disabilities Services, the Chief of Clinical Services for the Office of Mental Health, the Clinical Director for the Office of Developmental Disabilities, the Nursing Coordinator for the Office of Mental Health, the Nursing Coordinator for the Office of Developmental Disabilities, a facility medical director from the Office of Mental Health, a facility medical director from the Office of Developmental Disabilities, the Deputy Director of Pharmacy Services, and the Manager of the Bureau of Pharmacy and Clinical Support Services. The Chairperson of the Pharmacy and Therapeutics Committee shall be the Manager of the Bureau of Pharmacy and Clinical Support Services or his/her designee. The Chairperson shall appoint, as necessary, additional members representing a broad scope of disciplines. The Pharmacy and Therapeutics Committee shall review, at least annually, all medications within the pharmaceutical classes appearing on the Central Formulary, relative to their clinical efficacy and safety for either retention or removal from usage within the Department. The Chairperson may incorporate recommended changes to the Department's Central Formulary based upon his/her professional judgment. The Chairperson may, based on his/her professional judgment, order the immediate discontinuation of the use of a medication within the Department's State-operated facilities if it is withdrawn from marketing in the United States or when the U.S. Food and Drug Administration rescinds its approval for marketing in the United States, or when the Pharmacy and Therapeutics Committee recommends discontinuation based on information from Department experience with the medication, or from the medical literature, that the medication lacks clinical efficacy or is unsafe.

c) The official departmental listing of medication that contains those medications utilized as narcotics and psychotropic medications is the Department's Central Formulary. It shall be updated at least annually and forwarded to each State-operated facility. An additional listing shall be supplied to each State-operated facility that will contain, for each listed psychotropic and narcotic, the Department's maximum daily dose and other criteria relative to safe, effective pharmacotherapies.

d) Medications not appearing in the Department's Central Formulary that are newly approved for marketing and labeled for psychotropic indications by the U.S. Food and Drug Administration within the previous 12 months shall be prescribed only on the written interim authorization of the Chairperson of the Department's Pharmacy and Therapeutics Committee. The use of any such medication shall be requested by submission of Form IL 462-0705, Formulary Addition Request Form 705. At its next scheduled meeting, the Department's Pharmacy and Therapeutics Committee shall review the medication and shall approve or disapprove the use of the medication in Department facilities on the basis of available scientific information. Written notice of the Committee's decision will be given to facility directors, facility medical directors and facility pharmacy directors.

e) Medications not appearing in the Department's Central Formulary that are approved for marketing by the U.S. Food and Drug Administration, but are not labeled by the U.S. Food and Drug Administration for psychotropic indications, whose use for psychotropic indications is listed in the professional references identified in subsection (a), shall be prescribed only on the written interim authorization of the Department's Chairperson of the Pharmacy and Therapeutics Committee based upon the submission of Form IL 462-0705A, Non-Formulary Request Form 705A . The Pharmacy and Therapeutics Committee shall review the medication at its next scheduled meeting for permanent approval or removal on the basis of available scientific information and shall give written notice to facility directors, facility medical directors and facility pharmacy directors of its decision.

f) Medications appearing in the Department's Central Formulary that are approved for marketing by the U.S. Food and Drug Administration, but are neither labeled for psychotropic indications by the U.S. Food and Drug Administration nor listed as having psychotropic indications in the professional references identified in subsection (a), for which there is medical literature supporting their use for psychotropic indications, may be prescribed by the attending physician for up to three calendar days. The attending physician shall document the reason for such use in the recipient's medical record and shall notify the facility's medical director of the use no later than the next working day after administration of the medication. If the medication is to be utilized for more than three calendar days, authorization shall be obtained from the facility's medical director who is responsible for applying to the Chairperson of the Pharmacy and Therapeutics Committee for authorization. The facility medical director may authorize continuation of the use of the medication for up to seven calendar days beyond the initial three-day period (total of 10 calendar days), at which point medication must be discontinued without the authorization. The written response of the Chairperson of the Pharmacy and Therapeutics Committee, or his /her designee, shall be filed in the recipient's medical record together with a copy of the medical director's application.

g) Use of any medication not authorized pursuant to subsections (a) through (f) for psychotropic purposes is prohibited, unless its use has been approved for research in writing by the Chairperson of the Mental Health and Developmental Disabilities Services Pharmacy and Therapeutics Committee, based upon the Committee's review and authorization of the research.

h) Based upon peer-reviewed professional literature and clinical evaluations of facility Formulary Addition Request Forms, the Pharmacy and Therapeutics Committee shall develop and maintain the Department's official formulary of medication that may be used within Department in-patient facilities.

History

• Source: Amended at 25 Ill. Reg. 10834, effective August 2, 2001

59 Ill. Adm. Code 112.90 Administration of Psychotropic Medications and Ect

This Section addresses the use of psychotropic medications or electroconvulsive therapy (ECT) in the treatment of patients receiving services within Department programs.

Definitions

"Authorized involuntary treatment" means psychotropic medication or electroconvulsive therapy, including those tests and related procedures that are essential for the safe and effective administration of the treatment. [405 ILCS 5/1-121.5]

"Capable" means the ability of the recipient to make reasoned decisions regarding treatment/habilitation alternatives.

"Code" means the Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Electroconvulsive therapy (ECT)" means the use of electrical stimulation, for therapeutic ends, to induce a generalized seizure.

"Guardianship" refers to the legal relationship between an adult recipient or ward and a court appointed guardian, including a public guardian such as the Office of State Guardian. Illinois guardians may make legally binding decisions on behalf of wards in personal or financial affairs, or both. For the purposes of this Part, the guardian must have court authority to make personal decisions for the ward. Guardians with personal decision-making authority will typically act under a plenary guardianship. A plenary guardian is one who has full decision-making authority over the person without restrictions. However, a guardian may also legitimately act under a temporary or a limited guardianship in which the guardian has clearly defined medical decision-making authority. A parent of an adult recipient without guardianship is not legally authorized to make binding decisions on behalf of a recipient. When doubt exists as to the decision-making authority of a guardian, the guardian shall supply either letters of office or a copy of a court order documenting legal authority to act on behalf of the ward.

"Informed consent" means the voluntary and knowing choice by a recipient or his/her legal guardian.

"Lack of capacity" means the inability, due to mental impairment, to make reasoned decisions regarding treatment/habilitation alternatives, including the taking of medication, by evaluating, among other factors, information about the likelihood of therapeutic benefits and the risk of side effects.

"Legally and clinically competent recipient" means an individual who is not under guardianship and has the capacity to make reasoned decisions and give informed consent.

"Legally and clinically incompetent recipient" means an individual under guardianship or who lacks the capacity to make reasoned decisions and give informed consent.

"Long-acting psychotropic medication" means psychotropic medications, including but not limited to Haldol Decanoate and Prolixin Decanoate, that are designed so that a single dose will have an intended clinical effect for a period of at least 48 hours. [405 ILCS 5/1-113.5]

"Medical Coordinator" means the Medical Coordinator for Mental Health (if the recipient resides in a mental health facility) or the Medical Coordinator for Developmental Disabilities (if the recipient resides in a developmental disabilities facility).

"Medication", as used in this Section, means psychotropic medication.

"Psychotropic medication" means medication used for antipsychotic, antidepressant, antimanic, antianxiety, behavioral modification or behavioral management purposes, as listed in the Physician's Desk Reference (PDR), Drug Information Manual and Drug Facts and Comparisons, as incorporated by Section 112.80(a), or where there is a body of peer reviewed medical literature supporting its use.

"Substitute decision maker" means a person who possesses the authority to make decisions under the Powers of Attorney for Health Care Law [755 ILCS 45/Art. IV] or under the Mental Health Treatment Preference Declaration Act [755 ILCS 43]. [405 ILCS 5/1-110.5]

Procedures

a) Evaluation

1. No psychotropic medication or electroconvulsive therapy (ECT) shall be prescribed for a recipient unless examinations have been conducted in accordance with Section 112.30. The prescribing physician shall conduct the examinations personally, or shall review the record of the examinations. The prescribing physician shall record, sign, and date (with time) the prescription. The prescribing physician shall also document in the recipient's clinical record any appropriate clinical information.

2. With regard to psychotropic medication on an emergency basis, the requirements of subsection (a)(1) need not be met when the prescribing physician has determined by personal observation or from information supplied by another clinician with thorough knowledge of the recipient's current clinical condition that the recipient is in need of immediate medication in order to prevent the recipient from causing serious and imminent physical harm to self or others.

b) Informed Consent

Prior to prescribing psychotropic medications or ECT in non-emergency situations, a physician shall ascertain and document whether the recipient is capable of giving informed consent.

1. Legally and Clinically Competent Recipients

A) If the recipient is able to give informed consent, the physician shall advise the recipient, in writing, of the following:

i) nature and purpose of the proposed treatment;

ii) whether the proposed treatment requires periodic testing/procedures to ensure safety/efficacy;

iii) side effects, risks and benefits of the proposed treatment;

iv) prognosis and risks without the proposed treatment;

v) alternative treatments and their risks, side effects, benefits and efficacy; and

vi) the right to refuse the proposed treatment.

B) The required information shall be given to the recipient in a manner consistent with his/her ability to understand, including regular use of sign language for any deaf or hard of hearing individual for whom sign language is a primary mode of communication.

C) Informed written consent shall be obtained from the recipient.

D) If the recipient has previously executed a declaration for mental health treatment under the Mental Health Treatment Preference Declaration Act or a health care power of attorney under the Power of Attorney for Health Care Law, the facility is required to act in accordance with that declaration or power of attorney.

2. Legally and Clinically Incompetent Recipients

A) Prior to prescribing psychotropic medications or ECT in non-emergency situations, a physician shall advise the recipient and the recipient's guardian or substitute decision maker, in writing, of the following:

i) nature and purpose of the proposed treatment;

ii) whether the proposed treatment requires periodic testing/procedures to ensure safety/efficacy;

iii) side effects and risks of the proposed treatment;

iv) prognosis and risks without the proposed treatment;

v) alternative treatments and their risks, side effects, benefits and efficacy; and

vi) the right to refuse the proposed treatment.

B) The required information shall be given to the recipient and the recipient's guardian or substitute decision maker in a manner consistent with his/her ability to understand, including regular use of sign language for any deaf or hard of hearing individual for whom sign language is a primary mode of communication.

C) The recipient shall be asked if he/she agrees to receive the proposed treatment. If the recipient does not object, informed written consent shall be obtained from the recipient's guardian or substitute decision maker and shall be documented in the recipient's medical record. If the recipient has no guardian or substitute decision maker or if the guardian or substitute decision maker does not provide such informed written consent, any treatment must proceed in accordance with subsection (c) (Refusal of Treatment).

D) If the recipient objects to the proposed treatment, any treatment must proceed in accordance with subsection (c) (Refusal of Treatment).

E) If the recipient has previously executed a declaration for mental health treatment under the Mental Health Treatment Preference Declaration Act or a health care power of attorney under the Power of Attorney for Health Care Law, the facility is required to act in accordance with that declaration or power of attorney.

c) Refusal of Treatment

A recipient's refusal to receive psychotropic medication or ECT does not in itself constitute an emergency. Such refusal, as documented in the clinical record, shall be honored except in the following circumstances:

1. Emergencies

In an emergency, when treatment is necessary to prevent a recipient from causing serious and imminent physical harm to self or others.

A) In such an emergency, a member of the treatment/habilitation team shall document in the recipient's clinical record that the staff have explored alternative treatment options to contain the emergency. The documentation shall include a written explanation of the reasons why alternative treatments are not appropriate.

B) For administration of psychotropic medications the prescribing physician or a nurse in consultation with a physician shall document his/her determination that an emergency exists based on a personal examination of the individual. Administration of the medication shall be accompanied by a physician's order.

C) In prescribing psychotropic medications on an emergency basis the prescribing physician shall examine the recipient and document his/her determination of the initial emergency and response, including the circumstances leading up to the need for emergency treatment, in the recipient's clinical record as soon as possible, but within 24 hours. Psychotropic medication may not be continued unless the need for such medication is redetermined at least every 24 hours and the circumstances demonstrating that need are set forth in the recipient's clinical record. A redetermination is based on a personal examination of the recipient by a physician or a nurse with the consultation of a physician.

D) Treatment shall not be administered over a recipient's refusal under Section 2-107 of the Mental Health and Developmental Disabilities Code for a period in excess of 72 hours, excluding Saturdays, Sundays and holidays, unless the treating physician with the support of the treatment/habilitation team files a petition for a court order under Section 2-107.1 of the Code and the treatment continues to be necessary in order to prevent the recipient from causing serious and imminent physical harm to self or others. If no such petition is filed, treatment must be discontinued.

E) A restriction of rights form shall be completed for each administration of emergency treatment.

F) ECT may be administered over a patient's refusal only with a court order and prior written physician's order or in emergency situations as defined in Section 2-107 of the Code.

G) Upon commencement of services, or as soon thereafter as the condition of the recipient permits, the facility shall advise the recipient as to the circumstances under which the use of emergency forced medication is permitted under Section 2-107(a) of the Mental Health and Developmental Disabilities Code [405 ILCS 5/2-200(d)].

Concurrently, the facility shall ask the recipient which form of intervention he/she would prefer if any of these circumstances arise. The recipient's preference shall be documented in the clinical record and communicated by the facility to the recipient's guardian or substitute decision maker, if any. If any such circumstances arise, the facility shall give due consideration to the preferences of the recipient regarding which form of intervention to use as communicated to the facility by the recipient or as stated in the recipient's advance directive.

H) Under no circumstances may long-acting psychotropic medications be administered under Section 2-107 of the Code.

I) Under no circumstances may ECT be administered to a minor recipient without a court order.

2. Administration of Treatment on Court Order

A) If the treating physician, with the support of the treatment/habilitation team, determines that psychotropic medication or ECT is clinically indicated for a recipient who does not at the time pose an imminent risk of serious physical harm to self or others, and the situation described in subsections (b)(2)(c) or (b)(2)(D) of this Part applies, the facility may file a petition in the circuit court under Section 2-107.1 of the Code for court-ordered treatment.

B) If the treating physician, with the support of the treatment/habilitation team, files a petition under Section 2-107.1 of the Code, a physician shall examine the recipient and address the following issues for the court:

i) whether the recipient has a serious mental illness or developmental disability;

ii) whether, because of the mental illness or developmental disability, the recipient exhibits any one the following: deterioration of his/her ability to function, suffering, or threatening behavior;

iii) whether the illness or disability has existed for a period marked by the continuing presence of the symptoms set forth in subsection (c)(2)(B)(ii) or the repeated episodic occurrence of such symptoms;

iv) whether the predicted benefits of the treatment will outweigh any possible harm;

v) whether the recipient lacks the capacity to make a reasoned decision about the treatment;

vi) whether other less restrictive treatment methods have been explored and found to be inappropriate;

vii) the specific treatments proposed, including dosage range and/or frequency of administration, as applicable; and

viii) if the petition seeks authorization for testing and other procedures, the physician shall include a statement that such testing and procedures are essential for the safe and effective administration of the treatment.

C) If the court grants the petition for involuntary treatment pursuant to Section 2-107.1 of the Code, the recipient may be administered treatment over his/her refusal (or the guardian's or substitute decision maker's refusal if the recipient was legally incompetent but did not object) within the constraints and for the duration of the court order.

d) Monitoring of Treatment

1. Documentation

A) The attending physician shall examine and document the status of the recipient's condition in the recipient's clinical record as often as the recipient's clinical condition warrants but no less often than every 30 calendar days. Documentation of the rationale for treatment, including type, dosage or frequency of the proposed treatment as applicable, shall be included. Beneficial effects and significant side effects as well as their treatment and/or management or the absence of treatment and/or management shall also be noted.

B) Facility staff shall document in the recipient's clinical record additional clinical information such as assessments, evaluations or laboratory results as they become available.

2. Treatment Review

A) When a recipient at a State-operated mental health facility has been receiving psychotropic medications and/or ECT continuously or regularly for a period of three months, and if such treatment is continued, every six months thereafter for so long as the treatment shall continue, the facility medical director, or other physician designated by the facility director, shall convene a treatment review panel.

B) The panel shall consist of representatives from at least two of the following clinical disciplines: psychiatry, medicine, clinical pharmacy and nursing. At least one panel member shall be a physician with expertise in the use of psychotropic medication (for example, psychiatrist or behavioral neurologist).

C) At least 7 days prior to the date of the treatment review panel meeting, the recipient, guardian or substitute decision maker, if any, and any person designated under Section 2-200(b) of the Mental Health and Developmental Disabilities Code shall be given written notification of the time and place of the treatment review panel meeting. The notice shall also advise the recipient of his/her right to designate some person to attend the meeting and assist the recipient in accordance with Section 2-107.2 of the Mental Health and Developmental Disabilities Code.

D) The panel shall provide a recommendation concerning the suitability of continued treatment.

E) If, during the course of the treatment review panel meeting, the recipient advises the committee that he/she no longer agrees to continue receiving medication or ECT, or if the recipient has a guardian or substitute decision maker and the guardian or substitute decision maker refuses medication or ECT for the recipient, the treatment shall be discontinued, except when the recipient is receiving treatment pursuant to subsections (c)(1) and (c)(2) of this Section.

i) If the panel determines that the recipient is receiving appropriate treatment and that the benefit to the recipient outweighs the risk of harm to the recipient, treatment shall be continued, provided that the recipient does not object (and the guardian or substitute decision maker, if any, does not refuse). (See Section 2-107.2 of the Code.)

ii) If the findings of the treatment review panel are not in agreement with the current treatment plan, revision shall be considered by the treatment/habilitation team.

iii) If there is disagreement on the implementation of the panel recommendations, the facility medical director or lead physician (designated by the facility director) shall review the case and make a final decision. The facility medical director (or lead physician) may consult with the appropriate Medical Coordinator in making a final determination.

F) The participation of the recipient and guardian or substitute decision maker if any, and the recommendations of the treatment review panel shall be recorded in the recipient's clinical record.

3. Annual ECT Report

The Department of Human Services shall summarize on an annual basis all quarterly reports (prepared in accordance with Section 2-110.1 of the Mental Health and Developmental Disabilities Code) from State-operated hospitals or facilities at which ECT is performed.

History

• Source: Amended at 25 Ill. Reg. 10834, effective August 2, 2001

Part 115 Standards and Licensure Requirements for Community-Integrated Living Arrangements

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Added at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Added at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

5. Other initially assessed areas as determined by the team and with input from the individual and/or guardian.

History

• Source: Added at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Added at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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).

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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:

i) Review at least annually the CILA provider policies, procedures and practices which have the potential to restrict the rights of individuals;

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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Added at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 115.330 Accreditation (repealed)

History

• Source: Repealed at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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

The agency will notify BALC and DDD within 60 business days of any change of ownership including the type of business organization (see 805 ILCS 5 through 415), the names of all owners, partners, and/or stockholders.

e) CILA agencies must be operational within 18 months or the Department will consider the licensure process abandoned. Any future licensure application by the provider will be considered a new application.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• 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

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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).

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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.

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 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).

History

• Source: Added at 27 Ill. Reg. 5376, effective March 17, 2003

59 Ill. Adm. Code 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).

History

• Source: Amended at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 115.700 Purpose (repealed)

History

• Source: Repealed at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 115.710 Rate Components (repealed)

History

• Source: Repealed at 47 Ill. Reg. 8485, effective May 31, 2023

59 Ill. Adm. Code 115.APPENDIX A Specific Level of Functioning Assessment and Physical Health Inventory (repealed)

History

• Source: Repealed at 23 Ill. Reg. 9791, effective August 13, 1999

Part 116 Administration of Medication in Community Settings

59 Ill. Adm. Code 116.10 Purpose

The purpose of this Part is to ensure the safety of individuals in programs funded by the Department of Human Services by regulating the storage, distribution and administration of medications in specific settings, as well as training of non-licensed staff in the administration of medications. This applies exclusively to all programs for individuals with developmental disabilities in:

a) community day services;

b) residential settings of 16 persons or fewer that are funded, certified or licensed by DHS and that distribute or administer medications; and

c) all intermediate care facilities for persons with developmental disabilities with 16 beds or fewer that are licensed by the Illinois Department of Public Health.

History

• Source: Amended at 42 Ill. Reg. 20083, effective October 23, 2018

59 Ill. Adm. Code 116.20 Definitions

The words and phrases used in this Part shall mean the following, except when a different meaning is clearly intended from the context:

"Administer" or "Administration" − An act in which a single dose of medication is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use.

"Adverse drug reaction" − A person's response to medication that has an undesirable effect and may be harmful to the health of a person. The reaction may be temporary and resolve itself without lasting effects or it may require interventions to be resolved.

"Agency" − Any organization that operates a residential program for persons with developmental disabilities.

"Authorized direct care staff" − Non-licensed persons who have successfully completed a medication administration training program specified by the Illinois Department of Human Services and conducted by a Nurse-Trainer. This authorization, that can only be conferred by a Nurse-Trainer, is specific to an individual receiving services in a specific agency and does not transfer to another agency or individual. [20 ILCS 1705/15.4(b)]

"Community day services" – Assists with the acquisition, retention, or improvement in self-help, socialization, and adaptive skills that takes place in a non-residential setting, separate from the participant's private residence or other residential living arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, and personal choice.

"Community residence" − Any residence funded by DHS and provided by a licensed agency, or a residential setting certified or approved by DHS, or an intermediate care facility for 16 or fewer persons with developmental disabilities, licensed by the Illinois Department of Public Health as an Intermediate Care Facility for the Developmentally Disabled, 16 beds or fewer.

"Competency-based" − Training that is tied to an identified set of skills and knowledge and requires documentation of an acceptable level of performance of a task or achievement of an outcome.

"Controlled substance" − Any drug or other substance listed pursuant to a schedule in the Illinois Controlled Substances Act [720 ILCS 570].

"Days" − Unless otherwise indicated, all references to days in this Part refer to working days.

"DD Medical Director" − The physician serving as the Medical Director of the Division of Developmental Disabilities within the Illinois Department of Human Services (DHS-DD), or his or her designee.

"Delegation" − The transfer of responsibility for the performance of selected tasks by the registered nurse (RN) to authorized direct care staff in a selected situation, based upon the RN's plan of care. The RN retains professional accountability for the outcome of the delegated task and all the nursing care of the individual. No redelegation by authorized direct care staff may occur.

"Department" or "DHS" − The Illinois Department of Human Services.

"Distribute or distribution" − The act of controlling access to medications and allowing access by individuals to their medications at prescribed times.

"DPH" − The Illinois Department of Public Health.

"Findings" − An indicated determination by the Department of Children and Family Services under 89 Ill. Adm. Code 300, a substantiated case or verified determination by the Department on Aging under 89 Ill. Adm. Code 270, or a substantiated finding by the Department of Human Services Office of Inspector General under 59 Ill. Adm. Code 50.

"Functional literacy" − An individual's ability to read, write, speak, compute and solve problems at levels of proficiency necessary to function on the job, as assessed by standardized techniques.

"Guardian" − The parent of a child under the age of 18 whose parental rights have not been terminated or a person appointed by a court to be guardian of the individual.

"HFS" − The Illinois Department of Healthcare and Family Services.

"Insulin in an injectable form" − A subcutaneous injection via an insulin pen pre-filled by the manufacturer. [20 ILCS 1705/15.4(b)]

"Individual" − Any person with a developmental disability receiving services from a program.

"Intermediate care facility for the developmentally disabled" or "ICF/DD-16". A residence licensed by DPH to provide health or habilitative care on a long-term basis for 16 or fewer individuals with developmental disabilities.

"Licensed person or personnel" − A physician, a registered professional nurse, an advanced practice nurse, a licensed practical nurse, a dentist, a pharmacist, a physician assistant, an optometrist, or a podiatrist licensed in the State of Illinois.

"Master Nurse-Trainer" − An agent of DHS who is a registered professional nurse who has been designated by the DD Medical Director to train/educate Nurse-Trainers.

"Medication" − Means oral and topical medications, insulin in an injectable form, oxygen, epinephrine auto-injectors, and vaginal and rectal creams and suppositories as prescribed for the individual by a physician, a physician assistant, an advanced practice nurse, a dentist, a podiatrist, or a certified optometrist, including medication to be taken on a PRN basis and over-the-counter medication. "Oral" includes inhalants and medications administered through enteral tubes, utilizing aseptic technique. "Topical" includes eye, ear and nasal medications, patches, as well as creams for male and female genitalia. [20 ILCS 1705/15.4(b)]

"Medication error" − The administration of medication other than as prescribed, resulting in the wrong medication being given; or medication being given at the wrong time, in the wrong dosage, via the wrong route, or by the wrong person; or medication omitted entirely. It is meant to include a lack of documentation of medication administration or any error in that documentation. Medication errors must be documented and are subject to review by DHS or DPH, whichever is applicable. Medication errors that meet the reporting criteria in DHS' rules on Office of Inspector General Investigations of Alleged Abuse or Neglect or Deaths in State-Operated and Community Agency Facilities (59 Ill. Adm. Code 50) shall be reported to the Office of Inspector General.

"Medication administration record" or "MAR" − A written record of medications prescribed for, and administered to, an individual.

"Non-licensed staff training program" − A standardized competency-based medication administration training program approved by DHS. It is conducted by a Nurse-Trainer for the purpose of training persons employed or under contract to provide direct care or treatment to individuals receiving services to administer medications and implement self-administration of medication training to individuals under the supervision and monitoring of the Nurse-Trainer. It incorporates adult learning styles, teaching strategies, classroom management, curriculum overview, including ethical-legal aspects, and standardized competency-based evaluations on administration of medications and self-administration of medication training programs. [20 ILCS 1705/15.4(b)]

"Normalization" − A philosophy under which persons with a developmental disability are provided or restored to patterns and conditions of everyday life that are as close as possible to norms and patterns of the mainstream of society.

"Nurse-Trainer" − A registered professional nurse and/or advanced practice nurse who has successfully completed the DHS Nurse-Trainer Training Program.

"Nurse-Trainer Training Program" − A standardized competency-based medication administration program provided by DHS and conducted by a DHS Master-Nurse Trainer. Nurse-Trainers shall train persons employed or under contract to administer medication to individuals and provide self-administration of medication training to individuals under the supervision and monitoring of the Nurse-Trainer. It incorporates adult learning styles, teaching strategies, classroom management and a curriculum overview, including the ethical and legal aspects of supervising those administering medication. [20 ILCS 1705/15.4(b)]

"Patent or proprietary medications" − Medications and household remedies that are generally considered and accepted as harmless and nonpoisonous when used according to the directions on the label and for which there are written physician orders for their use.

"Physician" − A physician licensed to practice medicine in all of its branches.

"PRN" − Prescribed medications, to be taken as needed, for specific conditions.

"Registered professional nurse" − A person licensed as a registered professional nurse as defined in the Illinois Nurse Practice Act [225 ILCS 65/50-10].

"Self-administration" − An act in which an individual administers his or her own medications. To be considered "capable of self-administering medications", individual residents must, at a minimum, be able to identify prescribed medication by size, shape, or color and know when it should be taken and in what amount it should be taken each time. [20 ILCS 1705/15.4(b)]

"Substantial compliance" − Meeting the requirements set forth in this Part, except for variations from the strict and literal performance of those requirements that result in insignificant omissions and defects, given the particular circumstances and the history of those omissions and defects. Omissions that have an adverse impact on an individual's health and safety shall be considered significant and shall be considered substantial noncompliance.

"Supervision" − An active process in which the registered professional nurse monitors, directs, guides, and evaluates the outcomes of an activity or task. The registered professional nurse maintains the accountability for the tasks and responsibilities, as subcomponents of total patient care, delegated to authorized direct care staff.

"Unencumbered license" − As defined in the Nurse Practice Act [225 ILCS 65/50-10], a license in good standing issued by the Illinois Department of Financial and Professional Regulation.

History

• Source: Amended at 42 Ill. Reg. 20083, effective October 23, 2018

59 Ill. Adm. Code 116.30 Master Nurse-Trainer and Nurse-Trainers

a) The Department's Master Nurse-Trainers are designated by the DD Medical Director and shall meet the following criteria:

1. Demonstration of competence to teach adult learners through:

A) evidence of previous teaching or training experience; or

B) completion of courses in teaching and instructing.

2. Licensure as a registered professional nurse in Illinois with an unencumbered license.

b) All registered professional nurses seeking approval to be Nurse-Trainers to provide medication administration training to non-licensed staff shall:

1. Be licensed as a registered professional nurse in Illinois with an unencumbered license.

2. Possess one year of clinical registered professional nursing experience within the last five years, preferably in developmental disabilities.

3. Have successfully completed the DHS Nurse-Trainer Training Program.

c) Requests for approval as a Nurse-Trainer shall be submitted, in writing, to the DD Medical Director. The DD Medical Director shall approve all requests that show substantial compliance with the requirements. Previous history as a Nurse-Trainer will be considered during the review process. The decision to approve or deny requests shall be on file with the Department, which will maintain a list of all approved Nurse-Trainers.

d) The DD Medical Director shall, upon request, grant conditional approval to a registered professional nurse who fulfills the requirements but has not completed the required Nurse-Trainer course of instruction. Conditional approval shall be granted for no more than 90 calendar days following the date of conditional approval. The nurse given conditional approval shall not train or authorize non-licensed staff to administer medications, but may direct and monitor, as well as educate and train, previously authorized direct care staff on new medications or dosage changes as required.

e) The DD Medical Director shall revoke the Nurse-Trainer status if:

1. the Nurse-Trainer's registered professional nurse license is encumbered or revoked; or

2. the Nurse-Trainer has one or more substantiated or indicated findings or verified determinations of physical abuse, sexual abuse, egregious neglect or financial exploitation.

f) The DD Medical Director shall revoke the Nurse-Trainer status if, in the DD Medical Director's professional judgment:

1. the Nurse-Trainer has failed to adequately supervise authorized direct care staff in administering medications;

2. the Nurse-Trainer has one or more findings as defined in Section 116.20 other than the types of findings listed in Section 116.30(e)(2) and those findings warrant revocation of the nurse's Nurse-Trainer status; or

3. the Nurse-Trainer otherwise failed to carry out responsibilities in substantial compliance with this Part.

g) If the nurse's Nurse-Trainer status is revoked, the DD Medical Director shall notify the nurse of the revocation. The revocation letter will include the basis for the revocation, the effective date, and information about the nurse's right to appeal the revocation.

1. A nurse who receives a revocation letter including notice of an opportunity for an administrative hearing must submit a request for a hearing to the bureau as listed in the revocation letter. The request is to be provided in one of the formats indicated in the revocation letter and must be received by the date set forth in the letter. Failure to comply with this Section shall constitute a waiver of the person's right to an administrative hearing. If the nurse requests an appeal:

A) The Department shall be required to establish by a preponderance of the evidence that the DD Medical Director's revocation of the nurse's Nurse Trainer status is warranted.

B) Hearings under this Section shall be conducted in accordance with the Department's rules on the conduct of hearings and appeals (89 Ill. Adm. Code 508). In the event there is a conflict between 89 Ill. Adm. Code 508 and this Part, the provisions of this Part shall prevail.

C) The nurse may not function as a Nurse-Trainer during the appeal process.

2. If the nurse does not request a hearing or if the hearing results in a decision that the DD Medical Director's revocation of the nurse's Nurse-Trainer status is warranted, the DD Medical Director shall revoke the nurse's Nurse-Trainer status and notify the nurse, and any agency known to the Department where the nurse is acting as a Nurse-Trainer, of the revocation of the nurse's Nurse-Trainer status.

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.40 Training and Authorization of Non-Licensed Staff by Nurse-Trainers

a) Only a Nurse-Trainer may delegate, supervise and authorize the tasks of medication administration to authorized direct care staff.

b) Prior to training non-licensed staff to administer medication to an individual, the Nurse-Trainer must have an understanding and knowledge of the individual's physical and mental status, medical history, medication orders and medications prescribed to initially train and authorize unlicensed staff to administer medications and to provide any additional medication related training of non-licensed authorized staff. The following is acceptable evidence of that understanding and knowledge:

1. The registered nurse completing the assessment of an individual's health as required by Section 116.90(a) must sign and date the assessment. To be valid, this assessment can be no more than one year prior to the date of the training of the non-licensed staff.

2. If the Nurse-Trainer initially training and authorizing unlicensed staff or providing additional training is not the registered professional nurse who completed the assessment of an individual's health as required by Section 116.90(a), there must be clear evidence that the Nurse-Trainer has reviewed an individual's current assessment within the last 365 calendar days and considered other relevant information before doing any training or providing direction about medication administration for that individual.

c) Non-licensed direct care staff who are to be authorized to administer medications under the delegation of Nurse-Trainer shall meet the following criteria:

1. be age 18 or older;

2. complete high school or its equivalency (G.E.D.);

3. demonstrate functional literacy;

4. satisfactorily complete the Health and Safety component of the Direct Support Persons Core Training Program or a DHS approved equivalent Developmental Disabilities Aide Training Program prior to the beginning of medication administration training;

5. be initially trained and evaluated by a Nurse-Trainer in a competency-based, standardized medication curriculum specified by DHS;

6. score 80% or above on the written portion of the comprehensive examination furnished by DHS based on the information conveyed to them during a medication administration classroom course; and

7. score 100% on a written or oral competency-based evaluation specifically pertinent to those medications that these staff are responsible to administer.

d) Initial competency-based training toward delegation for medication administration shall include:

1. Best practice standards related to the rights of individuals, legal and ethical responsibilities, agency procedures and communication pertaining to medication administration.

2. Best practice nursing techniques associated with medication administration.

3. Classes of drugs and their effects and common side-effects.

4. Specific information regarding the individuals to whom the staff will administer medication and the medication the staff will administer.

5. Techniques to observe, report and document medication effects, side effects, adverse outcomes and vital signs when those skills are necessary for the safe administration of medication to that individual.

6. A final, individual-specific, competency-based evaluation performed by a Nurse-Trainer for each medication administered to persons at the program for whom the staff provide supports.

e) The Nurse-Trainer may delegate the administration of insulin subcutaneously using an insulin pen pre-filled with insulin by the manufacturer to authorized staff after the authorized staff has successfully completed a DHS approved advanced training program specific to diabetes and insulin administration.

1. Authorized direct care staff must consult with the Nurse-Trainer before administering any subcutaneous insulin dosage determined by a blood glucose test result.

2. Authorized direct care staff may not calculate the insulin dosage needed when the dose is dependent upon a blood glucose test report.

3. Authorized direct care staff may not administer insulin to individuals who require blood glucose monitoring greater than 3 times daily, unless directed to do so by the Nurse-Trainer.

f) Staff, after training, may administer epinephrine by auto-injector as prescribed by a physician as an emergency measure when an individual experiences a serious allergic reaction (e.g., anaphylactic shock). The administration of epinephrine by auto-injector by staff is not the responsibility of the Nurse-Trainer.

1. The agency is responsible for the training of all staff who may administer epinephrine by auto-injector. Training for staff in the use of epinephrine auto-injectors can be obtained through the American Heart Association, American Red Cross, or American Safety and Health Institute, or from a registered professional nurse or licensed practical nurse, as delegated by a registered nurse or physician.

2. Two unexpired epinephrine auto-injectors should be in close proximity to the individual for whom the medication is prescribed and available for immediate use at all times. For the purpose of this Part, close proximity means:

A) Within arm's reach of the individual responsible for administering the epinephrine auto injection when away from the residence; or

B) In a known location with easy, immediate access when at the residence.

3. Emergency medical services must be summoned immediately after the use of an epinephrine auto-injector.

g) The Nurse-Trainer may authorize direct care staff to administer medications through an enteral tube after the authorized staff has successfully completed a DHS approved advanced training program specific to enteral tubes, their maintenance and medication administration.

h) 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 [20 ILCS 1705/15.4(c)], as judged by a Nurse-Trainer.

i) Authorized direct care staff shall receive specific additional competency-based training and assessment by a Nurse-Trainer, as deemed necessary by the Nurse-Trainer, whenever a change of medication, including, but not limited to, dosage, time and route, occurs or a new individual who requires medication enters the program.

j) Direct care staff who fail to qualify for competency to administer medications shall be given additional education and testing to meet criteria for delegation authority to administer medications. Any direct care staff person who fails to qualify as an authorized direct care staff after initial training and testing must, within three months, be given another opportunity for retraining and retesting. A direct care staff person who fails to meet criteria for delegated authority to administer medication, including, but not limited to, failure of the written test on two occasions, shall be given consideration for shift transfer or reassignment, if possible. No employee shall be terminated for failure to qualify during the three month time period following initial testing. Refusal to complete training and testing required by this Section may be grounds for immediate dismissal [20 ILCS 1705/15.4(h)].

k) No authorized direct care staff person delegated to administer medication shall be subject to suspension or discharge for errors resulting from the staff person's acts or omissions when performing the functions unless the staff person's actions or omissions constitute willful and wanton conduct [20 ILCS 1705/15.4(i)].

l) Authorization of staff to administer medication shall be revoked if, in the opinion of the Nurse-Trainer, the authorized direct care staff person is no longer competent to administer medication [20 ILCS 1705/15.4(c)]. The degree of retraining and reassessment of competency should occur at the discretion of the Nurse-Trainer.

m) Clear documentation of training, retraining and evaluation shall be kept in each staff or contractual person's personnel file by each agency where authorized direct care staff are employed.

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.50 Administration of Medications

a) Medications shall be administered in accordance with the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705] and the Illinois Nurse Practice Act.

b) With the exception of subcutaneous insulin administration by insulin pen by authorized staff and emergency epinephrine administration by epinephrine auto-injector by staff trained in epinephrine administration, non-licensed staff shall not administer any medication in an injectable form.

c) Medications that are regularly available without a prescription at a commercial pharmacy (although need not be purchased there) may be purchased for stock when they are prescribed as PRN or regularly scheduled (such as daily, weekly or monthly, but not limited to those schedules) by a physician or any other person licensed to prescribe medications in Illinois. The following conditions shall apply:

1. The medication must be stored in the original container, with the original label intact.

2. No labeling other than the original container labeling is allowed. This labeling may not be obscured in any way.

3. The prescription instructions, as written by the physician or any other person licensed to prescribe medications in Illinois and as interpreted by the Nurse-Trainer, will be placed on the MAR as required by Section 116.70(b) and followed as written.

4. Providers may not repackage medications.

5. The provider shall communicate with all appropriate parties regarding regularly prescribed stock medications during an individual's absence from his or her residence during a medication administration period.

d) Medications that are regularly available without prescription at a commercial pharmacy, such as uncontrolled cough syrups, laxatives and analgesics, shall be given to an individual only upon written order of the physician or other person licensed to prescribe medications in Illinois.

e) Over-the-counter substances, such as skin care lotion, lip balm, sunscreen, mouthwash, non-medicated foot powder, and cough drops, are generally considered comfort treatments. As such, they are not subject to the requirements of this Part. When, however, these substances are prescribed by a physician or other person licensed to prescribe medications in Illinois, these substances become subject to this Part.

f) PRN medications shall be administered within one hour after the need is identified.

g) A registered professional nurse, advanced practice nurse, physician, or physician assistant shall be on duty or on call at all times in any program covered by this Part [20 ILCS 1705/15.4(j)].

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.60 Medication Self-Administration

a) As part of the normalization process, in order for each individual to attain the highest possible level of independent functioning, all individuals shall be permitted to participate in their total health care program [20 ILCS 1705/15.4(d)]. Every program shall include, but not be limited to, individual training in promoting wellness, prevention of disease, and medication self-administration procedures.

1. Every program shall adopt written policies and procedures for assisting individuals in obtaining preventative health and medication self-administration skills in consultation with the registered professional nurse [20 ILCS 1705/15.4(d)].

2. Individuals shall be evaluated to determine their self-administration of medication capabilities by a Nurse-Trainer through the use of DHS required, standardized screening and assessment instruments.

3. When the results of the screening and assessment indicate an individual not to be independently capable to self-administer his or her own medications, programs shall be developed in consultation with the Community Support Team (CST) or Interdisciplinary Team (IDT) to provide individuals with medication self-administration training as identified in each individual's treatment/service plan [20 ILCS 1705/15.4(d)].

b) Each individual shall be presumed to be competent to self-administer medications if he or she has been determined to be:

1. capable by a registered professional nurse or advanced practice nurse;

2. approved to self-administer medication by the individual's CST or IDT; and

3. authorized by a written order of a physician.

c) Training of individuals to self-administer medication shall minimally include instruction, for each medication prescribed, in the following areas:

1. identification of a medication by any of the following methods:

A) name;

B) purpose;

C) size;

D) shape;

E) color; or

F) other distinguishing feature;

2. dosage or quantity to be taken;

3. route of administration;

4. frequency or times of administration;

5. purpose of medication, special instructions, common side-effects and potential consequences of not taking the medication or of not taking the medication properly; and

6. when to seek medical assistance.

d) When requested to do so by an individual, authorized direct care staff may assist an individual in the self-administration of medications by taking the medication from the locked area where it is stored and handing it to the individual. If the individual is physically unable to open the container, a staff member may open the container for the individual. Agency staff may also assist physically impaired individuals, such as those who have arthritis, cerebral palsy or Parkinson's disease, in the removal of the medication from the container and in consuming or applying the medication.

e) Each individual shall remain under observation by authorized direct care staff and be assisted by the staff to correct or prevent medication errors and to safeguard against adverse drug reactions. Observation frequency shall be determined by the Nurse-Trainer and the individual's Community Support or Interdisciplinary Team to maintain an individual's safety when independently self-administering his or her medication. All observation and assistance shall be noted in the individual's file.

f) Individuals specifically determined to be competent, by a physician who has issued a written order, to self-administer their own medications may maintain possession of the key or combination of the lock to their own medication storage area. A duplicate key or a copy of the combination shall be kept in a secure location for emergency use by licensed personnel or authorized direct care staff, should the individual lose or misplace the key or forget the combination.

g) A medication administration record need not be kept for those individuals for whom the attending physician has given permission to have access to their own medications and to be fully responsible for taking their own medications. However, each agency shall develop and implement a quality assurance procedure to ensure that self-administered medications are taken in accordance with prescribed orders. Documentation must include medication name, dosage and frequency, and the identity of the prescribing physician or other person licensed to prescribe medications in Illinois.

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.70 Medication Administration Record and Required Documentation

a) All medications, including patent or proprietary medications (e.g., cathartics, headache remedies or vitamins, but not limited to those) shall be given only upon the written order of a physician, advanced practice nurse, or physician assistant. All orders shall be given as prescribed by the physician and at the designated time. Telephone orders may be taken by a registered professional nurse or licensed practical nurse. All orders shall be immediately written on the individual's record or a "telephone order form" and signed by the nurse taking the order. These orders shall be countersigned or documented by facsimile prescription or electronically signed by the physician within 10 days.

b) Medication Administration Record

1. Except as provided in Section 116.60(g), an individualized MAR shall be kept for each individual for medications administered, including PRN medications, and shall contain at least the following:

A) the individual's name;

B) the name and dosage form of the medication;

C) the name of the prescribing physician, physician assistant, dentist, podiatrist or certified optometrist;

D) dose or quantity to be taken;

E) frequency or times of administration;

F) route of administration;

G) date and time given;

H) most recent date of the order;

I) allergies to medication; and

J) special considerations, including special directions and precautions for the medication's preparation and administration and contraindications for the medication.

2. PRN medication must be documented on the MAR in accordance with Section 116.70(b)(1). In addition, the following information must be included on the MAR:

A) conditions for which the medication may be given; and

B) maximum or stop dosage.

3. The MAR for the current month shall be kept with the medications or in the individual's record.

4. The MAR shall be completed and initialed immediately after medication is administered by the registered professional nurse, licensed practical nurse, or authorized direct care staff. Each MAR shall have a section that contains the full signature and title of each individual who initials the MAR.

5. All changes in medication shall be noted on the MAR by a licensed practical nurse, registered professional nurse, advanced practice nurse, pharmacist, physician, physician assistant, dentist, podiatrist, or certified optometrist and reported to the Nurse-Trainer prior to the next dose. Upon the direct instruction of a Nurse-Trainer, authorized direct care staff may indicate on the MAR completion of the following actions:

A) discontinuation of a medication;

B) change in medication schedule; and/or

C) application of a medication information label issued with a medication by a licensed pharmacy.

6. Individual refusal to take medications shall be noted on the MAR. Authorized direct care staff shall document in the individual's record the reasons for refusal and notify the registered professional nurse, Nurse-Trainer, or person licensed to prescribe medication in Illinois to receive direction on any action to be taken. Refusal of medication by an individual is not considered a medication error.

7. For individuals who are independently self-administering medications, no MAR shall be required. However, any medication that individuals take shall be listed in their records, including dosage, frequency and identity of the prescribing physician, physician assistant, dentist, podiatrist or certified optometrist. Each agency shall develop and implement a quality assurance system to ensure that self-administered medications are taken in accordance with prescribed orders.

c) In the event of a medication error, authorized direct care staff shall immediately report the error to the registered professional nurse, Nurse-Trainer or person licensed to prescribe medication in Illinois to receive direction on any action to be taken. All medication errors shall be documented in the individual's record and a medication error report shall be completed within eight hours or before the end of the shift in which the error was discovered, whichever is earlier. The medication error report shall be sent to the Nurse-Trainer for review and further action within 7 calendar days after the occurrence. A copy of the medication error report shall be maintained as part of the agency's quality assurance program. Medication errors must be documented and are subject to review by DHS or DPH, whichever is applicable. Medication errors that meet the reporting criteria of DHS' rules on Office of Inspector General Investigations of Alleged Abuse or Neglect or Deaths in State-Operated and Community Agency Facilities (59 Ill. Adm. Code 50) shall be reported to the Office of Inspector General.

d) In the event of suspected drug reaction, authorized direct care staff shall immediately report the signs and symptoms to the registered professional nurse, advanced practice nurse, physician, physician assistant, dentist, podiatrist, or certified optometrist to receive direction on any action to be taken. All adverse drug reactions shall be documented in the individual's record and an adverse drug reaction report shall be completed within eight hours or before the end of the shift in which the reaction was discovered, whichever is earlier. The adverse drug reaction report shall be sent to the prescriber and the Nurse-Trainer for review and further action. A copy of the adverse drug reaction report shall be maintained as a part of the agency's quality assurance program.

e) An inventory and a record of use of controlled substances shall be maintained by the registered professional nurse in the program, and each substance shall require a separate sheet indicating the:

1. name of the individual;

2. name of the prescriber;

3. prescription number;

4. name of the drug and strength;

5. amount used;

6. amount remaining;

7. time and date administered;

8. name of the individual who administered the medication; and

9. documentation of a shift count done by authorized direct care staff. Any discrepancies shall be reported to the Nurse-Trainer for review and action in accordance with written policy.

A) A shift count must be completed when the responsibility for administering medications changes from one authorized direct care staff or nurse to another authorized direct care staff or nurse.

B) The authorized direct care staff or nurse passing on responsibility for medication administration will count the controlled substances with the authorized direct care staff or nurse assuming responsibility for medication administration.

C) The count completed when a controlled substance is administered is not considered a shift count.

f) Host Family Community Integrated Living Arrangements as described in 59 Ill. Adm. Code 115 must develop a quality assurance procedure to ensure accurate inventory and record of use of controlled substances.

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.80 Storage and Disposal of Medications

a) All medications shall be stored in locked compartments or within the locked medicine container, cabinet or closet.

b) Access to medications shall be limited to licensed personnel and authorized direct care staff. Each program shall maintain an up-to-date list of authorized direct care staff.

c) Each program shall have a written procedure for safeguarding medications kept in an individual's room or possession and shall require medications to be stored when individual safety cannot otherwise be assured.

d) All medications shall be stored in their original containers.

e) All prescription medications that are given to individuals at the direction of the physician, registered professional nurse, advanced practice nurse, pharmacist, physician assistant, dentist, podiatrist, or certified optometrist shall have a label with the same information as would appear on a pharmacy label in accordance with Section 22 of the Illinois Pharmacy Practice Act [225 ILCS 85] to show:

1. the name and address of the pharmacy where the prescription is sold or dispensed;

2. the name or initials of the person authorized to practice pharmacy;

3. the date on which the prescription was filled;

4. the name of the patient;

5. the prescription number as filed in the prescription files;

6. the last name of the practitioner who prescribed the prescription;

7. the directions for use as contained in the prescription; and

8. the proprietary name or names or the established name of the medications, the dosage and the quantity.

f) Disposal of all medications shall be in accordance with federal and State laws.

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.90 Individual Health Supports and Assessment

a) The registered professional nurse shall assess an individual's health status at least annually or more frequently at the discretion of the registered professional nurse.

b) A physician, advanced practice nurse or physician assistant shall assess an individual's health status at least annually or more frequently at the discretion of the physician or at the request of the agency or the registered professional nurse.

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.100 Quality Assurance

a) A registered professional nurse, advanced practice nurse, licensed practical nurse, pharmacist or physician shall review the following for all individuals:

1. medication orders;

2. medication labels and medications listed on the MAR to ensure that they match physician orders; and

3. MARs (for persons who are not self-medicating) to ensure that they are completed appropriately for:

A) medication administered as prescribed;

B) refusal by the individual; and

C) full signatures provided for all initials used.

b) Reviews, as described in subsection (a), shall occur at least quarterly, but may be done more frequently at the discretion of the registered professional nurse and/or advanced practice nurse.

c) At least annually, the agency, inclusive of the Nurse-Trainer, shall summarize and analyze all medication errors to identify patterns and trends and establish corresponding corrective action. The analysis and corrective action must be documented and that documentation shall be retained by the agency for at least five years.

d) All quality assurance records shall be confidential and may only be disclosed in accordance with Article VIII, Part 21, of the Code of Civil Procedure [735 ILCS 5/8-2101 through 8-2105].

History

• Source: Amended at 41 Ill. Reg. 6534, effective May 26, 2017

59 Ill. Adm. Code 116.110 Administrative Requirements

a) Written policies and procedures shall be developed by each agency that include:

1. Provisions for on-going supervision and monitoring of authorized direct care staff.

2. Provisions for annual review and any necessary retraining of authorized direct care staff in theory and practice of medication administration.

3. Provisions for a systematic review of all medication errors, adverse drug reactions, and incidents to identify contributing factors and plan corrective action.

4. Provisions for recording and reporting of all instances of retraining and retesting for failure to qualify as an authorized direct care staff.

b) Each program shall have written policies and procedures to include the governing of:

1. distribution of medications, including controlled substances, and persons authorized to distribute medications;

2. administration of medications;

3. quality assurance medication review;

4. storage and safekeeping of medications;

5. disposal of medications, including controlled substances; and

6. training, review and any necessary retraining of authorized direct care staff.

c) Policies and procedures shall be consistent with applicable rules, regulations, and federal and State law.

d) Each program shall have a copy of all policies and procedures related to medication on file and readily available to all programs at all times.

Part 117 Family Assistance and Home-Based Support Programs for Persons with Mental Disabilities

59 Ill. Adm. Code 117.100 Purpose

a) The purpose of the Home-Based Support Services Law for Mentally Disabled Adults [405 ILCS 80/2-1] is to authorize the Department to encourage, develop, sponsor and fund home-based and community-based services for adults who are mentally disabled in order to provide alternatives to institutionalization and to permit them to remain in their own homes (Section 2-2 of the Home-Based Support Services Law).

b) The purpose of the Family Assistance Law for Mentally Disabled Children [405 ILCS 80/3-1] is to create a mandate for the Department to strengthen and promote families who provide care within the family home for children whose level of mental illness or developmental disability constitutes a risk of out-of-home placement. It is intended to strengthen, promote and empower families to determine the most appropriate use of resources to address the unique and changing needs of those families' mentally disabled children (Section 3-2 of the Family Assistance Law).

59 Ill. Adm. Code 117.110 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.

59 Ill. Adm. Code 117.115 Principles

a) Individuals and their families or legal guardians shall select the needed supports and services.

b) Individuals shall live in homes of their choosing in communities with or near family and friends and other individuals who are important to them.

c) Services shall be designed as described in Subparts B and C of this Part and provided to enhance the individual's existing natural social support network of family, friends, and acquaintances within the larger community of persons without disabilities, as well as social contacts among peers and paid caregivers.

d) Individuals and their families or legal guardians shall be permitted to experience decision-making and risk in order to enhance personal growth.

e) Individuals shall not be obligated to participate in a particular training program or activity because it is part of the program structure or for the convinence of staff.

f) The type, intensity and source of support services shall vary according to the individual's needs, other supports available and personal preferences, shall promote community integration, independence and self-sufficiency, and shall change as the individual's needs and preferences change.

g) Training and assistance shall be provided to the extent possible in natural environments during the course of a normal day. This includes participating in general community life, school, work and leisure activities and accessing general community goods and services, rather than participating primarily or only within the service system with other persons with disabilities and paid caregivers.

h) The values of integration, individuality, personal choice and skill enhancement shall also encompass health, leisure and recreational activities, social services and education, as well as family and home-based supports.

i) Use of generic (non-disability) community resources such as church, Y.M.C.A., Y.W.C.A., educational, clubs, shopping and recreation shall be preferred over segregated programs for special populations, to the extent consistent with the needs of the individual and family. However, if it is difficult for the individual to use generic resources without support, support tailored to the individual's needs shall be offered.

j) Family support must focus on the family unit. Family support should be broadly defined so as to respond to the needs of all members of the family, including the individual with a developmental or mental disability, parents, siblings, and other extended family members living within the household.

59 Ill. Adm. Code 117.120 Definitions

Unless the context otherwise requires, the terms used in this Part have the meanings ascribed to them in this Section.

"Abuse." Any physical injury, sexual abuse or mental injury inflicted on an individual other than by accidental means (Section 1-101.1 of the Code).

Physical injury includes all injuries serious enough to require immediate medical treatment by a physician, such as fractures and lacerations which require suturing and all other injuries which because of the circumstances or nature of the injury indicate possible abuse or neglect;

Sexual abuse includes but is not limited to any sexual penetration or sexual conduct between an individual and other person if the individual has been adjudicated legally disabled, or has a guardian, or is unable to understand the nature of the act or is unable to give knowing consent, or is injured, or alleges that there is, or there is evidence of, use of force, coercion, or the exchange of money or anything of value; and

Mental injury includes use of words, signs, gestures or other actions by anyone against an individual which intimidates, demeans, harasses, causes emotional anguish or distress, ridicules, threatens, harms or shall knowingly incite or precipitate maladaptive behavior on the part of an individual. Mental injury also includes exploitation, which is any act that uses individuals, their resources or their possessions for an agency employee's personal gain or for an agency's benefit.

"Act." The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

"Adult." A person between the ages of 18 and 60 years, inclusive.

"Agency." A community mental health or developmental services organization which is a sole proprietorship, association, partnership, corporation or organization, public or private, either for profit or not for profit.

"Autism." A lifelong developmental disability which is manifested by a combination of significant disturbances in intellectual, sensory, cognitive, social, psychological, and emotional functioning and is distinguished from other related disorders by impaired or disordered language and communication; failure to develop appropriate social relationships; ritualistic or compulsive behaviors.

"Cerebral palsy." A disorder dating from birth or early infancy, non-progressive, characterized by absence or aberrations of motor function (paralysis, weakness, incoordination) and of the other manifestations of organic brain damage such as sensory disorder, seizures, mental retardation, learning difficulty and behavior disorders

"Child." A person who is 17 years old or younger.

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Crisis management." Emergency services of an intensive nature to alleviate stressful situations.

"Day." A calendar day unless otherwise specified.

"Department." The Department of Human Services.

"Department-funded out-of-home placement services." Those services for which the Department pays the partial or full cost of care of the residential placement.

"Developmental disability." Disability which is attributable to mental retardation, cerebral palsy, epilepsy or autism; or to any other condition which results in impairment similar to that caused by mental retardation and which requires services similar to those required by a mentally retarded person. Such disability must originate before the age of 18 years, be expected to continue indefinitely, and constitute a substantial handicap (Section 1-106 of the Code).

"Developmentally disabled." Having a developmental disability.

"DSM-III-R." The Diagnostic and Statistical Manual of Mental Disorders, Third Edition, revised (DMS-III-R, American Psychiatric Association, 1987 edition).

"Employment-related services." Services which allow an individual to participate in employment or which prepare an individual for future participation in employment.

"Epilepsy." A chronic disorder of the brain which is categorized by the tendency to have recurrent seizures. Seizures are sudden, uncontrolled episodes of excessive electrical discharges of brain cells with associated sensory, motor and/or behavioral changes.

"Family." The spouse and children and the parent or parent substitute, as defined by this Section, sister, and brother of an individual.

"Family Assistance Law." The Family Assistance Law for Mentally Disabled Children [405 ILCS 80/3-1].

"Goal." An expected result or condition that involves a specified period of time to achieve, that is specified in behavioral terms in a statement of relatively broad scope, and that provides guidance in establishing specific objectives directed toward its attainment.

"Habilitation." An effort directed toward the remediation of a disability or toward increasing an individual's level of physical, mental, social or economic functioning, independence and self-respect. Habilitation may include, but is not limited to, diagnosis, evaluation, medical services, residential care, day care, special living arrangements, training, education, sheltered employment, protective services, counseling and other services through interaction and participation in the community (Section 1-111 of the Code).

"Home-based services." Services provided to a mentally disabled adult who lives in his or her own home. These services may include but are not limited to: home health services, service facilitation, crisis management, training and assistance in self-care, personal care services, habilitation and rehabilitation services, employment-related services, respite care, and other skill training that enables a person to become self-supporting (Section 2-3 of the Home-Base Support Services Law).

"Home-Based Support Services Law." The Home-Based Support Services Law for Mentally Disabled Adults [405 ILCS 80/2-1].

"Illinois resident." an individual legally admitted to the United States who lives in Illinois, and has no present intention to move from Illinois.

"Individual" or "individuals." A person or persons who receives or receive services or support as described in this Part.

"Informed consent." Permission voluntarily granted by the individual or guardian for the release of information, for participation in the program services specified in the service/treatment plan or for the use of a specific procedure in the plan. Informed consent means full disclosure to the individual or guardian of the information required for him or her to make the decision intelligently.

"Legal guardian." The court-appointed guardian or conservator of the person (Section 1-110 of the Code).

"Licensed Clinical Psychologist." A clinical psychologist licensed by the Clinical Psychologist Licensing Act [225 ILCS 15].

"Mental disability." A developmental disability, a mental illness in an adult or an emotional disturbance in a child.

"Mentally disabled adult." A person between the ages of 18 and 60 years who lives in his or her own home; who needs home-based services, but does not require 24-hour-a-day supervision; and who has one of the following conditions: severe autism, severe mental illness, severe or profound mental retardation, or severe and multiple impairments (Section 2-3 of the Home-Based Support Services Law).

"Mental retardation." Significantly subaverage general intellectual functioning which exists concurrently with impairment in adaptive behavior and which originates before the age of 18 years (Section 1-116 of the Code).

"Natural support network." a social circle affiliated with an individual that may include, but is not limited to, family members, friends, co-workers and peers.

"Neglect." Failure to provide adequate medical or personal care or maintenance to an individual, which failure results in physical or mental injury to an individual or in the deterioration of the individual's physical or mental condition (Section 1-117.1 of the Code).

"Objective." An expected result or condition that involves a specified period of time to achieve, that is specified in behavioral terms and that is related to the achievement of a goal.

"Own home." In one's "own home" means that a mentally disabled adult lives alone; or that a mentally disabled adult is in full-time residence with his or her parents, legal guardian, or other relatives; or that a mentally disabled adult is in full-time residence in a setting not subject to licensure under the Nursing Home Care Act [210 ILCS 45] or the Child Care Act of 1969 [225 ILCS 10], with three or fewer other adults unrelated to the mentally disabled adult who do not provide home-based services to the mentally disabled adult. (Section 2-3 of the Home-Based Support Services Law).

"Parent" or "parent substitute." A person acting in the capacity of a parent with respect to an individual with mental disabilities who is 17 years old or younger. The parent shall be:

The legal guardian, if a legal guardian has been determined;

The natural or adoptive parent, if no legal guardian has been determined;

A person licensed as a foster parent and providing care under the Child Care Act of 1969; or

Another relative who is 21 years old or older who has a parent-like relationship with the individual with mental disabilities and who wishes to serve as the parent substitute. This relative shall be considered the parent for purposes of this Part if there is no objection from:

The individual;

The legal guardian, if a legal guardian has been determined; or

The natural or adoptive parent, if no legal guardian has been determined.

"Primary examiner." The licensed clinical psychologist and/or psychiatrist and/or physician asked to conduct an evaluation to determine whether an individual applying for programs under this Part meets the criteria for severe level of disability.

"Provider agency." (See "Agency.")

"Random selection." To ensure equal opportunity to the programs described in this Part, the Department shall use a random selection process. The selection process shall be implemented in the following manner: children and adults shall be selected separately, based on two programs and two line item appropriations; residents from each region of the State shall be selected in proportion to the population of that region; an equal number of adults with a developmental disability and mental illness shall be selected; and an equal number of children with a developmental disability and an emotional disturbance shall be selected. There shall be four pools within each region: children with an emotional disturbance; children with a developmental disability; adults with mental illness; adults with a developmental disability. Within each of the separate pools of applicants identified above, a computer shall randomly number all preliminary applications from one through the number of applications within that pool. The proper number of persons to be enrolled from each pool shall be chosen according to the per capita approach described above. This number of people (number one through the maximum permitted for each pool) shall be chosen as provisional participants. The provisional participants shall be requested to verify eligibility criteria and diagnosis through evaluation. If any provisional applicant is found ineligible, or for any other reason fails to enter the program, the next alternate based on the sequential numbering shall be selected for enrollment after undergoing verification of eligibility and diagnosis through evaluation.

"Region." A service division of the State created by the Department in accordance with Section 8 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/8].

"Rehabilitation." An effort toward the amelioration of a disability or toward restoring an individual's level of physical, mental, social or economic functioning, independence and self-respect.

"Relative." A person having any of the following relationships by blood, marriage or adoption: parent, son, daughter, brother, sister, grandparent, uncle, aunt, nephew, niece, great grandparent, great uncle, great aunt, stepbrother, stepson, stepdaughter, stepparent or first cousin (Section 2-3 of the Home-Based Support Services Law).

"Secretary." The Secretary of the Department of Human Services or his or her designee.

"Service facilitation." Assisting an adult individual participating in the Home-Based Support program with the development and modification of a service/treatment plan, helping the individual gain access to the services identified in the plan, and advocating on the individual's behalf if services are not being provided as prescribed in the plan or assisting a family participating in the Family Assistance Program in determining the most appropriate use of resources to address the needs of the child with a severe mental disability within the context of the family. Assisting families also includes providing information about local support services, locating, advocating for or creating services that conform to the individual family's desires.

"Service facilitator." An agency representative with experience in working with mentally disabled persons and who provides service facilitation.

"Service/treatment plan" or "plan." The basis on which services shall be planned by the individual, a service facilitator and other persons chosen by the individual, provided by a service agency, an organization, or an individual and reimbursed by the Department for purposes of the Home-Based Support Services Program.

"Services." Services which are rendered and are partially or wholly funded by the Department.

"Severe autism." A lifelong developmental disability which is typically manifested before 30 months of age and is characterized by disturbances in the rate and sequences of cognitive, affective, psychomotor, language and speech development. A person shall be determined severely autistic, for purposes of this Part, if he or she manifests all of the following characteristics: disturbance in the capacity to relate appropriately to people, events and objects; absence, disorder or delay of language; speech or meaningful communication; unusual or inconsistent response to sensory stimuli in one or more of the following: sight, hearing, touch, pain, balance, smell, taste, or the way the person holds his or her body; and insistence on sameness as shown by stereotyped or repetitive behavioral patterns, repetitive movements, abnormal preoccupation, or resistance to change. There shall be an absence of the characteristics associated with schizophrenia, such as delusions, hallucinations, loosening of associations and incoherence. (Section 2-3 of the Home-Based Support Services Law and Section 3-3 of the Family Assistance Law)

"Severe emotional disturbance." A child with a severe emotional disturbance is one who, on the basis of a psychosis or other emotional or behavioral disorder, suffers from severe disability which requires sustained treatment interventions for a year or more, and which generally requires attention from two or more agencies.

"Severe mental illness." The manifestation of both the following characteristics: the presence of a major mental disorder in adults, or a mental disorder in children or adolescents, classified in the DSM-III-R, excluding alcohol or substance abuse, Alzheimer's disease, or other forms of dementia based upon organic or physical disorders; and a functional disability of an extended duration for adults, or any duration for children or adolescents, which results in substantial limitations in major life activities. (Section 2-3 of the Home-Based Support Services Law and Section 3-3 of the Family Assistance Law)

"Severe or profound mental retardation." The manifestation of all of the following characteristics: development at a rate approximately four and one-half or more standard deviations below the mean as determined through intellectual assessment; lack of development primarily in the cognitive domain; and impairment of adaptive behavior. This impairment constitutes a substantial disability and can be expected to continue indefinitely. (Section 2-3 of the Home-Based Support Services Law and Section 3-3 of the Family Assistance Law)

"Severe and multiple impairments." The manifestation of all the following characteristics: multiple handicaps in the physical, sensory, behavioral or cognitive domains which constitute a severe or profound handicap; development at substantially less than expected rate for the age group in the cognitive, affective or psychomotor domains; and a diagnosis of a developmental disability as defined in Section 1-106 of the Code. (Section 2-3 of the Home-Based Support Services Law and Section 3-3 of the Family Assistance Law)

"Skills training." Services aimed at improving an individual's ability to perform the activities of daily living and/or community living and/or work-related proficiencies.

"Special education program." Specially designed instruction, at no cost to the parent or individual, to meet the unique needs of an individual with a disability up to age 21, including classroom instruction, instruction in physical education, home instruction and instruction in hospitals and institutions (Education for the Handicapped Act (20 U.S.C.A. 1400 (1996)) and the rules of the State Board of Education at 23 Ill. Adm. Code 226).

"Substantial disability." A physical and mental disability, resulting from mental retardation, cerebral palsy, epilepsy, or autism, of such severity that, alone or in connection with social, legal, or economic constraints, it requires the provision of specialized services over an extended period of time directed toward the individual's social, personal or economic habilitation or rehabilitation.

"Supported employment." Competitive work in integrated work settings for incidivuals with severe mental disabilities for whom competitive employment has not traditionally occurred or for individuals for whom competitive employment has been interrupted or intermittent as a result of a severe disability and who need ongoing support services to perform such work.

"Twenty-four-hour-a-day-supervision." Care by a trained mental health or developmental disability professional on an ongoing basis (Section 2-3 of the Home-Based Support Services Law).

59 Ill. Adm. Code 117.125 Individuals' Records and Informed Consent

a) The individual or guardian shall give informed consent for the release of information and to participate in the services specified in the service/treatment plan, which shall be documented in the individual's case record.

b) The Department shall maintain a roster of all applicants who have been chosen and have been determined eligible for the programs described in this Part.

c) The Department shall maintain a permanent case record for each individual who has been chosen and determined eligible. Control and protection of the record shall be governed by the Act.

d) Department staff shall maintain a continuous, chronological record of all activities and events in the case records. Events and activities shall be documented in a standard format with sufficient specificity that progress can be monitored by an uninformed reviewer without additional information from responsible staff.

e) Department-designated agencies shall also maintain a case record for each individual served. Control and protection of the records shall be governed by the Act.

59 Ill. Adm. Code 117.130 Outreach Plan

Annually, information shall be disseminated by the Department in English and in Spanish to individuals who may be eligible for the programs described in this Part, and to persons who have contact with individuals who may be eligible to participate in these programs. Furthermore, all developmental disability and mental health agencies, service facilitation units and other service organizations shall be sent brochures containing preliminary application forms (117.Appendix A) for distribution to potentially-eligible individuals. The Department shall diseminate letters explaining the programs to agencies and advocacy organizations around the State.

59 Ill. Adm. Code 117.135 Preliminary Application Process

a) The Department shall disseminate preliminary applications in English and Spanish annually to those individuals who may be eligible to participate in the programs described in this Part.

b) Applicants shall submit their completed preliminary applications to the Department, 405 Stratton Building, Springfield, IL 62765 annually by a date determined by the Department, but no later than July 31.

c) Preliminary application for the Home-Based Support Services Program, described in Subpart B (form DMHDD-1235), must be made by the individual or his or her guardian. Preliminary application for the Family Assistance Program, described in Subpart C (form DMHDD-1236), must be made by the child's parent. The applicant is responsible for providing complete and accurate information as specified in the application package and instructions (see Section 117.Appendix B, Illustrations A and B).

d) Individuals shall be chosen through a random selection process as described in Section 117.120. The number of individuals chosen to participate in these programs shall be contingent upon the availability of funds appropriated by the General Assembly for these purposes. The Department shall notify individuals in writing of their selection within 30 days after final approval of the application. In each year in which funds are available for expanded enrollment, the Department shall conduct a random selection process and select additional individuals for these programs.

59 Ill. Adm. Code 117.140 Application and Eligibility Determination Process

a) The Department shall send and ask applicants chosen through the random selection process to complete an application package (described in subsection (b) of this Section) within 30 days after being notified that they have been chosen.

b) The application package shall include:

1. A letter explaining the Department's eligibility verification process;

2. Instructions for submitting the necessary clinical information to verify the severity of the disability and other eligibility criteria;

3. A listing of Department-designated agencies in the applicant's region which may assist with verification of disability;

4. Written instructions to the primary examiners on what they must do to verify eligibility;

5. Eligibility criteria for individuals with severe mental illness or emotional disturbance, severe autism, severe mental retardation and severe and multiple impairments; and

6. Eligibility determination forms that must be signed by the primary examiner (see Section 117.Appendix B).

c) Documentation of a severe or profound mental retardation shall be based on a comprehensive documented evaluation by a licensed clinical psychologist or a certified school psychologist for children or for adults up to the age of 21 sho are in a special education program. The evaluation shall verify that the individual's severe or profound mental retardation originated before the age of 18 and has resulted in significantly subaverage general intellectual functioning in concurrence with impairment in adaptive behavior and meets the Classification in Mental Retardation (American Association on Mental Retardation, 1983 edition) or the DSM-III-R criteria of severe or profound mental retardation, i.e., an intelligence quotient (I.Q.) of 40 or below, and a severe or profound level of adaptive behavior in keeping with illustrations in the Classification in Mental Retardation.

d) Documentation of a severe mental illness shall be based on a comprehensive documented evaluation by a licensed clinical psychologist or psychiatrist. The evaluation shall verify that the individual's primary diagnosis meets one of the DSM-III-R major mental disorders listed below (such diagnosis may coexist with other DSM-III-R diagnoses in Axis I or other areas): schizophrenic disorder; delusional disorder; schizoaffective disorder; bipolaraffective disorder; atypical psychosis; or major depression, recurrent. The evaluation shall also verify that the individual's severe mental illness has substantially affected his or her functioning in at least two of the following areas: self maintenance, social functioning, activities of community living, work skills. There shall be detailed documentation of how the individual's functioning in these areas has been specifically affected and documentation that the substantial functional disabilities are expected to be present for at least one year, which results in substantial limitations in major life activities.

e) Documentation of severe autism shall be based on a comprehensive, documented evaluation by a licensed clinical psychologist or psychiatrist. The evaluation shall verify that a child or adult with severe autism has a lifelong developmental disability which is typically manifested before 30 months of age and is characterized by disturbances in the rate and sequences of cognitive, affective, psychomotor, language and speech development. The diagnosis of autistic disorder shall be in keeping with DSM-III-R 299.00 criteria of autistic disorder.

f) Documentation of severe and multiple impairments shall be based on a comprehensive, documented evaluation by a licensed clinical psychologist or a physician; and, depending on the individual's disability, one or more specialists. The evaluation shall verify that the individual has a substantial disability that can be expected to continue indefinitely. The individual meets the criteria for severe and multiple impairments based on a finding that criteria in subsections (f)(1) through (3) of this Section are met. Each item has its own sub-criteria which also shall be met, e.g., under subsection (f)(1)(A) or (B) of this Section, shall apply.

1. The evaluation determines the presence of a developmental disability based on:

A) Mental retardation, which is defined as general intellectual functioning that is two or more standard deviations below the mean; or

B) Cerebral palsy, epilepsy, autism or any other condition which results in impairment similar to that caused by mental retardation and which requires services similar to those required by persons with mental retardation.

2. The evaluation determines multiple handicaps in physical, sensory, behavioral and/or cognitive functioning which constitute a severe or profound impairment attributable to one or more of the following:

A) Physical functioning, which severely impairs or restricts the individual's motor performance that may be due to neurological, psychological or physical involvement resulting in a variety of disabling conditions, such as hemiplegia, quadriplegia, ataxia, in severe organ systems involvement such as congential defects, and other physical abnormalities resulting in the individual being non-mobile and non-ambulatory or confined to bed and receiving assistance in transferring, or requiring regular medical or nursing supervision such as gastrostomy care and feeding.

B) Sensory, which involves severe restriction due to hearing and/or visual impairment limiting the individual's movement and creating dependence in completing most daily activities.

i) Hearing impairment is defined, based on an evaluation by a board eligible or certified otolaryngologist or an audiologist with a Certificate of Clinical Competency, as loss of 70 dB aided or speech discrimination of less than 50% aided.

ii) Visual impairment is defined, based on an evaluation by a board eligible or certified ophthamologist or a licensed optometrist, as 20/200 in the better eye or a visual field of 20 degrees or less.

C) Behavioral, which involves severe or profound deficits in adaptive hehavior or severe maladaptive behavior.

i) Adaptive behavior, which is at a severe or profound level of functioning for the age group in self-care skills such as feeding, dressing, grooming or bathing, in social skills such as responses or interactions with others or in communication skills such as use of words or gestures expressively or receptively.

ii) Maladaptive behavior, which presents a danger to self or others, is destructive to property by deliberately breaking, destroying or defacing objects, is disruptive by fighting or prolonged arguing or crying, or has other socially offensive behaviors in sufficient frequency and/or severity to seriously limit social integration.

D) Cognitive, which involves severe or profound intellectual functioning at a measured I.Q. of 40 or below.

3. The evaluation determines that development is substantially less than expected for the individual's age in cognitive, affective or psychomotor behavior.

A) Cognitive, which involves intellectual functioning at a measured I.Q. of 70 or below.

B) Affective behavior, which involves over and under responding to stimuli in the environment and may be observed in mood, attention or awareness, or in behaviors such as euphoria, anger or sadness that seriously limit integration into society.

C) Psychomotor, which includes a severe developmental delay in fine or gross motor skills so that development in self-care, social interaction, communication or physical activity shall be greatly delayed or restricted.

g) Individuals or their guardians may use existing evaluations if they meet the criteria above and were completed within the following time frames:

1. For assessment of severe mental illness described in subsection (d) of this Section, within one year prior to the date submitted to the Department.

2. For assessment of the maladaptive behavior component of severe and multiple impairment described in subsection (f)(2)(C)(ii) of this Section, within one year prior to the date submitted to the Department.

3. For all other assessments required by subsections (c)(e) and (f) of this Section, within three years prior to the date submitted to the Department.

h) If existing evaluations are not available, outdated or do not meet the above criteria, individuals or their guardians shall choose the primary examiner of their choice or use Department-designated agencies or organizations to conduct the evaluations. The completed evaluation shall be submitted with forms DMHDD-1237.1, 1237.2, 1237.3, 1237.4, 1237.5 (see Section 117.Appendix B, Illustrations A, B, C, D, E).

i) The Department shall reimburse primary examiners and the other necessary examiners for the cost of the evaluation unless the individuals are eligible for partial or full payment for the evaluation by a third party payor. In such cases, the third party payor shall reimburse for the full or partial cost, depending on the individuals' coverage, and the Department shall reimburse the balance. The Department's reimbursement shall be tied to the usual and customary fee for such evaluations, based on the individuals' needs.

j) The primary examiner shall submit the completed application and verification of disability to the Department.

k) The Department shall review the completed application and verification of disability. The Department shall notify the applicant in writing within 30 days that the application has been received and is or is not complete, and shall specify in writing what additional information is necessary.

l) Should an application remain incomplete for more than 30 days after the request for additional information, the Department shall notify the applicant in writing of the incomplete status and what information is still lacking. Such notification of status shall be sent one additional time at a 30-day interval. If, within 30 days after the final notification, the applicant has not provided the additional information, the application shall be considered inactive.

59 Ill. Adm. Code 117.145 Hearings and Appeals

a) If the Department denies an individual's application for participation in the programs included in this Part, the Department shall give written notice within 30 days to:

1. The person who signed the application for participation in the Home-based Support Services Program; or

2. The parent for the Family Assistance Program.

b) The notice shall inform the individual of the right to appeal the decision and shall describe the appeal procedure.

c) The person who receives the notice may appeal the Department's denial within 20 days after receipt of the Department's written notice by mailing a written appeal request of the Department (see Sections 2-13 and 3-15 of the Home-Based Support Services Law). All appeal requests shall be sent to:

Hearings and Appeals Unit

Department of Human Services

401 Stratton Building

Springfield, IL 62765.

d) The Department may arrange pre-hearing conferences prior to scheduling a hearing if, in the opinion of the hearing officer, such conferences could develop factors not included in the Department's master case record, could clarify the facts or issues to be determined at the hearing or could result in a resolution of the case without a formal hearing. The individual is not required to participate in such a conference; if the individual does participate, he or she may be represented by the person of his or her choice. If the appellant and the Department agree, the appeal may be terminated at the pre-hearing conference.

e) The Department shall send by certified mail a notice stating the date, time, and place of the hearing to the address given on the individual's appeal request not later than 60 days after receiving the notice of appeal, unless the appeal is terminated at the pre-hearing conference. Hearings shall be scheduled at a time and place to be determined by the Department. The place selected shall be an appropriate location, with a view to geographic grouping of the cases to be heard, to keep travel at a minimum for all participants.

f) The individual requesting the appeal of the Department shall appear personally and may bring such witnesses as may be deemed necessary and may be represented by a person of his or her own choice.

g) A hearing officer duly authorized by the Secretary shall conduct the hearing as follows:

1. The hearing shall be tape or stenographically recorded.

2. The hearing shall be officially opened when its purpose has been stated and governing authorities have been cited.

3. The hearing officer shall present his or her credentials.

4. The hearing officer shall swear in those who are to testify as witnesses, including the appellant and others appearing on his or her behalf, the Department's representative or representatives, and identify them for the record by name and title.

5. The appellant shall be given preference as to the order of appearances by agreement as to the format of the hearing, as a result of a preliminary conference between both parties. If agreeable, the Department's case shall be recited first into the record for the purpose of developing a basis for the hearing. All documents, in support of such testimony, shall be numbered and offered into evidence as the Department's exhibits. Leave to substitute copies of such documents shall be sought, so the originals may be retained in the Department's master case record file.

6. The common law rules of evidence shall not be enforced in the conduct of the hearing (see Section 10-40 of the Illinois Administrative Procedure Act [5 ILCS 100/10-40]). The hearing officer may ask and receive answers to such questions as are pertinent and proper for a fair determination of the case. Exhibits may be received as part of the evidence and shall be numbered in order according to whether they are the Department's or the appellant's exhibits.

7. Upon completion of the Department's case, cross examination of the Department may be held if desired, whether by the appellant or his or her attorney, if so represented.

8. The appellant shall then state, either directly, or on examination by the counsel, the reason for requesting an appeal of the denial of the application, and shall submit documents to substantiate allegations made by him or her, or as a rebuttal of the Department's allegations. These exhibits shall be numbered and identified for record purposes as applicant's exhibits. The presiding hearing officer shall have complete authority for determining what testimony or evidence is relevant and admissible into the record, either by the Department or the appellant.

9. After all direct testimony has been completed and all evidence by both the Department and the appellant is in, cross-examination may again be held, if so desired.

10. When there is no further testimony, the hearing shall be adjourned.

h) Within five working days after the hearing, the hearing officer shall render his or her written decision as to whether the Department presented substantial evidence that the individual did not meet the criteria for eligibility set out in Section 117.200 or Section 117.300. Substantial evidence is such evidence as a reasonable person can accept as adequate to support a conclusion. If the hearing officer finds there was substantial evidence to justify the Department's decision, he or she shall deny the appeal. The hearing officer's decision shall contain findings of facts and conclusions. Copies of the decision shall be sent to the appellant and to the Department. The appellant shall be informed that he or she may appeal the hearing officer's decision by requesting a review by the Secretary within 10 days after the receipt of the appeal. The request must be made in writing to the Secretary.

i) If an appeal is requested, the Secretary shall review the hearing officer's decision and the evidence submitted at the hearing. Within 20 working days after receipt of the request for review, the Secretary shall issue a written decision upholding or reversing the hearing officer's decision. The Secretary shall uphold the decision if he or she determines that the procedures set out in this Section were followed and that the decision was supported by substantial evidence. Copies of the Secretary's decision shall be sent to the appellant and the Department.

j) The Department's denial of an appeal shall constitute a final administrative decision. Final administrative decisions shall be subject to judicial review exclusively as provided in the Administrative Review Law, as now or hereafter amended, except that any petition for judicial review of a final administrative decision by the Department under this subsection shall be filed within 30 days after receipt of notice of the Department's final administrative decision. The term "administrative decision" has the meaning ascribed to it in Section 3-101 of the Code of Civil Procedure. (Section 2-13 of the Home-Based Support Services Law and Section 3-15 of the Family Assistance Law)

59 Ill. Adm. Code 117.200 Eligibility Criteria

a) The number of eligible adults chosen to participate in this program shall be contingent upon the availability of funds appropriated by the General Assembly for these purposes.

b) To be eligible for the Home-Based Support Services Program an individual must:

1. Reside in Illinois;

2. Be between the ages of 18 and 60, inclusive;

3. Reside in his or her own home or, within two months of being notified that he or she has been chosen to participate in this program, he or she shall reside full-time in his or her own home.

4. Need home-based support services, but not require 24-hour-a-day supervision;

5. Be eligible and must have applied for federal Supplemental Security Income (SSI) (42 U.S.C.A. 1381 (1996)) or federal Social Security Disability Income (SSDI) (42 U.S.C.A. 401 (1996)) benefits;

6. Be diagnosed as having one of the following conditions:

A) Severe autism;

B) Severe mental illness;

C) Severe or profound mental retardation; or

D) Severe and multiple impairments.

7. Apply annually.

8. Not receive CILA services in conjunction with this Section. (Community Integrated Living Arrangements Licensure and Certification Act [210 ILCS 135].

59 Ill. Adm. Code 117.205 Notice of Eligibility and Service Authorization

a) The Department shall notify individuals found eligible, in writing, within 30 days after final approval of their applications. This notification shall include instructions for accessing services and the names of Department-designated agencies that can assist the individual in developing a service/treatment plan.

b) The service facilitator shall send a copy of the service/treatment plan, signed by the individual or his or her guardian, to the Department within 60 days from the date of the Department's final approval of the application. Payment for services shall be based on the plan and services delivered shall be consistent with the plan.

c) If an individual chosen to participate in this program is receiving Department-funded purchase of care or grant-in-aid services, reimbursement for his or her support under this program shall be reduced based on the Department's costs of the individual's purchase of care or grant-in-aid services. The individual can choose, however, to design his or her individualized plan to include newly-arranged services that may better meet the individual's needs and for which there is no offset.

59 Ill. Adm. Code 117.210 Notice of Ineligibility and Right to Appeal

a) If, based on the evaluations as described in Section 117.140, the individual is found ineligible, the Department shall notify him or her or the guardian in writing within 30 days.

b) Appeal of a service denial may be made as provided for in Section 117.145.

59 Ill. Adm. Code 117.215 Services and Funding Provisions

a) The Department shall purchase services from service agencies, organizations or individuals based on the service/treatment plan. Such services may include, but are not limited to:

1. Home health services;

2. Service facilitation;

3. Crisis management;

4. Training and assistance in self-care;

5. Personal care services;

6. Habilitation and rehabilitation services;

7. Employment-related services;

8. Supported employment;

9. Respite care for the caregiver; and

10. Other skills training that enables an individual to become self-supporting.

b) Home-based support services may not be used to:

1. Replace services for which the individual is otherwise eligible through federal, state or local public agencies such as special education programs, as described in 42 CFR 430, Subpart A (1996).

2. Deny, reduce or terminate services to individuals participating in this program.

c) The amount of home-based support services shall be determined by the individual's service/treatment plan but shall not exceed the following:

1. For adults who are not in a special education program, the cost of services shall be up to 300 percent of the monthly federal SSI payment for a person living along (Section 2-6 of the Home-Based Support Services Law).

2. For adults who are in a special education program, the cost of services shall be up to 200 percent of the monthly federal SSI payment for a person living alone (Section 2-6 of the Home-Based Support Services Law).

59 Ill. Adm. Code 117.220 Service Facilitation Services

a) The Department shall notify individuals who are chosen to participate in the program in writing of the availability of an array of community services which Department-designated agencies can provide, including service facilitation.

b) Periodically, as desired by the individual but no less than annually, the service facilitator shall review with the individual the adequacy of the plan and make any modifications desired by the individual.

59 Ill. Adm. Code 117.225 Service/Treatment Plan

a) The service/treatment plan shall be developed by the individual, his or her guardian, and other persons the individual asks to participate as well as a service facilitator.

b) The plan shall serve as the basis on which services may be billed by an agency, organization or individual and reimbursed by the Department.

59 Ill. Adm. Code 117.230 Selection of Services

Individuals whose eligibility has been verified and who have a completed service/treatment plan shall receive services on a monthly basis not to exceed the funding level set by the plan.

59 Ill. Adm. Code 117.235 Service Monitoring

Annually, the Department through on-site field review shall monitor a sample of the service/treatment plans of participating individuals to assure services are meeting the plans' stated goals, the needs of the individuals being served, and to ensure that the individuals are satisfied with the services which they are receiving.

59 Ill. Adm. Code 117.240 Service Termination

a) The funding for services will cease if any of the following occur:

1. The adult no longer meets the eligibility criteria;

2. The adult dies;

3. The adult reaches the age of 61 years; or

4. The adult or guardian submits false information during the application process.

b) Changes in eligibility shall be reported by the individual or his or her guardian to the Department in writing within 30 days after such changes occur.

59 Ill. Adm. Code 117.300 Eligibility Criteria

a) The number of eligible families chosen to participate in the Family Assistance Program shall be contingent upon the availability of funds appropriated by the General Assembly for these purposes.

b) To be eligible, a family must meet all of the following criteria:

1. Have a child 17 years old or younger who has a diagnosis of one of the conditions described in Section 117.200(b)(6) and who lives in the home. The eligible child may be living in an out-of-home placement at the time of application but must live with the parent within 60 days after the date of being notified of acceptance.

2. Reside in Illinois.

3. Have a maximum household federal taxable income of less than $65,000 annually (natural or adoptive family) as verified by the family's federal income tax return. Income eligibility shall be based on the year immediately preceding the date of application, unless the family can verify that its federal taxable income shall be less in the year the application is made. Families who can verify that they did not file an income tax return because of limited income shall be considered eligible. Such families shall be required to verify household income by listing all of their income from all sources from the previous year. The family income limit shall not apply to children in foster care. In such cases, the foster child's income shall be the determinant.

4. Apply annually.

History

• Source: Amended at 32 Ill. Reg. 9976, effective June 25, 2008

59 Ill. Adm. Code 117.305 Eligibility Determination Process

The eligibility determination process for the Family Assistance Program shall be conducted as follows:

a) Documentation of severe or profound mental retardation shall be in accordance with Section 117.140(c).

b) Documentation of a severe emotional disturbance shall be based on a comprehensive, documented evaluation by a licensed clinical psychologist or psychiatrist who shall verify that the child has a primary diagnosis which meets the DSM-III-R criteria of a mental disorder with onset in childhood or adolescence (excluding V-codes, adjustment disorders, mental retardation when no other mental disorder is present, or other forms of dementia based on organic, physical or alcohol/substance abuse disorders). A child who suffers from this severe disability requires sustained treatment intervention for a year or more and generally requires attention from two or more agencies. The child must meet DSM-III-R Axis V criteria of severe functional impairment (a score of 40 or below on the Global Assessment of Functioning Scale (GAF Scale) contained in the DSM-III-R) and must be experiencing significant limitations of major life activities in his or her capacity for living in a family or family equivalent and in two or more of the following areas (not to include impairment in functioning due to physical or environment limitation):

1. Self-care at an appropriate developmental level;

2. Perceptive and expressive language;

3. Learning; or

4. Social interaction and self-direction, including behavioral controls, decision-making, judgment and value systems at an appropriate developmental level.

c) Documentation of severe autism shall be in accordance with Section 117.140(e).

d) Documentation of severe and multiple impairments shall be in accordance with Section 117.140(f).

e) Families shall submit, with documentation of the child's severe disability, verification of income in accordance with Section 117.300(b)(3).

59 Ill. Adm. Code 117.310 Notice of Eligibility or Ineligibility

The Department shall notify families in writing within 30 days after its final approval or disapproval of the application.

59 Ill. Adm. Code 117.315 Right to Appeal

Appeal of a service denial may be made as set forth in Section 117.145.

59 Ill. Adm. Code 117.320 Services and Funding Provisions

a) The family shall use the monthly stipened to assist in meeting the expenses associated with the child's presence in the family home. The child's parent shall be responsible for determining the stipend's use. Examples of such uses of the stipend include:

1. Respite care;

2. Purchase of special equipment and supplies needed by the child;

3. Individual or family counseling;

4. Training for a parent or sibling;

5. Home remodeling to meet the needs of the child; or

6. A special car or a lift for a van to transport the eligible child.

b) Annually, the parent shall submit to the Department a signed, written statement verifying that the stipend was used to meet the special needs of the family.

c) The stipend shall be considered a benefit to the child and shall be paid monthly to the eligible child's parent. The amount shall be equal to the amount of the monthly SSI payment for an individual residing alone.

d) If the child is living outside the home, the family may apply for a single, one-time advance payment not to exceed twice the monthly stipend to prepare family members and/or the family home to meet the special needs of the eligible child. The monthly payment as described in subsection (c) of this Section shall begin during the month of the child's return home.

59 Ill. Adm. Code 117.325 Service Facilitation Services

The Department shall inform the family of eligible children in writing of the availability of service facilitation services. When serving families, the service facilitator shall provide information to the family concerning local support services, including but not limited to in-home services, crisis intervention, and respite care and shall advocate for the family in accessing desired services. The service facilitator's role is to assist the family to make its own decisions and choices by providing the family with information needed to better access the service system; to make the family aware of generic services that are available in the community; to assist in advocating for the family's expressed needs and desires; and to work with the family to creatively make suggestions regarding some potential uses of the family assistance dollars.

59 Ill. Adm. Code 117.330 Stipend Termination

a) Payment of the stipend shall cease when any of the following occur:

1. The family no longer meets the eligibility criteria;

2. The eligible child attains the age of 18;

3. The eligible child moves from the family home;

4. The parent no longer has custody of the child;

5. The family fails to make a report on any of the eligibility standards described in subsections (a)(1) through (4) of this Section as required by Section 117.320;

6. The parent does not submit the annual verification statement on the use of the funds to the Department as required by Section 117.320(b);

7. The parent submits false information to the Department in an application or a verification statement regarding the stipend's use;

8. The eligible child is abused or neglected as reported under the provisions of the Abuse and Neglected Child Reporting Act [325 ILCS 5] and as confirmed by the Department of Children and Family Services; or

9. The family uses the monthly stipend for alcohol, illegal drugs, gambling or any illegal activities.

b) The parent shall report changes in eligibility in writing to the Department within 30 days after such changes occur.

c) If the family moves, the parent shall report the change of address in writing to the Department within 14 days.

59 Ill. Adm. Code 117.335 Right to Investigate Suspected Fraud

The Department reserves the right to investigate suspected fraud of the Family Assistance Program and to take necessary action if such fraud is found.

59 Ill. Adm. Code 117.340 Denial of Other Services

Families participating in this program shall not be denied generic or specialized services available to all families with mentally disabled children because they are receiving a monthly stipend. Department-funded agencies shall not terminate services currently being offered to the eligible child due to the family's participation in this program nor shall the agencies introduce a service fee that was not in place prior to the family's participation in this program.

59 Ill. Adm. Code 117.345 Maximizing the Use of Other Agency Services

A family shall maximize the use of services and entitlements as provided by other governmental agencies such as provider agencies, SSI, SSDI, services of the Department, and special education services.

59 Ill. Adm. Code 117.350 Out-of-Home Placement

When the Department receives an application for out-of-home placements for children with severe mental disabilities, the Department shall make the parents aware of the availability of the Family Assistance Program. However, no entitlement to this program exists for such children.

59 Ill. Adm. Code 117.APPENDIX A Preliminary Application Forms

Section 117.ILLUSTRATION A DMHDD-1235, Home-Based Support Services Program Application

Illinois Department of Human Services

THE PRELIMINARY FAMILY ASSISTANCE PROGRAM APPLICATION

A new program for adults with a severe developmental disability or a severe mental illness. For more information call the Department's toll free number 1-800-843-6154.

Please read the brochure before completing items 1-10 below, print or type clearly and sign the application:

Applicant's name:

Sex:

Male

Female

Applicant's race

White

Black

Hispanic

Other

Applicant is believed to have:

severe autism;

severe mental illness;

severe or profound mental retardation;

severe and multiple impairments.

Applicant's birthdate:

/

/

Applicant's social security number:

Applicant's address:

Street

City

State

Zip

County

Applicant's telephone number:

Area code

Number

a.

The applicant lives in his/her own home/apartment now:

Yes

No

b.

The applicant lives outside his/her home now but is a planning to move to his/her own home/apartment if chosen to participate in this program:

Yes

No

Applicant is enrolled in a special education program

Yes

No

I declare that the information above is true and I understand that if I am chosen this information will be confirmed by the Illinois Department of Human Services through an assessment to assure my eligibility to participate in the Home-Based Support Services Program.

Applicant's or guardian signature

Date

Guardian's name

Guardian's telephone number:

Guardian's address:

Section 117.APPENDIX A Preliminary Application forms

Section 117.ILLUSTRATION B DMHDD – 1236, Family Assistance Program Application

Illinois Department of Human Services

THE PRELIMINARY FAMILY ASSISTANCE PROGRAM APPLICATION

A new program for adults with a severe developmental disability or a severe mental illness. For more information call the Department's toll free number 1-800-843-6154.

Please read the brochure before completing items 1-10 below, print or type clearly and sign the application:

Child's name:

Sex:

Male

Female

Child's race

White

Black

Hispanic

Other

I believe my child has:

severe autism;

severe emotional disturbance;

severe or profound mental retardation;

severe and multiple impairments.

Child's birthdate:

/

/

Child's social security number (if available):

Parent's/guardian's Name:

Street address:

City

State

Zip

County

Parent's/guardian's telephone number:

Family taxable income:

under $50,000

over $50,000

a.

My child lives in the family home now:

Yes

No

b.

My child lives outside the family home now, but if I am chosen to participate in this program I plan to bring my child back into the family home:

Yes

No

Is this a foster child:

Yes

No

I declare that the information above is true and I understand that if I am chosen this information will be confirmed by the Illinois Department of Human Services through an assessment to assure my eligibility to participate in the Home-Based Support Services Program.

Parent/guardian signature

Date

59 Ill. Adm. Code 117.APPENDIX B Eligibility Determination Forms

Section 117.ILLUSTRATION A DMHDD-1237.2, Eligibility Determination – Primary Examiners – Adults with a Severe Mental Illness

Illinois Department of Human Services

ELIGIBLITY DETERMINATION – PRIMARY EXAMINERS

– ADULTS WITH A SEVERE MENTAL ILLNESS

Name of applicant:

Date of examination:

I verify that I am a

board eligible/certified psychiatrist

licensed clinical psychologist

and that the above–named individual was evaluated personally by me.

I verify that I have found the person to meet the eligibility criteria for determination as an Adult with a Severe Mental Illness

I verify that I have found the person does not meet the eligibility criteria for determination as an Adult with a Severe Mental Illness.

I have attached my evaluation and copies of any other evaluations used by me in making this determination.

Name (type or print)

Signature

Address

License no.

Return in self-addressed, stamped envelope or send to:

Department of Human Services

Home-Based Support Services Program

Room 405 Stratton Building

Springfield IL 62765

Section 117.APPENDIX B Eligibility determination forms

Section 117.ILLUSTRATION B DMHDD-1237.2, Eligibility Determination – Primary Examiners – Children with Severe Emotional Disturbance

Illinois Department of Human Services

ELIGIBLITY DETERMINATION – PRIMARY EXAMINERS

– CHILDREN WITH A SEVERE EMOTIONAL DISTURBANCE

Name of applicant:

Date of examination:

I verify that I am a

board eligible/certified psychiatrist

licensed clinical psychologist

and that the above–named individual was evaluated personally by me.

I verify that I have found the person to meet the eligibility criteria for determination as a Child with a Severe Emotional Disturbance.

I verify that I have found the person does not meet the eligibility criteria for determination as a Child with a Severe Emotional Disturbance.

I have attached my evaluation and copies of any other evaluations used by me in making this determination.

Name (type or print)

Signature

Address

License no.

Return in self-addressed, stamped envelope or send to:

Department of Human Services

Home-Based Support Services Program

Room 405 Stratton Building

Springfield IL 62765

Section 117.APPENDIX B Eligibility determination forms

Section 117.ILLUSTRATION C DMHDD-1237.3, Eligibility Determination – Primary Examiners – Children and Adults with Severe Autism

Illinois Department of Human Services

ELIGIBLITY DETERMINATION – PRIMARY EXAMINERS

– CHILDREN AND ADULTS WITH A SEVERE AUTISM

Name of applicant:

Date of examination:

I verify that I am a

board eligible/certified psychiatrist

licensed clinical psychologist

and that the above–named individual was evaluated personally by me.

I verify that I have found the person to meet the eligibility criteria for determination as Children and Adults with a Severe Autism.

I verify that I have found the person does not meet the eligibility criteria for determination as Children and Adults with a Severe Autism.

I have attached my evaluation and copies of any other evaluations used by me in making this determination.

Name (type or print)

Signature

Address

License no.

Return in self-addressed, stamped envelope or send to:

Department of Human Services

Home-Based Support Services Program

Room 405 Stratton Building

Springfield IL 62765

Section 117.ILLUSTRATION D DMHDD-1237.4, Eligibility Determination – Primary Examiners – Children and Adults with Severe or Profound Mental Retardation

Illinois Department of Human Services

ELIGIBLITY DETERMINATION – PRIMARY EXAMINERS – CHILDREN AND ADULTS WITH A SEVERE OR PROFOUND MENTAL RETARDATION

Name of applicant:

Date of examination:

I verify that I am a

licensed clinical psychologist

certified school psychologist

and that the above–named individual was evaluated personally by me.

I verify that I have found the person to meet the eligibility criteria for determination as Children and Adults with a Severe or Profound Mental Retardation.

I verify that I have found the person does not meet the eligibility criteria for determination as Children and Adults with a Severe Profound Mental Retardation.

I have attached my evaluation and copies of any other evaluations used by me in making this determination.

Name (type or print)

Signature

Address

License no.

Return in self-addressed, stamped envelope or send to:

Department of Human Services

Home-Based Support Services Program

Room 405 Stratton Building

Springfield IL 62765

Section 117.APPENDIX B Eligibility determination forms

Section 117.ILLUSTRATION E DMHDD-1237.5, Eligibility Determination – Primary Examiners for Children and Adults with Severe and Multiple Impairments

Illinois Department of Human Services

ELIGIBLITY DETERMINATION – PRIMARY EXAMINERS

– CHILDREN AND ADULTS WITH SEVERE AND MULTIPLE IMPAIRMENTS

Name of applicant:

Date of examination:

I verify that I am a

board eligible/certified psychiatrist

licensed clinical psychologist

licensed physician

and that the above–named individual was evaluated personally by me.

I verify that I have found the person to meet the eligibility criteria for determination as Children and Adults with a Severe and Multiple Impairments.

I verify that I have found the person does not meet the eligibility criteria for determination as Children and Adults with a Severe and Multiple Impairments.

I have attached my evaluation and copies of any other evaluations used by me in making this determination.

Name (type or print)

Signature

Address

License no.

Return in self-addressed, stamped envelope or send to:

Department of Human Services

Home-Based Support Services Program

Room 405 Stratton Building

Springfield IL 62765

Part 119 Minimum Standards for Certification of Developmental Training Programs

59 Ill. Adm. Code 119.100 Applicability

a) Developmental training programs shall prepare adults 18 years of age or older who are developmentally disabled to live and function in integrated social settings.

b) Developmental training programs shall serve adults with developmental disabilities and major functional skill deficits to promote independence in daily living and economic self-sufficiency.

c) This Part is applicable to state-funded developmental training programs.

59 Ill. Adm. Code 119.110 Incorporation by Reference

Any rules or standards 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.

59 Ill. Adm. Code 119.120 Definitions

For the purposes of this Part, the following terms are defined:

"Abuse." Any physical injury, sexual abuse or mental injury inflicted on an individual other than by accidental means. (Section 1-101.1 of the Code)

Physical injury includes all injuries serious enough to require immediate medical treatment by a physician, such as fractures and lacerations which require suturing and all other injuries which because of the circumstances or nature of the injury indicate possible abuse or neglect;

Sexual abuse includes but is not limited to any sexual penetration or sexual conduct between an individual and another person if the individual has been adjudicated legally disabled, or has a guardian, or is unable to understand the nature of the act or is unable to give knowing consent, or is injured, or alleges that there is, or there is evidence of use of force, coercion, or the exchange of money or anything of value; and

Mental injury includes use of words, signs, gestures or other actions by anyone against an individual which intimidates, demeans, harasses, causes emotional anguish or distress, ridicules, threatens, harms or will knowingly incite or precipitate maladaptive behavior on the part of an individual. Mental injury also includes exploitation, which is any act that uses individuals, their resources or their possessions for an agency employee's personal gain or for an agency's benefit.

"Accreditation." A process establishing that a program complies with nationally-recognized standards of care as set by one of the following:

1997 Hospital Accreditation Standards (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996);

1997 Standards for Behavioral Health Care (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996);

1996 Comprehensive Accreditation Manual for Health Care Networks (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996); or

Council on Accreditation 1997 Standards for Behavioral Health Care Services and Community Support and Education Services (Council on Accreditation of Services for Families and Children, Inc. (COA), 120 Wall Street, 11th Floor, New York, New York 10005, 1996).

Outcome Based Performance Measures (The Council, 100 West Road, Suite 406, Towson, Maryland 21204, 1993);

Standards Manual and Interpretive Guidelines for Behavioral Health (Commission on Accreditation of Rehabilitation Facilities (CARF), 4891 East Grant Road, Tucson, Arizona 85711, 1996);

Standards Manual and Interpretive Guidelines for Employment and Community Support Services (Commission on Accreditation of Rehabilitation Facilities (CARF), 4891 East Grant Road, Tucson, Arizona 85711, 1996);

Education Standards (National Accreditation Council for Agencies Serving the Blind and Visually Handicapped, 15 West 65th Street, New York, New York 10023, 1994);

"Act." The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

"Adaptive behavior." The effectiveness or degree with which the individual approaches the standards of personal independence and social responsibility expected of the individual's age and cultural group as measured by adaptive behavior scales such as the Inventory for Client and Agency Planning (ICAP) (DLM Teaching Resources, One DLM Park, Allen, Texas 75002, 1986) and Scales of Independent Behavior (SIB) (DLM Teaching Resources, One DLM Park, Allen, Texas 75002, 1985).

"Authorized agency representative." A person appointed by the governing body who has responsibility for the program's administration including its content and fiscal affairs.

"Aversive procedures." The application of unpleasant or painful stimuli or stimuli that have a potentially noxious effect, contingent on the exhibition of a specific behavior that is not adaptive.

"Behavior management." Efforts to increase adaptive behaviors and to modify problem behaviors or behaviors that are not adaptive and replace them with behaviors and skills that are adaptive and socially productive.

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Day." A calendar day, unless otherwise indicated.

"Deemed status." If a provider has been accredited by an approved accrediting body as identified in the definition of "accreditation" in this Section, the Department shall deem the provider to be in substantial compliance with specific Sections of this Part. Deemed status, however, may be nullified by a finding by the Department that the provider is in substantial non-compliance with one or more of the designated Sections.

"Department." The Department of Human Services.

"Developmental disability." A disability which is attributable to mental retardation, cerebral palsy, epilepsy or autism; or to any other condition which results in an impairment similar to that caused by mental retardation and which requires services similar to those required by individuals with mental retardation. Such disability must originate before the age of 18, be expected to continue indefinitely, and constitute a substantial handicap. (Section 1-106 of the Code)

"Discharge." The full release of an individual from a program.

"Equivalency." Evidence to substantiate compliance with requirements of this Part by means other than indicated in this Part.

"Exclusion." Preventing an individual's entrance or continuation in a program due to the individual's disability, medical condition, or maladaptive behavior, or due to lack of space in the day program.

"Exploitation." Any act that uses individuals, their resources or their possessions for the provider's employee's personal gain or for the provider's benefit.

"Family." The individual's spouse, children, mother, father, sister and brother.

"Full compliance." A survey finding that a program has no identified deficiencies with the standards in this Part.

"Governing body." The provider's decision-making authority which establishes policies for the program's operation and the welfare of the individuals served.

"Guardian." The plenary or limited guardian or conservator appointed by the court for an individual over age 18 so long as the limited guardian's duties encompass concerns related to service requirements.

"Imminent risk." A situation in which individuals in a program are or may be subject to mental, physical or psychological harm which is not immediately correctable, such as environmental or safety hazards.

"Individual." A person who is applying for or receiving services in a program.

"Individual record" or "record." Materials kept chronologically by a program in the course of providing services to an individual.

"Individual services plan" or "plan." A written plan which includes an assessment of the individual's strengths and needs, a description of the services needed regardless of availability, objectives for each service, the role of the individual, guardian, significant others, and the family in the implementation, if the individual agrees to their participation. The plan shall also include a timetable for the accomplishment of objectives, and the names of the persons responsible for their implementation.

"Industrial norm." A standard of measured productivity outcomes of a specific work activity as determined by a time and motion study conducted on workers who are not impaired for the work being performed by age, physical or mental disability, or injury.

"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 the releases of information, as part of the individual's services plan.

"Interdisciplinary team" or "team." A group consisting of at least the individual, parents (except when a non-legally disabled individual or a legally disabled individual's guardian does not desire them to participate), the guardian, as well as representatives of disciplines and services necessary to identify the individual's needs and to design services and alternatives to meet them. At least one member of the team shall be a qualified mental retardation professional.

"Maladaptive behavior." Actions by the individual that interrupt services, require a specific program addressing the behavior developed by the interdisciplinary team and exclude instances requiring only a verbal prompt such as "please sit down."

"Mental retardation." Significantly subaverage general intellectual functioning which exists concurrently with impairment in adaptive behavior and which originates before the age of 18 years. (Section 1-116 of the Code)

"Moral turpitude." Moral quality of being inherently base, depraved, vile or wicked.

"Neglect." Failure to provide adequate medical or personal care or maintenance to an individual which results in physical or mental injury or in the deterioration of an individual's physical or mental condition. (Section 1-117.1 of the Code).

"Notice of violation." A report submitted by OAL to a provider listing the program's deficiencies with this Part as noted during a survey.

"OAL." The Department's Office of Accreditation and Licensure.

"Plan of correction." A written plan submitted by a provider to OAL in response to a notice of violation, which describes the steps the provider will take to bring the program into compliance, including the time-frames for completion of each step.

"Program." Services provided in non-residential facilities to adults who are developmentally disabled and require training in self-help, community living skills, social and leisure skills, communication or productive work.

"Progress notes." Narrative chronological documentation in an individual's record of service provided and its relationship to the plan.

"Provider." A sole proprietorship, association, partnership, corporation or organization, public or private, either for profit or not-for-profit, which operates a developmental training program under the jurisdiction of a governing body or board.

"Qualified mental retardation professional (QMRP)." A QMRP must have at least one year of experience working directly with individuals with mental retardation or other developmental disabilities 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 nurse licensed pursuant to the Illinois Nursing Act of 1987 [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 meet the education requirements for licensure and be 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 dietician registered by the American Dietetics 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 or psychology.

"Quality assurance." A systematic and objective approach to monitoring and evaluating the appropriateness, adequacy and quality of services in order to identify and resolve problems.

"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 handicap. The partial or total immobilization of an individual for the purpose of performing a medical or surgical procedure shall not constitute restraint. (Section 1-125 of the Code)

"Seclusion." Sequestration by placement of an individual alone in a room from which he or she has no means of leaving. (Section 1-126 of the Code)

"Secretary." The Secretary of the Department of Human Services or his or her designee.

"Self-administration of medications." An individual's ability to take medications independently or with verbal prompts.

"Skills training." Activities which focus on the development of daily living skills which enable individuals to achieve independent functioning and economic self-sufficiency.

"Substantial compliance." A determination that a surveyed program does not have a deficiency or group of deficiencies sufficient to jeopardize the health, welfare or safety of individuals or prevent their maximum development; or, when deficient, the provider has documented a plan of correction to rectify any deficiency or has an approved equivalency or waiver for it.

"Survey." A process to determine the degree of compliance with this Part which a program has maintained, including surveyor observation and an on-site examination of policies, procedures, records of individuals, written plans, and the physical plant. Interviews of individuals and staff are also a part of the survey.

"Suspension." The conditional release of an individual from a program.

"Time-out." When an individual is placed in a behavior modification program pursuant to his or her individual services plan, he or she may be removed from a situation that affords positive reinforcement to an area where reinforcement is not available for a reasonable period of time as determined by the team but not to exceed 30 minutes.

"Waiver." Department-granted exceptions to this Part on application by a provider, for a period not to exceed the duration of the current certificate.

"Work activity." The individual performs work such as contract janitorial, simulated assembly, and food service.

History

• Source: Amended at 21 Ill. Reg. 8297, effective June 25, 1997

59 Ill. Adm. Code 119.200 General Requirements

a) Programs shall be located to promote integration of individuals into their communities. In addition to the requirements in subsections (e) and (f) of this Section, examples of integration include locations near public transportation, shopping, restaurants, and recreation.

b) Programs shall provide a minimum of five hours of programming per day, excluding transportation time to and from the program, and excluding mealtime unless training during meals is a documented part of the plan. Individuals may attend less than 5 hours if required and documented by a physician or the interdisciplinary team.

c) No individual shall be transported in a one-way trip that exceeds one hour, excluding field trips.

d) Transportation required for individuals shall be the responsibility of the provider.

e) Programs shall not be located in buildings where individuals reside.

f) Programs attended by individuals residing in licensed long-term care facilities shall promote the principles of program independence and community integration by meeting two of the following three criteria:

1. No more than 25 percent of the direct-care staff hours allocated to the program shall be provided by personnel also employed by a licensed long-term care facility in a residential services capacity;

2. At least 30 percent of the individuals in the program shall not reside in the same licensed long-term care facility; or

3. The location of the program shall not be within or adjacent to the boundaries of any licensed long-term care facility having individuals in the program.

g) The Department shall grant a waiver of the requirements in subsections (f)(1) and (2) of this Section for individuals of licensed long-term care facilities whose physicians have determined that participation in a program away from the residence will present a risk to the individual's health. Physicians shall document and annually update this medical determination in the individual's records.

History

• Source: Amended at 22 Ill. Reg. 16244, effective August 27, 1998

59 Ill. Adm. Code 119.205 Criteria for Participation of Individuals

a) A minimum level of skill development shall not be required for entry into a program.

b) The criteria for exit from the program shall be as follows:

1. The individual shall perform four or more skills described in subsections (e)(1) through(7) of this Section; and

2. The individual shall not engage in maladaptive behavior more than 5 percent of the developmental training day. Maladaptive behavior shall require staff intervention and shall be documented in the plan.

c) Individuals who meet or exceed the exit criteria shall not enter or remain in the program unless the program can document that alternative resources in the individual's community do not exist to meet the service needs. Examples of documentation include denials of admission to other programs because of lack of capacity or the information that no other program exists in the indivdiual's community.

d) The team shall evaluate individuals who have attained the exit criteria to determine whether they should continue in the program, or if they should enter a program more integrated into the community such as supported employment. The team shall document reasons for its decision.

e) The team shall assess individuals on the following skills:

1. Motor development - The individual exhibits fine or gross motor skills independently or with minimal assistance. This is considered met if the individual meets the criteria for dressing, grooming, toilet or eating.

2. Dressing - The individual dresses self with verbal cues only.

3. Grooming - The individual grooms self with verbal cues only.

4. Toileting - The individual toilets with verbal cues only.

5. Eating - The individual eats a meal without cues from staff.

6. Language - The individual understands basic requests and expresses self verbally or with an alternative communication system such as signing, communication board, computer or writing.

7. Productive capacity - The individual consistently maintains a productive level of 25 percent of the industrial norm.

f) At least annually, the team shall assess the individual's skill level and review the current placement to determine if it is meeting the individual's needs.

g) The provider shall identify to the Department, with a release of information in keeping with the Act, the names of all individuals whom the team has determined should exit the program. The Department shall assist the provider in identifying alternative services. An individual shall continue in the program until an alternative day program that meets his or her needs is provided.

59 Ill. Adm. Code 119.210 Exclusion, Suspension or Discharge of an Individual

a) Exclusion, suspension or discharge may occur due to:

1. The individual's desire to stop participation;

2. The individual's attainment of the exit criteria;

3. The individual's physical disability or medical condition which places the individual in danger; or

4. Maladaptive behavior that places the individual or others in serious danger.

b) Lack of space in a program shall not be used to suspend or discharge individuals and shall be used only to deny admission to a program that is presently filled.

c) The provider shall refer all proposals excluding, suspending or discharging an individual to the team which shall determine whether the criteria in subsection (a) of this Section have been met, recommend alternative services and determine the criteria under which the individual may enter or re-enter the program.

d) Before exclusion, suspension or discharge, the team shall discuss, summarize and place in the individual's record the date and reason for this action.

e) A provider shall not suspend or discharge an individual from a program without at least a 10-day written notice to the individual or guardian except when it is documented that the individual is dangerous to himself or herself or others and the behavior cannot be corrected through special training procedures.

f) An individual shall have the opportunity to appeal to the agency representative the provider's decision to exclude, suspend or discharge him or her in accordance with the procedures required in Section 119.235(e) of this Part.

History

• Source: Amended at 21 Ill. Reg. 8297, effective June 25, 1997

59 Ill. Adm. Code 119.215 Program Staff

a) The provider shall designate a program administrator whose level of education and experience shall include an undergraduate degree in education, special education, psychology, rehabilitation counseling or social work, with two or more year's experience working with individuals who are developmentally disabled, or an equivalent combination of education and experience.

b) The provider shall designate at least one developmental instructor whose minimum level of education and experience includes an undergraduate degree in special education or a related human service field as specified in the definition of qualified mental retardation professional, plus one or more years experience working with individuals who are developmentally disabled, or an equivalent combination of education and experience.

c) The provider shall designate developmental trainers whose minimum level of education includes a high school diploma or general equivalency diploma (G.E.D.). A developmental trainer shall address the individual's needs as identified in the plan under the professional oversight of the developmental instructor.

1. The program administrator may function as the developmental instructor.

2. The program shall employ developmental instructors on an overall ratio of one developmental instructor to three developmental trainers.

3. The developmental instructor shall perform instructional duties as well as provide professional oversight of developmental trainers. Professional oversight includes answering questions about the implementation of the individual's plan and providing feedback to the developmental trainer and his or her supervisor on the developmental trainer's activities.

d) Staff ratios

1. The provider shall maintain staff ratios that will meet the individual's program needs. The Department's calculation of provider cost is based on the following ratios, but the provider will be given flexibility in grouping individuals to meet the individual's needs.

A) For individuals who have mild deficits in adaptive behavior as defined in Classification in Mental Retardation (American Association on Mental Retardation, 1719 Kalorama Road, NW, Washington D.C. 20009, 1983), and who have physical disabilities, mental disabilities or behavior disorders, the provider shall maintain on-duty trainers and instructors at a ratio of 1:10.

B) For individuals who have moderate deficits in adaptive behavior as defined in Classification in Mental Retardation and who have physical disabilities, mental disabilities or behavior disorders, the provider shall maintain on-duty trainers and instructors at a ratio of 1:8.

C) For individuals who have severe or profound deficits in adaptive behavior, as defined in Classification in Mental Retardation and who have physical disabilities, mental disabilities or behavior disorders, the provider shall maintain on-duty trainers and instructors at a ratio of 1:5.

D) The provider may request additional staff for individuals whom the team has assessed and who require and who are receiving specialized services stated in one of the following levels:

i) Level I. For individuals requiring and receiving staff assistance for the following specialized care: aids or appliances for visual or auditory deficits or both; aids, appliances or equipment for physical disabilities; in dwelling catheterization; insulin injections for stabilized diabetics; cardiovascular or respiratory medications and multiple daily monitoring; incontinence care and assistance in personal care; seizure medication and monitoring of unstable condition; or a moderately serious level of maladaptive behavior as measured by the Inventory for Client and Agency Planning (ICAP) (DLM Teaching Resources, One DLM Park, Allen, Texas 75002, 1986);

ii) Level II. For individuals requiring and receiving staff assistance for the following specialized care: personal care and assistance with transfer and movement about the facility; insulin injections for diabetics who are not stabilized; ostomy care; or a serious level of maladaptive behavior as measured by the ICAP; or

iii) Level III. For individuals requiring and receiving staff assistance for the following specialized care: intermittent catheterization; wound care; respiratory care; tracheotomy care; tube feeding; or a very serious level of maladaptive behavior as measured by the ICAP.

2. During breaks and non-training lunch periods, supervision shall be provided to maintain the safety of the individual.

3. There shall be at least one QMRP for every 30 individuals.

e) Each individual shall have a designated QMRP who shall:

1. Convene the team as required by Section 119.220 to develop or revise the plan;

2. Assure that the services specified in the plan are being provided;

3. Assure the participation of team members;

4. Identify and address gaps in the provision of service;

5. Monitor the individual's status in relation to the plan;

6. Advocate for the individual's rights and services;

7. Provide for a written record of team meetings; and

8. Initiate and coordinate a meeting of the team as often as the plan specifies or when required by problems or changes.

f) If the interdisciplinary team determines that services required to meet the individual's needs are not available in the developmental training program, the QMRP shall be responsible for linking the individual with the level of service that meets his or her needs.

59 Ill. Adm. Code 119.220 Interdisciplinary Team (team)

a) The provider shall assure that each individual has a single interdisciplinary team which shall be responsible for preparing, revising, documenting and implementing the plan in accordance with Section 119.230.

b) The team shall provide for and invite the active participation of:

1. The individual and his or her legal guardian or both;

2. The persons who work most directly with the individual both at the program and the individual's residence; and

3. The professionals who assess the individual's strengths and needs (in accordance with Section 119.225), and design and evaluate the individual's program.

c) At least one member of the team shall be a QMRP who shall provide services as specified in Section 119.215 and shall be responsible for convening the team.

59 Ill. Adm. Code 119.225 Assessment of Individuals

The provider shall assure that, at least annually, each individual receives assessments identified in Sections 119.205(e) and (f) that shall be documented in the individual's record and the results explained to the individual or guardian.

a) The assessment shall determine the individual's strengths and needs, level of adaptive and intellectual functioning, the presenting problem(s) and disability(s), diagnosis and the services required to meet the individual's needs.

b) The assessment shall be performed by staff trained in methods of assessment such as physical, psychological, and functional.

c) Through the method of assessment and the interpretation of results, the assessment 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.

d) Annual assessments for individuals shall include the ICAP or the Scales of Independent Behavior (SIB) (DLM Teaching Resources, One DLM Park, Allen, Texas 75002, 1985).

59 Ill. Adm. Code 119.230 Individual Services Plan (plan)

a) When the individual enters a program, staff shall:

1. Document in the record those services being provided to the individual until a plan is developed; and

2. Explain to the individual all rights stated in Section 119.235, and provide the individual with a copy of those rights. This shall be documented in the individual's record.

b) Within 30 days after an individual's entry into the program, a plan shall be developed by the team that states goals and objectives for developmental training that:

1. Is based on the assessment results;

2. Reflects the individual's or guardian's preferences for goals, objectives, and services;

3. Identifies services and supports to be provided and by whom; and

4. Has objectives that:

A) Are measurable;

B) Have timeframes for completion; and

C) Have a person assigned responsibility.

c) The plan shall include the names and titles of all staff and other persons contributing to the plan.

d) The plan shall be signed by the QMRP and the individual or guardian.

e) The individual or guardian shall be offered a copy of the plan.

f) The plan shall become a part of the individual's record.

g) At least monthly, the QMRP shall review the plan and document in the record that:

1. Services are being implemented; and

2. Services identified in the plan continue to meet the individual's needs or require modification or change to better meet the individual's needs.

h) The team shall review the plan, at least annually, and shall note the status of the individual including any progress or regression which might require modification to the plan.

59 Ill. Adm. Code 119.232 Work Activities

When an individual participates in work activities, the individual services plan must contain assessments or documentation that:

a) The work activities are necessary to achieve the individual's goals and objectives;

b) The work activities are part of an organized training program to teach the individual new skills;

c) The individual is not able to work at a competitive wage level;

d) The individual's other goals, objectives and needs are being addressed, whether in the developmental training program, in the residential program, or in the home; and

e) The work activities are not directly related to the preparation of the individual for a specific paid or unpaid job.

History

• Source: Added at 22 Ill. Reg. 16244, effective August 27, 1998

59 Ill. Adm. Code 119.235 Individual Rights and Confidentiality

To insure that the individual's rights are protected and that all services provided to the individual comply with the laws cited in subsections (a) and (b) of this Section, providers shall assure that:

a) The individual's rights are protected in accordance with the Code, except that the use of seclusion shall not be permitted.

b) The individual's right to confidentiality is in accordance with the Act.

c) Staff shall inform individuals entering a program of their rights in accordance with subsections (a) and (b) of this Section and of their right to contact the Guardianship and Advocacy Commission, Equip for Equality, Inc., and the provider's human rights committee. Staff shall offer assistance to individuals in contacting these groups, giving each individual the address and telephone number of the Guardianship and Advocacy Commission and Equip for Equality, Inc. This information shall be given to the individual and his or her guardian in writing. If the individual is unable to read, the information shall be read and explained to him or her in a language he or she understands. Staff shall, upon request, offer assistance to individuals in contacting the Commission and Protection and Advocacy.

d) There is documentation in the record that staff have advised the individual of his or her rights, provided justification for any restriction of the individual's rights in accordance with Chapter 2 of the Code or assisted in contacting the Guardianship and Advocacy Commission.

e) Providers have procedures that permit the individual or guardian to present grievances and to appeal decisions to deny, modify, reduce or terminate services up to and including the authorized agency representative. The procedures shall require, at a minimum:

1. Notification of a right to appeal actions to deny, modify, reduce or terminate services be given to the individual or guardian upon entry into the program;

2. Written notice shall be given, 10 days in advance, of actions to deny, modify, reduce or terminate services;

3. That no provider action shall be implemented pending a final administrative decision;

4. Time frames for notice of intent to appeal and the rendering of a final administrative decision; and

5. That no one directly involved in the action or decisions being grieved or appealed shall be part of the review of that action or decision.

f) The authorized agency representative's decision on the grievance shall constitute a final administrative decision and shall be subject to review in accordance with the Administrative Review Law [735 ILCS 5/Art. III].

g) The individual is not excluded, suspended or discharged from services and services are not reduced for exercising any of his or her rights.

59 Ill. Adm. Code 119.240 Special Training Procedures

a) The provider shall develop policies and procedures and shall govern the use of all special training procedures used to modify behaviors that the team determines to be a problem or maladaptive.

b) The program shall prohibit corporal punishment, seclusion, abuse, neglect and exploitation of individuals.

c) To maximize the individual's growth, development and independence, the program shall use positive reinforcement in keeping with the individual's developmental level and learning, emotional, and environmental needs.

d) The plan of an individual who exhibits maladaptive behavior shall include provisions to train the individual in the circumstances, if any, under which the behavior can be exhibited adaptively, or how to channel the behavior into similar but adaptive expressions, or how to replace the maladaptive behavior with adaptive behavior.

e) Procedures used to prevent individuals from harming themselves or others that are not part of the plan shall not be repeated more than three time within a six-month period without being incorporated into the plan.

f) Aversive procedures and time-out shall be used only as part of a plan.

g) Whenever physical restraint, medications to manage behavior, time-out rooms, aversive conditioning or other procedures with similar degrees of restriction or intrusion are used to manage maladaptive behavior:

1. The team shall determine and document in the record that the harmful effects of the behavior clearly outweigh all of the potentially harmful effects of the procedure;

2. The procedure shall be an integral part of the plan which will lead to a less restrictive way to manage, and ultimately eliminate the behavior;

3. The record shall document that informed consent was obtained; and

4. The program's behavior management committee and human rights committee shall review and approve the procedure in accordance with Section 119.245.

h) The behavior management committee and human rights committee shall review and approve proposed special training procedures that call for concurrent administration of more than one medication to manage an individual's behavior while attending the program. Medications so ordered shall be accompanied by a physician's progress note substantiating that use of the medication is justified, is within a therapeutic dosage range, and will not adversely affect the therapeutic benefits of other medications. The medically supervised special training procedures shall assure that:

1. The medications are not administered in doses that will interfere with the individual's daily living activities;

2. The medications are monitored for desired responses and adverse consequences; and

3. The medications are gradually withdrawn at least annually unless clinically contraindicated.

i) Programs using restraints in any special training procedure shall comply with Section 2-108 of the Code.

j) The use of time-out rooms shall be in accordance with 42 CFR 483 (1996) (Conditions of Participation for Long Term Care Facilities.)

k) The team shall implement time-out, medications for behavior management and aversive procedures programs only when:

1. The individual's behavior is likely to cause physical or psychological harm to the individual or others;

2. Positive procedures used within the past six months have been documented to be ineffective in reducing or eliminating this particular behavior;

3. Both the human rights committee and the behavior management committee have approved the program prior to implementation; and

4. The authorized agency representative has given written approval.

l) Any approval by the program's human rights and behavior management committees and authorized agency representative of an individual's written aversive procedures program shall expire in 30 days. The program shall not continue beyond that time unless it is reviewed and approved by both committees and the authorized agency representative.

59 Ill. Adm. Code 119.245 Committees

a) A program shall have a human rights committee.

1. Not more than half of the members shall be program employees.

2. The committee shall review program policies, procedures and practices which restrict an individual's rights.

3. The program shall inform the committee of any complaints involving individual's rights, violations and any corrective actions.

4. At least one member shall be an individual or his or her representative.

b) A program which uses special training procedures as specified in Section 119.240 for managing maladaptive behavior shall establish a behavior management committee.

1. Members shall include persons qualified to evaluate published behavior management studies and the technical adequacy of proposed behavior management interventions. Persons are qualified by training and experence such as a clinical psychologist to review oversight procedures.

2. When drugs to manage behavior are used, a professional qualified to evaluate their use, such as a physician or pharmacist, shall be a member of the committee.

c) The human rights committee and behavior management committee shall:

1. Approve special training procedures prior to their implementation and review those procedures at least every three months, except aversive conditioning procedures which shall be reviewed and approved at least every 30 days;

2. Maintain minutes, including attendance and decisions made; and

3. Have at least five members.

59 Ill. Adm. Code 119.250 Medications and Medical Care

a) All medications shall be specifically prescribed for the individual by a physician or a dentist with the intent of the physician or dentist that it be taken by the individual under program oversight of the provider staff.

b) The provider as it exercises program oversight may, as needed, guide the individual in self-administration of medications as part of the training program for independent living if the individual is not capable of self-administration.

c) Medications shall be secured from unauthorized access and only a physician, pharmacist, registered or licensed practical nurse or program personnel authorized to provide program oversight of the self-administration of medications shall have access to medications.

d) Programs shall provide an area for care of individuals who become ill.

e) Programs shall have available the American Red Cross First Aid Kit or the equivalent contents.

59 Ill. Adm. Code 119.255 Environmental Management

a) Buildings used by the provider for the program shall:

1. Be safe and clean;

2. Conform with Chapters 28, 29, and 31 (specifically Section 31-1.1 through 31-1.6 of Chapter 31) of the NFPA 101, Life Safety Code (National Fire Protection Association, 1988) (Storage buildings of less than 200 square feet of floor area are exempt from compliance with Chapter 29);

3. Conform with the Environmental Barriers Act [410 ILCS 25] and 71 Ill. Adm. Code 400 (Illinois Accessibility Code);

4. Have a normal temperature and humidity comfort range in accordance with the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), Handbook of Fundamentals (National Association of American Society of Heating, Refrigerating, and Air Conditioning, United Engineering Center, 345 East 47th Street, New York, New York 10017, 1977); and

5. Have a written preventive maintenance program which includes a schedule for inspection and service of equipment and physical plant.

b) Toilets and bathrooms shall provide privacy and be located and equipped to facilitate accessibility and independence. When needed by the individual, special assistance or devices shall be provided.

c) The provider shall maintain copies of inspections performed by local and state inspectors in regard to health, sanitation and environment.

d) The provider shall develop, implement and maintain a disaster preparedness plan which shall be reviewed annually, revised as necessary, and ensure that:

1. Records and reports of fire and disaster training are maintained;

2. A record of actions taken to correct noted deficiencies in disaster drills or inspections is maintained;

3. Staff know how to react to fire, severe weather, missing persons, medical emergencies, poison control and deaths;

4. Individuals can react to fire and severe weather emergencies or they are receiving training;

5. Staff and individuals can locate fire-fighting equipment, first aid kits, evacuation routes and procedures; and

6. A telephone is available with a list of the telephone numbers of the nearest poison control center, the police, the fire department and emergency medical personnel.

e) The provider shall have procedures for evacuation which ensure that:

1. Evacuation drills are conducted at a frequency determined by the provider based on the needs and abilities of the individuals served;

2. Evacuation drills occur at least annually;

3. Special provisions are made for those individuals who cannot evacuate the building without assistance, including those with physical disabilities and individuals who are deaf and/or blind;

4. All personnel are trained to carry out their assigned evacuation tasks;

5. Corrective action is taken when inefficiency or problems are identified during an evacuation drill; and

6. Drills include actual evacuation of individuals to safe areas.

59 Ill. Adm. Code 119.260 Administrative Requirements

a) Governing body

1. Each program 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 program in compliance with the General Not For Profit Corporation Act of 1986 [805 ILCS 105], and with the Department's rules at 59 Ill. Adm. Code 103 (Grants).

2. The names and addresses of all owners or controlling parties (whether they are sole proprietorship, association, partnership, corporation, or subdivisions of other bodies, such as public agencies or religious, fraternal or other charitable organizations) shall be fully disclosed and provided to the Department annually. For corporations, the names and addresses of all officers, directors, and principal stockholders, either beneficial or of record, shall be disclosed.

3. The governing body shall include persons who have no direct or indirect financial interest in the program and who reside in the geographic area served by the program and include persons with developmental disabilities and consumer representatives.

4. The provider shall notify the governing body of the Department's annual survey and other State and local inspections which indicate the outcome and disposition of any findings resulting from a survey.

b) Advisory board

1. A program which is owned or operated by a sole proprietor or partnership shall appoint and maintain an advisory board whose members shall be persons who have no direct or indirect financial interest in the program, and who reside in the geographic area served by the program, and who include persons with developmental disabilities and consumer representatives.

2. The advisory board shall ensure that each program owned or operated by a sole proprietor or partnership shall have a charter, mission statement, goals and objectives.

c) Authorized agency representative

The provider shall appoint an authorized agency representative whose qualifications and duties are defined in writing and include authority for program administration and management. His or her performance shall be reviewed and documented annually by the governing body.

d) Provider policy requirements

1. The program shall have written policies which shall be reviewed annually, revised as necessary and approved by the governing body or advisory board and shall describe:

A) Goals and objectives reflecting annual and long-range plans;

B) The population served, including age groups, disabilities and the geographic service area;

C) The services provided in response to individual and community needs including:

i) The hours and days of operation;

ii) The methods used to perform initial screening and assessment of individuals;

iii) A description of processes used for development of the services plan;

iv) The use and approval of special training procedures such as time-out, restraint and aversive techniques;

v) Handling emergencies and disasters; and

vi) Maintenance of buildings, vehicles and equipment.

2. Program policy shall ensure the availability of professional, administrative and support staff to assess and address the needs of individuals. This includes personnel and consultants who can communicate, either verbally or non-verbally, with individuals.

3. Program policy shall ensure that Department-authorized consumer-interest groups shall be permitted, with the consent of the individuals, to visit a program.

A) Consumer interest groups must request authorization in writing to visit specific programs. The request shall be made to the Department and shall specify the program to be visited and the reason for the group's proposed visit. If the group agrees to the conditions set out below, the request shall contain those agreements.

B) The Department shall authorize a group to visit a program for a period of one year if:

i) The group has as one of its organizational purposes to review public services for mentally disabled individuals;

ii) The group agrees that its visits will not interfere with the program; and

iii) The group agrees to abide by the provisions of the Act concerning records and communications of individuals in programs.

C) The Department shall revoke its authorization or not renew the authorization if it has information that the group has not abided by the conditions set out above.

D) Any group whose authorization has been denied, revoked or not renewed may appeal the decision in writing to the Secretary, who shall review the decision and accept or reverse it within 30 days. The Secretary shall uphold the decision if he or she finds that the group has not abided by this Part.

e) Personnel requirements

1. Programs shall not discriminate in the hiring or employment of staff on the basis of race, color, age, national origin, sex, religion, or handicap.

2. Personnel policies and procedures shall be in writing and available for review.

3. The program shall have written job descriptions or contractual agreements for every position, including consultant and direct-service volunteer positions, which list the job title, duties and responsibilities, minimum experience and educational requirements, immediate supervisor and subordinates.

4. Staff shall be licensed, registered or certified by the State, if required.

5. When paraprofessional or untrained staff are used in direct services, they shall be supervised by professional staff.

6. A pay plan for all position titles in use shall be available for review by the Department.

7. An agency shall not employ a person in any capacity until the agency has inquired of the Department of Public Health as to information in the Nurse Aide Registry concerning the person. If the Registry has information substantiating a finding of abuse or neglect against the person, the agency shall not employ him or her in any capacity.

f) Staff and volunteer training

1. Training in principles and practices in the following areas shall be provided to direct service and professional staff:

A) Cardiopulmonary resuscitation (CPR), Heimlich maneuver and first aid;

B) Behavior management;

C) Normalization;

D) Age and cultural appropriateness;

E) Safety, fire, and disaster procedures including:

i) Use of fire-fighting equipment; and

ii) Familiarity with the disaster preparedness plan.

F) Prevention, handling, and reporting of abuse, neglect, exploitation, unusual incidents (see subsection (h) of this Section):

G) Individual rights in accordance with Chapter 2 of the Code and maintaining confidentiality in accordance with the Act;

H) Team planning;

I) Infection control and sanitation; and

J) Food preparation and handling for staff who prepare and serve food to individuals.

2. Training for volunteers working directly with individuals shall be provided in the areas discussed in subsections (f)(1)(A), (E), (F) and (G) of this Section. The agency shall provide a training program for other volunteers.

g) Quality assurance

1. There shall be a written quality assurance plan and ongoing activities designed to review and evaluate services to individuals, operation of programs and to resolve identified problems.

2. The scope of quality assurance shall include reviewing semi-annually, or more frequently if problems are identified, at least the following:

A) Service planning;

B) The use of special training procedures including behavior management procedures;

C) Unusual incidents relative to services to individuals;

D) Service utilization;

E) Individuals' records ensuring that they meet the requirements of this Part;

F) Subcontracted services to ensure that the needs of individuals are being met; and

G) The status of individuals receiving service.

3. Records of quality assurance reviews and activities shall be filed separately from the records of individuals.

h) Unusual incidents

1. The provider shall have written policies and procedures for handling, investigating, reporting, tracking and analyzing unusual incidents through the provider's management structure, up to and including the authorized agency representative. The provider shall ensure that staff demonstrate their knowledge of, and follow such policies and procedures that shall include but are not limited to:

A) Rape or sexual assault;

B) Abuse or neglect;

C) Death;

D) Physical injury;

E) Assault;

F) Missing individuals;

G) Theft; and

H) Criminal conduct.

2. Within 24 hours after becoming aware of an incident, the provider shall report to the appropriate law enforcement agencies any incident which is subject to the Criminal Code of 1961 [720 ILCS 5].

3. The provider shall ensure that suspected instances of abuse or neglect against individuals in programs that are certified by the Department are reported to the Office of Inspector General (Section 6.2 of the Abused and Neglected Long Term Care Facility Residents Reporting Act [210 ILCS 30/6.2]).

i) Individual's record (record)

1. The program shall ensure the confidentiality of an individual's record in accordance with the Act and shall ensure safekeeping of all records against loss or destruction. Individuals or their guardians shall have access to the individual's record upon request.

2. The program shall maintain a chronological record for each individual. Records shall be located at a site, designated by the program, that is accessible and convenient to staff contributing to the plan.

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 program shall provide a legend, standardized throughout the program, to explain them.

3. The following information shall be obtained and recorded when an individual enters a program, and shall be updated as necessary:

A) Identifying information including name, date of birth, sex, race, social security number and legal status;

B) The name, address and telephone number of the guardian or the person to be notified in case of an emergency;

C) The language spoken or understood by the individual including, in the case of a hearing impaired or non-verbal individual, the individual's preferred mode of communication, e.g., American sign language, signed English, aural, oral or tactile communications device;

D) Psychological assessments and recommendations;

E) Prescribed 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) Prior service history;

B) Initial assessments and plan and the most recent assessments and plan;

C) Documentation of approval and their results when special training procedures are used such as time-out, restraint and aversive procedures; and

D) Chronological progress notes, at least monthly, documenting the individual's involvement in and response to the plan.

j) Financial and operational requirements

Programs shall comply with 59 Ill. Adm. Code 103 (Grants).

History

• Source: Amended at 23 Ill. Reg. 10211, effective August 23, 1999

59 Ill. Adm. Code 119.261 Application for Waiver of the Prohibition Against Employment

a) Hiring of direct care employees

A provider shall not knowingly hire or retain any person after January 1, 1998 in a full-time, part-time or contractual direct care position if that person has been convicted of committing or attempting to commit one or more of the following offenses unless the applicant or employee obtains a waiver pursuant to subsections (i) through (l) of this Section (Section 25 of the Health Care Worker Background Check Act [225 ILCS 46/25]):

1. Murder, homicide, manslaughter or concealment of a homicidal death (Sections 9-1 through 9-3.3 of the Criminal Code of 1961 [720 ILCS 5/9-1 through 9-3.3]);

2. Solicitation of murder and solicitation of murder for hire (Sections 8-1.1 and 8-1.2 of the Criminal Code of 1961 [720 ILCS 5/8-1.1 and 8-1.2]);

3. Kidnaping or child abduction (Sections 10-1, 10-2, 10-5 and 10-7 of the Criminal Code of 1961 [720 ILCS 5/10-1, 10-2, 10-5 and 10-7]);

4. Unlawful restraint or forcible detention (Sections 10-3, 10-3.1 and 10-4 of the Criminal Code of 1961 [720 ILCS 5/10-3, 10-3.1 and 10-4]);

5. Assault, battery or infliction of great bodily harm (Sections 12-1, 12-2, 12-3, 12-3.1, 12-3.2, 12-4, 12-4.2, 12-4.3, 12-4.4, 12-6 and 12-7 of the Criminal Code of 1961 [720 ILCS 5/12-1, 12-2, 12-3, 12-3.1, 12-3.2, 12-4, 12-4.2, 12-4.3, 12-4.4, 12-6 and 12-7]);

6. Sexual assault or abuse (Sections 12-13, 12-14, 12-15 and 12-16 of the Criminal Code of 1961 [720 ILCS 5/12-13, 12-14, 12-15 and 12-16]);

7. Indecent solicitation of a child (Section 11-6 of the Criminal Code of 1961 [720 ILCS 5/11-6]);

8. Predatory criminal sexual assault of a child (Section 12-14.1 of the Criminal Code of 1961 [720 ILCS 5/12-14.1]);

9. Sexual exploitation of a child (Section 11-9.1 of the Criminal Code of 1961 [720 ILCS 5/11-9.1]);

10. Exploitation of a child (Section 11-19.2 of the Criminal Code of 1961 [720 ILCS 5/11-19.2]);

11. Child pornography (Section 11-20.1 of the Criminal Code of 1961 [720 ILCS 5/11-20.1]);

12. Endangering the life or health of a child (Section 12-21.6 of the Criminal Code of 1961 [720 ILCS 5/12-21.6]);

13. Cruelty to children (Section 53 of the Criminal Jurisprudence Act [720 ILCS 115/53], repealed by P.A. 89-234, effective January 1, 1996);

14. Abuse or gross neglect of a long-term care facility resident (Section 12-19 of the Criminal Code of 1961 [720 ILCS 5/12-19]);

15. Criminal neglect of an elderly or disabled person (Section 12-21 of the Criminal Code of 1961 [720 ILCS 5/12-21]);

16. Theft, financial exploitation of an elderly or disabled person, robbery or burglary (Sections 16-1, 16-1.3, 16A-3, 18-1, 18-2, 19-1 and 19-3 of the Criminal Code of 1961 [720 ILCS 5/16-1, 16-1.3, 16A-3, 18-1, 18-2, 19-1 and 19-3]);

17. Aggravated robbery (Section 18-5 of the Criminal Code of 1961 [720 ILCS 5/18-5]);

18. Criminal trespass (Section 19-4 of the Criminal Code of 1961 [720 ILCS 5/19-4]);

19. Home invasion (Section 12-11 of Criminal Code of 1961 [720 ILCS 5/12-11]);

20. Arson (Sections 20-1 and 20-1.1 of the Criminal Code of 1961 [720 ILCS 5/20-1 and 20-1.1]);

21. Unlawful use of weapons or aggravated discharge of a firearm (Sections 24-1 and 24-1.2 of the Criminal Code of 1961 [720 ILCS 5/24-1 and 24-1.2]);

22. Armed violence (Article 33A of the Criminal Code of 1961 [720 ILCS 5/Art. 33A]);

23. Heinous battery (Section 12-4.1 of the Criminal Code of 1961 [720 ILCS 5/12-4.1]);

24. Tampering with food, drugs or cosmetics (Section 12-4.5 of the Criminal Code of 1961 [720 ILCS 5/12-4.5]);

25. Aggravated stalking (Section 12-7.4 of the Criminal Code of 1961 [720 ILCS 5/12-7.4]);

26. Ritual mutilation and ritualized abuse of a child (Sections 12-32 and 12-33 of the Criminal Code of 1961 [720 ILCS 5/12-32 and 12-33]);

27. Forgery (Section 17-3 of the Criminal Code of 1961 [720 ILCS 5/17-3]);

28. Vehicular hijacking and aggravated vehicular hijacking (Sections 18-3 and 18-4 of the Criminal Code of 1961 [720 ILCS 5/18-3 and 18-4]);

29. Manufacture, delivery or trafficking of cannabis (Sections 5, 5.1 and 9 of the Cannabis Control Act [720 ILCS 550/5, 5.1 and 9]); and

30. Delivery of cannabis on school grounds (Section 5.2 of the Cannabis Control Act [720 ILCS 550/5.2]);

31. Delivery of cannabis by a person at least 18 years of age to a person under 18 who is at least three years his or her junior (Section 7 of the Cannabis Control Act [720 ILCS 550/7]); and

32. Manufacture, delivery or trafficking of controlled substances (Sections 401, 401.1, 404, 405, 405.1, 407 and 407.1 of the Illinois Controlled Substances Act [720 ILCS 570/401, 401.1, 404, 405, 405.1, 407 and 407.1]).

b) Definitions

For the purposes of this Section, the following terms are defined:

"Applicant." A person seeking employment with a provider who has received a bona fide conditional offer of employment. (Section 15 of the Health Care Worker Background Check Act [225 ILCS 46/15])

"Conditional offer of employment." A bona fide offer of employment by a provider to an applicant, which is contingent on the receipt of a report from the Department of State Police indicating that the applicant does not have a record of conviction of any of the criminal offenses enumerated in subsections (a)(1) through (32) of this Section. (Section 15 of the Health Care Worker Background Check Act [225 ILCS 46/15])

"Direct care." The provision of nursing assistance with meals, dressing, movement, bathing, or other personal needs of maintenance, or general supervision and oversight of the physical and mental well-being of an individual who is incapable of maintaining a private, independent residence or who is incapable of managing his or her person whether or not a guardian has been appointed for that individual. (Section 15 of the Health Care Worker Background Check Act [225 ILCS 46/15])

"Initiate." The obtaining of the authorization for a record check from a student, applicant, or employee. The provider shall transmit all necessary information and fees to the Illinois State Police within 10 working days after receipt of the authorization. (Section 15 or the Health Care Worker Background Check Act [225 ILCS 46/15])

"Nurse Aide Registry." The registry of nurse aides kept by the Department of Public Health pursuant to Section 3-206.01 of the Nursing Home Care Act [210 ILCS 45/3-206.01].

"UCIA" The Uniform Conviction Information Act [20 ILCS 2635].

c) Nurse Aide Registry

For all applicants for nurse aide positions, the provider shall check the Nurse Aide Registry to determine the date of the applicant's last UCIA criminal history record check. If it has been more than one year since the records check, the provider must initiate or have initiated on its behalf a UCIA criminal history record check for the nurse aide. (Section 30(b) of the Health Care Worker Background Check Act [225 ILCS 46/30(b)])

d) Conditional offers

Effective January 1, 1996, if the provider makes a conditional offer of employment to an applicant other than a nurse aide who is not exempt under subsection (m) of this Section for a direct care position, the provider shall initiate or have initiated on its behalf a UCIA criminal history record check except as provided for in subsection (e)(2) of this Section. (Section 30(c) of the Health Care Worker Background Check Act [225 ILCS 46/30(c)])

e) Initiation of UCIA criminal history record check

1. By January 1, 1997 the provider must initiate a UCIA criminal history record check for all direct care employees who were hired before January 1, 1996, who have not already had a UCIA criminal history record check and who are not exempt in accordance with subsection (m) of this Section. (Section 30 of the Health Care Worker Background Check Act [225 ILCS 46/30])

2. If the agency initiated a criminal background check on an employee hired after January 1, 1996 and before January 1, 1998, the agency does not need to initiate an additional criminal history record check to determine if the employee has a record of conviction of any of the offenses enumerated in subsections (a)(2), (7), (9) through (13), (17), (22) through (28), (30) and (31) of this Section. (Section 25.1 of the Health Care Worker Background Check Act [225 ILCS 46/25.1])

f) Request for UCIA criminal history record check

The provider shall request the UCIA criminal history record check in accordance with the requirements of the Department of State Police. (See 20 Ill. Adm. Code 1265.) The provider shall notify the applicant or employee of the following whenever a non-fingerprint UCIA Criminal History Record search is made. (Section 30 of the Health Care Worker Background Check Act [225 ILCS 46/30]):

1. That the provider shall request or have requested on its behalf a UCIA criminal history record check pursuant to the Health Care Worker Background Check Act;

2. That the applicant or employee has a right to obtain a copy of the criminal records report, challenge the accuracy and completeness of the report and request a waiver in accordance with subsection (j)(1) of this Section;

3. That the applicant, if hired conditionally, may be terminated if the criminal records report indicates that the applicant has a record of conviction of any of the criminal offenses enumerated in subsections (a)(1) through (32) of this Section unless the applicant's identity is validated and it is determined that the applicant or employee does not have a disqualifying criminal history record based on a fingerprint-based records check pursuant to subsection (h) of this Section or the employee receives a waiver pursuant to subsection (j)(1) of this Section;

4. That the applicant or employee cannot work in a direct care position while a waiver request is pending;

5. That the applicant, if not hired conditionally, shall not be hired if the criminal records report indicates that the applicant has a record of conviction of any of the criminal offenses enumerated in subsections (a)(1) through (32) of this Section unless the applicant's record is cleared based on a fingerprint-based record check pursuant to subsection (h) of this Section or the employee receives a waiver pursuant to subsection (j)(1) of this Section;

6. That the employee may be terminated if the criminal records report indicates that the employee has a record of conviction of any of the criminal offenses enumerated in subsections (a)(1) through (32) of this Section unless the record is cleared based on a fingerprint-based records check pursuant to subsection (h) of this Section or the employee receives a waiver pursuant to subsection (j)(1) of this Section.

g) Conditional employment

The provider may conditionally employ an applicant to provide direct care for up to three months pending the results of a UCIA criminal history record check. (Section 30(g) of the Health Care Worker Background Check Act [225 ILCS 46/30(g)])

h) Request for fingerprint-based UCIA criminal records check

An applicant, employee, or nurse aide whose UCIA criminal history record check indicates a conviction for committing or attempting to commit one or more of the offenses enumerated in subsections (a)(1) through (32) of this Section may request that the provider commence a fingerprint-based UCIA criminal records check by submitting information in a form and manner prescribed by the Department of State Police (see 20 Ill. Adm. Code 1265) within 30 days after receipt of the criminal records report to validate identity and clear one's record. (Section 35 of the Health Care Worker Background Check Act [225 ILCS 46/35])

i) Eligibility for waiver

1. An applicant, employee, or nurse aide may request a waiver of the prohibition against employment. (Section 40 of the Health Care Worker Background Check Act [225 ILCS 46/40])

2. The Department may grant a waiver based on any mitigating circumstances, which may include but not be limited to:

A) The applicant's, employee's or nurse aide's age at the time that the crime was committed;

B) The circumstances surrounding the crime;

C) The length of time since the conviction;

D) The applicant or employee's criminal history since the conviction;

E) The applicant or employee's work history;

F) The applicant or employee's current employment references;

G) The applicant or employee's character references;

H) Nurse Aide Registry records; and

I) Other evidence demonstrating the ability of the applicant or employee to perform the employment responsibilities competently and evidence that the applicant or employee does not pose a threat to the health or safety of residents, recipients or clients. (Section 40(b) of the Health Care Worker Background Check Act [225 ILCS 46/40(b)])

j) Application for waiver

1. If the applicant, employee or nurse aide wishes to request a waiver, the request shall be submitted within 5 calendar days after receipt of the criminal records report. A complete waiver request shall include the following:

A) A statement specifying any mitigating circumstances (see subsection (i)(2) of this Section) the person believes are relevant to the employment in question; and

B) Either:

i) Information necessary for the Department to obtain a fingerprint-based UCIA criminal records check, including a suitable set of fingerprints, in a form and manner prescribed by the Department of State Police (see 20 Ill. Adm. Code 1265), the fee for such a check (which shall not exceed the actual cost of the check) and the findings of the required non fingerprint-based UCIA criminal records check conducted by the Department of State Police; or

ii) The report of the results of the fingerprint-based UCIA criminal records check done pursuant to subsection (h) of this Section.

2. Provider staff may assist the applicant, employee or nurse aide in completing the application.

3. The waiver request shall be submitted to:

Accreditation, Licensure and Certification

Department of Human Services

405 Stratton Building

Springfield IL 62765

k) Waiver decision

1. The waiver request shall be reviewed by a panel of Department staff. The Department shall return a decision to the applicant, employee, or nurse aide and the provider within 30 calendar days after receipt of the completed waiver request including receipt of a report from the State Police based on the fingerprint-based record check.

2. The provider is not obligated to hire or offer permanent employment to an applicant or to retain an employee who is granted a waiver. (Section 40(f) of the Health Care Worker Background Check Act [225 ILCS 46/40(f)])

3. The Department shall be immune from liability for any waivers granted. (Section 40(e) of the Health Care Worker Background Check Act [225 ILCS 46/40(e)])

l) Appeal of the decision

1. The applicant, employee, or nurse aide may request further review of his or her request for a waiver within 30 calendar days after the receipt of the Department's denial of the waiver.

2. The applicant, employee, or nurse aide may submit additional documentation of the mitigating circumstances.

3. The appeal shall be submitted to:

Director

Division of Disability and Behavioral Health Services

Department of Human Services

100 South Grand Avenue East

Springfield IL 62762

4. The Secretary shall act on the appeal within 30 calendar days after receipt of the appeal and shall issue a final decision granting or denying the waiver request.

m) This Section shall not apply to:

1. An individual who is licensed by the Department of Professional Regulation or the Department of Public Health under another law; or

2. An individual employed or retained by the provider as defined by Section 15 of the Health Care Worker Background Check Act [225 ILCS 46/15] for whom a criminal background check is required by another law of this State. (Section 20 of the Health Care Worker Background Check Act [225 ILCS 46/20])

n) The provider shall send a copy of the results of the UCIA criminal history record check to the State Nurse Aide Registry for an individual employed as a nurse aide within 10 working days after receipt of the results. (Section 30(b) of the Health Care Worker Background Check Act [225 ILCS 46/30(b)])

o) The provider shall retain on file for a period of five years records of criminal records requests for all employees. The files shall be subject to inspection by the Department's Office of Accreditation and Licensure. The provider shall retain the results of the UCIA criminal history records check and waiver, if appropriate, for the duration of the individual's employment. A fine of $500 may be imposed for failure to maintain these records. (Section 50 of the Health Care Worker Background Check Act [225 ILCS 46/50])

History

• Source: Amended at 23 Ill. Reg. 190, effective December 15, 1998

59 Ill. Adm. Code 119.270 Accreditation

a) Providers demonstrating current accreditation status under any of the standards of the accrediting organizations identified in the definition of "accreditation" in Section 119.120 of this Part shall be granted deemed status for the following Sections of this Part:

1. Section 119.200(a) and (b);

2. Section 119.205;

3. Section 119.210(a) through (d);

4. Section 119.215;

5. Section 119.220;

6. Section 119.225;

7. Section 119.230(a) and (c) through (f);

8. Section 119.240(a) and (c) through (h);

9. Section 119.245;

10. Section 119.250; and

11. Section 119.260(a) through (e)(1) through (6), (g), (i) and (j).

b) Demonstration of current accreditation status shall be achieved by submission of a certificate of accreditation and the most recent accreditation report by the provider to the Department.

c) If the provider's accreditation status changes for any reason, the provider shall notify the Department of that change within 30 days after the effective date of the change.

History

• Source: Amended at 23 Ill. Reg. 10211, effective August 23, 1999

59 Ill. Adm. Code 119.300 Issuing a Certificate and Period of Certification

a) The Department shall issue a certificate after receipt of a completed application, including the authorized agency representative's signature and the date, and after verifying the provider's compliance with this Part.

b) The Department shall survey providers and their certified program. The Department shall review the provision of services, observe individuals and staff, and inspect the records and premises for the purpose of determining compliance with this Part.

c) The Department shall survey providers to determine their compliance with this Part at the time of initial certification or certificate renewal.

d) If a provider requests a waiver of any standard in this Part, it shall present to the Department a plan of correction to comply with the required standard, including a timetable for compliance and its rationale for the waiver request. Standards identified in Sections 119.325(a)(1)(A), (B), (C) and (D) shall not be waived.

e) If a provider is not able to comply with a standard in this Part due to insufficient funding or no funding, the following shall occur:

1. The provider shall request a waiver of the specific standard in its plan of correction which shall state that the provider cannot comply with the standard due to insufficient funding or no funding;

2. The Department's Division of Developmental Disabilities shall review the waiver request and determine if the waiver shall be granted, except that no waiver shall be granted for any standard identified in Sections 119.325(a)(1)(A), (B), (C), and (D); and

3. If the Division of Developmental Disabilities determines that a waiver should be granted, it shall direct the Bureau to waive the specific standard.

f) If a provider requests an equivalency for any standard in this Part, it shall present a written description to the Department of the equivalency containing specific reference as to how the equivalency meets the standard. An equivalency shall not be granted on standards identified in Sections 119.325(a)(1)(A), (B), (C), and (D).

g) A certificate shall be valid for one year unless denied by the Department.

59 Ill. Adm. Code 119.305 Application for Certification

a) Forms

Providers shall obtain application forms by writing to:

Office of Accreditation and Licensure

Department of Human Services

405 Stratton Building

Springfield IL 62765

b) Certification renewal

1. Each certified provider shall submit a renewal application at least 120 days before expiration of the certification. The Department shall mail an application to the provider prior to the 120 day period before expiration.

2. Prior to recertification, OAL shall survey a provider.

3. The Department shall recertify a provider in compliance with this Part for an additional one-year period.

4. When the Department does not approve a provider for recertification, the Department shall notify the provider, in writing, within 30 days after the decision.

5. The notice shall include a clear and concise statement of the violation on which the determination is based and notice of the opportunity for a hearing in accordance with Section 119.330 of this Part.

6. The Department shall consider approving written requests for the development and certification of new providers when the following conditions are presented to the Department and verified:

A) The provider shall not force:

i) The provision of a service or residential setting on an individual or guardian which does not meet the individual's needs and desires; or

ii) Residential relocation of individuals away from participating relatives;

B) The provider demonstrates through letters of support or working agreement, a willingness to work cooperatively in coordinating services with residential service providers in the geographic area where services are provided; and

C) The provider shall identify unserved individuals who have been assessed to be in need of developmental training.

History

• Source: Amended at 21 Ill. Reg. 8297, effective June 25, 1997

59 Ill. Adm. Code 119.310 Application Acceptance and Verification

a) Applications for certification shall be deemed received by the Department on the postmarked date.

b) The Department shall notify a provider of any error or omission made on the application within 30 days. If the provider fails to respond to the notice within 30 days, the Department shall terminate the application process and notify the provider within 30 days.

c) The Department shall either approve or disapprove the application within 90 days after its receipt.

d) The Department shall verify information supplied in applications. This may be done by telephone with the applicant or through information provided by independent parties.

59 Ill. Adm. Code 119.315 Non-Transferability of a Certificate

a) A certificate is not assignable or transferable.

b) Change in ownership or discontinuation of operations causes the certificate to be void.

c) Certification documents and all copies shall remain Department property and shall be returned by the provider within 10 days after notifying the Department of a change in ownership.

59 Ill. Adm. Code 119.320 Cessation of Operations

a) When a provider decides to terminate operation of a program, it shall notify the following of its decision at least 60 days in advance of termination:

1. The Department;

2. Individuals who must be transferred or discharged;

3. The individual's guardian and members of the individual's family, when applicable;

4. Contractual staff; and

5. Subcontractors working with affected individuals.

b) The notice shall state the proposed date and reason for the program's termination.

c) The provider shall advise individuals on available alternatives and shall assist them in securing alternative services. If the provider is unable to find an alternative, the Department shall assure placement for those individuals funded by the Department. For residents of licensed long-term care facilities, the facility shall assure placement.

d) After termination of a program, funding shall be continued in the individual's new alternative by the State agency funding the individual in the terminating program.

59 Ill. Adm. Code 119.325 Certificate Denial

a) The Department shall deny certification at any time if the provider:

1. Fails to maintain full compliance with standards identified in:

A) Sections 119.235 (a) through (e);

B) Sections 119.240 (b), (g)(4), (i);

C) Sections 119.250 (a), (b); and

D) Sections 119.255 (a)(1) through (a)(3), (b), (d)(1) through (d)(6), (e)(1), (e)(3), (e)(5), (e)(6);

2. Fails to maintain substantial compliance with all standards in this Part other than those identified in subsection (a)(1) of this Section;

3. Fails to submit a plan of correction acceptable to the Department for any violations resulting from an on-site survey by the Department within 30 days of receipt of the notice of violation. A plan will be acceptable to the Department if the proposed correction will cause compliance with the applicable standard and if the timetable is reasonable. Criteria for the timetable being reasonable include that the correction be made immediately if the standard not complied with affects the safety or health of individuals, or that compliance occurs within the period of certification for all other standards noted as deficient;

4. Submits false information either on Department forms, plan(s) of correction or during an on-site survey;

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 the Code or in the Act.

b) The Department shall refuse to certify a program or shall deny a certificate if the owner, authorized agency representative or certificate holder has been convicted of a felony, or a misdemeanor involving moral turpitude, as shown by a certified copy of the court of conviction.

c) If the Department determines that individuals are at imminent risk which has not or cannot be corrected, it shall immediately close the affected program, plan for the immediate removal of all individuals and deny the certificate of the provider. The affected program shall not operate and shall not receive Department funding during the period of any appeal.

d) If a provider contests the Department's certification decision pursuant to subsection (a), (b) or (c) of this Section, it may request a hearing in accordance with Section 119.330, by providing written notice. The Department shall notify the provider of the time and place of the hearing not less than 14 days before the hearing date.

e) If the provider does not provide written notice, the Department shall deny the certificate.

f) The Department shall immediately notify the Department of Public Aid of the decertification of any provider.

59 Ill. Adm. Code 119.330 Hearings

a) The Department may not deny or suspend a certificate unless the provider is given written notice of the grounds for the Department's action. Except when denial of a certificate is based on imminent risk as described in Section 119.325, the provider may operate and receive a reimbursement for services during the period preceding the hearing, until such time as a final decision is made.

b) Hearings shall be conducted in accordance with the Department's rule at 89 Ill. Adm. Code 508.

History

• Source: Amended at 23 Ill. Reg. 10211, effective August 23, 1999

Part 120 Medicaid Home and Community-Based Services Waiver Program for Individuals with Developmental Disabilities

59 Ill. Adm. Code 120.10 Definitions

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.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.20 Purpose

a) The intent of this Part is to provide uniform direction for providers, Individuals, and guardians enrolled in one of the following Medicaid Home and Community-Based Services (HCBS) Waiver Programs:

1. Adults with Developmental Disabilities Waiver;

2. The Children's Residential Waiver; or

3. The Children's Support Waiver.

b) This Part also provides direction to Independent Service Coordination (ISC) agencies regarding case management activities.

c) The Illinois Department of Healthcare and Family Services (HFS) is the single State Medicaid Agency designated to administer and oversee the administration of the Medicaid program under Title XIX, Medical Assistance, of the Social Security Act (42 U.S.C. 1395a (2018) and 42 CFR 431 (2017)) and the Illinois Public Aid Code [305 ILCS 5].

d) The Department is designated as a State Operating Agency having primary responsibility for administering the delivery of HCBS Waiver programs for Individuals with developmental disabilities under the Code.

e) HFS and the Department have entered into an interagency agreement to specify their respective roles and responsibilities regarding the HCBS Waiver Program for Individuals with developmental disabilities.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.25 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.

History

• Source: Added at 20 Ill. Reg. 4762, effective March 8, 1996

59 Ill. Adm. Code 120.30 Program Description (repealed)

History

• Source: Repealed at 20 Ill. Reg. 4762, effective March 8, 1996

59 Ill. Adm. Code 120.40 Service Descriptions

a) The services covered under the Medicaid HCBS Waiver Programs shall be rendered as specified by the Division, in accordance with a written Personal Plan and Implementation Strategy and shall be designed to ensure the continuity of supports and services for Individuals. HCBS Waiver services, for the purpose of this Part, do not include:

1. Special education and related services (as defined in Section 602(16) and (17) of the Individuals with Disabilities Education Act (20 U.S.C.A. 1400 (2015)) which otherwise are available to the Individual through a local education agency; or

2. Vocational rehabilitation services which otherwise are available to the Individual though a program funded under Section 110 of the Rehabilitation Act of 1973 (20 U.S.C.A. 794 (2018)).

b) HCBS residential habilitation services shall promote the health, safety, and well-being of Individuals receiving such services. These services are designed to assist children/adolescents and adults in acquiring, retaining, and improving skills related to living in the community. These services include, but are not limited to, self-help, socialization, community inclusion, daily living, and adaptive skills necessary to reside successfully in HCBS Waiver settings.

c) Day and employment services are provided to adults enrolled in the Adults with Developmental Disabilities Waiver program and are intended to enhance Individual life skills, community and social skills, work-related activities, and employment skills.

d) HCBS Home Based Support Services (HBS) is an individually designed program of separately-covered services, or assessment of the need for these services, to assist Individuals to live in a private family home or an individually-owned or -controlled home. HBS has a monthly dollar cost maximum set by the Department that will be communicated by an award letter at the time of program enrollment. All services provided must be for the direct benefit of the Individual and must be directly related to their disability. HBS, and the services available within the program, are further detailed at 59 Ill. Adm. Code 117.

e) HCBS Waivers provide a variety of other services and supports to address an Individual's habilitation, mobility, emotional, cognitive, or behavioral needs. The services must be included in the Personal Plan and can be provided in a variety of ways including, but not limited to, direct support and/or treatment, evaluations, intervention strategies, staff training, equipment, environmental changes, and emergency supports. HCBS Waiver services can be combined with State Medicaid Plan services to support an Individual's needs.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.50 Target Population

Individuals to be served under this Part are Medicaid-eligible Illinois adults and children with developmental disabilities who otherwise would require ICF/DD (42 CFR 440.150) level of care. Adults entering the Adults with Developmental Disabilities Waiver must be at least age 18 years or older. Children entering the Children's Residential or Children's Support Waiver must be at least age 3 years old and can remain through age 21. Individuals served shall meet Illinois Medicaid eligibility standards, non-financial eligibility criteria under this Part, and be:

a) Residents of State-operated facilities who are able to live in the community and/or who prefer services in an HCBS Waiver;

b) On PUNS, including Individuals currently living at home, living in private ICF/DDs and living in Medically Complex facilities for persons with Developmental Disabilities;

c) Individuals being subjected to abuse, neglect, homelessness; or

d) Youth who are 18 years or older, but prior to their 22nd birthday, residing as an adult in a DDD child group home;

e) Illinois Department of Children and Family Services youth in care who are 18 years or older, but prior to their 22nd birthday;

f) A Bogard class member, i.e., certain Individuals with developmental disabilities who currently reside or previously resided in a nursing facility; or

g) Part of a DHS Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD) Downsizing. The ICF/DD must have an agreement with the Division.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.60 Overview (repealed)

History

• Source: Repealed at 20 Ill. Reg. 4762, effective March 8, 1996

59 Ill. Adm. Code 120.65 Conflict of Interest-Free Case Management

a) The Department shall contract ISC agencies to provide conflict of interest-free case management, as described in 42 CFR 441.301(c)(1)(vi).

b) Case management shall include, but not be limited to:

1. Determination of eligibility. In accordance with Section 120.140, the Department has the responsibility to oversee the accuracy, quality, and appropriateness of functions provided by ISC agencies and reserves the right to review and approve or reject determinations of eligibility made by ISC agencies.

2. Development and annual update of the Personal Plan as described in 42 CFR 441.301(c)(1)(vi) and Section 120.160(b).

3. Enrolling and maintaining Individuals in PUNS.

4. Ensuring the provision of informed choice of all services (including State Plan, entitlement services, unpaid, and natural supports) and providers.

5. Collaboration with service providers to ensure Individual's health, safety, welfare, well-being, and satisfaction with services funded by DDD, and as such, addressing problems related to outcomes and quality.

6. Supporting Individuals, including but not limited to, advocacy, exercising rights, and securing and maintaining services.

c) Conflict of interest occurs when the entity providing case management is:

1. A provider agency or a person who has an interest in, or who is employed by, a provider.

2. A person who is related by blood or marriage to the Individual or to any paid caregiver of the Individual.

3. A person who is financially responsible for the Individual.

4. A person who is empowered to make financial or health-related decisions for the Individual.

History

• Source: Added at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.70 Service Provider Requirements

a) New and current provider agencies must be enrolled as a Medicaid provider in the Illinois Medical Program Advanced Cloud Technology (IMPACT) system with HFS.

b) The provider shall meet Department standards applicable to the specific services to be provided and shall demonstrate competency to provide services.

c) Service providers shall:

1. Meet the fiscal, program, and reporting requirements of the Medicaid HCBS Waiver programs

2. Be willing to serve eligible individuals from a variety of backgrounds including, but not limited to, former or potential residents of State-operated facilities or ICF/DDs;

3. Comply with applicable Medicaid provider requirements, appropriate licensure procedures, and/or standards, as well as Department operational procedures for purchase of service or grant programs (see the Department's Rules at 59 Ill. Adm. Code 103, 113, 115 and 119); and

4. Comply with intake, assessment, monitoring, and billing procedures established for services under this Part.

d) Provider-owned or -controlled residential and non-residential settings must 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 (42 CFR 441.301(c)(4)):

1. Be integrated in and support full access of Individuals receiving Medicaid HCBS to the greater community, including opportunities to:

A) Seek employment and work in competitive integrated settings;

B) Engage in community life, to the extent chosen by the Individual;

C) Control personal resources; and

D) Receive services in the community, to the same degree of access as Individuals not receiving Medicaid HCBS.

2. Be selected, with the assistance of the ISC agency, by the Individual from among setting options including non-disability specific settings and an option for a private bedroom or unit in a residential setting. The setting options are identified and documented by the ISC agency in the Personal Plan and are based on the Individual's needs, preferences, and, for residential settings, resources available for room and board. When feasible, the provider agency should offer the option for a private bedroom or unit in a residential setting.

3. Ensure an Individual's rights to privacy, dignity and respect, and freedom from coercion and restraint.

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.

5. Facilitate Individual choice regarding services and supports and who provides them.

6. Provider-owned or -controlled residential settings, in addition to the qualities described in subsections (d)(1) through (d)(5), must meet the following additional conditions:

A) The residential setting is a specific physical place that can be owned, rented, or occupied under a legally-enforceable agreement (consistent with the guidelines issued by the Department) by the Individual receiving services, and the Individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, and/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.

B) Each Individual has privacy in their residential setting.

i) Residential settings shall have entrance doors lockable by the Individual, with only appropriate staff having keys to doors.

ii) Individuals sharing a residential setting shall have a choice of roommates in that setting.

iii) Individuals shall have the freedom to furnish and decorate their residential setting within the lease or other agreement.

C) Individuals have the freedom and support to control their own schedules and activities and have access to food at any time.

D) Individuals can have visitors of their choosing at any time.

E) The setting is physically accessible if required by the needs of any Individuals served in the setting. Providers should access all available resources, through the Division and community, to accommodate accessibility needs. All communal areas must meet standards set forth by the ADA and other federal, State, or municipal regulations. Providers must ensure sites are certified and have capacity for a non-ambulatory Individual before offering placement. The non-ambulatory capacity is indicated in the certification letter given to each provider by the Department for every site.

F) Any modification of the additional conditions, under subsections (d)(6)(A) through (E), must be supported by a specific assessed need and justified in the Personal Plan. The following requirements must be documented in the Personal Plan and Implementation Strategy:

i) Identify a specific and individualized assessed need.

ii) Document the positive interventions and supports used prior to any modifications to the Personal Plan.

iii) Document less intrusive methods of meeting the need that have been tried but did not work.

iv) Include a clear description of the condition that is directly proportionate to the specific assessed need.

v) Include regular collection and review of data to measure the ongoing effectiveness of the modification.

vi) Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated.

vii) Include the informed consent of the Individual and guardian.

viii) Include an assurance that interventions and supports will cause no harm to the Individual.

e) Providers who deliver authorized services to Individuals determined eligible under the Medicaid HCBS Waiver Programs shall be paid by the Department on a monthly basis on submission of service reports/billing statements.

f) Providers shall cooperate with:

1. Quality assurance reviews, monitoring, evaluations, information requests (conducted by the Department, HFS, or by other entities that are authorized by the Department or HFS, such as ISC agencies, auditors, or evaluators) and when necessary, sanctions. Prior to initiating formal action to sanction a provider agency, the Department will allow the provider an opportunity to take corrective action to eliminate or ameliorate a deficiency except in cases in which the Department determines that emergency action is necessary to protect the public or individual interest, safety, or welfare.

2. Licensure and certification surveys, monitoring, evaluations and information requests, (conducted by the Department) and when necessary, sanctions. The Department will conduct onsite surveys of providers to ensure that they maintain compliance with established rules, regulations, and standards. Providers who fail to comply with the established rules, regulations, and standards set forth by the Department shall receive sanctions that include hold on admissions or payment, decertification of a site, and licensure revocation. Once a provider comes into compliance, the sanction shall be lifted, and the Department will proceed with the required survey process unless the Department has decertified a site or revoked the license in which case the sanction will not be lifted.

g) Provider agencies shall only use Restraint as allowed and directed pursuant to statutes and administrative rules applicable to the program (i.e., 59 Ill. Adm. Code 115, 59 Ill. Adm. Code 119, 77 Ill. Adm. Code 370, 89 Ill. Adm. Code 384, 89 Ill. Adm. Code 401, 89 Ill. Adm. Code 403, 210 ILCS 35/18, and 405 ILCS 5). If any type of Restraint not allowed and/or directed by administrative rule applicable to the program is utilized by an Agency employee, the incident must be reported via the Critical Incident Reporting and Analysis System (CIRAS) as well as reported to the Office of the Inspector General.

h) When a provider determines it will reduce, suspend, or terminate services to an Individual in an HCBS Waiver Program, the agency must do so according to the following, unless specified otherwise in the statutes or administrative rules applicable to the program (i.e., 59 Ill. Adm. Code 115, 59 Ill. Adm. Code 119, 77 Ill. Adm. Code 370, 89 Ill. Adm. Code 384, 89 Ill. Adm. Code 401, 89 Ill. Adm. Code 403, 210 ILCS 35/18, and 405 ILCS 5):

1. A provider agency shall terminate its services if an Individual or guardian chooses either of the following actions, both of which are considered voluntary, and the termination is not appealable:

A) An Individual transfers to another qualified provider; or

B) An Individual or Individual's guardian withdraws the Individual from the provider agency's services (with no intention of returning).

2. A provider agency may involuntarily reduce, suspend, or terminate services to an Individual for the following reasons:

A) The medical needs of the Individual cannot be met by the provider agency as documented in the Individual's record.

B) The behavioral needs of an Individual cannot be met by the provider agency to ensure the physical safety of the Individual and/or others as documented in the Individual's record.

3. A notice of reduction, suspension, or termination issued by a provider agency, must:

A) Be in writing.

B) Be sent to the Individual, guardian, and ISC agency.

C) Include a time frame for the action. For involuntary terminations, the provider shall issue the Individual and guardian at least a 30-day notice, except in emergency situations as described in Section 120.110(i).

D) Provide a clear statement of the action to be taken.

E) Provide a clear statement of the reason for the action.

F) Include a complete statement of the Individual's right to appeal, including the provider's grievance process; it must also include the Department's informal review process and HFS' hearing process as described in Section 120.110.

i) Appeals by providers. Provider agencies may appeal the Department's administrative decisions (i.e., licensure or certification denial, notice of deficiencies), and request an administrative hearing as outlined in 89 Ill. Adm. Code 508. Providers may not appeal the Department's decisions related to discharge, termination, or reduction of services to an Individual.

1. As the single State Medicaid agency, HFS is responsible for conducting all provider administrative hearings and rendering the final administrative decision. The appeal requirements and process are contained in HFS's rules at 89 Ill. Adm. Code 104.200 through 104.210.

2. The Department shall conduct informal reviews of provider appeals to attempt to resolve issues without a formal administrative hearing.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.80 Program Assurances

In addition to program requirements specified in other Sections of this Part, assurances for the Medicaid HCBS Waiver Program will include:

a) Level of care determination

An evaluation and periodic (at least annual) reevaluations of the Individual's need for the level of care provided in an ICF/DD, as defined by 42 CFR 483.400 through 483.480, shall be conducted for an Individual when there are indications (see 42 CFR 483.440 (a)) that the Individual might need such services in the near future.

b) Informing Individuals of choice

All Individuals participating in HCBS Waivers must have a Personal Plan (see Section 120.160) which facilitates Individual choice regarding services and supports, and who provides them, per 42 CFR 441.301(c)(4)(v).

c) Average per capita expenditures

The average per capita Medicaid expenditures, including HCBS Waiver services, will not exceed 100 percent of the average per capita expenditures that would have been made under the Medicaid State Plan for the levels of care specified for this waiver had the waiver not been granted. The State must therefore limit participating Individuals and expenditures under this program to meet the per capita cost requirements.

d) Rate methodology

Rates for reimbursement of program services shall be established by the Department and approved by HFS. Rate levels shall be determined for each type of Medicaid HCBS Waiver service by unit of service provided, e.g., per hour, per day. Providers shall receive written notification of rates and rate changes at least annually.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.90 Department Audit

The Department requirements for service providers annual audits are found in 89 Ill. Adm. Code 507 Section.

History

• Source: Amended at 22 Ill. Reg. 22399, effective December 8, 1998

59 Ill. Adm. Code 120.95 Electronic Signatures

a) Electronic signature or computer-generated signature codes are acceptable as authentication of record content.

b) In order for a provider or ISC agency to employ electronic signatures or computer-generated signature codes for authentication purposes, the provider or ISC agency must adopt a policy that permits authentication by electronic or computer-generated signature.

c) At a minimum, the electronic or computer-generated signature policy shall include adequate safeguards to ensure confidentiality of the codes, including, but not limited to, the following:

1. Each user must be assigned a unique identifier that is generated through a confidential access code.

2. The provider or ISC 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.

3. 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.

4. The provider or ISC agency must monitor the use of identifiers periodically and take corrective action as needed. The process by which the provider or ISC agency will conduct monitoring shall be described in the electronic or computer-generated signature policy.

d) 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:

1. 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.

2. The system must make an opportunity available to the user to verify that the document is accurate and the signature has been properly recorded.

3. The provider or ISC agency must periodically sample records generated by the system to verify the accuracy and integrity of the system.

e) Each document generated by a user must be separately authenticated.

History

• Source: Added at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.100 Overview of Rights

a) Observation and protection of rights of Individuals

1. The observation and protection of rights of Individuals receiving developmental disability services in the public and the private sector as set forth in Chapter 2 of the Code, except that the use of Seclusion will not be permitted, are applicable to all Sections of this Part.

2. Individuals receiving HCBS Waiver services must be free from:

A) Abuse, neglect, and financial exploitation, pursuant to 59 Ill. Adm. Code 50.10.

B) Seclusion and coercion.

C) Restraint (other than what is allowed and directed pursuant to statutes and administrative rules applicable to the program (i.e., 59 Ill. Adm. Code 115, 59 Ill. Adm. Code 119, 89 Ill. Adm. Code 401, 89 Ill. Adm. Code 403, 89 Ill. Adm. Code 384, 210 ILCS 35/18, and 77 Ill. Adm. Code 370).

3. Service providers shall ensure that Individuals, guardians, and others designated by the Individual receive a complete explanation of their rights, as documented in the IL 462-1201 form, and responsibilities at the time of service initiation, annually thereafter, and on request.

4. The ISC shall complete the Rights of Individuals form (IL 462-1201) with Individual and/or guardian signing the document at the time of service initiation, annually thereafter, and on request.

5. The justification for any restriction of Individual's HCBS Waiver rights, as indicated in Section 120.70(e)(6)(A) through (E), shall be:

A) Documented in the Individual's Personal Plan and Implementation Strategy pursuant to Section 120.160.

B) Reviewed and approved by the provider agency's Human Rights Committee before the restriction is implemented.

6. An Individual's confidentiality shall be governed by the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

b) Non-discrimination

In accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d (2009)), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794 (2015)), the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 through 12213 (2008) and 47 U.S.C. 225 and 611 (2010)) and the regulations at 45 CFR 80 (2005) and 45 CFR 84 (2010), the Department assures that no Individual shall be subjected to discrimination under this Part on the grounds of race, color, sex, religion (creed), gender identity, gender expression, age, national origin (ancestry), ethnicity, disability, marital status, sexual orientation, or military status.

c) Confidentiality of case information

For the protection of Individuals, any information about an Individual or case is confidential and may be used only for purposes directly related to the administration of the Medicaid HCBS Waiver Programs. The Department and service providers shall inform all entities to whom information is furnished that this material is confidential, subject to the provisions of the Confidentiality Act, and shall be so considered by the entity. An authorization for release of information shall be used to secure the Individual's or guardian's consent to share information.

d) Notice of action. Individuals requesting or receiving HCBS Waiver services have the right to:

1. A written notice of:

A) Denial of clinical eligibility by the Division or an ISC agency;

B) Denial of service(s) by the Division; and

C) Reduction, suspension, or termination of HCBS Waiver services by the Division or a provider agency.

2. Appeal the decision disposition (reduction, suspension, termination, or denial of HCBS services) pursuant to Section 120.110.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.110 Appeals and Fair Hearings

a) The Individual, parents, guardian, or the Individual's representative may appeal the following actions:

1. Refusal of the Division or ISC agency to accept a request for Waiver program enrollment.

2. Failure of the Division or ISC agency to act on a request for services within the mandated time period.

3. Denial of a requested Waiver service by the Division or ISC agency (i.e., Individual in Home-Based Supports and is now requesting Assistive Technology).

4. Denial of clinical eligibility by the Division or an ISC agency.

5. Suspension, termination, or reduction of services by the Division or a provider agency.

b) The desire to appeal any action listed under subsection (a) shall be communicated to the ISC within 10 working days after the date the Individual or guardian receives the notice of action from the provider. The communication shall be followed by a written request to appeal signed by the Individual, parent, guardian, or Individual's representative.

c) Within 45 days after receiving notification to appeal, the ISC must:

1. Gather the following:

A) The written request to appeal signed by the Individual, parent, guardian, or Individual's representative.

B) A complete appeal checklist.

C) A complete Documentation for Medicaid Waiver Appeals form (IL444-0171) and supporting documents as indicated in the form.

D) Documents from the provider agency to support its decision to suspend, terminate, or reduce services.

E) Any additional documentation relevant to the appeal.

2. Submit the documents pursuant to subsections (c)(1)(A) through (E) to DDD's Appeals Unit by:

A) Secure email. Emails should be directed to DHS.DDDAppeals@illinois.gov;

B) Fax to 217-558-2799 Attn: Appeals Unit supervisor; or

C) Mail to:

DHS/DDD – Program Development

Attn: Appeals Unit Supervisor

600 East Ash Street Building 400, 3rd Floor South

Springfield, IL 62703

d) Within 30 working days after the appeal and supporting documents indicated in subsection (c)(1) are received, DDD shall conduct an informal review of the appealed action listed in subsection (a) and either uphold or not uphold the appealed action. The Individual, parent, guardian, or Individual's representative (if any), and the service providers shall be notified in writing of DDD's decision within 10 working days after the informal review is complete. The written notification shall include:

1. A clear statement of the action to be taken;

2. A clear statement of the reason for the action;

3. A specific policy reference which supports such action; and

4. A complete statement of the Individual's right to continue the appeal and have an Administrative Hearing with HFS. When DDD's Informal Review decision does not support the Individual's appeal, the Individual, parent, guardian, the Individual's representative, and provider, if applicable, will be notified that the appeal will continue to HFS for an Administrative Hearing.

e) When DDD's informal review decision does not support the Individual's appeal, within 10 working days after the decision, DDD shall forward the appeal and all documents reviewed to HFS for an administrative hearing to be scheduled by HFS.

f) The hearing shall be conducted by an impartial hearing officer appointed by HFS.

g) The hearing may be held by telephone.

h) HFS' hearing rules for assistance appeals, as set forth at 89 Ill. Adm. Code 104, shall apply, except that subsection (d) shall apply rather than any similar HFS rule.

i) Following the hearing, the Director of HFS shall issue a final administrative decision in accordance with 89 Ill. Adm. Code 104.70. Copies of the decision shall be mailed to the Individual, guardian, parent, the Individual’s representative (if any), the provider, and the Supervisor of DDD's Appeals Unit.

j) The receipt of the appeal shall stay the decision pending the final administrative decision or the withdrawal of the appeal. If the decision being appealed is regarding suspension, termination, or reduction of services, services shall not be suspended, terminated, or reduced until the appeal is resolved, except as described below.

1. Services may be suspended, terminated, or reduced before the final administrative decision when:

A) The physical safety or health of the Individual or others is in extreme risk of harm; or

B) Appropriate medical services are not available at the provider agency thereby jeopardizing the health of the Individual; and

C) The ISC agency has:

i) Reviewed the Individual's record and clinical information;

ii) Reviewed the actions, including the supports implemented, of the provider;

iii) Discussed the current situation and alternatives available with the Individual and guardian;

iv) Determined that a delay in termination, suspension, or reduction in services would put the safety of the Individual or others in extreme risk of harm and has documented that fact in the Individual's record; and

v) Consulted with the Division of Developmental Disabilities.

2. If the conditions of subsection (j)(1) are met, services to the Individual may be terminated, suspended, or reduced and the notice of action shall be given in accordance with Section 120.70(h) as soon as possible, but in no case later than 48 hours before the termination, suspension, or reduction in services.

3. The provider shall continue to provide services until the appeal is resolved except as described in subsection (j)(l).

4. If the conditions of subsections (j)(l)(A) or (B) exist, the Individual (if possible), the guardian, the ISC agency, and a Department representative will work together to secure alternative services. The provider agency (including the QIDP) shall work cooperatively with the Individual, the guardian, the ISC agency and the Department in effort 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 the Individual's care.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.120 Individual's Responsibilities

a) Information to establish eligibility

The Individual shall provide, as able, the factual information necessary to establish eligibility, including the consent to release information as provided for in Section 120.100(c). The ISC agency or service provider, with the consent of the Individual, may assist in obtaining such information.

b) Reporting changes in personal information and services

1. It is the responsibility of the Individual or guardian to report all changes in circumstances (including change in address, housing arrangements, income or assets, or eligibility for other benefits or programs) to the Department and to the provider within five working days after the change.

2. It is the responsibility of the Individual or guardian to report changes in services currently provided by other entities which might affect the extent of supports or services provided through the Medicaid HCBS Waiver Program. Such information shall be reported to the provider.

c) Application for other benefits

Individuals are required to apply for all other financial benefits, such as Supplemental Security Income, public assistance (the Illinois Public Aid Code [305 ILCS 5]), veterans benefits (38 U.S.C. 521, 541, and 542 (2011)), unemployment compensation (the Unemployment Insurance Act [820 ILCS 405]), Social Security retirement and disability benefits (Title II of the Social Security Act, 42 U.S.C. 401 (2011)), Worker's Compensation (Workers' Compensation Act [820 ILCS 305]), and Supplemental Nutritional Assistance Program (SNAP), for which they may qualify and to avail themselves of such benefits at the earliest possible date.

d) Social security number

The Department, in compliance with the Identity Protection Act [5 ILCS 179], may request Individuals receiving program services to supply a social security number for program administration purposes. The service coordinator or provider can assist the Individual in applying for a social security number if the Individual so wishes.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.130 Filing an Application (repealed)

History

• Source: Repealed at 20 Ill. Reg. 4762, effective March 8, 1996

59 Ill. Adm. Code 120.140 Eligibility Criteria

a) The Individual's age shall be within guidelines set forth by the Adults with Developmental Disabilities Waiver, Children's Residential Waiver, or the Children's Support Waiver at the time services are initiated.

b) The Individual shall be a resident of Illinois.

c) Prior to Medicaid waiver enrollment, an ISC agency shall assess the Individual and determine that a developmental disability is present, that the Individual could benefit from active treatment, and that the Individual does not require 24-hour nursing care.

1. Individuals shall be given a choice of alternative services through the pre-admission screening process. The choice shall include both ICF/DD and Home and Community-Based Waiver services, which are an alternative to ICF/DD placement.

2. The criteria for this determination are contained in HFS' rule at 89 Ill. Adm. Code 140.642.

d) The Individual shall meet all financial and non-financial Medicaid eligibility criteria as specified in the approved State Medicaid Plan.

e) The Individual shall not be receiving services in a nursing facility, Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), Intermediate Care Facility for Developmental Disabilities (ICF/DD), State-Operated Facility, Medically Complex facility for persons with Developmental Disabilities (MC/DD), hospital, or another Medicaid Waiver program (without direct approval from the Secretary of the Department) at the time HCBS Waiver services are being delivered.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.150 Eligibility Determination

a) HFS shall determine the Individual's financial eligibility per 89 Ill. Adm. Code 120.

b) Individuals shall be served by the ISC agency that is located in the geographic area where the person resides. The ISC agency shall be responsible for:

1. Compiling information as needed for the determination of clinical eligibility pursuant to Section 120.140; and

2. Completing a determination of HCBS Waiver eligibility pursuant to the criteria in Section 120.140.

c) Eligibility for services under this Part may be denied for the following reasons:

1. An Individual fails to meet the eligibility criteria specified in Section 120.140 of this Part.

2. The applicant does not supply needed information to complete the eligibility determination.

3. The Individual's Personal Plan cannot be designed to adequately meet the Individual's needs within the program limits. In the case of HBS, the services must be within the service cost limitations.

4. Individuals and expenditures under this program do not meet the average per capita cost.

d) The ISC agency shall conduct a redetermination of Medicaid HCBS Waiver program eligibility within 12 months after the last eligibility determination or redetermination. A redetermination shall also be conducted if, before 12 months have elapsed, there is a change in circumstances affecting eligibility (see Section 120.120(b)). A redetermination shall include an examination of criteria identified in Section 120.140. A redetermination of the presence of developmental disability is not required.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

59 Ill. Adm. Code 120.160 Person-Centered Planning

a) Individuals who are or who will be enrolled in an HCBS Waiver Program, guardians, ISC agencies, and provider agencies shall comply with Person-Centered Planning requirements pursuant to 42 CFR 441.301(c)(1) through (c)(3) and as set forth by the Department. The Person-Centered Planning process:

1. Must be driven by the Individual who is or who will be enrolled in an HCBS Waiver Program. The ISC agency shall facilitate the process and the guardian must be included. Other persons invited by the Individual and agencies currently providing services shall be invited to contribute to the process.

2. Provides necessary information and support to ensure that the Individual directs the process to the maximum extent possible and is enabled to make informed choices and decisions.

3. Is timely and occurs at times and locations of convenience to the Individual.

4. Reflects cultural considerations of the Individual and is conducted by providing information in plain language and in a manner that is accessible to Individuals with disabilities and persons who have limited English proficiency.

5. Includes strategies for solving conflict or disagreement within the process, including clear conflict of interest guidelines for all planning participants.

6. Is initiated and overseen by a conflict of interest-free case management entity as indicated in Section 120.65. Providers of HCBS Waiver services, or those who have an interest in or are employed by a provider of HCBS Waiver services must not provide case management or develop the Personal Plan.

7. Offers informed choices to the Individual regarding the services and supports that they receive and from whom.

8. Includes a method for the Individual to request updates to the plan as needed.

9. Records the alternative home and community-based settings that were considered by the Individual.

b) ISC agencies shall initiate the Person-Centered Planning process for each Individual who is or who will be enrolled in an HCBS Waiver Program by conducting a discovery process designed to gather information about an Individual's preferences, interests, abilities, preferred environments, activities, and supports needed.

1. The ISC agencies will be responsible for facilitating the discovery process, as outlined by the Department, and for documenting what they gather.

2. This process should begin with the Individual and then include the guardian, advocate, family, and others chosen by the Individual. It must also include information from current providers.

3. The information captured during this process is used to develop the Personal Plan, which summarizes key and critical areas of the Individual's life.

c) After the discovery process is complete, the ISC agency shall develop the Personal Plan. The Personal Plan must reflect the services and supports that are important for the Individual to meet the needs identified through the discovery process, as well as what is important to the Individual with regard to preferences for the delivery of such services and supports. The written plan must:

1. Reflect that the setting in which the Individual resides is chosen by the Individual. The State must ensure that the setting chosen by the Individual is integrated in, and supports full access of, Individuals receiving Medicaid HCBS to the greater community, including 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.

2. Reflect the Individual's strengths and preferences.

3. Reflect clinical and support needs, as identified through the discovery process.

4. Include individually-identified and -desired outcomes.

5. Reflect the services and supports (paid and unpaid) that will assist the Individual to achieve identified outcomes, and the providers of those services and supports, including natural supports.

6. Reflect risk factors and measures in place to minimize them, including individualized back-up plans and strategies, when needed.

7. Be understandable to the Individual receiving services and supports, and to those who are important in supporting the Individual. At a minimum, for the written plan to be understandable, it must be written in plain language and in a manner that is accessible to Individuals with disabilities and to persons who have limited English proficiency.

8. Identify the person and/or entity responsible for monitoring the plan.

9. Be finalized and agreed to, with the informed consent of the Individual in writing. The persons and providers responsible for its implementation shall sign the completed plan.

10. Be distributed to the Individual and other people involved in the plan.

11. Include those services which the Individual elects to self-direct.

12. Prevent the provision of unnecessary or inappropriate services and supports.

13. Include any modification of the conditions in Section 120.70(d)(6)(A) through (d)(6)(E). Modifications of these conditions must be supported by a specific assessed need and justified in the Personal Plan. The following requirements must be documented in the Personal Plan:

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 a 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 informed consent of the Individual.

H) Include an assurance that interventions and supports will cause no harm to the Individual.

d) The Personal Plan must be reviewed and revised upon reassessment of functional need, as required by 42 CFR 441.365(e), at least every 12 months, when the Individual's circumstances or needs change significantly, or at the request of the Individual.

e) Provider agencies must comprehensively address the needs of Individuals enrolled in an HCBS Waiver and for whom they have signed a Personal Plan through the development of an Implementation Strategy as it relates to their Personal Plan.

1. Within 20 calendar days of the provider's signature on the Personal Plan, an Implementation Strategy shall be developed that:

A) Is based on the Personal Plan developed by the ISC agency and on the 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 or staff notes indicating why there is no signature and why the Individual's and guardian's agreement is not reflected.

D) Describes and directs the activities and methods used to provide services and supports the areas of an Individual's Personal Plan for which the provider is responsible.

E) Addresses and accounts for the priorities, strengths, support needs, and risk factors identified in the Personal Plan for those areas of the provider's responsibility.

F) Justify and document the restriction of an Individual's HCBS Waiver rights, which are outlined in Section 120.70(d)(6)(A) through (E)

G) Addresses outcomes identified in the Personal Plan that the provider agency agreed to support the Individual in.

H) Identifies the agencies' services to support the Individual in attaining skills or achieving outcomes identified in the Personal Plan, detailing timeframes for completion, staff positions assigned responsibility, and benchmarks for determining the success of the strategies.

I) Identifies the services chosen by the Individual and guardian and indicates the type and the amount of supervision provided to the Individual.

J) Includes the names and titles of all employees and other persons contributing to the Implementation Strategy.

K) Is signed by the Individual, guardian, and provider agency representatives.

2. The Individual, guardian and ISC 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, sign, and date in the Individual's monthly summary that:

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 to better meet the Individual's needs.

C) Outcomes are being supported as specified in the Personal Plan and Implementation Strategy.

D) Progress is being made toward outcomes, as identified in the Personal Plan and Implementation Strategy. In situations when there is no progress made, provider agencies must document barriers and/or reasons why progress was not made.

5. 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.

6. All services specified in the Implementation Strategy, whether provided by an employee of the agency, consultants, or sub-contractors, shall be provided by or under the supervision of a QIDP.

7. The provider agency must ensure that current copies (digital or paper) of Individuals' Personal Plans and Implementation Strategies are kept at the provider agency.

8. The provider agency must also ensure that direct care workers (including employees, contractual persons, 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 of the Personal Plans and Implementation Strategies.

History

• Source: Amended at 48 Ill. Reg. 5279, effective March 21, 2024

Part 125 Recipient Discharge/Linkage/Aftercare

59 Ill. Adm. Code 125.10 Purpose

a) The intent of this Part is to define and describe the role of the Department of Human Services once the decision has been made by direct service personnel that a recipient is a candidate for discharge from a State-operated facility. A person shall not remain in a State-operated facility after it has been clinically and professionally determined that therapeutic services as defined within the Mental Health and Developmental Disabilities Code [405 ILCS 5] are no longer needed by the recipient. Adequate discharge planning, linkage and aftercare within an appropriate setting with individualized follow-up services will be provided for each recipient. Recipients will not be discharged from State-operated facilities without assurance that linkage will occur, unless the recipient refuses individualized follow-up services.

b) The policies and procedures within this document are consistent with the statutes which contain the Mental Health and Developmental Disabilities Code and the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705] and provide uniform direction to Department employees beginning with the decision to discharge a recipient and continuing through the follow-up process. The approach contained in this Part should enhance the quality of delivery of services to recipients and provide for improved public accountability.

c) This Part shall be used to assist in the orientation and training of staff as well as to provide guidance which may be necessary on a day-to-day basis. It is written in such a way that the policy expectations of the Department in terms of the roles and responsibilities of those involved in the discharge/linkage/aftercare process are addressed, including:

1. Central Office personnel;

2. Department facility and regional personnel;

3. Follow-up staff; and

4. Community providers.

d) The Department has always placed a special emphasis upon the necessity of continuity of care among service providers. Evidence of collaborative interagency agreements which assure prompt access to needed services is a requirement for the receipt of Department of Mental Health and Developmental Disabilities grant funds. Nationally recognized accreditation organizations have also emphasized the importance of this area through the development of standards concerning discharge planning, linkage and aftercare services.

e) The programmatic issue of assuring linkage of a recipient of services to the receiving agency/facility as distinguished from the monitoring and tracking of the recipient through the system has been given special consideration. Consequently, the Department's primary emphasis is to assure this linkage. The contents of this Part reflect this emphasis.

f) The provision and delivery of aftercare services to the recipient are the responsibility of the receiving agency/facility. The assurance that the services are appropriate and continue to be provided are the responsibility of the case coordinator and/or the designated mandated follow-up staff.

g) Facilitating the linkage of each recipient to a receiving agency while at the same time respecting the individual's rights as set forth in the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110] requires that any recipient identifying information contained in the Department's automated linkage system be maintained on a time limited basis. Confirmation of linkage for a time period, not exceeding 180 days from the date of absolute discharge from a state-operated facility is maintained in the automated linkage system. An exception to this practice will exist for those recipients placed by the Department into licensed long-term care facilities. In these cases, the Department will maintain recipient identifying information for a minimum of one year in order to fulfill the mandated follow-up responsibility specified in Sections 15 through 16 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15 through 16].

h) The policies and procedures contained in this Part articulate specific activities which must be accomplished. Further, terminology used in this Part has been standardized to facilitate its usefulness as well as gain greater clarity in communications among responsible personnel.

59 Ill. Adm. Code 125.15 Definitions

For purposes of this Part, the following terms are defined:

"Aftercare." The continuation of needed care and services of a recipient discharged from a state-operated facility within an appropriate setting with individualized follow-up services.

"Case coordination." The provision of assistance and advocacy services to a recipient for the purpose of assuring and/or coordinating the provision of necessary services and support.

"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Community agency/facility." A locally-operated organization which provides treatment/habilitation services to persons who are dysfunctional due to mental illness, developmental disability or alcohol abuse. An agency/facility may have an agreement with the Department to provide services in consideration of payment through a grant or purchase care funding mechanism. A grant funded agency must be in compliance with Grants (59 Ill. Adm. Code 103) and report its activities through the extramural information reporting system.

"Department." The Department of Human Services.

"Individualized services plan." A written plan for persons who are dysfunctional due to mental illness, developmental disability or alcohol abuse. This plan includes an assessment of the recipient's treatment/habilitation needs, a description of the services recommended for treatment/ habilitation, the goals of each type of the element of service, the role of the family in the implementation of the plan, when indicated, an anticipated timetable for the accomplishment of the goals, and the name of the person or persons responsible for the implementation of the plan (Sections 3-209 and 4-309 of the Code [405 ILCS 5/3-209 and 4-309]).

"Licensed long-term care facility." A private home, institution, building, residence, or other place as defined by the Nursing Home Care Act [210 ILCS 45] whether operated for profit or not; a county home for the infirm and chronically ill which provides personal care, sheltered care, or nursing for three or more persons not related to the applicant or owner by blood or marriage; or an out-of-state facility meeting Illinois standards. Facilities included are those that are licensed by the Department of Public Health for skilled nursing, skilled/pediatric nursing, intermediate care, intermediate care for the developmentally disabled (ICF/DD), intermediate care for the developmentally disabled with 15 beds and under, sheltered care, and facilities for individuals under age 22.

"Linkage." Person to person contact between a recipient being discharged from a State-operated facility and the staff of a community agency/facility which has agreed to provide necessary aftercare services following the recipient's discharge. Linkage may include, but is not limited to, the recipient's pre-discharge visit to the receiving agency/facility; the receiving agency/facility pre-discharge visit with the recipient at a State-operated facility; and/or post discharge initiation of service delivery.

"Mandated follow-up." The statutorily-required monitoring of recipients placed by the Department in licensed long-term care facilities utilizing on-site visits to the facility for the purpose of observing the health, well-being and adjustment of the recipient as well as the appropriateness of the services and the suitability of the facility. This monitoring activity must be provided for twelve months following placement, including weekly visits during the first month, or for longer periods as required (see Section 15 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15]).

"Placement." The act of Departmental staff, based upon the finalization of appropriate plans for discharge, linkage, and aftercare, in securing residential services in a licensed long-term care facility for a recipient discharged from a state-operated facility for whom Sections 15, 15a, 15b, and 16 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15, 15a, 15b and 16] mandates follow-up monitoring services.

"Recipient of services" or "recipient." A person who has received or is receiving treatment or habilitation (Section 1-123 of the Code [405 ILCS 5/1-123]).

"State-operated facility." A mental health and/or developmental center operated by the State of Illinois, under the jurisdiction of the Department, which provides treatment/habilitation services for recipients who are mentally ill, developmentally disabled or those alcohol abusers who are a danger to themselves or others.

"Termination." The formal discontinuance of mandated follow-up monitoring of recipients placed in licensed long-term card facilities and/or the discontinuance of case coordination for recipients who were previously served in state-operated facilities.

59 Ill. Adm. Code 125.20 Recipient Rights

a) The rights of recipients of mental health and developmental disabilities services in the public as well as the private sector are set forth in Sections 2-100 through 2-111 of the Code [405 ILCS 5/2-100 through 2-111].

b) The observation and protection of recipient rights, as specified in the statute, are applicable to all sections of this Part.

c) As a general rule, individuals lose none of their rights, benefits, or privileges because they receive mental health or developmental disabilities services. For example, a recipient does not lose the right to vote, attend religious services or any other rights guaranteed by federal and State constitutions and laws.

d) A summary of rights to which the recipients of services are entitled include the following:

1. Adequate and humane care and services in the least restrictive environment and an individualized services plan.

2. To communicate with other people in private, without obstruction or censorship by the staff at the facility. This right includes mail, telephone calls, and visits. There are limits upon this right, e.g., communication by these means may be reasonably restricted by the facility director, but only to protect the recipient or others from harm, harassment or intimidation. All letters addressed by a recipient to the Governor, members of the General Assembly, Attorney General, judges, state's attorneys, officers of the Department, or licensed attorneys at law must be forwarded at once to the persons to whom they are addressed without examination by the facility authorities. Letters in reply from the officials and attorneys mentioned above must be delivered to the recipient without examination by the facility authorities.

3. To receive, possess, and use personal property unless it is determined that certain items are harmful to the recipient or others. On discharge all lawful property must be returned to the recipient.

4. To use money as a recipient chooses, unless the recipient is under 18 or under a court imposed restriction, including the appointment of a guardian.

5. To deposit money in a bank or place it for safekeeping with the facility. If the facility deposits a recipient's funds, any interest earned will be the recipient's. Neither the facility nor any of its employees may act as payee to receive any payment or assistance directed to a recipient, including Social Security and pension, annuity, or trust fund payments without informed consent of the recipient/guardian.

6. To be paid for work a recipient was asked to perform which benefits the facility; the recipient may be required to do personal housekeeping chores without being paid.

7. To refuse services, including medication. If refused, the recipient will not be given such services except when necessary to prevent serious harm to self or others.

8. To have restraints used only to protect the recipient from physically harming self or others, or as a part of a medical/surgical procedure.

9. Seclusion used only to prevent the recipient from physically harming self or others.

10. A recipient will not receive electro-convulsive therapy (electroshock) without informed consent as provided for in Section 2-110 of the Code [405 ILCS 5/2-110].

11. Any unusual, hazardous, or experimental services require the recipient's written and informed consent.

12. Except in emergencies, medical or dental services will not be provided without informed consent of the recipient/guardian.

13. If recipient rights are restricted, the facility must notify the following (using form MHDD-4, "Notice Regarding Rights of Recipient"):

A) Recipient and the person of the recipient's choice;

B) Parent or guardian, if the recipient is under age 18;

C) Court-appointed guardian for adult recipient;

D) The Guardianship and Advocacy Commission, if so designated (see Section 2-201 of the Code [405 ILCS 5/2-201]).

59 Ill. Adm. Code 125.30 Overview

a) Department facilities are primarily intensive treatment/habilitation resources which provide therapeutic services to recipients unable to adjust to community settings. As recipients respond to the intensive services provided in Department facilities, they are encouraged to attain greater degrees of independence in alternate living situations within the community, either in their homes, or in residential facilities.

b) The optimal transition of recipients from State-operated facilities requires active interaction among public and private sector service providers. The components described in this Part, including the regional discharge/linkage/aftercare (DLA) plan, discharge planning, and interagency agreements, are designed to facilitate such interaction. Full implementation of these components should result in the enhancement of the quality of the service system and provide improved public accountability.

59 Ill. Adm. Code 125.40 Regional Dla Plan

a) Each region shall develop a regional DLA plan which articulates how the region will implement the policies and procedures contained in this Part.

b) The plan must be developed to assure the quality, effectiveness and continued appropriateness of aftercare services for each recipient discharged from state-operated facilities and to provide an audit trail which includes documentation and records to identify and track recipients, to evaluate quality and quantity of services delivered, to monitor fiscally and for compliance with related statutes and regulations as well as compliance with responsibilities and functions outlined in this Part.

c) The content of the plan shall include:

1. Discussion of the regional DLA network, its strengths, deficiencies and direction, and identification of those portions of the network with which there will be written interagency agreements.

2. Designation of DLA staff responsibilities in the regional office, at state-operated facilities and/or community agencies for functions required by this Part.

3. Designation of case coordinator model(s) to be used in the region.

4. Assessment of licensed long-term care facility staff training needs and training plans to address these needs.

5. Procedures for handling mandated follow-up monitoring, transfers and terminations.

6. Interagency agreements.

7. Procedures for reporting, with recipient consent, to the referring agency/facility that a recipient is not referred for aftercare treatment/habilitation services.

8. Process for developing and maintaining required records and reporting.

9. Procedures for the dissemination of regional DLA plan.

10. Time frame for implementation of the DLA plan.

d) The regional DLA plan shall be submitted, within 60 days after the effective date of the adoption of this Part, to the associate directors for the Secretary's approval. The plan must assure regional compliance with this Part. The Plan shall be reviewed annually and significant changes including but not limited to changes in the regional network, dropped or added interagency agreements, case coordinator model changes and available services shall be submitted to the associate directors for the Secretary's approval.

59 Ill. Adm. Code 125.50 Discharge Planning

a) During the earliest treatment/habilitation planning activities within a State-operated facility, active consideration must be given to the current and anticipated needs of the recipient. While formal as well as informal planning is conducted with the recipient, the individualized services plan is recorded, as it evolves, in the recipient's record consistent with professional judgment and the provisions set forth in the Code, and Departmental and facility policy. Establishing and maintaining the recipient's record is first and foremost a necessary practice which contributes to planning for and providing the most appropriate services. In addition, recordkeeping establishes the necessary documentation which provides an audit trail which is used for a variety of accountability purposes such as securing facility certification and accreditation, responding to judicial inquiries and the assurance of general public accountability.

b) As the facility related treatment and habilitation goals contained in the individualized services plan come closer to realization, greater attention must be paid to numerous DLA related considerations. Prior to making the decision to discharge and refer a recipient, the recipient's readiness for that move must be assessed as well as the recipient's desire and agreement to participate. In this assessment, consideration must be given, not only to the desires of the recipient and the recommendations of State-operated facility treatment/habilitation staff, but also the desires and recommendations of the recipient's guardian, family, follow-up monitoring staff, community agency staff previously involved with the recipient or likely to provide services after discharge, and staff of other involved State agencies (such as Department of Public Aid, Department of Children and Family Services, State Board of Education and the Department of Corrections).

Agency note: Recipients who are drug abusers shall be referred to the state Office of Planning and Program Development, Dangerous Drugs Commission. The Commission shall participate in DLA planning and shall be responsible for assuring the treatment/habilitation services, placement and/or follow-up are provided to meet the individual recipient's aftercare needs.

c) The following general areas must be addressed for all recipients regardless of the aftercare setting to which the recipients may be discharged:

1. The need of the recipient for various services as detailed in the individualized services plan.

2. The readiness and desires of the recipient or the recipient's guardian.

3. The recipient's area of origin and/or location of social supports.

4. The effectiveness of any previous individualized services plans or other services the recipient may have received in the community prior to the last admission to the State-operated facility.

5. A general assessment of the recipient's intellectual and emotional state including the recipient's behavior.

6. Medication needs of the recipient.

7. Special procedures which must be followed related to the legal status of the recipient due to the relationship of the recipient to the criminal justice system. This includes recipients who are legally classified as:

A) Not guilty by reason of insanity (NGRI);

B) Guilty but mentally ill;

C) Unfit to stand trial, to plead or be sentenced;

D) Hold order from the court.

AGENCY NOTE: These recipients can only be released pursuant to the provisions of the Unified Code of Corrections [730 ILCS 5]. Further clarification on this subject is found in the publication entitled "Responsibilities of DMHDD for Persons Admitted as Unfit to Stand Trial, To Plead or Be Sentenced in Accordance With Public Act 81-1217", December, 1981.

8. The availability of financial resources for recipients discharged from State-operated facilities including:

A) Consideration of the recipient's ability to be self-supporting;

B) Consideration of other sources of personal or family income;

C) Assisting the recipient who does not return to independent or semi-independent living in accessing necessary financial support, e.g., Supplemental Security Income (SSI), Department of Public Aid, and/or other applicable funding;

D) Reasonable assistance in accessing financial support for recipients returning to independent or semi-independent living.

9. After considering the factors listed above, a decision may be made to discharge and refer the recipient to available and appropriate aftercare services.

10. Before the actual discharge is completed the applicable items listed below on the discharge planning check list need to be completed:

A) Secure the recipient's informed consent on form DMHDD-146, "Authorization for Release of Information", in order to communicate and share records with individuals and organizations regarding the recipient.

B) Identify the location, when possible, of the aftercare living situation. For a recipient being placed in long-term care, the licensed facility shall be identified.

C) Facilitate appropriate contact and linkage with family and/or other individuals who can provide extended social support to the recipient (see Section 125.50(b)).

D) Assist the recipient in accessing necessary financial resources. Special emphasis must be given to this activity when the recipient is not returning to independent or semi-independent living. In these cases, applicable funding approval, such as the SSI approval letter or Department of Public Aid point count, shall be forwarded to the receiving facility.

E) Refer the recipient to available support services including social, psychological, vocational and transportation, and assist in the actual linkage contact between the aftercare service provider(s) and the recipient.

F) Notify the recipient, guardian, attorney or person who executed the application for admission of the intent to discharge. Special attention as outlined in Section 125.50(c)(7) must be given to the discharge notification process for recipients who are associated with the criminal justice system.

G) Notice of discharge has been given and any and all written objections relating to it have been heard and an administrative decision has been rendered.

H) Complete part one of form DMHDD-20, "Discharge Summary", by the date of discharge and part two of DMHDD-20, within 48 hours following discharge. For recipients placed in a licensed long-term care facility, the DMHDD-20 must be transmitted at the time of placement.

I) Forward as necessary, any relevant medical or dental reports to the appropriate aftercare agency/facility.

J) Assure the provision of an adequate supply of medication sufficient to last until the first scheduled aftercare visit as contained in the recipient's DLA plan.

K) Forward a copy of the guardianship papers to the aftercare service provider(s) if the recipient is legally incompetent.

L) Assist the recipient in securing personal clothing, property and funds.

M) Complete parts one and two of form DMHDD-189, "Recipient Transfer Summary", for all recipients being placed in a long-term care facility and transmit both parts of the form to the facility at the time of placement.

N) Notify designated mandated follow-up staff of the placement of the recipient in a licensed long-term care facility.

O) Transmit to the ICF/DD facility a copy of a psychological assessment completed within the past 36 months for recipients who are being placed there.

P) Provide placement notification, when such agencies are the funding agencies, to the Department of Public Aid and the Social Security Administration, stating the recipient's name, address of the facility and date of placement.

59 Ill. Adm. Code 125.60 Discharge Notification and Objection Process

a) Written notice of discharge shall be given to the recipient, if 12 years of age or older; to the attorney of record and guardian, if any; and to the person who executed the application for admission. This notice shall include the reason for the discharge and a statement of the right object (Section 3-903 of the Code).

b) Whenever possible, notice of the discharge shall be given at least seven days prior to the intended discharge date from a mental health facility and 14 days prior to discharge from a developmental disabilities facility (Sections 3-903 and 4-704 of the Code).

c) The recipient, if 12 years of age or older, may object to discharge, or the attorney or guardian of a recipient or the person who executed the application may object on behalf of a recipient. Prior to discharge, a written objection shall be submitted to the director of the facility in which the recipient is located. Upon receipt of an objection, the facility director shall promptly schedule a hearing, with the utilization review committee, to be held at the facility within seven days (Sections 3-207, 3-903, 4-209 and 4-704 of the Code).

d) No discharge shall proceed pending a hearing on an objection, unless the person objecting to the discharge consents to discharge pending the outcome of the hearing (Sections 3-903 and 4-704 of the Code).

e) At the hearing, the Department shall have the burden of proving that the recipient meets the standard for discharge under the Code and under Section 15 of Mental Health and Developmental Disabilities Administrative Act (Sections 3-903 and 4-704 of the Code).

f) Within three days after the conclusion of the hearing, the utilization review committee shall submit its written recommendations to the facility director. A copy of the recommendations shall be given to the recipient and the objector. (Sections 3-903 and 4-704 of the Code)

g) Within seven days after receipt of the recommendations, the facility director shall provide written notice to the recipient and objector of either acceptance or rejection of the recommendations and reasons therefor.

h) If the facility director rejects the recommendations, or if the recipient or objector requests a review of the facility director's decision, the facility director shall promptly forward a copy of the decision, the recommendations, and the record of the hearing to the Secretary of the Department for final review. The decision of the facility director or the decision of the Secretary of the Department, if his review was requested, shall be considered a final administrative decision.

i) Any person affected by a final administrative decision of the Department may have such decisions reviewed only under and in accordance with the Administrative Review Law [735 ILCS 5/Art. III]. The Administrative Review Law, and the rules adopted pursuant thereto, apply to and govern all proceedings for the judicial review of final administrative decisions of the Department (Section 6-101 of the Code).

59 Ill. Adm. Code 125.70 Interagency Agreements

a) Recipients shall be referred from state-operated facilities to supportive community programs in ways which insure the continuity of needed services. Interagency coordination then is an essential element for improving the capacity of the services system to provide necessary support. Written interagency agreements facilitate the establishment, as well as the understanding and observance of the agreements by various personnel associated with the organizations.

b) Each Department region and/or State-operated facility must maintain current written linkage agreements as part of its DLA plan with appropriate community agencies involved in the network of services in that region. The following elements are suggested for consideration in the development of these interagency agreements.

1. Clear statement of the purpose of the agreement between parties, identifying specific programs to be effected, with delineation of goals and measurable objectives for the terms of the agreement.

2. Definitions of any terms that could be ambiguous between the parties.

3. Specific actions, roles and responsibilities of each party to the agreement as well as mutual responsibilities.

4. Designation of staff position(s) within each agency responsible for:

A) Implementing the agreement as specified;

B) Monitoring the implementation;

C) Negotiating change when necessary to update agreement;

D) Resolving disagreements.

5. General administrative procedures for parties affected by the agreement (i.e., specified time period for agreement, mechanism for updating/revising, scheduling meetings, confidentiality safequards, referral mechanisms, information sharing, and other assurances).

6. Evaluation design specified and agreed upon by all parties to be used in monitoring implementation of agreement; identification of person(s) responsible for evaluating and sanctions agreed on to assure its implementation.

c) It is important that each region and/or facility maintain these agreements and provide adequate staff to implement the provisions. This may involve meeting regularly with staff from community agencies/facilities as well as including community agency/facility staff on state-operated treatment/habilitation teams. Alcoholism agencies must be in conformance with 59 Ill. Adm. Code 107.50.

d) Agencies which are performing mandated follow-up services for the Department shall enter into an agreement which, in essence, establishes the principle that mandated follow-up services are a statutory responsibility of the Department. While performance of the function may be delegated to a community agency, responsibility for the function cannot be delegated. Therefore, the community agency acts as an agent of the Department in complying with this legal mandate.

e) Additional policies and procedures required of community agencies receiving financial support from the Department are contained in Grants (59 Ill. Adm. Code 103) and in purchase of care program guidelines. Designated regional staff are assigned to work with each community agency to facilitate compliance with the requirements.

59 Ill. Adm. Code 125.80 Recipient Financial Support

a) During DLA planning, financial support for the recipient's continued treatment/habilitation services and other needs must be considered. Designated staff will assist the recipient, family or guardian in understanding their respective liabilities for treatment/habilitation and in accessing available financial resources. The required authorizations to investigate or access assets, income or benefits must be secured.

b) Sources to contact for information are the recipient, family or guardian at admission, during treatment/habilitation or prior to discharge. Sources which may be considered include insurance carriers, funding agencies, e.g., Social Security offices, federal fiscal intermediaries (Blue Cross/Blue Shield or E.D.S. Federal Corporation), and the Department of Public Aid (the single State agency for Medicaid and administering agency for public assistance and the State supplement), and township assistance agencies.

c) Resources which may be available for support based on recipient eligibility include:

1. Private funding

A) Recipient's personal funds, e.g., assets which are negotiable or can be liquidated;

B) Income, from employment, from assets, estates, trusts, and facility trust funds;

C) Family funds, e.g., voluntary or due to legal liability.

2. Third party payments

A) Private insurance (disability and/or medical) carried by the recipient or family;

B) Health maintenance organization plans (HMOs);

C) Black lung disease benefits (30 U.S.C.A. 924 (1981));

D) Civilian Health and Medical Program of the Uniformed Services (CHAMPUS/CHAMPVA) (38 U.S.C.A. 601 (1981));

E) Medicare, which is short-term hospital and medical insurance (42 U.S.C.A. 1395b-1 (1981));

F) Medicaid, which is public medical assistance for the aged, blind and disabled (42 U.S.C.A. 1396a (1981)).

3. Federal/state/local benefits/other

A) Social Security Retirement and Survivors Benefits (SSDI) (42 U.S.C.A. 401 (1981)) which is based on wage earners and employers contributions;

B) Supplemental Security Income (SSI) (42 U.S.C.A. 1381 (1981)), a federal income maintenance program for aged, blind and disabled, which also requires documentation to establish disability for the blind and disabled by the Department's Bureau of Disability Adjudication Services;

C) Railroad Retirement benefits (45 U.S.C.A. 231 (1981)) and Veterans' Administration benefits (38 U.S.C.A. 521, 541, and 542 (1981)).

D) General/township assistance, state supplemental payments and Bureau of Employment Security Benefits, Department of Labor.

E) Private industry professional groups, labor unions and other organizations.

4. Local school district services or funding

When a recipient aged 3 to 21 years is handicapped as defined in Section 14-1.02 of the School Code [105 ILCS 5/14-1.02] and has not been graduated from high school, the recipient is probably eligible to receive special education services from a local school district. The parent or guardian should be assisted in obtaining these services or funding.

5. Department sources

There is a variety of purchase of care programs for the mentally ill, developmentally disabled or alcohol abusers for which individuals may qualify.

59 Ill. Adm. Code 125.90 Competency

a) A recipient age 18 or over is presumed legally competent. A recipient is considered incompetent upon the filing of a petition with the court where the court adjudges a recipient to be a disabled person. At the time of the hearing a guardian may be appointed. (See Sections 11a-2 and 11a-3 of the Probate Act of 1975 [755 ILCS 5/11a-2 and 11a-3])

b) Guardianship is ordered only to the extent necessitated by the recipient's actual mental, physical and adaptive limitations.

c) A guardian may be appointed for a recipient, if, because of disability, there is a lack of sufficient understanding or capacity to make or communicate responsible decisions concerning personal care. A guardian may be appointed for the estate of a disabled recipient, if, because of disability, the recipient is unable to manage an estate or financial affairs.

d) The appointment of a limited guardian does not constitute a finding of legal incompetence. The appointment of a plenary guardian constitutes a finding of legal incompetence (see Section 11a-14 of the Probate Act of 1975 [755 ILCS 5/11a-14]).

e) The Code does not require the appointment of a guardian prior to discharge.

59 Ill. Adm. Code 125.100 Overview

a) Public accountability of the Department's efforts to assist recipients of mental health, developmental disability, or alcoholism services in accessing appropriate levels of aftercare according to their needs is achieved by documenting the process for discharge planning, linkage and aftercare services. Depending on the types of community agencies/facilities involved, this documentation is accomplished at the present time through an information system which is either automated or manual. The uniform method of reporting to be used by all receiving Department organizational units and grant agencies is the Department's extramural system and its subsystem, the aftercare linkage system (ACL). The description of this system and reporting instructions are found in the Department's extramural systems manual, revised July 1, 1980. This current computer system does not allow for recording of the referral to more than one provider. Therefore, it is necessary to indicate the primary agency/facility to whom the recipient is being referred for aftercare treatment/habilitation services even though the discharge plan calls for multiple service providers. The primary agency/facility for a recipient being placed in a licensed long-term care facility must be that designated agency/facility or Department organizational unit which has responsibility for the mandated follow-up monitoring services.

AGENCY NOTE: For the purpose of documenting the linkage and mandated follow-up monitoring services provided to recipients being placed in a licensed long-term care facility, the receiving agency to whom the recipient is referred shall be either the designated Department organizational unit or the designated grant agency. The linkage of the recipient to the licensed long-term care facility is documented through noting the home code of the facility in which the recipient is placed, using form DMHDD-1001, "Inpatient Statistical Reporting Form".

b) For referral to non-grant agencies or non-state-operated facilities the method of reporting is similar but the documentation is effected through other reporting mechanisms set forth in this Part.

c) Accurate recording of the discharge/linkage/aftercare status for each person discharged from Department facilities is fundamental to the effective management of the DLA system. The process explained in this Part is absolutely necessary to document the successful linkage and provision of aftercare services to the discharged recipient to be documented within the Department.

d) When the discharge plan has been completed and the recipient is ready for discharge, documentation is necessary to indicate the recipient's agreed upon referral according to the following categories:

1. Referred for aftercare treatment/habilitation services

A) To a Department grant agency;

B) To a Department organizational unit;

C) To a Department purchase care facility;

D) To a non-Department funded agency;

E) To a licensed, registered, or certified private practitioner;

F) To a Veterans Administration (VA) facility;

G) Remanded by the court to another setting; or

H) Transferred to another state.

2. Not referred for aftercare treatment/habilitation services

A) Recipient refused aftercare services;

B) Aftercare, provided within the formal human service system structure, is not required; or

C) Left against staff advice.

59 Ill. Adm. Code 125.110 Reporting Responsibilities and Methods

The duties and responsibilities of all Department DLA staff and the responsibilities agreed to by the receiving agency/facility shall be broadly outlined within the regional DLA plan. Active participation includes, but is not limited to representation on a discharge planning team and participation in the development of the individualized services plan, by communication and consultation with designated follow-up staff, of the community agency/facility in discharge planning is highly desirable as linkage can be more readily achieved and the recipient may be more willing to follow through on the discharge plan. Outlined below are those responsibilities which must be incorporated into and provided for in the regional DLA plan.

a) Designated DLA staff responsibilities for referral to agencies reporting through the extramural system consist of ensuring the accomplishment of the following functions:

1. Securing recipient's agreement for linkage to an agency for aftercare treatment/habilitation services and consent for release of information confirming that the recipient has received initial service in accordance with the discharge plan (form DMHDD-146, "Authorization for Release of Information").

2. Communication with the proposed receiving agency to achieve the following:

A) Obtaining the agency's identification (ID) number for the recipient (current number if an open case); or the ID number for a recipient whose case has been closed and is now being reopened; or the new ID number assigned to a recipient being opened to the agency for the first time;

B) Active participation by the receiving agency in the development of the discharge plan;

C) Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient is to see) to receive the initial service indicated in the discharge plan;

D) Prompt completion and dispatch of the completed parts one and two of form DMHDD-20, "Discharge Summary", within 48 hours after discharge, excluding Saturdays, Sundays and holidays.

3. Communication with proposed receiving licensed long-term care facility for those recipients being placed in such settings to achieve the following:

A) Active participation in the development of the discharge plan;

B) Confirmation of the date of placement;

C) Copies of the completed form DMHDD-20, parts one and two, "Discharge Summary", and form DMHDD-189, parts one and two, "Recipient Transfer Summary", must accompany the recipient at the time of placement.

4. Retention of all Department forms used in the discharge process in the recipient's State-operated facility medical record.

b) Designated DLA staff responsibilities for referral to agencies/facilities not reporting through the system consist of ensuring the accomplishment of the following functions:

1. Recipient's agreement for linkage to an agency/facility for aftercare treatment/habilitation services and consent for release of information confirming that recipient has received initial service in accordance with the discharge plan (form DMHDD-146, "Authorization for Release of Information").

2. Communication with proposed receiving agency/facility to achieve the following:

A) Active participation by the receiving agency/facility in the development of the discharge plan;

B) Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient is to see) to receive the initial service indicated in the discharge plan;

C) Prompt receipt (within 48 hours after discharge, excluding Saturdays, Sundays and holidays) of copies of the completed form DMHDD-20, "Discharge Summary", parts one and two;

D) Confirmation of the initial service provided to the recipient after discharge.

3. Notification of the Department's Bureau of Information Services of recipient information, including confirmation of receipt of initial service after discharge, on the form DMHDD-1001 series, "Inpatient Statistical Reporting Form".

4. Retention of all Department forms used in the discharge process in the recipient's State-operated facility medical record.

c) Responsibilities of receiving agency reporting through the extramural system ensuring the accomplishment of the following functions:

1. Recipient's authorization for release of information to the Department discharging facility for the confirmation of linkage and initial service delivery after discharge.

2. Communication with the discharging facility to achieve the following:

A) Providing the agency's ID number for the recipient (current number if an open case); or the ID number for a recipient whose case had been closed and is now being reopened; or the new ID number assigned to a recipient being opened to the agency for the first time;

B) Active participation in the development of the discharge plan;

C) Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient is to see) to receive the initial service indicated in the discharge plan.

3. Confirmation and accounting for services provided to the recipient through the extramural system and the aftercare linkage system.

d) Responsibilities of receiving agency/facility not reporting through the extramural system consist of ensuring communication with the discharging facility to achieve the following:

1. Active participation in the development of the discharge plan.

2. Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient is to see) to receive the initial service indicated in the aftercare services plan.

3. Confirmation of the initial service provided to the recipient after discharge.

59 Ill. Adm. Code 125.120 Overview

This Subpart describes the process by which the Department and/or designated staff assures the quality, the effectiveness and the continued appropriateness of aftercare services for each DLA recipient needing case coordination and/or mandated follow-up monitoring services which are intended to assure the following:

a) The recipient's rights and desires have been taken into consideration through mutual planning, if feasible.

b) The recipient's family has been included in the placement process, whenever possible, consistent with confidentiality requirements.

c) The receiving agency/facility is best able to meet the recipient's needs.

1. An individualized services plan has been completed by the discharging facility and accepted by the receiving agency/facility.

2. Firm recipient referral has been effected and the recipient is being served by the receiving agency/facility.

3. The joint planning process for the recipient's progress provides for the continuity of services within the services network.

d) On an ongoing basis, a recipient is not being abused, neglected, or improperly cared for, and health needs are being met.

e) The designated staff will offer appropriate treatment/habilitation alternatives as clinically indicated and assists, as appropriate, in transfers.

59 Ill. Adm. Code 125.130 Case Coordination

a) Case coordination is a mechanism for assuring and coordinating services to meet the needs of those recipients who require this service. It provides the necessary advocacy function to facilitate the linkage of a recipient who has identified service needs to the available resources. The case coordinator principally focuses on the service delivery system from the vantage point of the individual recipient in need of the service, and engages in resource identification and linkage.

b) Case coordination attends to the practical level of synchronizing the efforts of multiple service providers and other supportive resources which enable the recipient to live successfully in a community setting. However, the case coordination function does not displace the responsibility of other service providers to work directly with the recipient or with the family, community supportive resources or other service organizations as provided for in the individualized services plan. Rather, the case coordinating function complements and integrates the usual services for those recipients whose need is so substantial so as to require an extraordinary level of service attention. Case coordinators rely, in large part, on:

1. Working knowledge of the nature and consequences of the recipient's disability;

2. Functional knowledge of the service delivery system, recipient eligibility requirements and procedures;

3. A working understanding of potential recipient resources, particularly those available through federal, State and local governmental agencies; and

4. The ability to work cooperatively with the many individuals and organizations which can provide services and assistance to the recipient.

c) Typical settings – Case coordination shall be provided through various organizational entities:

1. By the Department;

2. Through an entity which also provides direct recipient services or other indirect services; or

3. Through a free-standing entity whose sole function is the provision of case coordination services.

d) Typical activities – Activities a case coordinator engages in may include:

1. Assessment of service need: Participates with direct service staff in assessing an individual's needs and readiness to move into alternate services or settings, utilizing clinical evaluation of intellectual, emotional and functioning levels. Where appropriate, standardized assessment instruments, such as the Illinois Client Information System (ICIS) for developmentally disabled recipients, will be used in conjunction with the professional evaluation of need.

2. Development of recipient individualized services plan: Participates with responsible program staff in developing a plan for the most effective and appropriate continuum of generic and specialized services.

3. Arrangement for service delivery: Assists recipient in identifying appropriate providers of care, screening and assistance in the eligibility process for Department or Department-supported programs as well as other public or private programs, and facilitating the linkage of recipients to service provider(s), and case coordination in a new location, if appropriate.

4. Coordination and advocacy with service providers: Is responsible for enabling continuity, accessibility and the most effective delivery of services as prescribed in the individualized services plan including the facilitation of coordination activities among multiple providers.

5. Follow-up: Conducts scheduled activities to monitor and evaluate the recipient's progress toward established service goals, and the need for continuing services. While follow-up activities focus on recipient status, they also may provide commentary on service irregularities or deficiencies and provide recommendations on the status and quality of care provided by the service delivery system.

59 Ill. Adm. Code 125.140 Mandated Follow-Up Monitoring Services

a) Provisions contained within Sections 15 through 16 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15 through 16] mandate specific types of follow-up services for recipients who are being discharged from Department State-operated facilities and placed in licensed long-term care facilities, as defined by Section 1-113 of the Nursing Home Care Act [210 ILCS 45/1-113].

b) Before discharge from a state-operated facility can be considered, a clinical and professional decision must have been made that a recipient will derive benefits from a proposed placement, is legally competent (or is in the process of having legal competency restored), has a guardian if declared legally incompetent (or is in the process of having a guardian appointed), and requires the medical and personal care and/or supervision as described in the Nursing Home Care Act. The lack of a guardian, however, shall not inhibit discharge planning and placement once it has been deemed that continuing State-operated treatment/habilitation services will no longer be of benefit to a recipient. Department staff will do all that is possible to obtain suitable guardians; however, if these efforts prove to be unsuccessful the regional office of the Guardianship and Advocacy Commission shall be contacted and all appropriate information, such as but nor limited to, the recipient, the recipient's condition, the inability to locate a person to serve as guardian and the need for guardianship, forwarded.

c) Mandated follow-up services may be delegated by the Department to community agencies. This delegation shall be based on but not limited to caseload needs, availability of staff and available resources. This arrangement, however, will require a special contract between the Department and the agency. This contract establishes that the community agency acts as an agency of the Department and is bound by this Part. In addition, employees of any community agency that has a long-term care monitoring contract with the Department, is subject to the same conflict of interest rule as Department employees (59 Ill. Adm. Code 101.80).

d) As required by the Mental Health and Developmental Disabilities Confidentiality Act the recipient's confidentiality shall be protected.

59 Ill. Adm. Code 125.150 Pre-Placement Guidelines

a) In order to fulfill statutory directive as well as providing due process for persons placed in licensed long-term care facilities, designated DLA staff shall assure that requirements of the Mental Health and Developmental Disabilities Code summarized in Section 125.40 and of the Nursing Home Care Act are followed.

b) Consideration shall also be given to the interests and the needs of the recipient and the capacity of the facility to address those needs.

1. Out-of-region placement of recipients is permissible and requires written approval between the designated regional staff of the regions involved. Approval will be based on criteria in Section 125.160(f)(1).

2. The Department shall not place discharged recipients in facilities located outside of the State of Illinois unless appropriate facilities are not available within the State, or if placement in a contiguous state results in locating a recipient in a facility closer to home or family.

3. When it becomes necessary for arrangements to be made for placement in a state other than Illinois, the designated DLA staff shall notify the appropriate regional administrator who approves of the transfer based on criteria in Section 125.160(f)(1), and who shall notify the Department's Interstate Services Branch.

4. The Department is responsible for providing follow-up services to all recipients placed residentially in out-of-state facilities and shall indicate the regional DLA plan how follow-up services will be provided. A recipient cannot be placed in an out-of-state facility if it is not licensed by the state in which the facility is located. Subsequent to placement, if an appropriate facility within the State becomes available at a distance equal to or closer to the recipient's home or family, the recipient shall be returned and placed at this facility.

AGENCY NOTE: Three months after an out-of-state placement has been made, the Department must send copies of visitation reports to the recipient's parent(s), guardian or nearest responsible relative (see Section 15.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15.1]).

59 Ill. Adm. Code 125.160 Follow-Up Monitoring Guidelines

Designated mandated follow-up staff shall assure compliance with the provisions of the Mental Health and Developmental Disabilities Administrative Act and compliance with the following Departmental policies.

a) Recipient monitoring

1. Provide or contract for the provision of individual monthly monitoring of recipients placed in a licensed long-term care facility for at least 12 months, including visits on a weekly basis during the first month.

2. Interview the recipient during the course of follow-up visits and discuss program involvement and/or other needs with staff in the licensed long-term care facility.

3. Observe, review and document the following:

A) The recipient's comments and concerns;

B) The recipient's overall adjustment to the facility; and

C) The adequacy of the recipient's current individualized services plan as maintained by the facility.

4. The adequacy of the programs and services available in the facility and in the community for meeting the needs of the recipient which may include, but are not limited to:

A) Activities;

B) Social (re)habilitation;

C) Restoration nursing;

D) Diagnostic testing; and

E) Psychological and social services.

5. Sufficiency of the nursing and medical services to meet the physical health needs of the recipient.

AGENCY NOTE: For the conditionally discharged recipient, designated staff must visit or consult with the recipient and the family on the condition of the recipient and advise the family of care that will be most favorable for the recipient. This visitation and contact requirement shall remain in effect while the recipient is on conditional discharge and shall terminate when such status is terminated.

b) Reporting and records

1. Reports of deaths, accidents and unusual occurrences

A) All deaths of recipients, or accidents and unusual occurrences, such as reports of abuse, neglect and improper care, involving a recipient, shall be reported by the facility by telephone within twelve hours to the designated mandated follow-up staff, guardians (including the Office of the State Guardian, where appointed) and next of kin and confirmed in writing no later than the next working day with a complete statement of circumstances. The facility must promptly notify the coroner of all deaths pursuant to Section 3-3013 of the Counties Code [55 ILCS 5/3-3013].

B) Designated staff shall close cases in which death occurs in the Department's extramural reporting system by filing form DMHDD-1006, "Case Information".

2. Monthly facility report – Designated staff shall report on the results of their onsite visits to each facility on the monthly evaluation report for long-term care facilities. Copies of this report shall be submitted to the licensed long-term care facility and to the designated regional staff, with a copy being retained by the designated mandated follow-up staff.

3. Semiannual facility report

A) The regional administrator will submit to the associate directors, semiannually, a summary of the monthly facility reports for each facility within the region.

B) These reports may be used for the evaluation and continued approval or denial of placements in licensed long-term care facilities.

4. Monthly and annual information report

Monthly and annually a report shall be produced for Central Office and regional use by the Department's Bureau of Information Services including the following information by disability:

A) The total number of facilities serving the Department's mandated follow-up recipients;

B) The total number of Department recipients placed during the current month and year-to-date;

C) The total number of Department mandated follow-up recipients in each facility;

D) The total number of Department mandated follow-up recipients being monitored on a weekly and monthly basis;

E) The number of mandated follow-up recipients readmitted to state-operated facilities from licensed long-term facilities for the current month and year-to-date;

F) The number of mandated follow-up recipients transferred to another licensed long-term care facility, to a State-operated facility, to independent living for the current month and year-to-date;

G) The number of deaths of Department mandated follow-up recipients for the current month and year-to-date; and

H) The total number of drug abusers for the current month and year-to-date.

c) Program development and monitoring

1. When necessary, designated mandated follow-up staff may provide training as outlined in Section 15 of the Mental Health and Developmental Disabilities Administrative Act as outlined to assist facilities in meeting the unique needs of persons previously served by the Department.

2. Designated mandated follow-up staff will assist a facility in arranging for resources to program for these populations, e.g., activity programs, treatment/habilitation programs and other specialized programs. These program development functions may include:

A) Providing time limited direct services in an effort to train facility staff;

B) Providing workshops on special programs or procedures;

C) Consulting with program staff or licensed long-term care facilities regarding the development of individualized services plans;

D) Developing methods of implementation; and

E) Evaluating programs available in the licensed long-term care facility.

3. At least annually, the Department must review facility training records prescribed by Department of Public Health standards for licensure of long-term care facilities (Minimum Standards for the Licensure of Long-Term Care Facilities for the Developmentally Disabled (77 Ill. Adm. Code 350); Minimum Standards for the Licensure of Long-Term Care Facilities – Persons Under Twenty-Two (22) Years of Age (Divisions 1 through 73); Minimum Standards for the Licensure of Long-Term Care Facilities – Sheltered Care Facilities (77 Ill. Adm. Code 330); and Minimum Standards for the Licensure of Long-Term Care Facilities – Skilled Nursing Facilities and Intermediate Care Facilities (77 Ill. Adm. Code 300)) and make recommendations regarding future training needs. Specific recommendations regarding orientation and inservice staff training must be included in the semiannual facility report. This report must also contain a judgment as to the sufficiency and capability of the staff in the facility.

4. Program development and monitoring activities must be documented and maintained in a file readily available to the appropriate region office.

AGENCY NOTE: Designated mandated follow-up staff shall not provide consulting services for the purpose of meeting Department of Public Health licensure requirements, nor can fees be charged for the program development services provided by the Department or its contracted agents performing follow-up monitoring services.

d) Termination from mandated follow-up services

1. Termination of follow-up monitoring services occurs after the 12-month period, except in cases of death, discharge to other than a licensed long-term care facility, or discharged for leaving against staff advice. Termination which is an individualized programmatic and clinical decision is based on the following criteria:

A) A clinical determination has been made that mandated follow-up services to the recipient are no longer necessary to maintain adjustment in the licensed long-term care facility.

B) Appropriate and necessary linkage to community resources have been established which will enable the recipient to function independently.

C) The developmentally disabled recipient is receiving specialized programmatic services to meet the objectives for further personal development as contained in the individualized services plan, and that procedural continuity is established which is essential to maintain adaptive levels and/or to prevent behavioral/developmental regression.

D) The recipient has substantially achieved the objectives outlined in the individualized services plan.

E) The facility has demonstrated its ability to provide the necessary continuing support and appropriate programming to the recipient.

AGENCY NOTE: When the decision to terminate has been made, designated staff shall check the follow-up notes and recipient records to insure that the recipient's recorded progress clinically supports the decision to terminate. In cases of developmentally disabled individuals on conditional discharge, who are being considered for termination from mandated follow-up services, a copy of the community placement termination summary will be forwarded to the regional administrator or designee as the recommendation for termination. The regional administrator or designee must give approval before the termination is effected.

2. The termination of recipients from mandated follow-up services, however, does not necessarily mean that contact with these persons shall cease. Statutorily required follow-up monitoring services and reporting shall cease, services including but not limited to those covered in the individualized services plan may continue to be provided. Supportive services and/or case coordination, if appropriate, should be provided based on the recipient's on-going needs.

e) Continuing mandated follow-up status

Monthly comments will be forwarded to the designated Department region staff on each community placement recipient who exceeds one year in continuing mandated follow-up status. Comments will relate to specifics pertaining to inadequate adjustment of the recipient or any other cause considered significant enough to maintain the case in mandated status.

f) Transfers of recipients

1. Transfers, when necessary, from one long-term care facility to another may be to assure the recipient's health and well being. Primary attention shall be given to the needs and choices of the individual recipient (a recipient cannot be moved against the recipient's will except in an emergency). A transfer is indicated if the facility cannot meet the current needs of the recipient; or the recipient has been neglected, abused or improperly cared for; or if the facility is not in substantial compliance with previously cited licensure standards or has not developed an acceptable plan of correction as determined by the Illinois Department of Public Health.

2. If a transfer is indicated, designated staff shall cooperate in the transfer of mandated follow-up recipients from one licensed long-term care facility to another. The regional DLA plan shall specify how transfer activities shall be coordinated with involved State agencies.

3. In times of disaster or emergency, designated staff may need to be involved in the transfer of recipients who have been terminated from mandated follow-up monitoring services.

AGENCY NOTE: Designated staff must document all transfer activities and maintain the documentation in the recipient's record.

4. Routine transfers

A) All recipients shall be transferred insofar as possible, in or near the communities in which the recipients reside or in which the recipients' families or significant others, such as a guardian or a friend, reside. The same considerations and procedures followed for the initial planning for discharge/linkage/aftercare shall apply (see Section 125.40).

B) Transfers may be initiated at the request of the recipient or legally responsible party. Transfers may also be initiated by the long-term care facility's administrator. Under such situations, designated staff will work with the Department of Public Aid and other involved agencies.

5. Inter-region transfers

Recipients may be moved between regions provided there is a prior agreement with both regional administrators or their designated agents involved in the transfer.

6. Emergency transfers

A) The Department of Public Health under Sections 3-401 through 3-423 of the Nursing Home Care Act [210 ILCS 45/3-401 through 3-423] and the Department under Section 15 of the Mental Health and Developmental Disabilities Administrative Act are empowered to take specific action to transfer recipients who are not receiving appropriate services and/or when conditions exist in a facility which imperil the health or pose a serious and imminent threat to the life or safety of those recipients.

B) Both Departments must make all reasonable efforts to eliminate any threats to the safety and well-being of any recipient, through consultation with the facility, the attending physician, and the recipient, spouse, parents, responsible relative or guardian (see Section 15 of the Mental Health and Developmental Disabilities Administrative Act).

C) The Department of Public Health is given broad statutory authority and primary responsibility to transfer any individual who is not receiving appropriate services in licensed long-term care facilities. The Department's legal authority deals specifically with individual recipients who have been placed by the Department in these facilities.

D) The Department must work in close cooperation with the Department of Public Health to effect the transfer of recipients whose life or safety is in imminent danger. However, the Department may, in the proper exercise of its statutory mandate, initiate action to provide for the health and welfare of mandated follow-up recipients residing in a facility.

59 Ill. Adm. Code 125.170 Staff Action in Emerging or Extraordinary Circumstances

a) Designated mandated follow-up staff shall personally observe the recipient, review individual progress and adjustment within the placement setting, and review the following considerations:

1. The recipient's rights and desires have been taken into consideration;

2. The receiving agency/facility continues to meet recipient needs;

3. The individualized services plan is being constantly updated by staff of the receiving agency;

4. Joint planning for the recipient's progress continues; and

5. On an on-going basis, the recipient has not been abused, neglected or improperly cared for.

b) As mandated follow-up or other visits are made, designated staff shall review for:

1. Prolonged understaffing;

2. Suspected abuse/neglect;

3. Inappropriate level of care;

4. Unattended medical needs;

5. Unexplained weight loss or gain;

6. Filth, dirt and odors; and

7. Inquiries from family, media or elected officials.

c) If these or other untoward or extraordinary situations such as room temperature extremes, contagious diseases and natural catastrophes are noted, the following steps shall be undertaken and fully documented:

1. Consultation with the licensed long-term care facility administrator and/or appropriate staff shall occur to discuss any deficient conditions. This consultation and any actions agreed to shall be fully documented. If resolution is achieved, further steps need not be taken. Regional offices of the Department of Public Health shall be kept informed.

2. If resolution is not reached, immediate verbal reports to the regional and central offices of the Department of Public Health, as well as to the regional administrator and appropriate associate directors of the Department must be made, followed by written confirmation within 24 hours.

3. Initiate regional interagency review with involved state agencies and formulate necessary action to resolve the situation. The right to a neutral hearing as provided for in Sections 3-703 through 3-802 of the Nursing Home Care Act [210 ILCS 45/3-703 through 3-802] and Sections 2-704, 3-207, 3-903, 4-209 and 4-709 of the Code must, however, be observed.

4. If a regional solution is not reached, the appropriate associate directors are notified and requested to facilitate resolution with the appropriate state agencies.

5. If resolution is not reached, the region will be instructed to initiate transfer by:

A) Consulting with each recipient potentially involved in the transfer and documenting the recipient's response and notifying family or legal guardian;

B) Locating and arranging for suitable alternative placement;

C) Coordinating the transfer with the Department of Public Health and applicable funding agencies;

D) Assuring that records required in this Part are maintained and personal effects are properly safeguarded; and

E) Submitting a follow-up report to the associate directors.

d) Report of abuse or neglect of a recipient by an owner, licensee, administrator, employee, or agent of a facility shall be made to local law enforcement officials as provided in the Abuse and Neglected Long Term Care Facility Residents Reporting Act [210 ILCS 30].

Part 130 Recovery and Mental Health Tax Credit

59 Ill. Adm. Code 130.10 Purpose

The Department is tasked by the Recovery and Mental Health Tax Credit Act [35 ILCS 50] with providing tax credit awards to certain qualified employers who employ eligible individuals diagnosed with a mental illness and/or substance use disorder to provide additional employment opportunities and expand the pool of potential workers in Illinois.

59 Ill. Adm. Code 130.20 Definitions

The following definitions are applicable to this Part.

"Act" means the Recovery and Mental Health Tax Credit Act [35 ILCS 50].

"Applicant" means a qualified employer who submits an application to the Department for the tax credit established under this Act.

"Certificate" means the tax credit certificate issued by the Department under Section 3-15 of the Act.

"Credit" means the amount awarded by the Department to a qualified employer by issuance of a certificate under Section 3-15 of the Act.

"Department" means the Department of Human Services. [35 ILCS 50/3-10]

"Eligible individual" means an individual with a substance use disorder or an individual with a mental illness who is in a state of wellness and recovery. [35 ILCS 50/3-10]

"Mental illness" is defined in Section 1-129 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/1-129] as a mental, or emotional disorder that substantially impairs a person's thought, perception of reality, emotional process, judgment, behavior, or ability to cope with the ordinary demands of life, but does not include a developmental disability, dementia or Alzheimer's disease absent psychosis, a substance use disorder, or an abnormality manifested only by repeated criminal or otherwise antisocial conduct.

"Newly hired" means an employee first employed by an applicant after January 1, 2023, or any employee that was released from employment prior to January 1, 2023 and re-hired on or after January 1, 2023. The term "newly hired" does not include:

A person who was previously employed in Illinois by the applicant or a related qualified employer prior to January 1, 2023, and has not been rehired since January 1, 2023;

Any individual who has a direct or indirect ownership interest of at least 5% in the profits, capital, or value of the applicant or a related qualified employer;

An employee of the applicant who was previously employed in Illinois by the applicant or a related qualified employer and whose employment was shifted to the applicant after the applicant applied for the tax credit certificate.

"Qualified employer" means an employer operating within the State that has received a certificate of tax credit from the Department after the Department has determined that the employer:

Provides a recovery supportive environment for their employees evidenced by a formal working relationship with a substance use disorder treatment provider or facility or mental health provider or facility, each as may be licensed or certified within the State of Illinois, and providing reasonable accommodation to the employees to address their substance use disorder or mental illness at no cost or expense to the eligible individual; and

Satisfies all other criteria in Section 3-10 of the Act and established by the Department in this Part to participate in the recovery tax program created hereunder. [35 ILCS 50/3-10]

"Related qualified employer" means a person that, with respect to the applicant during any portion of the incentive period, is any one of the following:

An individual, if the individual and the members of the individual's family (as defined in section 318 of the Internal Revenue Code) own directly, indirectly, beneficially, or constructively, in the aggregate, at least 50% of the profits, capital, stock, or other ownership interest in the applicant.

A partnership, estate, or trust and any partner or beneficiary, if the partnership, estate, or trust and its partners or beneficiaries own directly, indirectly, beneficially, or constructively, in the aggregate, at least 50% of the profits, capital, stock, or other ownership interest in the applicant.

A corporation, and any party related to the corporation in a manner that would require an attribution of stock from the corporation under the attribution rules of section 318 of the Internal Revenue Code, if the applicant and any other related member own, in the aggregate, directly, indirectly, beneficially, or constructively, at least 50% of the value of the corporation's outstanding stock.

A corporation and any party related to that corporation in a manner that would require an attribution of stock from the corporation to the party or from the party to the corporation under the attribution rules of section 318 of the Internal Revenue Code, if the corporation and all such related parties own, in the aggregate, at least 50% of the profits, capital, stock, or other ownership interest in the applicant.

A person to or from whom there is attribution of stock ownership in accordance with section 1563(e) of the Internal Revenue Code, except that for purposes of determining whether a person is a related member under this subsection, "20%" shall be substituted for "5%" whenever "5%" appears in section 1563(e) of the Internal Revenue Code.

"State of wellness and recovery" means there is an abatement of signs and symptoms that characterize active substance use disorder or mental illness, and that the individual has demonstrated to the qualified employer's satisfaction, pursuant to rules adopted by the Department in this Part, that they have completed a course of treatment or are currently in receipt of treatment for such substance use disorder or mental illness. [35 ILCS 50/3-10]

"Substance use disorder" is defined in Section 1-10 of the Substance Use Disorder Act [20 ILCS 301/1-10] as a spectrum of persistent and recurring problematic behavior that encompasses 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics and anxiolytics; stimulants; and tobacco; and other unknown substances leading to clinically significant impairment or distress.

"Taxpayer" means any individual, corporation, partnership, trust, or other entity subject to the Illinois income tax. For the purposes of this Act, two individuals filing a joint return shall be considered one taxpayer. [35 ILCS 50/3-10]

59 Ill. Adm. Code 130.30 Qualified Employer Determination

a) To be a qualified employer, an employer must apply annually to the Department to claim a credit based upon eligible individuals employed during the preceding calendar year, using the forms prescribed by the Department. [35 ILCS 50/3-15(b)]

b) To be approved for a credit pursuant to the Act, the employer must:

1. Agree to provide to the Department the information necessary to demonstrate that the employer has satisfied program eligibility requirements and provided all information requested or needed by the Department, including the number of hours worked by the eligible individual and other information necessary for the Department to calculate the amount of credit permitted; and

2. Agree to provide names, employer identification numbers, amounts that the employer may claim, and other information necessary for the Department to calculate any tax credit. [35 ILCS 50/3-15(b)]

c) An applicant must provide a recovery-supportive workplace environment, as evidenced by both of the following programs or practices:

1. A documented working relationship to provide treatment or support to employees in recovery in partnership with a local mental health and/or substance use disorder treatment organization certified or licensed by the State of Illinois; and

2. Documented policies or programs to provide reasonable accommodations to employees to address their substance use disorder and/or mental illness, at no cost to the employee.

d) An applicant may also provide additional evidence of their recovery-supportive workplace environment, including one or more of the following:

1. Certification as a recovery-supportive workplace by a non-profit, third-party recovery organization;

2. A documented training program for management and human resources personnel on supporting employees in recovery; and/or

3. Engagement in community-based prevention or recovery-focused activities at least once per year.

e) The applicant must provide documentation establishing its recovery-supportive workplace environment to the Department's satisfaction at the time of its first application for the tax credit. The Department may request additional documentation, if needed, to determine whether a qualified employer provides a recovery-supportive workplace environment. The Department will notify the applicant whether the applicant has met the requirements of this Section at the time of application.

f) After being approved for a tax credit, the qualified employer can attest that they continue to offer a recovery-supportive workplace environment in future applications without submitting additional supporting documentation. The Department reserves the right to request additional documentation for any application or to audit any qualified employer's recovery-supportive workplace implementation.

59 Ill. Adm. Code 130.40 Eligible Individuals

a) An eligible individual must be:

1. Diagnosed with a substance use disorder and/or mental illness; and

2. In a state of wellness and recovery from said substance use disorder and/or mental illness. This includes the eligible individual reporting that they are receiving treatment for, or have completed a course of treatment for, their substance use disorder and/or mental illness.

b) The qualified employer is solely responsible for determining whether an eligible individual meets the criteria under subsection (a). The qualified employer must maintain confidential documentation supporting this determination, which may be requested by the Department for audit purposes.

c) The qualified employer must maintain the confidentiality of the eligible individual's protected health information consistent with all applicable laws and regulations including, but not limited to, the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110], the Health Insurance Portability and Accountability Act (Public Law 104-191) and associated regulations (45 CFR 160, 162, 164), and the Americans with Disabilities Act (42 U.S.C. 12101). The qualified employer must take steps to ensure that the eligible individual's protected health information is not disclosed to other employees or to members of the public.

d) The eligible individual's disclosure of their substance use disorder and/or mental illness must be completely voluntary. The qualified employer must securely maintain documentation, such as a release of information, confirming that the eligible individual's health information was disclosed voluntarily.

e) A relapse in an individual's state of wellness shall not make the individual ineligible, so long as the individual shows a continued commitment to recovery that aligns with an individual's relapse prevention plan, discharge plan, or recovery plan. [35 ILCS 50/3-10]

f) The eligible individual must be newly hired by the qualified employer on or after January 1, 2023.

g) The qualified employer may only determine an employee's status as an eligible individual after the employee is hired, rather than before hiring.

h) The eligible individual must have been employed by the qualified employer in the State of Illinois for a minimum of 500 hours during the calendar year in which they are hired. [35 ILCS 50/3-15(c)]

i) The tax credit qualification period may only begin on the date the eligible individual is hired by the qualified employer. The qualification period will end on December 31 of that calendar year or the date that the eligible individual's employment with the qualified employer ends, whichever occurs first. [35 ILCS 50/3-15(c)]

j) Only one tax credit may be awarded for any eligible individual while employed by the same or related qualified employer. [35 ILCS 50/3-15(c)]

k) The hours of employment of two or more eligible individuals may not be aggregated to reach the minimum number of hours. [35 ILCS 50/3-15(c)]

l) If an eligible individual has worked more than 500 hours but fewer than 2,000 hours between the date of hiring and December 31 of the same year, a qualified employer can elect to compute and claim a credit for such eligible individual in that year based on the hours worked by December 31. Alternatively, the qualified employer may choose to count the hours worked between the date of hiring and December 31 of the following year, or the last day of employment, in claiming the credit for the year following the date of hiring.

59 Ill. Adm. Code 130.50 Application Format

a) The Department will make application materials available on its website. The submission of an application does not commit the Department to award assistance or to pay any costs incurred by the applicant in the preparation of an application.

b) All applications must be submitted electronically in a secure format to the Department following the instructions provided by the Department. The application shall include, at a minimum:

1. The name, address, email, and telephone number of the employer; key contact person name and title; and company tax ID, such as Federal Employer Identification Number (FEIN) or Social Security Number (SSN).

2. The qualified employer's assertion that they meet the criteria as a recovery-supportive workplace.

3. The name of each eligible individual employee; the date each employee was hired; and the number of hours worked by the eligible employee since they were hired.

4. Any other provisions or information that the Department determines to be necessary to facilitate the Department's processing or evaluation of the application.

c) The applicant is responsible for the accuracy of all data, information, and documentation submitted to the Department.

d) The Department will not permit public inspection or copying of any material that is or would be confidential under State law, specifically including the exemptions set forth in the Freedom of Information Act [5 ILCS 140]. If an applicant submits information it considers to be of a confidential nature as part of its application or request for a tax credit certificate, such information shall be marked or labeled "CONFIDENTIAL" in capital letters. The applicant shall also submit a statement briefly setting forth the grounds on which the information should be treated as confidential. Should the Department determine, at its sole discretion, the propriety nature of the material and privacy of the applicant's confidential information, the Department shall not disclose the materials to the public.

e) Any individual or patient-specific information collected by the Department or the Department of Revenue shall not be subject to public disclosure or Freedom of Information Act requests. [35 ILCS 50/3-15(i)]

59 Ill. Adm. Code 130.60 Application Review

a) The Department will accept applications for each year's tax credits beginning on January 1 of the following year and ending on March 1 of the same year.

b) The Department will only accept applications submitted pursuant to the requirements outlined in Section 130.50.

c) After receiving an application, the Department will confirm receipt of the application in writing.

d) The Department will review all applications received during the acceptance period to verify an employer's status as a qualified employer and the eligibility of each individual for whom a credit is being claimed.

e) The Department may request additional information during the review process if needed to confirm an employer's or an individual's eligibility.

f) The Department will complete its review of all applications by March 31 of each year and determine the credit amount following the process outlined in Section 130.80.

g) The Department is not responsible for any errors or delays in providing an application denial or approval caused by errors in any of the application information provided by the applicant or by any technical problems beyond the Department's control.

59 Ill. Adm. Code 130.70 Application Approval or Denial

a) Applicants will be notified in writing of the Department's approval or denial of all completed applications.

b) If the Department denies the application for a credit, it will specify the reasons for the denial.

c) If the Department approves the application for a credit, it will issue a certificate of tax credit to the qualified employer following the procedures in Section 130.90.

d) Applicants have the right to appeal a denial. The applicant must submit a written notice for an appeal to the Department. This notice must be received by the Department within 30 calendar days after the applicant receives the notice of denial. The appeal must contain a clear statement disputing the reasons for the denial. The notice of appeal should be mailed to:

Recovery and Mental Health Tax Credit Coordinator

Illinois Department of Human Services, Division of Mental Health

401 S Clinton St.

Chicago, IL 60607

e) The Department will convene an appeal hearing within 30 days of receiving the notice of appeal. The appeal hearing committee will consist of the Recovery and Mental Health Tax Credit Coordinator or their designee, the Division of Mental Health Deputy Director of Wellness and Recovery Services or their designee, and the Division of Substance Use Prevention and Recovery Behavioral Health Advisor or their designee.

f) The applicant will be notified of the hearing by phone and mail. The applicant will have an opportunity to be present and to provide written or verbal objections to the denial at the time of the hearing. The applicant may choose to be represented by an attorney but is not required to have representation.

g) The Department will issue its written final decision to the applicant within five working days after the appeal hearing. All final decisions shall specify that they are final and subject to the Illinois Administrative Review Law [735 ILCS 5/Art. III]. The final decision shall be served on parties, or their agents appointed to receive service of process, either personally or by registered or certified mail. [5 ILCS 100/10-50].

59 Ill. Adm. Code 130.80 Determination of Credit Amount

a) The Department shall determine the amount of credit awarded under the Act.

b) If Department criteria within this Part and all other requirements under the Act are met, a qualified employer shall be entitled to a tax credit equal to the product of $1 and the number of hours worked by each eligible individual during the eligible individual's period of employment with the qualified employer. [35 ILCS 50/3-15(d)]

c) The tax credit awarded under this Act may not exceed $2,000 per eligible individual employed by the qualified employer in this State. [35 ILCS 50/3-15(d)]

d) The aggregate amount of all credits the Department may award under this Act in any calendar year may not exceed $2,000,000. [35 ILCS 50/3-15(e)]

e) In determining the amount of tax credit that any qualified employer may claim, the Department shall review all claims submitted for credit by all employers and, to the extent that the total amount claimed by employers exceeds the amount allocated for this program in that calendar year, shall issue tax credits on a pro rata basis corresponding to each qualified employer's share of the total amount claimed. [35 ILCS 50/3-15(d)]

f) A taxpayer who is a qualified employer who has received a certificate of tax credit from the Department shall be allowed a credit against the tax imposed equal to the amount shown on such certificate of tax credit. [35 ILCS 50/3-15(f)]

g) The credit must be claimed in the taxable year in which the tax credit certificate is issued. The credit cannot reduce a taxpayer's liability to less than zero. If the amount of the credit exceeds the tax liability for the year, the credit may not be carried forward. [35 ILCS 50/3-15(g)]

59 Ill. Adm. Code 130.90 Tax Credit Certificate

a) The Department shall award the tax credit by issuance of a certificate of tax credit to the qualified employer. [35 ILCS 50/3-15(a)]

b) The certificate will include the following:

1. The name, taxpayer identification number, and address of the qualified employer;

2. The date on which the certificate is issued;

3. The number of eligible individuals employed and the total number of hours worked by eligible individuals;

4. The credit amount; and

5. Any other information the Department determines to be appropriate.

c) The qualified employer will present the certificate of tax credit to the Department of Revenue by attaching the certificate to its tax return, as a credit against the qualified employer's income tax liability in accordance with the Illinois Income Tax Act. [35 ILCS 50/3-15(a)]

d) The Department shall maintain an electronic listing of the certificates issued by which the Department of Revenue may verify tax credit certificates issued. [35 ILCS 50/3-15(a)]

Chapter IV Department of Human Services

Part 132 Medicaid Community Mental Health Services Program

59 Ill. Adm. Code 132.5 Covid-19 Vaccination of Entity Staff (repealed)

History

• Source: Repealed at 48 Ill. Reg. 918, effective December 29, 2023

59 Ill. Adm. Code 132.10 Purpose

a) To facilitate the establishment of a comprehensive and coordinated continuum of community-based programs, sensitive to the needs of local communities, for persons with or at risk for a diagnosis of mental illness.

b) To effectuate the Division of Mental Health's role as the federally-recognized State Mental Health Authority with statutory mandates to plan, fund and monitor community-based mental health programs.

c) To promote the availability of culturally relevant, evidence-based, developmentally appropriate, trauma-informed mental health programs across the lifespan.

d) To maximize the effectiveness and quality of programs to ensure cost efficiency and best possible outcomes in natural settings that reduce the use of institutional care.

e) To establish criteria for certification and recertification of Comprehensive Community Mental Health Centers (CMHC) and other entities seeking to offer programs directly funded by DHS-DMH and DCFS.

59 Ill. Adm. Code 132.15 Incorporation by Reference

Any rules or standards 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.

59 Ill. Adm. Code 132.25 Definitions

For the purposes of this Part, the following terms are defined:

Accessibility – Compliance with all appropriate provisions of the Americans With Disabilities Act (ADA) of 1990 (42 USC 12101 et seq.), as amended, and section 504 of the Rehabilitation Act of 1973 (29 USC 794), and the most recent standards identified in the Illinois Accessibility Code (71 Ill. Adm. Code 400) and/or ADA Accessibility Guidelines, whichever standard is more stringent.

Assertive Community Treatment Program or ACT Program – An evidence-based program that includes all components necessary to provide the assertive community treatment model.

Applicant −An entity that seeks certification as a Certified Specialty Provider (CSP) or CMHC under this Part

Centers for Medicare and Medicaid Services or CMMS – A federal agency within the U.S. Department of Health and Human Services with responsibility for Medicare, Medicaid, State Children's Health Insurance (SCHIP), Health Insurance Portability and Accountability Act (HIPAA), and Clinical Laboratory Improvement Amendments (CLIA).

Certifying State Agency or CSA − Departments responsible for determining and monitoring compliance with this Part, i.e., Department of Human Services or Department of Children and Family Services.

Client − An individual who is receiving community mental health services eligible for Medical Assistance funding.

Certified Comprehensive Community Mental Health Center or CMHC – An entity that meets the requirements of Subparts C and D and has been certified by a Certifying State Agency. Any entity certified as a CMHC under this Part shall be designated as an Essential Community Behavioral Health Center by the Division of Mental Health.

Certified Specialty Provider or CSP – An entity that has chosen to meet the requirements set forth in Subpart B to be eligible to provide specialty programs directly funded by DHS-DMH and/or DCFS.

Community Support Team Program – A program designed with the infrastructure and supports necessary to provide team-based care consistent with DHS-DMH certification requirements.

Day − A calendar day unless otherwise indicated.

Department – The Illinois Department of Human Services (DHS)

Department of Children and Family Services or DCFS – The State child welfare agency responsible for:

protecting children who are reported to be abused or neglected and to increase their families' capacity to safely care for them;

providing for the well-being of children in care; providing appropriate, permanent families as quickly as possible for those children who cannot safely return home;

supporting early intervention and child abuse prevention activities and working in partnerships with communities to fulfill this mission.

Department of Human Services or DHS − The State agency responsible for providing a wide variety of safety net services to Illinois residents in poverty who are facing other economic challenges or who have any of a variety of disabilities or health challenges.

Department of Human Services-Division of Mental Health or DHS-DMH – A program division of DHS that, as the State Mental Health Authority pursuant to Department of Human Services (Mental Health and Developmental Disabilities) Law [20 ILCS 1710], is responsible for assuring that children, adolescents and adults throughout Illinois have the availability of and access to public-funded mental health services.

Emotional Disturbance – For clients under age 21, symptoms of an emotional disorder contained in the DSM-5 and ICD-10-CM that is the condition that will be the main focus of treatment. For clients under age 6, DC 0-5 may be utilized to develop an age appropriate diagnosis, then the crosswalk between the DSM 5/ICD -10/DC 0-5 shall be used to identify which DSM-5/ICD-10 condition will be the main focus of treatment. Emotional disturbance does not include organic disorders such as dementia and those associated with known or unknown physical conditions such as hallucinations, amnestic disorder and delirium; psychoactive substance induced organic mental disorders; and intellectual disabilities, autism spectrum disorders or psychoactive substance use disorders.

Enrollment −The official act of registering an entity or an individual as a provider in the Illinois Medical Assistance Program.

Guardian − The court-appointed guardian or conservator of the person under the Probate Act of 1975 [755 ILCS 5] or a temporary custodian or guardian of the person of a child appointed by an Illinois juvenile court or a legally-appointed guardian or custodian or other party granted legal care, custody and control over a minor child by a juvenile court of competent jurisdiction located in another state whose jurisdiction has been extended into Illinois via the child's legally authorized placement in accordance with the applicable interstate compact. (See the Juvenile Court Act of 1987 [705 ILCS 405] and the Interstate Compact on the Placement of Children [45 ILCS 15].)

Healthcare and Family Services or HFS − The State agency responsible for administering Medicaid for Illinois.

Health Information Technology for Economic and Clinical Health (HITECH) Act – Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA), P.L. 111-5 (Feb. 17, 2009).

Health Insurance Portability and Accountability Act or HIPAA − 42 USC 1320 et seq. and 45 CFR 160 and 164 (2003).

Illinois Medicaid Program Advanced Cloud Technology or IMPACT – The HFS web-based Medicaid Management Information System platform.

Intensive Outpatient Program − A program designed with the infrastructure and supports necessary to provide group therapeutic sessions consistent with the clinical standards set forth in Subpart E.

Interdisciplinary Care − Professionals from a range of disciplines working together to deliver comprehensive services and supports that address as many of the client's needs as possible. This can be delivered by a range of professionals and paraprofessionals functioning as a team under one organizational umbrella or from a range of organizations, including private practice, brought together as a unique team. As a client's condition changes over time, the composition of the team may change to reflect the changing clinical and psychosocial needs of the client.

Licensed Clinician – An individual who is:

A licensed practitioner of the healing arts (LPHA);

A licensed social worker (LSW) possessing at least a master's degree in social work and licensed under the Clinical Social Work and Social Work Practice Act [225 ILCS 20] with specialized training in mental health services or with at least two years' experience in mental health services;

A licensed professional counselor (LPC) possessing at least a master's degree and licensed under the Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107] with specialized training in mental health services or with at least two years' experience in mental health services;

A registered professional nurse (RPN) licensed under the Nurse Practice Act [225 ILCS 65] with at least one year of clinical experience in a mental health setting or who possesses a master's degree in psychiatric nursing; or

An occupational therapist (OT) licensed under the Illinois Occupational Therapy Practice Act [225 ILCS 75] with at least one year of clinical experience in a mental health setting.

Licensed Practitioner of the Healing Arts or LPHA − A LPHA is defined as one of the following (additional information can be found in 89 Ill. Adm. Code 140.453):

Physician;

Licensed advanced practice registered nurse with psychiatric specialty;

Licensed clinical psychologist;

Licensed clinical professional counselor;

Licensed marriage and family therapist; or

Licensed clinical social worker.

Medical Assistance − Health care benefits authorized by HFS under Article V of the Illinois Public Aid Code [305 ILCS 5].

Mental Health Professional or MHP − An individual who provides services under the supervision of a Qualified Mental Health Professional (additional information can be found in 89 Ill. Adm. Code 140.453) and who possesses:

A bachelor's degree in counseling and guidance, rehabilitation counseling, social work, education, vocational counseling, psychology, pastoral counseling, family therapy, or a related human service field;

A bachelor's degree in any other field with two years of supervised clinical experience in a mental health setting;

A practical nurse license under the Illinois Nurse Practice Act [225 ILCS 65];

A certificate of psychiatric rehabilitation from a DHS-approved program, plus a high school diploma or GED, plus 2 years of experience in providing mental health services;

A recovery support specialist certified by, and in good standing with, the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc.;

A family partnership professional certificate from and in good standing with the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc.;

An occupational therapy assistant licensed under the Illinois Occupational Therapy Practice Act [225 ILCS 75] with at least one year of experience in a mental health setting;

A minimum of a high school diploma or GED and 5 years supervised clinical experience in mental health or human services; or

Any individual employed as an MHP prior to July 1, 2013 may continue to be so designated unless employment changes.

Mental Health Setting – A location, public or private, in a group or individual practice, in a mental health center, hospital or clinic where services intended to reduce symptoms of mental illness are provided to persons with mental illness.

Mental Illness − For clients age 18 and older, a mental disorder diagnosis contained in the DSM-5 and ICD-10-CM. Mental illness does not include organic disorders such as dementia and those associated with known or unknown physical conditions such as hallucinations, amnestic disorder and delirium; psychoactive substance induced organic mental disorders; and intellectual disabilities, autism spectrum disorders or psychoactive substance use disorders.

Natural Setting − A setting where an individual who has not been diagnosed with a mental illness typically spends time, including home, work, churches, community centers, libraries, parks, recreation centers, educational settings, courthouses, jails or other public buildings. These sites are not licensed, certified or accredited as a treatment setting nor typically identified as treatment sites.

Natural Support – Persons identified by the client who are not paid to provide support, e.g., family, friends, pastor, colleague, landlord.

Notice of Violation or NOV – A written document that specifies the standards within this Part with which the entity/CMHC is not compliant.

Psychiatric Resource −

A physician licensed under the Medical Practice Act of l987 [225 ILCS 60] to practice medicine or osteopathy with training in mental health services or one year of clinical experience, under supervision, in treating problems related to mental illness, or specialized training (i.e., the treatment of children and adolescents);

A psychiatrist (a physician licensed under the Medical Practice Act of l987 [225 ILCS 60]) who has successfully completed a training program in psychiatry approved by the American Medical Association, the American Osteopathic Association or other training program identified as equivalent by the Department;

An advanced practice registered nurse (APRN) with a psychiatric specialty licensed in Illinois under Article 65 of the Nurse Practice Act [225 ILCS 65]; or

A prescribing psychologist licensed in Illinois pursuant to the Clinical Psychologist Licensing Act [225 ILCS 15], practicing within his or her scope of practice and adhering to all applicable federal and State administrative rules and policies, with sufficient credentials to prescribe psychotropic medications in Illinois.

Psychosocial Rehabilitation Program or PSR − A facility-based program designed with the infrastructure and supports necessary to provide intensive skill development in a classroom-based setting, consistent with clinical standards set forth in Subpart E.

Public Payer − A State agency or a unit of local government that is responsible for payment for services provided to a client.

"Qualified Mental Health Professional" or "QMHP" means one of the following:

Any individual identified as an LPHA.

A registered professional nurse who holds a valid license in the state of practice, is legally authorized under state law or rule to practice as registered nurse or registered professional nurse, so long as that practice is not in conflict with the Illinois Nurse Practice Act, and has training in mental health services or one year of clinical experience, under supervision, in treating problems related to mental illness, or specialized training in the treatment of children and adolescents.

An occupational therapist who holds a valid license in the state of practice and is authorized under state law or rule to practice as an occupational therapist, so long as that practice is not in conflict with the Illinois Occupational Therapy Practice Act, with at least one year of clinical experience in a mental health setting. If the state of practice does not provide a legal authority for licensure, the individual must meet the requirements of 42 CFR 484.4 for an occupational therapist.

An individual who possesses a master's or doctoral degree in counseling and guidance, rehabilitation counseling, social work, psychology, pastoral counseling, family therapy, or a related field and has:

Successfully completed 1,000 hours of practicum and/or internship under clinical and educational supervision; or

One year of documented clinical experience under the supervision of a QMHP.

Rehabilitative Services Associate or RSA − An RSA assists in the provision of rehabilitative services under the supervision of a QMHP (additional information can be found in 89 Ill. Adm. Code 140.453) and must:

Be at least 21 years of age;

Have demonstrated skills in the field of services to adults or children;

Have demonstrated the ability to work within agency structure and accept supervision; and

Have demonstrated the ability to work constructively with clients, other providers and the community.

SAMHSA − The federal Substance Abuse and Mental Health Services Administration responsible for guidance to the State Mental Health Authorities, including administration of the federal block grant, defining and identifying evidence-based practices, and translation of research to practice.

Safety Net – A collection of services provided, in collaboration with health care and social service providers throughout the community, to the uninsured and other vulnerable populations. The collection of services is designed to help prevent individuals from further emotional, mental, physical and economic decompensation, while promoting stability and empowerment.

Specialty Certification – The confirmation from DHS-DMH, the Illinois State Mental Health Authority, that a program meets the required clinical standards set forth in Subpart E.

State Mental Health Authority or SMHA – The entity within a state with federal and state statutorily assigned responsibility for planning, organizing, delivering and monitoring the programs that provide critical mental health services, through the development of safety net programs that provide critical care to individuals with serious mental illnesses who lack insurance and/or have high levels of service needs. In Illinois, DHS-DMH is charged with this responsibility, which includes the development and implementation of a plan for comprehensive community mental health systems and reporting a set of standardized utilization and outcome measures.

Supervision of Treatment Services – The dedicated time an LPHA or QMHP spends with his or her supervisees discussing the supervisees' work. This may include reviewing individual cases, treatment plans, group counseling, individual counseling, progress made by clients, or problem solving when progress is not occurring or when individuals are not engaged in the therapeutic process. Supervision may be done individually or in groups.

Treatment, Habilitation and Support Services – Services designed to:

help individuals develop skills that promote independence and improved levels of social and vocational functioning and personal growth; and

provide nontreatment support services necessary for successful community living [405 ILCS 30/2(e)].

59 Ill. Adm. Code 132.30 Client Rights

To assure that a client's rights are protected and that all services provided to clients comply with the law, all providers under this Part shall ensure that:

a) A client's rights shall be protected in accordance with Chapter 2 of the Mental Health and Developmental Disabilities Code [405 ILCS 5].

b) The right of a client to confidentiality shall be governed by the Mental Health and Developmental Disabilities Confidentiality Act and the federal Health Insurance Portability and Accountability Act of 1996.

c) Staff shall inform the client upon intake and annually of the following:

1. The rights in accordance with subsections (a) and (b);

2. The right to contact the Illinois Guardianship and Advocacy Commission and Equip for Equality, Inc. The provider shall offer assistance to a client in contacting these groups, giving each client the address and telephone number of the Guardianship and Advocacy Commission and Equip for Equality, Inc.;

3. The right to be free from abuse, neglect and exploitation;

4. The right to be provided mental health services in the least restrictive setting;

5. The client's right or the guardian's right to present grievances up to and including the provider's Executive Director or comparable position. The client or guardian will be informed of how his or her grievances will be handled at the provider level. A record of, and the response to, those grievances shall be maintained by the provider. The Executive Director's decision on the grievance shall constitute a final administrative decision (except when the decisions are reviewable by the provider's governing board, in which case the governing board's decision is the final authority at the provider level);

6. The right not to have services reduced, denied, suspended or terminated for exercising any rights;

7. The right to contact the public payer or its designee and to be informed of the public payer's process for reviewing grievances;

8. The right to have disabilities accommodated as required by the Americans With Disabilities Act, section 504 of the Rehabilitation Act and the Human Rights Act [775 ILCS 5]; and

9. The right to contact HFS or its designee and to be informed by HFS or its designee of the client's healthcare benefit and the process for reviewing grievances.

d) The sharing of information consistent with this Section shall be communicated in a language or a method of communication that the client understands. Documentation that this information was shared in that manner shall be noted in the clinical record.

59 Ill. Adm. Code 132.35 Inter-Departmental Administration and Coordination of Services

a) DHS-DMH and DCFS, pursuant to an executed interagency agreement with the Department, shall ensure the administration and coordination of mental health services.

b) Specific service details of Medicaid Rehabilitation Option (MRO) qualified mental health services pursuant to section 1905(a)(13)(C) of the Social Security Act are found in 89 Ill. Adm. Code 140.453(e) and (f).

59 Ill. Adm. Code 132.40 Definition and Characteristics

a) The Department shall make CSP certification available on a voluntary basis to entities seeking CSP designation. CSP certification may be required for receipt of DHS-DMH and DCFS funding.

b) A CSP is an entity providing community-based mental health services under the direction of an LPHA in a specific geographic area or to a specialized population. At a minimum, a CSP:

1. Provides services necessary to prevent unnecessary institutionalization.

2. Collaborates with other entities supporting the needs of individuals, including, but not limited to, primary care providers, coordination entities and/or managed care entities.

3. Meets all of the requirements outlined in Subpart D, as demonstrated by having been issued a certificate by a CSA in accordance with the requirements set forth in this Part.

59 Ill. Adm. Code 132.45 General Requirements

a) The CSP shall operate in a manner compliant with all applicable State and federal laws, regulations, and adopted policies and procedures.

b) The CSP shall establish and maintain policies and procedures to be used by all CSP staff in the administration of programs and the delivery of services from any CSP site or location.

59 Ill. Adm. Code 132.50 Quality Systems Requirements

a) The CSP shall establish and maintain continuous quality improvement systems to ensure quality of care provided in the least restrictive setting supporting the ongoing purchase of services.

b) The CSP shall establish and maintain a Utilization Review Plan for the ongoing review and assessment of delivered services and client outcomes to ensure services are cost effective and result in the expected outcomes.

c) The CSP shall establish and maintain a system for obtaining feedback from individuals served and community stakeholders.

Part 132 Community Mental Health Services Program

59 Ill. Adm. Code 132.55 Personnel and Staffing Requirements

The CSP shall:

a) Establish and maintain a comprehensive set of personnel policies and procedures, minimally addressing hiring, training, evaluation, disciplining, termination, and other personnel matters related to staffing. Establish and maintain job descriptions detailing the duties and qualifications for all positions, including volunteers, interns and unpaid personnel. Establish and maintain individual personnel records for all personnel, paid and unpaid, minimally including the following components:

1. Documentation of current education, experience, licensure and certification;

2. Employment status of the individual (e.g., hire date, employee/contractor, termination date, etc.);

3. Review of individual employee's performance within the last 12 months; and

4. Documentation of training and continuing education units, as applicable.

b) Upon hire, perform sufficient background checks for all employees, volunteers, interns, unpaid personnel, or other individuals who are agents of the CSP or CMHC. At a minimum, the review shall include:

1. Searching the Illinois Department of Public Health's (DPH) Health Care Worker Registry concerning the person. If the Registry has information substantiating a finding of abuse or neglect against the person, the provider shall not employ them in any capacity.

2. Performing background checks in compliance with requirements set forth in the Health Care Worker Background Check Act [225 ILCS 46] and in DPH rules at 77 Ill. Adm. Code 955.

3. Reviewing the Provider Sanctions List, provided by the HFS Office of Inspector General (HFS-OIG), to ensure the provider is not on the list of sanctioned providers. The CSP/CMHC shall not employ or contract with any provider found on the List.

c) The provisions of Section 132.55(b), except for subsection (b)(3), do not apply to Peer Support Workers (PSWs) providing services as part of a Violence Prevention Community Support Team (VP-CST) pursuant to 89 Ill. Adm. Code 140.453. PSWs delivering VP-CST must meet the background check requirements outlined in 89 Ill. Adm. Code 140.TABLE P.

d) Annually, at a minimum, comply with all requirements set forth in the Health Care Worker Background Check Act and in DPH rules.

e) Ensure that all assessment activities and subsequent individual treatment plans are developed with the active involvement of a QMHP and the clinical review of an LPHA.

f) Ensure management and oversight of all treatment staff by a QMHP. Management and oversight may be face to face or virtual, to include group supervision as well as supervision by teleconference and videoconference. All treatment staff must have access to a QMHP who is available for immediate consultation and supervision of treatment services.

g) All staff shall receive, at a minimum, one hour of supervision per month delivered face to face, or by teleconference or videoconference.

1. Group supervision is acceptable and the size of the group shall be conducive to the topic being discussed.

2. Supervision must be documented in a written record.

3. LPHAs are not required to have supervision under this Section.

4. QMHPs must be supervised by an LPHA. MHPs and RSAs must be supervised by, at a minimum, a QMHP.

History

• Source: Amended at 48 Ill. Reg. 12012, effective July 25, 2024

Part 132 Medicaid Community Mental Health Services Program

59 Ill. Adm. Code 132.60 Recordkeeping Requirements

a) The CSP shall maintain records, including but not limited to the following:

1. Clinical records;

2. Service billing files;

3. Organizational records, including policies and procedures;

4. Personnel records; and

5. All other documents required in this Part.

b) Required records shall be retained for a period of not less than 10 calendar years from the date of service, or origin of the record, except that, if an audit is initiated within the required retention period, the records shall be retained until the audit is completed and every exception resolved. This provision is not to be construed as a statute of limitations.

c) Required records shall be readily available for inspection, audit and copying during normal business hours by personnel representing the CSA, the public payer, HFS, CMMS, or U.S. Department of Health and Human Services, as applicable.

d) The compilation, storage of, and accessibility to records, including electronic records, shall be governed by written policies and procedures, in accordance with the Confidentiality Act, HIPAA, HITECH, and all other applicable State and federal laws.

e) Clinical records and other client information, regardless of format, shall be secured from theft, loss or fire.

f) Electronic or digital signature of records is acceptable when the CSP has established the necessary policies and procedures to:

1. safeguard the issuance and identity of users;

2. ensure uniqueness in issuance of signature;

3. regularly review the usage of signature;

4. ensure adequate safeguards within the system upon application of signature to documents; and

5. audit users to remove unnecessary, unused, and abuses on a regular frequency.

59 Ill. Adm. Code 132.65 Physical Plant Location Requirements

a) At a minimum, a CSP shall have a single discrete physical location, owned, leased or controlled by the entity seeking certification.

b) All additional locations where treatment services occur, if owned, leased or controlled by the CSP, must be certified. Locations meeting the definition of natural settings do not need to be certified.

c) All locations must meet the following physical plant requirements for certification:

1. Provide a safe, functional, sanitary and comfortable environment for clients and staff that is conducive to the provision of behavioral health services.

A) A safe, functional and sanitary environment includes the establishment and maintenance of policies and procedures specific to the operation of each specific physical plant, including an emergency disaster plan, fire evacuation plan, and procedures for managing the basic mechanics of the site.

B) A comfortable environment shall be reflective of trauma informed care, ensuring that the interventions being provided and the populations being served have access to an environment that ensures the physical, psychological and emotional safety of both employees and populations being served;

2. Meet health and safety standards and State health care occupancy regulations as applicable;

3. Be deemed accessible in accordance with the ADA, the Illinois Accessibility Code, and the ADA Accessibility Guidelines, whichever is more stringent. Providers must maintain a written policy for reasonable accommodations for the provision of services to clients unable to access the provider's sites due to physical inaccessibility;

4. Be in compliance with approved State and local building and fire ordinances and codes as follows:

A) Fire safety in accordance with rules of the Office of the State Fire Marshal at 41 Ill. Adm. Code 100.

B) Building requirements in compliance with the uniform or national building code adopted by local or county ordinance.

59 Ill. Adm. Code 132.70 Definition, Characteristics and Incentives

a) Certified Comprehensive Community Mental Health Centers are a specialty service provider type embedded in the community with knowledge and expertise in providing services to adults with or at risk of serious mental illnesses (SMI) and/or children and youth with or at risk of serious emotional disturbances (SED. CMHCs respond to the unique mental health needs of the community with a continuum of services ranging from prevention/promotion through treatment and recovery. CMHCs collaborate with other social service and health care providers to deliver integrated care to individuals in the identified geographic service area. CMHCs must be nonprofit or local government entities.

b) CMHCs shall:

1. Comply with all requirements of a CSP as articulated in Subpart B, in addition to the requirements set forth in this Subpart C.

2. Operate within a system of care that provides treatment, habilitation and support services.

3. Provide a comprehensive strengths-based array of mental health services within an identified geographic service area.

4. Provide care to individuals with or at risk for SMI/SED by using a person-centered approach to care performed by an interdisciplinary team.

5. Serve individuals who have complex needs as a result of child welfare, justice or multisystem involvement, medical co-morbidity, homelessness, dual disorders, etc.

6. Ensure the connectability of services in the service area for individuals across the life span.

7. Provide services in the client's natural settings.

8. Provide a safety net for individuals with SMI/SED who are indigent.

9. Provide outreach and engagement to individuals in need of mental health services.

10. Provide evidence-based and evidence-informed developmentally appropriate practices in a proficient manner.

11. Provide for a screening prior to a referral to a more intensive level of care.

12. Provide education and resources to the public on mental health issues, including suicide prevention and wellness.

13. Prioritize principles of recovery, system of care, trauma informed care, and culturally relevant practices.

14. Provide access or linkage to psychiatric services and other health and social services.

c) CMHCs are the only entities that may pursue certifications of the following programs:

1. Assertive Community Treatment Programs; and

2. Psychosocial Rehabilitation Programs.

d) DHS-DMH will recognize certified CMHCs as preferred provider types when awarding State grant funds to support mental health treatment programs and services as State laws permit.

e) DHS-DMH will recognize certified CMHCs as preferred provider types when pursuing federal or other grants within DMH or when awarding federal pass-through funds as federal and State laws permit.

f) DHS-DMH will recognize certified CMHCs as preferred provider types when establishing technical assistance and training programs.

59 Ill. Adm. Code 132.75 General Requirements

a) Establish and maintain policies and procedures to be used by all CMHC staff in the administration of CMHC programs and the delivery of services from any CMHC site or location.

1. Policies detailing the organization's clear commitment to person-centered recovery and resilience principles and the empowerment of families and individuals served. Programs and services should promote personal choice, self-help measures, the strengthening of natural supports, the use of education and interventions in natural settings, and the reduction of the utilization of institutional levels of care.

2. Policies detailing how clients will actively participate in the development, planning and oversight of programs and services.

3. Policies and procedures to ensure co-morbid physical healthcare needs are addressed for clients as needed. A CMHC that is not licensed to provide Level 1 and Level 2 Substance Use services and enrolled to participate in the Illinois Medical Assistance Program shall develop policies and procedures to ensure clients receive referrals for services as needed.

4. Policies and procedures to ensure SAMHSA's principles of trauma informed approaches are embedded into the organizational structure and clinical practices of the CMHC.

b) Ensure the availability of services that are culturally and linguistically appropriate and responsive to the needs of clients served, including but not limited to children/youth, military families, those in the criminal justice system, and the LGBTQ population.

c) Ensure the availability of and/or linkage to a psychiatric resource for the purpose of consultation, evaluation, prescription and management of medication as needed by clients served by the CMHC. This may be secured through various arrangements, including but not limited to employment, contractual relationship or mutual agreement.

d) Identify a specific geographic service area in which the CMHC will operate and organize the delivery of services and programs and provide interventions to clients.

e) Maintain insurance against professional and physical liabilities.

f) Ensure the estimated incidence and prevalence of serious mental illness and severe emotional disturbance are collected. Providers must participate in DHS-DMH surveys to collect data to meet federal reporting requirements via registration information and/or ad hoc surveys.

Part 132 Community Mental Health Services Program

59 Ill. Adm. Code 132.80 Personnel and Staffing Requirements

Establish and maintain an organizational structure that includes a staffing structure and management system consistent with the following:

a) Employ a full-time LPHA to oversee and direct the clinical functions of the CMHC;

b) Maintain staff with training and credentialing to provide interdisciplinary person-centered care, evidence based/informed practices, developmentally appropriate trauma informed care, and culturally and linguistically responsive services.

c) When good cause is established by the organization, an exception to the full-time status of the LPHA may be granted by the Department in accordance with the process and criteria outlined in this subsection (c).

1. The organization shall submit a request for consideration of waiver to the Department detailing the reasons for the request.

2. The organization shall provide a detailed staffing plan that includes the number and credential levels of all staff providing direct services that include a calculation of the hours of clinical supervision necessary to meet the requirements of Section 132.55(g)(4).

3. The organization shall provide a projected number of individuals to be served on annual basis and calculation of the hours required for provision of clinical oversight and direction of all clinical functions related to those services. This calculation shall be based on a needs assessment of the service area completed by the organization.

4. The organization shall propose a staffing equivalency for clinical oversight and direction by the LPHA that is sufficient to meet the needs identified in Section 132.80(c)(2) and (3).

5. The organization shall describe a plan to ensure access to clinical direction and oversight of an LPHA by less-credentialed staff in the event of emergent situations.

6. Request for an exception must be submitted to the Department for consideration at least 30 calendar days prior to the anticipated need for the exception.

History

• Source: Amended at 48 Ill. Reg. 12012, effective July 25, 2024

Part 132 Medicaid Community Mental Health Services Program

59 Ill. Adm. Code 132.85 Addition and Removal of Physical Plant Locations

a) Upon enrollment and establishment of the CMHC, the entity may seek to add additional physical plant locations to operate as part of the CMHC, pursuant to Section 132.65. All CMHC requirement documentation and plans must be updated to reflect the addition of the physical plant location and must meet standards established in Subparts B and C.

b) The CMHC must notify the CSA and HFS of a change in status if any physical plant location is removed from the CMHC or becomes inactive. Furthermore, such a change must note if the removal or inactive status impacts the CMHC's ability to meet the standards detailed in Subparts B and C.

c) The addition, removal or other potential changes in status reported by the CMHC to the CSA and HFS may result in a review of documents and plans consistent with Subparts B, C and D, resulting in certification, compliance review, or failure of the CMHC to retain status as a CMHC.

59 Ill. Adm. Code 132.95 Certified Specialty Providers (csp) and Certified Comprehensive Community Mental Health Center (cmhc) Certification Process

a) The IMPACT portal is the enrollment site for the HFS Provider Participation Unit. Entities seeking certification as a CMHC shall request enrollment through the IMPACT portal. Any entity enrolled through the IMPACT portal may request certification from a CSA as a CSP or CMHC.

b) During the IMPACT application process, entities shall determine what population they will be serving and will be directed to the appropriate CSA to complete the certification process.

1. If an entity intends to contract for services with more than one CSA, it shall submit its certification application to the State agency that provides the most funding for community mental health services.

2. If the funding from both CSAs is equal, the provider shall submit the application to DHS.

c) The entity shall contact the CSA in writing to request the application packet.

DHS-BALC:

401 S. Clinton, 7th Floor

Chicago IL 60627

DHS.BALC@illinois.gov

DCFS:

DCFS.Medicaid@illinois.gov

d) IMPACT will issue notice of initial enrollment to the provider and the CSAs within 10 days. The CSA shall review the provider information provided through the IMPACT portal.

e) Upon review of all submitted materials, the CSA shall determine that:

1. The submitted materials meet the standards of a CSP or CMHC established in Subparts B and C; or

2. The submitted materials do not meet the standards established in Subparts B and C.

f) If the CSA determines that the submitted materials meet the standards established in Subparts B and C, the CSA shall issue a provisional certification determination to HFS, if applicable, and the entity within 30 days after reviewing materials and reaching a determination.

1. The effective date of provisional certification shall indicate the type of certification awarded and the date that the application was approved.

2. A provisional certificate shall be in effect for 12 months, unless extended by the CSA.

3. An entity issued a provisional certificate shall enroll in any information system required by the CSA.

g) If the CSA determines that the submitted materials do not meet the standards established in Subparts B and C, the CSA shall issue the applicant a Notice of Violation within 30 days after the review. The NOV shall provide the entity 30 days to remedy the violations.

1. If the entity intends to proceed with certification as a CSP or CMHC, the entity may submit notice and documentation of corrections to the CSA to address all identified violations by the due date indicated on the NOV.

2. If the notice and documentation of corrections is found to address all of the identified violations included in the NOV, then the CSA shall continue with the certification process outlined in this Part.

3. If the entity pursuing CMHC certification fails to supply the necessary materials or the supplied materials fail to meet the standards detailed in this Part, the CSA shall notify HFS and the entity in writing of the entity's failure to obtain certification as a CMHC and right to appeal pursuant to Section 132.110.

4. If the entity pursing CSP certification fails to supply the necessary materials or the supplied materials fail to meet the standards detailed in this Part, the CSA shall notify the entity in writing of the entity's failure to obtain certification as a CSP and right to appeal pursuant to Section 132.110.

h) The CSA may supply technical assistance through the certification process as deemed necessary.

59 Ill. Adm. Code 132.100 Initial on-Site Certification

a) The CSA shall be granted access to all physical plant locations.

b) The CSA shall be granted access to all records, upon request, during any certification or other compliance review activities.

c) On-site Certification

1. The CSA shall perform an on-site review within the provisional certification period outlined in Section 132.95(f) to confirm the findings of the provisional certification determination. If the CSA determines the CSP or CMHC to be:

A) In compliance, the CSA shall notify the CSP or CMHC. For providers enrolled in the IMPACT system, the CSA shall notify HFS of the change in certification status from provisional to full certification.

B) Not in compliance, the CSA shall issue the CSP or CMHC a Notice of Violation within 15 days after the on-site review. The entity shall respond to the NOV by the due date indicated on the NOV, which shall be approximately 30 days after the date of the NOV.

2. The CSP or CMHC shall submit notice and a Plan of Correction to the CSA to address all identified violations by the due date indicated on the NOV.

3. If the notice and Plan of Correction is found to address all of the identified violations, the CSA shall assure implementation of the Plan of Correction. The program certification status must be in "good standing" with the CSA. The CSA shall notify the CSP or CMHC of the change in certification status from provisional to full certification. For entities enrolled in the IMPACT Portal, the CSA shall notify HFS of the change in certification status from provisional to full certification.

4. If the CSP or CMHC fails to supply a Plan of Correction or fails to implement its approved Plan of Correction and is "not in good standing" with the CSA, as detailed in this Part, the CSA shall notify the entity in writing of its failure to retain certification and right to appeal pursuant to Section 132.100. For entities enrolled in IMPACT, the CSA shall also notify HFS of the entity's failure to retain certification.

5. If the CSA finds evidence of suspected fraud or abuse relating to Medical Assistance, the CSA shall refer that evidence to HFS-OIG for further action.

59 Ill. Adm. Code 132.105 Certification Review Cycle

a) The CSA may perform a review for compliance with the standards of this Part at any CSP or CMHC, at will, regardless of deemed status and without prior notice to the entity.

b) The CSAs shall, at a minimum, review one-third of all CSPs and CMHCs on an annual basis, ensuring that all CSPs and CMHCs are reviewed within a three year period. If the CSA determines the entity to be:

1. In compliance with Subparts B, C and D, the CSA shall notify the entity of retention of certification. For entities enrolled in the IMPACT system, the CSA shall notify HFS of retention of certification.

2. Not in compliance, the CSA shall issue the entity a Notice of Violation within 15 days after the on-site review. The entity shall respond to the NOV by the due date indicated on the NOV, which shall be approximately 30 days after the date of the NOV.

A) The entity shall submit a Plan of Correction to the CSA to address all identified violations by the due date indicated on the NOV.

B) If the Plan of Correction is found to address all of the identified violations included in the NOV, the CSA shall assure implementation of the Plan of Correction, which will determine the certification status. The program certification status must be in "good standing" with the CSA. The CSA shall notify the entity of retention of certification. For an entity enrolled in IMPACT, the CSA shall also notify HFS of the entity's retention of certification.

c) If the entity fails to supply the necessary materials or the supplied materials fail to meet the standards detailed in Subparts B, C and D, the CSA shall notify the entity of its failure to retain certification and the right to appeal pursuant to Section 132.340. For entities enrolled in IMPACT, the CSA shall also notify HFS in writing of the entity's failure to retain certification.

d) If the CSA finds evidence of suspected fraud or abuse relating to Medical Assistance, the CSA shall refer that evidence to HFS Office of Inspector General for further action.

e) Revocation of Certification

1. The CSA may revoke an entity's certification at any time for any of the following reasons:

A) The entity meets any of the grounds for termination set forth in 89 Ill. Adm. Code 140.16;

B) The entity is convicted of defrauding the Medical Assistance Program under Article VIIIA of the Illinois Public Aid Code; or

C) The entity fails to comply with the requirements of Subpart B, C or D.

2. The CSA shall notify the entity in writing of the entity's revocation of certification and right to appeal pursuant to Section 132.110. For providers enrolled in the IMPACT system, the CSA shall notify HFS.

59 Ill. Adm. Code 132.110 Appeal of Certification Determination

a) An entity may appeal the following actions detailed in this Part:

1. Refusal to issue a provisional certification;

2. Refusal to issue full certification;

3. Refusal to retain certification; or

4. Revocation of certification.

b) If the CSA determines that provisional certification or certification shall not be issued, that certification shall not be retained, or that an entity's certification shall be revoked, the CSA shall send written notice to DHS and the entity within 30 days after that determination. The notice shall contain the specific requirements with which the entity has not complied, the CSA's proposed action, and the entity's rights as follows:

1. If the entity chooses to appeal the CSA's decision, the entity shall submit a written request for a hearing to the DHS Bureau of Hearings, within 20 days after the date of the notice.

2. If an appeal is initiated by a CMHC with provisional certification or certification, the entity may continue to provide services pending a final administrative decision unless the entity's continued provision of services would present an imminent risk of harm.

3. Hearing Process

A) The DHS rules at 89 Ill. Adm. Code 508 (Administrative Hearings) shall apply.

B) The sole issue at the hearing shall be whether the provider is in compliance with certification requirements set forth in this Part or meets the criteria for revocation of certification set forth in this Part.

C) The burden of proof in hearings conducted pursuant to this Section shall be on the appealing entity.

4. If the final administrative decision pursuant to appeal is that certification shall not be issued or retained, or that an entity's certification shall be revoked, the notice shall specify that the decision shall take effect upon receipt by the entity and that the entity shall not be certified as a CMHC during the pendency of any proceeding for judicial review of the hearing decision, except by court order.

59 Ill. Adm. Code 132.115 Nontransferability

a) CMHC certification is assignable or transferable consistent with the policies and procedures established by the HFS Provider Participation Unit related to the assignment and transferability of an entity's enrollment status with HFS.

b) CMHC certification is not assignable or transferable between or among entity-owned or leased physical plant locations without an on-site review of the location to ensure compliance with this Part.

59 Ill. Adm. Code 132.120 Deemed Status

a) The CSA, in qualifying an entity as a CMHC for participation and enrollment in the Illinois Medical Assistance Program as governed by the Social Security Act and all applicable federal regulations, shall grant deemed status to accredited CMHCs, pursuant to Section 3 of the Community Services Act [405 ILCS 30] and this Section.

1. "Deemed status" means that, if an entity is actively accredited by an Acknowledged Accrediting Organization (AAO) or Standard identified in subsection (a)(2), the CSA shall deem the entity to meet all qualifying requirements of this Part covered by the AAO, as determined by DHS in collaboration with the AAOs, consistent with subsection (b).

2. Acknowledged Accrediting Organizations and Standards

A) The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace IL 60181; Standards for Behavioral Health Care Accreditation; Standards for Hospital Accreditation

B) Council on Accreditation (COA), 45 Broadway, 29th Floor, New York NY 10006; Standards for Private Organization/Behavioral Health Services Accreditation; Standards for Public Agency/Behavioral Health Services Accreditation

C) The Council on Quality and Leadership, 100 West Road, Suite 300, Towson MD 21204; Standards for Quality Assurances Accreditation; Standards for Person-Centered Excellence Accreditation; Standards for Person-Centered Excellence Accreditation with Distinction

D) Commission on Accreditation of Rehabilitation Facilities (CARF), 6951 East Southpoint Road, Tucson AZ 85756-9407; Standards for Behavioral Health Accreditation

E) Healthcare Facilities Accreditation Program (HFAP), 142 E. Ontario Street, Chicago IL 60611; Standards for Behavioral Health Accreditation

b) Determination of Covered Standards. In an effort to afford entities and CMHCs a streamlined certification process, DHS shall complete a process to determine covered standards pursuant to Section 3(d-10) of the Community Services Act;

1. Due to the proprietary nature of the intellectual property retained by the AAO within its standards, DHS shall require the AAO to complete the following documents:

A) Crosswalk of Standards. On and after January 1, 2019, and upon any material changes to any standard, the Crosswalk of Standards shall be completed and submitted by the AAOs with their Attestation of Accrediting Standards. The AAO can provide an updated Crosswalk of Standards, including new standards, at any time. The standards received by the CSA by January 31 of any given year will be considered for deeming at the start of the next State Fiscal Year.

B) Attestation of Accrediting Standards. The Attestation of Accrediting Standards shall be completed, signed and submitted to DHS prior to May 30 of any given year when material changes to the standards that are matched to requirements in this Part are made, in attestation for the following State Fiscal Year to begin on July 1.

C) The Crosswalk of Standards and Attestation of Accrediting Standards shall be submitted to:

DHS Bureau of Accreditation, Licensure and Certification

401 S. Clinton Street, 7th Floor

Chicago IL 60607

2. The CSAs reserve the right to request additional detail regarding any submitted Crosswalk of Standards or Attestation of Accrediting Standards.

3. Entities and CMHCs accredited by an AAO or Standard shall be deemed to have met any certification requirements of this Part that are determined by DHS pursuant to this Section to be covered by the accreditation standards of that AAO.

4. Non-deemed requirements and applicable violations identified in the AAO report shall be reviewed for compliance by the CSA.

c) The CMHC shall demonstrate current accreditation status by submission to the CSA of a certificate of accreditation and the most recent accreditation report.

d) If the CMHC's accreditation is suspended, lost or discontinued, the CMHC shall notify the CSA of that change within 30 days after the effective date of the change.

e) The CMHC shall submit its complete accreditation report to the CSA within 30 days after receipt from the AAO.

f) Deemed status may be nullified in part or in whole by a complaint or report to the CSA that the CMHC is noncompliant with Subpart B, C or D.

g) Upon notification of loss or discontinuance of accreditation or nullification of deemed status, the CSA shall prepare to review the CMHC pursuant to Section 132, applying all of the standards of Subparts B, C and D.

59 Ill. Adm. Code 132.125 Capacity and Organizational Readiness

Entities requesting certification shall demonstrate sufficient capacity and organizational readiness to deliver specialty programs safely, effectively, and in a manner consistent with evidence-based and developmentally appropriate practices.

59 Ill. Adm. Code 132.130 Interdisciplinary Care

Organizations certified as competent in interdisciplinary care have access to the range of professionals and paraprofessionals necessary to meet the variety of mental health needs of individuals in their community. Components of this certification include:

a) Demonstration of collaboration across disciplines, as described in the organization's policy and practices;

b) Demonstration of clinical leadership by an LPHA;

c) Demonstration of team development as informed by the clinical needs of the client;

d) Demonstration of training in evidence-based/evidence-informed practices,

e) Demonstration of the infrastructure necessary to support cross-training and shared learning;

f) Demonstration of the ability to appropriately share client information across multiple providers to support ongoing collaboration, treatment planning, and after care; and

g) Demonstration of a staff-to-client ratio sufficient to meet the needs of individual clients.

59 Ill. Adm. Code 132.135 Assertive Community Treatment Program

Components of this certification include:

a) Demonstration of ability to conduct thorough assessments of individuals with dual diagnoses of mental illness and substance use disorder;

b) Demonstration of ability to provide the evidence-based treatment model for Assertive Community Treatment;

c) Demonstration of ability to meet the six-member-team-based requirements of ACT, including but not limited to:

1. Supervision by a licensed clinician, as defined in Section 132.25, who is the team leader;

2. A full time RN;

3. Program support provided by a psychiatrist and a program administrative assistant;

4. An individual certified in substance abuse treatment;

5. An individual who can provide rehabilitative counseling; and

6. A Certified Recovery Support Specialist;

d) Demonstration that the team can maintain a client-to-staff ratio of no more than 10 clients to one full time staff member, which shall not include the psychiatrist and program administrative assistant;

e) Demonstration of the ability for the ACT team to meet daily (a minimum of four times/week) to conduct an organizational staff meeting; and

f) Demonstration of the ability to meet the training and documentation requirements included in the provider manual.

59 Ill. Adm. Code 132.140 Psychosocial Rehabilitation Program

Components of this certification include:

a) Demonstration of a QMHP providing on-site supervision 50% of the program time;

b) Demonstration that, at minimum, an RSA provides the PSR services;

c) Demonstration of ability to maintain a maximum client-to-staff ratio of 15 to one;

d) Demonstration that, at minimum, one staff member has documented experience and training to provide services and interventions to individuals with co-occurring psychiatric and substance use disorders;

e) Demonstration of ability to provide PSR services on site;

f) Demonstration of coordination of access to the mental health services identified in the individual treatment plan; and

g) Demonstration that training and documentation requirements included in the provider manual are met.

59 Ill. Adm. Code 132.145 Community Support Team Program

Components of this certification include:

a) Demonstration of ability to meet staffing requirement that each team includes a minimum of three and a maximum of six full-time equivalent employees, consisting of no more than eight different staff members.

b) Demonstration of ability to meet the requirement to staff the program with a QMHP who is the full-time team leader and functions as a practitioner on the team.

c) Demonstration of ability to maintain a maximum client-to-staff ratio of 18 to one.

d) Demonstration that the team includes at least one Certified Recovery Support Specialist (CRSS) or Certified Family Partnership Professional (CFPP) as a team member.

e) Demonstration of ability to provide 60% of CST services in a natural setting.

59 Ill. Adm. Code 132.150 Intensive Outpatient Program

Components of this certification include:

a) Demonstration of QMHP providing program supervision and oversight.

b) Demonstration of ability to maintain a maximum client-to-staff ratio of four to one for children and adolescents and eight to one for adults.

c) Demonstration that services are available a minimum of four hours per day, five days per week.

59 Ill. Adm. Code 132.155 Specialty Certification Process

a) The provider shall submit to DHS.DMH.SPC@illinois.gov information that demonstrates compliance with the components listed in this Subpart E for each specialty program in which it is seeking certification.

b) CMHCs shall be awarded deemed status, pursuant to Section 132.120, for components that are covered by accreditation or certification.

c) DMH will review all submitted materials to determine eligibility for special program certification within 90 days after receipt.

1. If the provider is eligible for special program certification, DHS-DMH will issue a certificate to the provider and inform HFS of the certification status.

A) Special program certification will be effective on date of issue.

B) Recertification of a specialty program shall occur annually.

2. If the provider is ineligible for special program certification, DHS-DMH will issue a Notice of Violation that will provide the entity 30 days to remedy the violations.

A) If the entity submits documentation of corrections by the due date indicated on the NOV, DHS-DMH will review and make a determination within 10 days after receipt; and

B) DHS-DMH will notify the entity of the outcome within 15 days.

3. The appeals process for a specialty certification shall follow the process defined in 89 Ill. Adm. Code 140.Table N.

d) DHS-DMH may supply technical assistance through the certification process as deemed necessary.

Chapter I Department of Human Services

Part 145 Permanent Supportive Housing & Bridge Subsidy Model for Persons with Mental Illnesses

59 Ill. Adm. Code 145.10 Purpose

The goal of the Department of Human Services-Division of Mental Health (DHS-DMH) Permanent Supportive Housing (PSH) and Bridge Subsidy model is to provide persons who have serious mental illnesses access to housing that is safe, decent and affordable and within the resources that the tenant has available and that the living environments meet standards of safety. The purpose of this Part is to:

a) Assure that PSH that is paid for by DHS-DMH programs meet all applicable standards for environmental safety and management of the property;

b) Detail the processes and conditions under which DHS-DMH will provide funding for PSH and transitional assistance into that housing;

c) Assure that access to a PSH unit is not contingent on the tenant receiving any specific services or support;

d) Assure that PSH permits the tenant to receive appropriate available services or supports requested in a flexible manner;

e) Assure that monthly case management wellness visits (in-home, at alternative locations, or virtual) to tenants occur by a designated DHS-DMH or State Service Provider; and

f) Define the roles and responsibilities of the DHS-DMH contracted Subsidy Administrators (SA) for the Bridge Subsidy model.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.20 Definitions

Adult – An individual who is 18 years of age or older or a person who is emancipated pursuant to the Emancipation of Mature Minors Act [750 ILCS 30].

Agency – The local DHS or State contracted Service Provider. An "Agency" may also be referred to as "Provider."

Annual Income Re-examination Review – The annual review of the tenant's annual income to determine continued eligibility for rent payments under the PSH models. The annual re-examination is completed to determine the Housing Assistance Payment Contract by calculating applicant's rent share/30% of income toward their rent.

Area Median Income or AMI – The federal Department of Housing and Urban Development's (HUD) calculation of income limits for eligibility in a variety of housing programs.

Bridge Subsidy – Payment by DHS-DMH of a portion of the rent for a PSH unit through the Bridge Subsidy model of PSH until the tenant is able to secure a permanent housing subsidy through a local, State or federal program.

Case Management Services – Assessment, planning, coordination and advocacy services for clients who need multiple services and require assistance in gaining access to and in using mental health, social, vocational, educational, housing, public income entitlements and other community services to assist the client in the community. Case management activities may also include identifying and investigating available resources, explaining options to the client and linking the client with necessary resources.

Code – The Mental Health and Developmental Disabilities Code [405 ILCS 5].

Care Manager – A staff member of a State-contracted Service Provider who is assigned to monitor and/or provide support services to a tenant residing in a DHS-DMH Permanent Supportive Housing and/or Bridge Subsidized unit.

Community Vendor – A DHS contracted entity.

Confidentiality Act – The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

Consumer – An adult with a diagnosis of mental illness as defined in 59 Ill. Adm. Code 132 and/or other disability contributing to eligibility for long-term care. For the purpose of this Part, all consumers who are living in a unit supported in whole or in part with DHS-DMH funding may also be referenced as "tenants".

DCFS or Illinois Department of Children and Family Services – The State child welfare agency responsible for: protecting children who are reported to be abused or neglected and to increase their families' capacity to safely care for them; providing for the well-being of children in care; providing appropriate, permanent families as quickly as possible for those children who cannot safely return home; supporting early intervention and child abuse prevention activities and working in partnerships with communities to fulfill this mission.

Department or IDHS or DHS or The Illinois Department of Human Services – The State agency responsible for providing a wide variety of safety net services to Illinois residents in poverty who are facing other economic challenges or who have any of a variety of disabilities or health challenges.

DHS-DMH or DMH or The Illinois Department of Human Services-Division of Mental Health – A program division of DHS that, as the State Mental Health Authority pursuant to Department of Human Services (Mental Health and Developmental Disabilities) Law [20 ILCS 1710], is responsible for assuring that children, adolescents and adults throughout Illinois have the availability of and access to public-funded mental health services.

Employee – Any person who provides direct services or supports to a tenant of Permanent Supportive Housing at the direction of a DHS contracted vendor. This includes staff on the agency payroll, contractors, interns and volunteers, regardless of number of hours or schedules worked or volunteered.

Engagement Services – Home-based or community-based visits that assist the individual with maintaining their housing, and providing other wrap-around support, including linkage to mental health or substance use recovery support services. Such engagement services shall align with Medicaid-covered tenancy support services, and Medicaid community-based mental health and substance use treatment services, including case management, to ensure alignment with any existing or future Illinois Medicaid benefits, waivers or State plan amendments that include these services, and to maximize any potential federal Medicaid matching dollars that may be available to support engagement services [405 ILCS 125/3]

Fair Market Rent or FMR – Maximum rental amounts payable in specific geographical areas established by HUD.

Family Support Program (FSP) – Formerly known as the Individual Care Grant program, this program of the Illinois Department of Healthcare and Family Services (HFS) provides access to intensive mental health services and supports to youth with a severe emotional disturbance. The goal of the FSP is to support eligible youth and their families by strengthening family stability, improving clinical outcomes, and promoting community-based services.

HIPAA – The Health Insurance Portability and Accountability Act (42 U.S.C. 1320 et seq.) (45 CFR 160 and 164 (2013)).

Homeless – An individual or family meeting the definition used by the U.S. Department of Health and Human Services, Health Resources and Services Administration in Section 330(h)(5)(A) of the Public Health Services Act (42 U.S.C. 254(b)). A homeless individual under this definition is an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations, and an individual who is a resident in transitional housing. This includes individuals who are doubled up with other households [405 ILCS 125/3].

Housing Assistance Payment Contract or HAP Contract – A contract executed between the Subsidy Administration or PSH Provider and the leasing agent (landlord or property management entity).

Housing Dwelling – A house rented according to the same Fair Market Rate as an apartment located in the same geographical area. This type of PSH is applicable in rural areas.

Housing Quality Standards or HQS – HUD's specifications and guidance that outline inspection standards for all PSH units that fall under this Part.

HUD – The U.S. Department of Housing and Urban Development.

Individual at High Risk of Overdose – A person with a substance use disorder who is homeless (or will be homeless upon hospital discharge or correctional facility release) who has:

had three or more hospital inpatient or inpatient withdrawal management or community-based withdrawal management stays for a substance use disorder within the most recent 12-month period;

had three or more stays in a State or county correctional facility in the State of Illinois within the most recent 12-month period; or

been incarcerated in a State or county correctional facility in Illinois for the most recent 12 consecutive months; or

had one or more drug overdoses in the last 12 months [405 ILCS 125/3].

Individual at High Risk of Unnecessary Institutionalization – A person who has a serious mental illness who is homeless (or will be homeless upon hospital discharge or correctional facility release) and who has:

had three or more psychiatric inpatient hospital admissions within the most recent 12-month period;

had three or more stays in a State or county correctional facility in the State of Illinois within the most recent 12-month period; or

been incarcerated in a State or county correctional facility in Illinois for the most recent 12 consecutive months; or

had a disability determination due to a serious mental illness and has been incarcerated in a State or county correctional facility in Illinois within the most recent 12 consecutive months [405 ILCS 125/3].

Landlord Property Management Entity – The owner of one or more units/apartments receiving or approved to receive rental payments from DHS‑DMH, inclusive of private market and not-for-profit housing providers.

Long Term Care Facility or LTC Facility – A facility designated as a nursing home under the Nursing Home Care Act [210 ILCS 45].

Open Round – The point in time when DHS-DMH allows applications to be submitted for consideration of a Bridge Subsidy, excluding a court order, lawsuit or settlement.

Permanent Supportive Housing or PSH – A self-contained (inclusive of kitchen and bathroom facilities) unit that is decent, safe and affordable community-based housing. The tenant has rights of privacy and access; holds a lease, sublease, or occupancy agreement; and has full rights of tenancy under State and local landlord and tenant laws. Any services or supports received are voluntary, flexible and designed to meet the tenants' needs and preferences.

Provider – The local DHS or State contracted Service Provider. A Provider may also be referred to as "Agency."

PSH Provider – The DHS-DMH contracted entities responsible for conducting income verifications, unit inspections, development of HAP contracts or other agreements with landlords, and ongoing rental payments in accordance with Section 145.70 through a model of PSH other than the Bridge Subsidy model.

Rental Assistance – The DHS-DMH subsidized rental amount paid to a landlord for a unit occupied and leased by a tenant eligible and approved for a DHS-DMH Bridge Subsidy or PSH program utilizing a similar model of housing assistance.

Rental Payments – Any payments made to a landlord in accordance with a lease agreement for a housing unit in which an individual or family receiving services from a Provider is residing, whether the executed lease is between the landlord and the Provider (leasing) or between the landlord and the tenant (rental assistance).

Service Provider – An entity contracted by DHS or the State to provide publicly-funded support services to residents of Permanent Supportive Housing.

Serious Mental Illness – Meeting both the diagnostic and functioning criteria consistent with the definition of Serious Mental Illness in the most current edition of the Illinois Department of Human Services/Division of Mental Health Community Mental Health Provider Manual [405 ILCS 125/3].

Site – Any building, under one continuous roof, in which a tenant receiving DHS‑DMH Bridge rental assistance lives. This includes houses, apartment buildings, duplexes and other living arrangements owned, leased or managed by a rental agent, management company, property owner, landlord or development entity.

Subsidy Administrator or Subsidy Administration or SA – The DHS-DMH contracted entities responsible for conducting income verifications, unit inspections, development of HAP contracts with the landlord, and ongoing subsidized rental payments in accordance with Section 145.70 through the Bridge Subsidy model.

Substance Use Disorder – As defined in Section 1-10 of the Substance Use Disorder Act [20 ILCS 301].

Tenant – For the purpose of this Part, the words "tenant" and "consumer" are interchangeable. The tenant must be a consumer of a DHS or State contracted Service Provider and be in one of the priority populations defined in Section 145.110(g).

Transition Assistance Funds or TAF – A one-time allocation, as determined by DHS‑DMH, for the specific purpose of paying security deposits and utility connections (but not for arrearages) and to assist the tenant in purchasing basic allowable household needs. Transition Assistance Funds used for the purchase of obtaining allowable household goods are handled by the Care Manager (see Section 145.200).

Unit – A rental apartment (efficiency, studio, one bedroom or multiple bedroom apartments) or housing dwelling that receives DHS-DMH funded rental payments. Housing intended as transitional or temporary housing does not qualify as a PSH Bridge unit.

History

• Source: Amended at 47 Ill. Reg. 7096, effective May 15, 2023

59 Ill. Adm. Code 145.30 Compliance with Federal and State Laws

Notwithstanding anything to the contrary, this Part shall be construed in conformity and compliance with applicable federal and State law.

59 Ill. Adm. Code 145.40 Nondiscrimination

Landlords and property management entities shall comply with the applicable provisions of the Illinois Human Rights Act [775 ILCS 5] and the regulations under that Act (see 38 Ill. Adm. Code 800; 44 Ill. Adm. Code 750; 56 Ill. Adm. Code 2500, 2510, 2530 and 2540; and 71 Ill. Adm. Code 2300), the Fair Housing Act (42 USC 3601), section 504 of the Rehabilitation Act of 1973 (29 USC 794), the Illinois Accessibility Code (71 Ill. Adm. Code 400), and all other State, federal and local statutes and regulation concerning discrimination and fair housing.

59 Ill. Adm. Code 145.50 Permanent Supportive Housing Models

All PSH models will utilize Scattered Sites (as described below). The DMH PSH Bridge Subsidy model provides rental payments for all of the following:

a) Scattered Sites

Dwellings that exist in the private and public rental market for which the tenant holds the lease and rental payment agreements are made directly with the property owner. Units are not concentrated in any one building. Living arrangements in scattered-site housing include:

1. Single room occupancy (SRO) or studio/efficiency apartments that have self-contained kitchens and bathrooms;

2. One-bedroom apartments;

3. Two-bedroom or larger shared apartments as needed to accommodate larger households, live-in aides, or storage of necessary medical equipment (with no more than two unrelated consumers per unit under an arrangement agreed to by both consumers); or

4. Single family homes.

b) Project Based Developments

Multifamily dwellings that were developed and financed as a project for the purpose of providing supportive or affordable housing. The tenant holds the lease and rental assistance agreements are made directly with the landlord or property owner. If the project development receives public financing, in addition to funding from DHS-DMH, the funding regulations and tenant selection plans of the public funding entity (e.g., HUD) supersedes this Part. Living arrangements in project-based developments include:

1. SRO or studio/efficiency apartments that have a self-contained kitchen and bathroom; or

2. One-bedroom apartments or two-person two-bedroom shared apartments.

c) Master Leasing

Master leasing is a flexible resource that creates a variety of housing options in terms of housing type, density and location. This model is based on mutually beneficial relationships with private landlords or property management entities for which long-term agreements are made with guaranteed payment in exchange for discounted rental rates. The master leasing approach shall be focused primarily on existing rental housing to secure a targeted number of rental units as outlined in Section 145.210. DHS-DMH will utilize the SA entity to conduct all activities in accordance with Section 145.70.

History

• Source: Amended at 47 Ill. Reg. 7096, effective May 15, 2023

59 Ill. Adm. Code 145.60 Permanent Supportive Housing Service Linkage

a) All DHS-DMH PSH models assure that needed services and supports are available to the tenant living in a PSH/Bridge Subsidy unit.

1. The tenant should have access to a flexible and comprehensive array of recovery-oriented services and supports to assist the tenant in achieving a successful community adjustment.

2. Services shall be elective, support the tenant's clinical/therapeutic or treatment needs to function and live independently in the community, and must be based on medical necessity. All services shall be provided in mutual agreement with the person receiving the services.

b) As part of the enrollment process for PSH, the tenant will be required to consent to case management visits conducted by the DHS or State contracted vendor at the tenant's residence, at an alternatively arranged location, or virtually with assistive technology to help determine the wellness of the tenant.

c) Service Providers are encouraged to proactively seek to engage tenants in on-site and community-based services and supports. In addition, Care Managers are encouraged to work with landlords, as appropriate, to develop and execute coordinated strategies for addressing issues that may threaten housing stability for the tenant, such as mental health crisis, substance use and relapse.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.70 Administration Requirements

As determined by DMH, the SA or PSH Provider shall:

a) Serve as the authorized entity for the administration of rental payments to landlords and property management entities.

b) Fulfill the roles outlined in Subpart B, including income certification and annual income recertification, unit inspections, rent reasonableness determinations, and lease review. Specifically, the SA or PSH Provider shall:

1. Conduct initial and annual income verification;

2. Conduct an inspection of the unit in consideration for leasing, using HUD HQS and annual reinspection upon lease renewal. The HQS can be found at 24 CFR 982.401;

3. Where the lease is held by the tenant, initiate a HAP contract with the leasing agent, landlord or property management entity, as a commitment to pay the remaining rental balance;

4. Disburse and ensure that rental payments are received by the landlord and property management entities by the established rent due date;

5. Maintain a database and analyze data on the number of PSH housing units utilized by tenants; and

6. Report to DMH, as requested, all fiscal and tenant information and participate in all audits referred by DMH.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.100 Tenant Rights and Choices

a) To assure that tenant rights are protected and that owners/landlords who establish leases for PSH and/or Bridge subsidized units comply with written law, providers and rental agents (landlords or property management entities) shall ensure that:

1. The tenant's rights are protected in accordance with Chapter 2 of the Mental Health and Developmental Disabilities Code;

2. The tenant's right to confidentiality is governed by the Mental Health and Developmental Disabilities Confidentiality Act and HIPAA;

3. The tenant has full rights to make choices concerning the level of any services received;

4. The tenant has full rights to select a service provider from which services are delivered;

5. The tenant has full rights to identify the geographic or community areas where he/she wants to establish residency;

6. The tenant has rights to be free from abuse, neglect and exploitation; and

7. The tenant has rights to contact DMH or its designee and to be informed of DMH policy or protocol for filing complaints or grievances.

b) The information in this Section shall be explained by the Service Provider responsible for conducting the case management wellness visits, using language or a method of communication that the tenant understands. Documentation of the explanations shall be placed in the tenant's record maintained by the contracted Service Provider.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.110 Eligibility Criteria for the Dhs-Dmh Permanent Supportive Housing Bridge Subsidy Model

a) Individuals eligible for the PSH Bridge Subsidy model shall meet the following criteria:

1. Have a clinical diagnosis of serious mental illnesses (SMI) with an exception only for anyone identified as a Colbert Class Member, including functional duration, history and severity, for one or more of the following diagnoses:

A) Schizophrenia;

B) Schizophreniform Disorder;

C) Schizo-Affective Disorder;

D) Delusional Disorder;

E) Psychotic Disorder;

F) Bipolar Disorders;

G) Cyclothymic Disorder;

H) Disruptive Mood Dysregulation Disorder;

I) Major Depressive Disorders;

J) Obsessive-Compulsive Disorder;

K) Anorexia Nervosa;

L) Bulimia Nervosa;

M) Post-Traumatic Stress Disorder;

2. Be an adult;

3. Have a current household income at or below 30% of Area Median Income (AMI) as defined by HUD;

4. Be a current Medicaid recipient;

5. Be on a current Public Housing Authority waiting list for a Housing Choice Voucher (HCV) or agree to register or apply for an HCV or comparable permanent rental subsidy when registration or application opportunity becomes available;

6. Currently not receiving rental assistance under a local, State or federal housing program; and

7. Meet one of the following criteria:

A) A resident of an LTC facility as described under the Nursing Home Care Act;

B) At risk of placement in an LTC facility described under the Nursing Home Care Act;

C) A patient of an Illinois State-operated psychiatric hospital for eight months or longer;

D) An aging-out adolescent or young adult transitioning from the HFS Family Support Program (FSP);

E) A DCFS ward aging out of guardianship (89 Ill. Adm. Code 306);

F) A resident of a DHS-DMH contracted 24-hour Supervised Transitional Residential or Supported Residential setting including Mental Health Community Integrated Living Arrangement (59 Ill. Adm. Code 115).

G) Experiencing homelessness as defined in this Part.

b) Potential tenants with criminal justice histories may be eligible for the PSH Bridge Subsidy model contingent on clinical documentation supporting his or her appropriateness to live independently in the community without 24-hour supervision, as determined by DMH.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.115 Eligibility Criteria for the Housing Is Recovery Pilot Program Model

Individuals eligible for the Housing is Recovery Pilot Program model shall:

a) Meet one of the following criteria:

1. An individual at high risk of unnecessary institutionalization who is 18 years of age or older or is aging out of guardianship under DCFS, and who is eligible to enroll in, or is enrolled in, Medicaid for the purposes of receiving mental health treatment pursuant to 89 Ill. Adm. Code 140.

2. An individual at high risk of overdose who is 18 years of age or older or is aging out of guardianship under DCFS, and who is eligible to enroll in, or is enrolled in, Medicaid for the purposes of receiving substance use treatment. [405 ILCS 125/10]

b) Have a current household income at or below 30% of Area Median Income (AMI) as defined by HUD;

c) Be on a current Public Housing Authority waiting list for a Housing Choice Voucher (HCV) or agree to register or apply for an HCV or comparable permanent rental subsidy when registration or application opportunity becomes available;

d) Be placed on, or agree to register for, or apply to be placed on the Illinois Housing Development Authority's Statewide Referral Network; and

e) Currently not be receiving rental assistance under a local, State, or federal housing program.

History

• Source: Amended at 49 Ill. Reg. 2353, effective February 18, 2025

59 Ill. Adm. Code 145.120 Housing Search Criteria

a) Potential tenants may choose the geographic location where they would like to reside.

b) Housing location assistance will be provided by a DMH contracted vendor.

c) Within 60 days after approval to locate and lease a PSH Bridge Subsidy model unit, the potential tenant must select and identify a unit that passes established HQS inspection standards and rent reasonableness criteria.

d) Extensions beyond the 60 days to select and identify a unit for a PSH Bridge Subsidy will be granted by DMH on a case-by-case basis if the potential tenant has actively sought housing during the 60-day period and can reasonably be expected to complete a successful search for a suitable housing unit during the extended period.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.130 Tenant Income and Documentation

Income is any money earned or benefits payment received by the tenant. Adjusted gross income is the amount of income earned after any deductions are made. A tenant rent payment amount shall be calculated based on adjusted gross income over the most recent three-month period.

a) Income that is to be considered when calculating a tenant's household gross income includes:

1. Social Security Supplemental Income;

2. Social Security Disability Income;

3. Earned income;

4. Self-employment/business income;

5. Interest and dividend income or income from other assets or family sources;

6. Pension/retirement income;

7. Unemployment income;

8. Temporary Assistance for Needy Families (TANF); and

9. Armed Forces income.

b) Income that shall not be considered when calculating tenant's household gross income includes:

1. Medical expense reimbursements;

2. Deferred and lump sum Social Security and SSI payments;

3. Self-Sufficiency Program income;

4. Student financial aid;

5. Special pay to a family member serving in the Armed Forces who is exposed to hostile fire;

6. Income of full-time students;

7. Income tax and property tax refunds;

8. Stipends or allowances to persons with disabilities for basic needs and expenses associated with integrated and independent living situations or as incentives for participation in vocational service programs that are funded by a government entity; and

9. Other temporary, nonrecurring or sporadic income.

c) The household must provide the SA or PSH Provider with written documentation of the specific sources of income included in the gross income calculation.

d) The SA or PSH Provider shall gather, maintain and determine the validity of the documentation provided and used to calculate the tenant's rental contribution.

e) If a tenant does not have income due to a psychiatric or other disability, the tenant shall be offered the opportunity for assistance with filing a Supplemental Security Income (SSI)/Social Security Disability Income (SSDI) Outreach, Access, and Recovery (SOAR) application by the PSH Provider or another DMH-contracted provider. A tenant is not required to apply for a disability determination.

History

• Source: Amended at 47 Ill. Reg. 7096, effective May 15, 2023

59 Ill. Adm. Code 145.140 Tenant Rent Payments

a) Tenants shall not be required to pay more than 30% of their adjusted household gross income for rent for assisted units that meet rent reasonableness and FMR criteria (see Section 145.150), including an allowance for any consumer paid utilities.

b) The rental payment amount shall be determined by the SA or PSH Provider and communicated and documented to both the tenant and the landlord or property management entity, and reflected on the HAP contract when the lease is held by the tenant.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.150 Amount of Rental Assistance

a) The amount of rental assistance for each unit shall be the difference between the amount of the rent for the unit and the tenant's rent payments.

b) When identifying the appropriateness of the amount of rent to be paid for a unit, the SA or PSH Provider shall complete a rent reasonableness determination. Prior to approval and signing of a lease, data shall be gathered by the SA or PSH Provider on a variety of units and used to make a comparability determination on the affordability and suitability of the unit. The unit must pass the rent reasonableness determination to be deemed appropriate for PSH rental payments.

c) Rents shall not exceed the Fair Market Rent (FMR) established for the geographical area, as determined annually by HUD. An exception exists if rents throughout the local community are above FMR and it is highly unlikely that there will be units available for inclusion in PSH. In these situations, if a tenant seeks to utilize a housing unit with a rent level greater than the FMR, the SA or PSH Provider must document the circumstances and obtain the approval of DMH.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.160 Rent Redeterminations

a) The tenant shall notify the SA or PSH Provider within 30 days if tenant income increases by 75% or more. Increases of less than 75% shall be reported during the Annual Income Re-examination Review process.

b) If a decrease in income occurs, the tenant should contact the SA or PSH Provider immediately. The SA or PSH Provider shall then recalculate the tenant's portion of the rent for the next rent payment based on the decreased income amount.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.170 Tenants with Incomes Exceeding 30% Ami (over-Income)

The SA or PSH Provider shall annually recertify the income of each tenant's household for the most recent three months prior to the renewal of the lease. If the annual household income exceeds 30% of AMI, the tenant is no longer eligible for PSH, and a transition plan shall be developed among the SA or PSH Provider, the community vendor and the tenant.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.180 Rent Increases

Upon request of the landlord or property management entity, DMH may allow an annual increase in the rent for the respective unit.

a) The rent increase must not exceed the existing rent multiplied by the most recent HUD Annual Adjustment Factor that can be found at http://www.huduser.org/ portal/datasets/aaf.html.

b) Landlords must address any proposed increases to leases via requests to the SA or PSH Provider in accordance with leases and contracts.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.190 Housing Inspections

Before the tenant signs a lease, and annually thereafter, it shall be the responsibility of the SA to conduct housing inspections of the unit or the responsibility of the PSH Provider to ensure that housing inspections are completed to determine compliance with HUD's HQS. In addition to any violations of compliance with a local code enforcement bureau, the HQS consists of the following performance requirements:

a) Sanitary bathroom facilities;

b) Food preparation and refuse disposal;

c) Space and security;

d) Thermal environment;

e) Illumination and electricity;

f) Structure and materials;

g) Interior air quality;

h) Water supply;

i) Lead-based paint;

j) Private access;

k) Site and neighborhood;

l) Sanitary conditions (the unit must be free of vermin); and

m) Smoke detectors.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.200 Transition Assistance Funds Provided Under Psh/Bridge Subsidy Model and Housing Is Recovery Pilot Program Model

a) DMH may provide one-time Transition Assistance Funds (TAF), identified as a set amount to be used solely for the purpose of assisting individuals who are in the process of moving into a PSH unit that has a secured lease. These funds are to provide basic move-in expenses, obtain basic household items, pre-approved by DMH, in addition to the payment of security deposit and utility connection fees, excluding arrearages.

b) TAF are processed by the designated DHS-DMH contracted Service Provider and released to the Care Manager upon receipt of supporting documentation approved by the respective DMH program staff. TAF are restricted in use, only available to DHS-DMH contacted Service Providers as specified in their contacts, and may only be applied for the purpose of assisting the tenant in transitioning and moving into a PSH unit. Responsibility for appropriate expenditure of TAF rests with the DHS-DMH contracted Service Provider. The tenant, family members and guardians shall have no access to these funds.

c) TAF shall be accessed and approved through an established DMH process. TAF cannot be used to pay arrearages.

d) TAF may be utilized for items including, but not limited to:

1. Security deposits;

2. Unit application fees;

3. Utility activation deposits;

4. Furniture;

5. Bedding;

6. Small appliances; and

7. Cleaning equipment and supplies.

History

• Source: Amended at 47 Ill. Reg. 7096, effective May 15, 2023

59 Ill. Adm. Code 145.210 Leases

Under the PHS Bridge Subsidy model, the lease for the housing unit is held by the tenant. Flexible leasing options may be made available through alternative PSH programs/models funded by DMH, but PSH Providers will be responsible for compliance with leasing terms as stipulated in their executed contract and/or PSH program-specific guidance provided by DMH. There are three options to obtain leases in a PSH Bridge Subsidy model:

a) Under Tenant Executed Leases:

1. The landlord or property management entity shall enter into a direct written lease with each tenant.

2. The lease shall have a term of no less than 12 months (unless reviewed and approved by DMH on a case-by-case basis) and shall contain a HAP contract.

3. The SA shall review each lease to certify to DMH that the lease does not violate any provisions of State or local law or this Part.

4. The landlord or property management entity shall provide each tenant and the SA with a copy of the lease and execute the HAP contract with the SA.

5. The tenant is responsible for his/her portion of the rent up to 30% of his/her income (based on the SA's income verification process) paid directly to the landlord. The SA will pay the remaining amount of the rental balance.

6. Lease responsibilities for the unit will rest with the tenant.

b) Under an Executed Master Lease Agreement:

1. The SA under authorization of DMH, will execute a HAP contract with the landlord or property management entity for a select number of rental units that will be held available until a lease is signed with a prospective tenant.

2. The landlord or property management entities shall enter into a lease with the tenant that shall have a term of no less than 12 months (unless other lease terms are approved by DMH).

3. The SA shall review each lease to certify to DMH that the lease does not violate any provisions of State or local law or this Part.

4. The tenant is responsible for his/her portion of the rent up to 30% of his/her income (based on the SA's income verification process) paid directly to the landlord. The SA will pay the remaining amount of the rental balance.

5. Lease responsibilities for the unit will rest with the tenant.

c) Under Project Based Leases:

1. DMH can partner with developers, property managers or landlords to identify apartment unit resources that are either scattered site or within a designated project.

2. This partnership would be facilitated under all PSH Bridge Subsidy processes in order to set up a leasing arrangement for an identified number of unit resources.

3. The landlord or property management entities shall enter into a lease with the tenant that shall have a term of no less than 12 months (unless other lease terms are approved by DMH).

4. The contracted SA will monitor this arrangement for either scattered site or project-based units.

5. The tenant is responsible for his/her portion of the rent up to 30% of his/her income (based on the SA income verification process) paid directly to the landlord. The SA will pay the remaining amount of the rental balance.

6. The SA shall review each lease to certify to DMH that the lease does not violate any provisions of State or local law or this Part.

7. Lease responsibilities for the unit will rest with the tenant.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.220 Contracts with Landlords or Property Management Entities

HAP contracts are required for DHS-DMH funded PSH units where the tenant holds the lease. Flexible leasing options may be made available through alternative PSH programs/models funded by DMH, but PSH Providers will be responsible for compliance with leasing terms and other contractual arrangements as stipulated in their executed contract and/or PSH program-specific guidance provided by DMH. For rental assistance/subsidy-based units:

a) The SA or PSH Provider shall enter into a HAP contract with each landlord or property management entity for all units that the landlord has negotiated to receive rental payments.

b) The HAP contract shall provide that the SA or PSH Provider will make rental assistance payments to the landlords as instructed by DMH.

c) The HAP contract shall identify the landlord and SA or PSH Provider.

d) The term of the HAP contract shall not be less than 12 months (unless pre-approved).

e) The units to receive rental assistance must be identified by address and unit designation.

f) The rent amount to be charged is to be set forth for each unit and will identify the tenant's portion of rent (all contracts shall not be greater than the FMR or rent amount approved by DMH).

g) The landlord shall abide by the requirements of this Part as detailed in the HAP contract.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.230 Subsequent Tenant Unit Relocations

a) As the end of the lease agreement approaches, and with the consent of the landlord, the tenant shall have a choice to remain in the current unit if the tenant wishes to do so.

b) If the tenant chooses to move, the tenant shall notify the landlord, SA or PSH Provider, and Care Manager no later than 60 days before the lease end date to facilitate a new housing search.

c) If the tenant elects to move, he/she will be responsible for paying any newly incurred security deposit and utility connections, unless there is an extenuating circumstance. Extenuating circumstances will be reviewed by DMH on a case-by-case basis. The Department reserves the right to determine the parameters of extenuating circumstances.

d) To receive rental payments, all units must pass HQS inspection and the rent reasonableness determination by the SA or PSH Provider before a lease can be signed and Bridge Subsidy payment approved.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.240 Temporary Tenant Absences

a) For tenants in PSH programs other than the Housing is Recovery Pilot Program:

1. A tenant shall continue to maintain eligibility for PSH during brief absences lasting no longer than 90 days.

2. Tenants shall continue to maintain eligibility for PSH up to 90 days in cases of required psychiatric or medical hospitalization or temporary absences from the unit, as reviewed and approved by DMH.

3. Extensions beyond 90 days may be granted by DMH when there is a demonstrated likelihood that the tenant will return to the unit within an additional 30-day period.

b) For tenants in the Housing is Recovery Pilot Program:

1. A tenant shall continue to maintain eligibility for the subsidy during brief absences lasting no longer than six consecutive months.

2. During a stay in a LTC Facility, Institution for Mental Disease (IMD), Specialized Mental Health Rehabilitation Facility (SMHRF), residential substance use disorder treatment program, or correctional facility of less than six months, the program will continue to pay the subsidized portion of the rent.

3. A subsidy does not terminate if the subsidy holder is required to move multiple times due to landlord eviction or does not engage in treatment. Termination shall occur only as outlined in Section 145.250.

History

• Source: Amended at 47 Ill. Reg. 7096, effective May 15, 2023

59 Ill. Adm. Code 145.250 Program Terminations and Appeals

a) A tenant may be terminated from PSH, after all attempts at tenant participation and mitigation have failed, under any one or more of the following circumstances, unless a reasonable modification of this policy is necessary to prevent the exclusion or denial of benefits of the program and service on the basis of disability pursuant to Title II of the Americans with Disabilities Act (42 U.S.C. 12101):

1. Missing their portion of the rent payment three times or more within an existing current lease period (late payments are not an immediate factor);

2. Refusing to pay their portion of the rent as stipulated in the lease agreement;

3. Refusing to allow or respond to requests for case management wellness visits (in-home, at alternative locations, or virtual) as deemed appropriate by the contracted Service Provider;

4. Serious and repeated lease violations that pose a threat or serious hazard to other residents of the rental property;

5. Convictions by a court of law for a felony offense;

6. Failure to accept an offer for a permanent rental subsidy when one is made available;

7. Receiving rental payments while residing in a unit owned by any family member of the tenant (unless DMH has determined and approved the rental of the unit as providing reasonable accommodations for a person with a disability);

8. Subleasing the unit, assignment of the lease or transfer of the unit;

9. Excessive and continuous damage to the unit or premises by the tenant or any guest to the unit or premises;

10. Engaging in or allowing a guest to engage in any behavior that disturbs the peaceful and quiet enjoyment by others of the premises and the neighborhood;

11. Engaging in or allowing a guest to engage in drug-related criminal activity or violent criminal activity or other criminal activity that threatens the health, safety or right to peaceful enjoyment of other residents and persons residing in the immediate vicinity of the premises;

12. Illegal possession or use of a firearm or aggravated assault weapon in violation of federal, State or local criminal or civil laws;

13. Failure to complete an Annual Income Re-examination Review with the SA or PSH Provider; and

14. Fraud, including falsifying income, unauthorized occupants in the housing unit, or deliberate failure to report changes in household composition that would affect program eligibility.

b) If a termination occurs from PSH:

1. The tenant shall be responsible for 100% of the total rent amount as of the date that the final termination determination notice is released by the SA or PSH Provider and as authorized by DMH; and

2. The SA shall inform the landlord in writing directly of the tenant's exit from PSH and the termination of rental payments.

c) A tenant has the right to appeal a termination decision. The tenant or their representative must submit a written notice for an appeal to DMH. This notice is to be received by DMH within 15 calendar days from receipt of the Bridge Subsidy or PSH termination letter. The notice must contain a clear statement disputing the reasons for termination. The notice is to be mailed to:

Housing Coordinator

Department of Human Services-Division of Mental Health

122 S Michigan Avenue, 20th Floor

Chicago IL 60603

d) DMH will convene an appeal hearing within 15 days after receipt of the appeal notice. The appeal hearing committee members shall be composed of the DMH Housing Coordinator, the Deputy Director of Systems Rebalancing, or the Deputy Director of Community Programs and the assigned SA or PSH Provider.

e) The tenant and/or their representative will be notified of the hearing by phone and mail. At least three attempts at phone contact should be made to ensure that the tenant and/or their representative are aware of the hearing. The tenant or representative may be present to provide written or verbal objections to the termination at the time of the hearing.

f) DMH will issue its written determination decision to the tenant and/or representative within two work days after the appeal hearing.

g) Depending on the circumstances of termination, a former PSH tenant may reapply for a Bridge Subsidy, when an open round becomes available, by submitting a formal letter of request to the DMH Housing Coordinator, accompanied with a letter of support from a State contracted Service Provider.

History

• Source: Amended at 47 Ill. Reg. 7096, effective May 15, 2023

59 Ill. Adm. Code 145.260 Forms and Procedures for Permanent Supportive Housing

DMH may prepare, use, supplement and amend forms, agreements, documents and procedures as may be necessary to implement PSH and the Bridge Subsidy model. Except as otherwise permitted by this Part or by DMH, all providers must use the forms prepared by DMH.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.300 Record Submission and Retention

Landlords shall maintain monthly records of tenant's rental assistance payments received for each unit, including unit vacancies under Master Leasing Agreements, for the term of the lease. Landlords shall notify the SA or PSH Provider by phone or mail within seven days after the rent due date if the tenant's portion of the rent has not been received.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.310 Lead-Based Paint

a) All units eligible for PSH must be free of lead-based paint hazards.

b) Before the execution of the lease, the responsible landlord or property management entity shall certify to the SA or PSH Provider that the housing unit contains no lead-based paint hazards.

c) For units in buildings constructed prior to January 1, 1978, this certification must include assurance that the landlord or property management entity has visually inspected the unit for lead-based paint hazards and, if lead hazards have been found, has performed remediation, abatement or encapsulation in conformance with federal and State law (Lead Poisoning Prevention Act [410 ILCS 45]).

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.320 Housing Quality Standards

Landlords must maintain each unit in compliance with the HQS that can be found at 24 CFR 982.401.

59 Ill. Adm. Code 145.330 Compliance with State and Local Laws

Landlords must certify to the SA or PSH Provider that the lease for each unit receiving rental assistance does not violate State or local laws or this Part.

History

• Source: Amended at 45 Ill. Reg. 11027, effective August 30, 2021

59 Ill. Adm. Code 145.340 Eviction

Landlords shall have the right to evict a tenant from a unit for good cause, as permitted through the lease agreement in accordance with State and local laws.

Part 150 Mental Health Reporting for Firearm Owner's Identification Card

59 Ill. Adm. Code 150.10 Purpose

a) The requirements set forth in this Part establish the criteria for reporting by various providers under Sections 6-103.2 and 6-103.3 of the Mental Health and Developmental Disabilities Code [405 ILCS 5] and Section 12(b) of the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

b) The requirements set forth in this Part establish the procedures by which the Department of Human Services (DHS) shall collect information that the Illinois State Police (ISP) will be able to use to determine eligibility or continued eligibility for a Firearm Owner's Identification Card under Section 8 of the Firearm Owner's Identification Card Act (FOID Act) [430 ILCS 65].

59 Ill. Adm. Code 150.20 Incorporation by Reference

Any rules or standards 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.

59 Ill. Adm. Code 150.30 Definitions

For the purposes of this Part, the following terms are defined:

"Adjudicated a mentally disabled person" – The person is the subject of a determination by a court, board, commission or other lawful authority that the person, as a result of marked subnormal intelligence, mental illness, mental impairment, incompetency, condition or disease:

presents a clear and present danger to himself, herself or others;

lacks the mental capacity to manage his or her own affairs or is adjudicated a disabled person as defined in Section 11a-2 of the Probate Act of 1975 [755 ILCS 5];

is not guilty in a criminal case by reason of insanity, mental disease or defect as provided in Section 5-2-4 of the Unified Code of Corrections [730 ILCS 5];

is guilty but mentally ill, as provided in Section 5-2-6 of the Unified Code of Corrections;

is incompetent to stand trial in a criminal case as provided in Article 104 of the Code of Criminal Procedure [725 ILCS 5];

is not guilty by reason of lack of mental responsibility pursuant to Articles 50a and 72b of the Uniform Code of Military Justice (10 USC 850a and 876b);

is a sexually violent person under Section 5(f) of the Sexually Violent Persons Commitment Act [725 ILCS 207];

has been found to be a sexually dangerous person under the Sexually Dangerous Persons Act [725 ILCS 205];

is unfit to stand trial under the Juvenile Court Act of 1987 [705 ILCS 405];

is not guilty by reason of insanity under the Juvenile Court Act of 1987;

is subject to involuntary admission as an inpatient as defined in Section 1-119 of the Mental Health and Development Disabilities Code [405 ILCS 5];

is subject to involuntary admissions as an outpatient as defined in Section 1-119.1 of the Mental Health and Developmental Disabilities Code;

is subject to judicial admission as set forth in Section 4-500 of the Mental Health and Developmental Disabilities Code; or

is subject to the provisions of the Interstate Agreements on Sexually Dangerous Persons Act [45 ILCS 20] (see Section 1.1 of the FOID Act).

"Clear and present danger" – a person who:

communicates a serious threat of physical violence against a reasonably identifiable victim or poses a clear and imminent risk of serious physical injury to himself, herself or another person as determined by a clinician; or

demonstrates threatening physical or verbal behavior, such as violent, suicidal or assaultive threats, actions or other behavior, as determined by a clinician, school administrator or law enforcement official (see Section 1.1 of the FOID Act).

"Clinical psychologist" – a person licensed by the Illinois Department of Financial and Professional Regulation under the Clinical Psychologist Licensing Act [225 ILCS 15] (see 405 ILCS 5/1-103).

"Clinical social worker" – a person who:

has a master's or doctoral degree in social work from an accredited graduate school of social work; and

has at least 3 years of supervised postmaster's clinical social work practice that shall include the provision of mental health services for the evaluation, treatment and prevention of mental and emotional disorders (see 405 ILCS 5/1-122.1).

"Clinician"– a physician, psychiatrist, clinical psychologist or qualified examiner.

"Confidentiality Act" – the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

"Determined" – the mandated reporter has completed a formal structured evaluation and/or assessment that, in his or her clinical judgment, supports the diagnosis of developmentally disabled and/or intellectual disability.

"Developmentally disabled" – a person with a disability that is attributable to any other condition that results in impairment similar to that caused by an intellectual disability and that requires services similar to those required by intellectually disabled persons. The disability must originate before the age of 18 years, be expected to continue indefinitely, and constitute a substantial handicap (see Section 1.1 of the FOID Act). This can include an intellectual disability, autism, cerebral palsy and epilepsy.

"DHS" – the Illinois Department of Human Services.

"DPH" – the Illinois Department of Public Health.

"FOID Act" – the Firearm Owner's Identification Card Act [430 ILCS 65].

"Intellectual disability" – significantly subaverage general intellectual functioning that exists concurrently with impairment in adaptive behavior and that originates before the age of 18 years.

"Involuntarily admitted" – has the meaning prescribed in Sections 1-119 and 1-119.1 of the MHDD Code (see Section 1.1 of the FOID Act).

"MHDD Code" – the Mental Health and Developmental Disabilities Code [405 ILCS 5].

"Mental health facility" – any licensed private hospital or hospital affiliate, institution or facility, or part thereof, and any facility, or part thereof, operated by the State or a political subdivision thereof that provides treatment of persons with mental illness and includes all hospitals, institutions, clinics, evaluation facilities, mental health centers, colleges, universities, long-term care facilities, and nursing homes, or parts thereof, that provides treatment of persons with mental illness whether or not the primary purpose is to provide treatment of persons with mental illness (see Section 1.1 of the FOID Act). For purposes of this Part, an inpatient mental health facility includes:

State-operated mental health facility as described in Section 4 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705];

Psychiatric hospital as authorized by DPH;

The specific units of a general hospital providing psychiatric services as authorized by DPH; and

Residential settings. Residential settings include:

Nursing homes or long-term care facilities that are considered Institutes for Mental Disease as that term is described in section 1905(i) of Title XIX of the Social Security Act (42 USC 1396d(i));

The specific units of a nursing home or long-term care facility authorized by DPH to provide psychiatric or behavioral healthcare;

The specific units of a nursing home or long-term care facility held out by the facility as providing psychiatric or behavioral health care;

Specialized Mental Health Rehabilitation Facilities as described in the Specialized Mental Health Rehabilitation Act of 2013 [210 ILCS 49]; and

A supervised transitional residential program funded by the DHS Division of Mental Health (DHS-DMH) when that level of service has been determined to be medically necessary as that term is defined by 59 Ill. Adm. Code 132.

For the purposes of this Part, an outpatient mental health facility includes:

A community mental health agency;

A general hospital that does not provide inpatient psychiatric care;

A general hospital emergency department;

The portions of a psychiatric hospital (or general hospital with psychiatric services) that do not provide inpatient psychiatric services;

A nursing home or long-term care facility that does not provide inpatient psychiatric care;

A health counseling center or health clinic operated by a college or university;

A clinic.

It is possible for a facility to qualify as both an inpatient and outpatient mental health facility.

"National Instant Criminal Background Check System" or "NICS" – the system that a federal firearm licensee must, with limited exceptions, contact for information on whether receipt of a firearm by a person who is not licensed under 18 USC 923 would violate federal or State law (28 CFR 25.2).

"Patient" –

a person who voluntarily receives mental health treatment as an inpatient or resident of any public or private mental health facility, unless the treatment was solely for an alcohol abuse disorder and no other secondary substance abuse disorder or mental illness; or

a person who voluntarily receives mental health treatment as an outpatient or is provided services by a public or private mental health facility, and who poses a clear and present danger to himself, herself or others (see Section 1.1 of the FOID Act).

For the purposes of this Part, a person is considered to voluntarily receive mental health services on an inpatient basis if the person is admitted:

On a voluntary basis as that term is used in Article IV of Chapter III of the MHDD Code;

On an informal basis as that term is used in Section 3-300 of the MHDD Code;

As a juvenile under the provisions of Article V of Chapter III of the MHDD Code;

On a petition, or a petition and one or more certificates, as described in Article VI, VII or VII-A of Chapter III of the MHDD Code; or

On a court order for detention and examination under the provisions of Section 3-607 of the MHDD Code.

"Physician" – any person licensed by the State of Illinois to practice medicine in all its branches and includes any person holding a temporary license, as provided in the Medical Practice Act of 1987 [225 ILCS 60]. Physician includes a psychiatrist as defined in this Section [405 ILCS 5/1-120].

"Psychiatrist" – a physician as defined in this Section who has successfully completed a residency program in psychiatry accredited by either the Accreditation Council for Graduate Medical Education (www.acgme.org) or the American Osteopathic Association (www.osteopathic.org) [405 ILCS 5/1-121].

"Qualified examiner" – a person who is:

A clinical social worker as defined in this Part;

A registered nurse with a master's degree in psychiatric nursing who has 3 years of clinical training and experience in the evaluation and treatment of mental illness that has been acquired subsequent to any training and experience that constituted a part of the degree program;

A licensed clinical professional counselor with a master's or doctoral degree in counseling or psychology or a similar master's or doctorate program from a regionally accredited institution who has at least 3 years of supervised post-master's clinical professional counseling experience that includes the provision of mental health services for the evaluation, treatment and prevention of mental and emotional disorders; or

A licensed marriage and family therapist with a master's or doctoral degree in marriage and family therapy from a regionally accredited educational institution or a similar master's program or from a program accredited by either the Commission on Accreditation for Marriage and Family Therapy Education http://www.aamft.org/imis15/content/

coamfte/About_COAMFTE.aspx) or the Council for Accreditation of Counseling & Related Educational Programs (www.cacrep.org), who has at least 3 years of supervised post-master's experience as a marriage and family therapist that includes the provisions of mental health services for the evaluation, treatment and prevention of mental and emotional disorders.

A social worker who is a qualified examiner shall be a licensed clinical social worker under the Clinical Social Work and Social Work Practice Act [225 ILCS 20] (see 405 ILCS 5/1-122).

59 Ill. Adm. Code 150.40 Immunity

a) Any person, institution, or agency, under this Part participating in good faith in the reporting or disclosure of records and communications otherwise in accordance with this provision or with rules, regulations or guidelines issued by DHS shall have immunity from any liability, civil, criminal or otherwise, that might result by reason of the action. For the purpose of any proceeding, civil or criminal, arising out of a report or disclosure in accordance with this provision, the good faith of any person, institution or agency so reporting or disclosing shall be presumed. The full extent of the immunity shall apply to any person, institution or agency that fails to make a report or disclosure in the good faith belief that the report or disclosure would violate federal regulations governing the confidentiality of alcohol and drug abuse patient records under 42 USC 290dd-3 and 290ee-3 (see Confidentiality Act, Section 12(b)).

b) The clinician making the determination that the person poses a clear and present danger or making the determination that the person has a developmental disability and his or her employer may not be held criminally, civilly or professionally liable for making or not making the notification required under this Section, except for willful or wanton misconduct (see Sections 6-103.2 and 6-103.1 of the MHDD Code and Section 8.1 of the FOID Act).

59 Ill. Adm. Code 150.100 Reporting

a) Inpatient mental health facilities are required to report to DHS all persons who are prohibited from obtaining a FOID Card under Section 8(e), (f), (g), (r), (s) and/or (t) of the FOID Act.

1. Those provisions cover the following situations:

A) a person who has been a patient of a mental health facility within the past 5 years (see Section 8(e) of the FOID Act);

B) a person who had been a patient in a mental health facility more than 5 years ago who has not received the certification required under Section 8(u) of the FOID Act (see Section 8(e) of the FOID Act);

C) a person who is a clear and present danger to himself or herself, any other person or persons, or the community (see Section 8(f) of the FOID Act);

D) a person who is intellectually disabled (see Section 8(g) of the FOID Act);

E) a person who has been adjudicated as a mentally disabled person (see Section 8(r) of the FOID Act);

F) a person who has been found to be developmentally disabled (see Section 8(s) of the FOID Act); or

G) a person involuntarily admitted into a mental health facility (see Section 8(t) of the FOID Act).

2. It should be noted that outpatient mental health facilities that provide only outpatient services must report events that would quality under Section 8(f), (g), (r), (s) and/or (t) of the FOID Act.

b) Mental health facilities are required to report within 7 calendar days after a person is admitted as an inpatient or as a resident and within 7 calendar days after a person is discharged from inpatient or residential care.

1. The following are several examples relating to inpatient settings that clairify when an inpatient setting is required to report to DHS:

A) The person is admitted to the hospital and to the psychiatric or behavioral health unit of the hospital for evaluation and treatment of a mental illness. The person would be reported as an admission.

B) The person is admitted to the hospital and to the psychiatric or behavioral health unit of the hospital for evaluation and treatment of a mental illness and an alcohol or substance abuse issue. The person would be reported as an admission.

C) The person with mental illness is admitted to the hospital and to a non-psychiatric or behavioral health unit (e.g., intensive care unit, rehabilitation unit, etc.) of the hospital for evaluation and treatment of an injury or illness. The hospital transfers the person to the psychiatric or behavioral health unit. The person would be reported as an admission.

D) The person with mental illness comes to the emergency department of a hospital for the mental illness and is transferred to another hospital for admission to its psychiatric or behavioral unit. The person would not be reported by the sending hospital but is required to be reported by the receiving hospital as an admission.

2. The following are several examples relating to inpatient settings that clarify when an inpatient setting is not required to report to DHS:

A) The person is admitted to the hospital and to the behavioral health unit of the hospital for evaluation and treatment of only an alcohol or substance abuse issue. The person would not be reported as an admission.

B) The person is admitted to the hospital and to the psychiatric or behavioral health unit of the hospital for evaluation and treatment of a mental illness. Upon evaluation, the person is determined to only have an alcohol or substance abuse issue. The person would not be reported as an admission.

C) The person with mental illness is admitted to the hospital and to a non-psychiatric, non-behavioral health unit (e.g., intensive care unit, rehabilitation unit, etc.) for evaluation and treatment of an injury or illness. The hospital provides maintenance medication for the mental illness, but the person is not admitted to the psychiatric or behavioral health unit. The person would not be reported as an admission.

D) The person with mental illness comes to the emergency department of a hospital for an injury or illness, is treated and released. The person would not be reported as an admission.

E) The person with mental illness comes to the emergency department of a hospital for an injury or illness, is admitted to the hospital (non-psychiatric unit) for the injury or illness. The person would not be reported as an admission.

F) The person with mental illness comes to the emergency department of a hospital for an injury or illness and is moved to an observation area for 48 hours. The person is treated and released. The person would not be reported as an admission.

G) The person with mental illness comes to the emergency department of a hospital for mental illness and is given a prescription for medication and a referral, but not admitted to the hospital. The person would not be reported as an admission.

3. The following are several examples relating to residential settings that clarify when a residential setting is required to report to DHS:

A) The person with mental illness is admitted to a nursing home and is placed on a specialized behavioral health unit. The person would be reported as an admission.

B) The person with mental illness is provided outpatient treatment while living in a supervised transitional residential program. The supervised transitional residential program would report the person as an admission. The outpatient program would not report the person.

C) The person with mental illness resides in a Specialized Mental Health Rehabilitation Facility. The facility would report the person as an admission.

4. The following are several examples relating to residential settings that clarify when a residential setting is not required to report to DHS:

A) The person with mental illness is admitted for outpatient treatment at a community mental health agency or a clinic setting while living in his or her own home or apartment. The person would not be reported.

B) The person with mental illness is admitted to a nursing home for rehabilitation and/or physical therapy and is not placed in a specialized behavioral health unit. The person would not be reported as an admission.

5. An adjudication as a mentally disabled person or an involuntary admission is required to be reported within 7 calendar days after the event or knowledge of that event. This may occur during the course of a patient's admission, resulting in a report of the admission, a report of the adjudication as a mentally disabled person, and a report upon discharge. It is possible that for a single admission there could be several reporting events.

6. When a person is determined to be a clear and present danger, he/she must be reported within 24 hours. If a person is determined to be a clear and present danger during his/her admission to a mental health facility, both a report of an admission and a report of a clear and present danger must be made.

7. When a person has been determined to be developmentally disabled, that event is required to be reported within 24 hours. This may occur during the course of a patient's admission, resulting in a report of the admission, a report of the determination that a person is developmentally disabled, and a report upon discharge.

8. To assist in meeting the reporting timeframes, DHS shall establish a web-based reporting platform. DHS shall update its records and information and shall notify ISP. Information disclosed under this Section shall remain privileged and confidential, and shall not be re-disclosed, except as required under Section 3.1(e) of the FOID Act, nor used for any other purpose. The method of providing this information shall guarantee that the information is not released beyond that necessary for the purpose of this Section.

9. The identity of the mental health facility reporting under this Section shall not be disclosed to the person who is the subject of the report.

59 Ill. Adm. Code 150.110 Recordkeeping

Persons who are reported by mental health facilities shall remain in the database unless removed under Section 150.120 or 150.500.

59 Ill. Adm. Code 150.120 Error Correcting

The mental health facility reporting the information shall be responsible for assuring the accuracy of the information it provides to the database and shall correct any of its errors.

59 Ill. Adm. Code 150.200 Reporting of Developmental Disabilities

a) Irrespective of whether the clinician is employed by the State or privately, the clinician shall notify DHS within 24 hours after making the determination that the person has a developmental disability.

b) DHS shall establish a web-based reporting platform. DHS shall update its records and information and shall notify ISP. Information disclosed under this Section shall remain privileged and confidential, and shall not be re-disclosed, except as required under Section 3.1(e) of the FOID Act, nor used for any other purpose. The method of providing this information shall guarantee that the information is not released beyond that necessary for the purpose of this Section.

c) The identity of the clinician reporting under this Section shall not be disclosed to the person who is the subject of the report.

59 Ill. Adm. Code 150.210 Reporting of Clear and Present Danger

a) Irrespective of whether the clinician is employed by the State or privately, the clinician shall notify DHS within 24 hours after making the determination that the person poses a clear and present danger as that term is defined in Section 1.1 of the FOID Act.

b) DHS shall establish a web-based reporting platform. DHS shall update its records and information and shall notify ISP. Information disclosed under this Section shall remain privileged and confidential and shall not be re-disclosed, except as required under Section 3.1(e) of the FOID Act, nor used for any other purpose. The method of providing this information shall guarantee that the information is not released beyond that necessary for the purpose of this Section.

c) The identity of the clinician reporting under this Section shall not be disclosed to the person who is the subject of the report.

59 Ill. Adm. Code 150.220 Recordkeeping

Persons who are reported by a clinician shall permanently remain in the database unless removed under Section 150.230 or 150.500.

59 Ill. Adm. Code 150.230 Error Correcting

The clinician shall be responsible for assuring the accuracy of the information he or she provides to the database and shall correct any of his or her errors.

59 Ill. Adm. Code 150.400 Database Use

a) The information maintained in the database shall be used to assist ISP in determining eligibility for a Firearm Owner's Identification Card under the FOID Act. The process used shall be to cross-reference entries in the DHS FOID database file against entries in the database file of FOID card applicants and current cardholders supplied by ISP. Only those entries that are common to both database files shall be forwarded to ISP for further action.

b) As provided in Section 3.1(e)(2) of the FOID Act and in the Memorandum of Understanding developed pursuant to Section 150.600, certain information may be provided to the National Instant Criminal Background Check System Index, Denied Persons Files (28 CFR 25).

c) The DHS database is prohibited from additional uses not associated with the FOID Act.

59 Ill. Adm. Code 150.500 Appeals

a) Appeals may be made by utilizing the provisions of 20 Ill. Adm. Code 1230.

b) An individual whose adjudication as a mentally disabled person has been overturned by the court system may submit a copy of the court order. Upon verification and consultation with ISP, the adjudication that has been overturned by the court order may be removed from the database.

59 Ill. Adm. Code 150.600 Memorandum of Understanding

Pursuant to Section 3.1(e)(2) of the FOID Act, ISP and DHS shall, in accordance with State and federal law regarding confidentiality, enter into a memorandum of understanding with the Federal Bureau of Investigation for the purpose of implementing the National Instant Criminal Background Check System in this State. ISP shall report the name, date of birth, and physical description of any person prohibited from possessing a firearm pursuant to the FOID Act or 18 USC 922(g) and (n) to the National Instant Criminal Background Check System Index, Denied Persons Files (28 CFR 25).

Chapter IV Department of Human Services

Part 270 Autism Research Fund Scientific Review Committee

59 Ill. Adm. Code 270.10 Purpose

The Department shall promulgate rules for the creation of a scientific review committee to review and assess applications for the grants authorized under this Part.

59 Ill. Adm. Code 270.20 Definitions

For the purposes of this Part, the following terms are defined:

"Autism" means a severely incapacitating life-long developmental disability that:

may be manifested before a person is 30 months of age;

may be caused by physical disorders of the brain; and

is characterized by uneven intellectual development and a combination of disturbances in the rates and sequences of cognitive, affective, psychomotor, language and speech development.

This syndrome is further evidenced by abnormal responses to sensory stimuli, problems in developing social relationships, and ritualistic and compulsive behavior.

"Autism Research Fund" means a special fund in the State Treasury that is for the purpose of funding research concerning autism.

"Autism Task Force" means the task force appointed by the Secretary of the Department of Human Services that offers policy recommendations on autism services to the Secretary and that assisted in preparing the September 1, 2005 report to the Governor and the General Assembly required by Public Act 93-773.

"Department" means the Illinois Department of Human Services.

"Research" means, without limitation, expenditures to develop and advance the understanding, techniques, and modalities effective in the detection, prevention, screening, and treatment of autism and may include clinical trials.

"Scientific Review Committee" means the body mandated by Section 10-8 of the Department of Human Services Act [20 ILCS 1305/10-8] to review and assess applications for the grants authorized by that statute.

"Secretary" means the Secretary of the Illinois Department of Human Services.

59 Ill. Adm. Code 270.30 Role of the Scientific Review Committee

A Scientific Review Committee shall make recommendations to the Department regarding the award of grants from funds appropriated from the Autism Research Fund. The funds are to be used to support research concerning autism. The Scientific Review Committee's recommendations shall be based on its review and assessment of applications for these grants.

59 Ill. Adm. Code 270.40 Membership and Operations of the Scientific Review Committee

a) The Scientific Review Committee shall develop specific objectives and internal procedures necessary to receive grant applications, review grant applications and form recommendations to the Department;

b) The committee shall serve without compensation;

c) The Scientific Review Committee shall consist of:

1. the Clinical Director of the Department's Division of Developmental Disabilities, or designee, who shall serve as Chair and who shall only vote in case of a tie among the members of the Scientific Review Committee, so long as a quorum of 5 members (including the Chair) is present and voting;

2. the Clinical Director of the Department's Division of Mental Health, or designee;

3. one doctoral level psychologist who is an employee of the Division of Developmental Disabilities, appointed by the Director of the Division of Developmental Disabilities;

4. one doctoral level psychologist who is an employee of the Division of Mental Health, appointed by the Director of the Division of Mental Health;

5. one employee of the Division of Developmental Disabilities who has two or more years experience in direct clinical services, appointed by the Director of the Division of Developmental Disabilities;

6. one employee of the Division of Mental Health who has two or more years experience in direct clinical services, appointed by the Director of the Division of Mental Health; and

7. two representatives from the Autism Task Force, to be selected by the Autism Task Force.

d) The Scientific Review Committee's review and recommendations must consider and address the following items:

1. a statement of the research question or hypothesis, or a description of interventions or model programs upon which the research will be based;

2. a prioritized listing of measurable objectives for the project;

3. for each objective proposed for the project, a sequential listing of activities to achieve the objective, the time line for completing each activity, and identification of the individual responsible for coordinating the implementation of each objective; and

4. a description of the evaluation methods to be used to measure progress in achieving objectives and a plan for monitoring the overall project.

e) DHS will choose not to act on a Scientific Review Committee recommendation in the following circumstances:

1. an entity recommended to receive a grant is identified by the DHS Office of Contracts as an entity whose contract with DHS has been terminated within the 10 years prior to the entity's application for failure to comply with contractual terms; or

2. an entity recommended to receive a grant is identified by the DHS Office of Contracts as an entity with whom DHS has refused to contract within the 10 years prior to the entity's application for any reason other than inadequate appropriation funds.

59 Ill. Adm. Code 270.50 Application Procedures

a) All applications shall include the following:

1. the applicant's name, address, telephone number, and FAX and teletypewriter (TTY) numbers, if available.

2. the curriculum vitae of the principal researcher;

3. a one-page, non-technical abstract including a description of the significance of the applicant's project for autism research;

4. the Taxpayer Identification Number (TIN);

5. the signature of an agency official authorized to certify the application;

6. the dates of the project period;

7. a detailed budget for the funding period, providing sufficient resources to carry out the project. The budget shall be by line item category and shall provide sufficient detail to justify the use of grant funds to support project activities. The applicant shall indicate the total cost of conducting the project, the anticipated funding request for the second and third years of the project ( if applicable), the source of other funds supporting the project, and the amount of support requested from the Department; and

8. a signed statement of assurances indicating compliance with applicable State and federal requirements, such as the Fiscal Control and Internal Auditing Act [30 ILCS 10], bribery certification, contract debarment, unlawful discrimination, Illinois Human Rights Act [775 ILCS 5], federal civil rights statutes (18 USC), Drug Free Workplace Act [30 ILCS 580], Davis-Bacon Act (40 USC 276a through 276a-5), conflict of interest provisions specified in the Illinois Purchasing Act [30 ILCS 505], the Americans With Disabilities Act (42 USC 12101 et seq.), and the protection of the confidentiality of services.

b) In addition to the requirements of subsection (a), all initial applications shall include the following:

1. a statement of the research question or hypothesis, or a description of interventions or model programs on which the research will be based;

2. a prioritized listing of measurable objections for the funding period;

3. for each objective proposed for the first funding period of the project, a sequential listing of activities to achieve the objective, the timeline for completing each activity, and identification of the individual responsible for coordinating the implementation of each objective; and

4. a description of the evaluation methods to be used to measure progress in achieving objectives and a plan for monitoring the overall project.

c) In addition to the requirements of subsection (a), all continuation applications shall include the following:

1. a progress report that contains a description of the findings to date, as described in subsection (b)(4);

2. a description of the applicant's progress in meeting each project objective;

3. project objectives for the new funding period, along with activities and time lines for completion of each activity; and

4. any revisions in the evaluation methods or the monitoring plan, along with rationale for those revisions.

d) All entities receiving grants under this Part shall be entities with whom DHS has not terminated a contract in the past 10 years for failure to comply with contractual terms or shall be entities with whom DHS has not refused to contract within the 10 years previous to this contract for any reason other than unavailable appropriation funds.

Chapter I Department of Human Services

Part 299 Sexually Violent Persons

59 Ill. Adm. Code 299.100 Purpose

This rule implements the Sexually Violent Persons Commitment Act [725 ILCS 207].

59 Ill. Adm. Code 299.110 Incorporation by Reference

Any rules of an agency of the United States or the State of Illinois 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.

59 Ill. Adm. Code 299.120 Definitions

"Act" means the Sexually Violent Persons Commitment Act [725 ILCS 207].

"Administrative Officer on Call" or "AOC" means the designated management staff responsible for responding to after-hours and weekend emergency calls from an on-duty facility staff.

"Administrative Officer on Duty" or "AOD" means the designated management staff responsible for the daily operation of the Program and/or responding to emergency calls.

"Allowable Reserve" means an amount set by the Department that is exempt from services charges. This amount shall not be less than the exemptions from garnishment set forth in Part 7 of Article 12 of the Code of Civil Procedure [735 ILCS 5] or otherwise provided under Section 299.1030(e) or (f).

"Ancillary Services" means services not covered under the Sex Offender Evaluation and Treatment Provider Act [225 ILCS 109], such as general healthcare, education/vocational, recreation, rehabilitation, anger management, mental health treatment, substance use and abuse treatment, victim empathy, tactics, penile plethysmograph, etc.

"Annual Income" means adjusted gross income as defined by Section 2-203 of the Illinois Income Tax Act [35 ILCS 5].

"Assault" means conduct described in Sections 12-1 and 12-2 of the Criminal Code of 2012 [720 ILCS 5].

"Assets" means:

any property, tangible or intangible, real or personal:

belonging to or due to a service recipient from social security, worker's compensation, veteran's compensation, or pension benefits; or

from any other source whatsoever; and

any and all assets and property of whatever character held in the name of the service recipient, held for the benefit of the service recipient, or payable or otherwise deliverable to the service recipient.

Any trust, or portion of a trust, of which a recipient is a beneficiary shall be construed as an asset of the recipient if, under terms of the trust, benefits may be paid to the recipient.

"Attempt to Resolve" or "ATR" means the process a resident uses to try to resolve incidents, problems or general complaints. Complaints concerning behavior management proceedings are not handled through the ATR process.

"Average Per Capita Cost" means the amount calculated for the daily average per capita cost of operation, as applicable, of either:

the secure residential facility, for the fiscal year immediately preceding the period of State care for which the rate is being calculated; or

the average daily costs associated with the service recipient's conditional release.

"Battery" means the conduct described in Sections 12-3 and 12-3.05 of the Criminal Code of 2012 [720 ILCS 5].

"Behavior Committee" consists of a security representative and at least two members of the clinical staff.

"Behavioral Intervention" means a response to a violation of the facility rules.

"Chemical Agent" means a compound such as mace, pepper spray, etc., utilized to manage a resident who is violent, disruptive and/or out of control. "Clinical Director" means the staff member responsible for the oversight and provision of sex offender specific treatment and certain ancillary services at the facility, or that person's designee.

"Clinical File" consists of the records relating to sex offender treatment and certain ancillary services.

"Close Status" means a management status to which residents are assigned as a step-up from special management or reassignment after rule violations. Residents will remain on Close Status for a period of time determined by the Behavior Committee for observation of their ability to successfully reintegrate. Any rule violation at this level may result in either an extension of this status or a change of management status.

"Committed Person" means a person who has been committed to the custody of the Department under the Sexually Violent Persons Commitment Act.

"Conditional Release" means a committed person who has been placed into the community on court ordered supervision, treatment and related services as authorized by the Act.

"Contraband" means any item that is proscribed by criminal law, Department rules, facility rules or posted notices; an itemthat a resident has no authorization to possess; or property that is in excess of that authorized by the facility. This includes, but is not limited to, any:

altered property; property fashioned into a weapon; property not being used for its intended design or its initial purpose; or

object, item or food/beverage product that has been determined to pose a therapeutic, fire, health and/or safety risk.

"Deadly Force" means force that is likely to cause death or great bodily harm.

"Department" or "DHS" means the Illinois Department of Human Services.

"Detained Person" means a person who the court has sent to a detention facility approved by the Department, pursuant to a detention order or after a probable cause hearing under Section 30 of the Act.

"DHS Victim-Notification Coordinator" means the person who is responsible for securely and confidentially maintaining all victim requests for notification and for following the procedures for notifying victims (see Section 299.500).

"Discharge" means the court-ordered release of a committed person from the custody of DHS.

"Emergency Mental Health Care" refers to those interventions used to protect the life and health of residents who are at risk to harm themselves or others as the result of mental illness or mental disorder. Harm is defined as physical injury. Residents may be at risk of harming themselves or others when they are physically or verbally assaultive or aggressive; engage in or threaten to engage in self-injurious behavior; use, misuse or destroy property in a fashion that could be used to harm oneself or others (e.g., use glass shards to cut or stab); or refuse direction to the point that force is needed to secure the resident's compliance.

"Emergency Mental Health Status" is the emergency placement of a resident on either Mental Health Status 1 or Mental Health Status 2, as ordered by a mental health professional pursuant to Section 299.345.

"Employee" means any person providing services at the direction of the DHS Secretary or Program Director, on or off site. For the purposes of this Part only, this includes payroll personnel, contractors, subcontractors and volunteers. Under no circumstances does this definition intend to confer employment status upon contractors, subcontractors or volunteers.

"Estate of Recipient" means all income and assets of a service recipient, including, but not limited to, real property.

"Force" means physical contact used to coerce or prevent some action on the part of a resident, including the use of chemical agents.

"General Status" means a management status to which residents are assigned after they have completed admission/orientation evaluations or as a reassignment from Close or Intermediate Status. Residents remain on this status when they are without a major rule violation, or without more than two minor rule violations, for 180 consecutive days.

"Grievance Examiner" means the employee or employees designated by the Program Director to review and, as appropriate, resolve problems and grievances that residents have been unable to resolve through routine channels.

"Ill-1, Financial Questionnaire" means a designation assigned to a set of schedules developed for the purpose of collecting financial data on service recipients.

"Incident Report" means a report that must be completed by an employee when he/she observes any unusual occurrence or situation that may pose a threat to the safety or security of the facility, staff, residents, visitors or others.

"Individualized Treatment Plan" or "ITP" or "Treatment Plan" means the set of goals and levels of progress within the Program for each resident. The Treatment Plan is reviewed every six months and includes recommendations relative to the treatment phase, testing, diagnosis, resident cooperation and participation, as well as levels of programming.

"Informed Consent" means consent of the resident to treatment and ancillary services after being advised of the attendant risks and benefits.

"Intermediate Status" means a management status to which residents are assigned after they have completed general status. Residents remain on this status when they are without a major rule violation, and without more than two minor rule violations, for 180 consecutive days.

"Internal Security Investigator" means the person who investigates, as assigned by the Program Director, incidents within the secure residential facility or incidents that affect recipients on conditional release.

"Legal Dependents" means those persons:

dependent on the recipient for more than one-half of their support; and

shown as dependents on the recipient's U.S. Individual Income Tax Return.

"Management Status" means the provision of different levels of privileges, responsibilities and activities to provide a greater degree of individualization in the treatment of residents. These levels include Admission Status; General Status; Intermediate A, B, and C Status; Close Status; and Special Management Status.

"Medical Director" means the physician responsible for the oversight and provision of medical treatment in the Program, or that person's designee.

"Medical File" consists of the records relating to health care services. The provision of psychotropic medication is a health care service.

"Medical Professional" means a person who provides medical care under the overall supervision of the Medical Director. This could include a physician licensed to practice medicine in all its branches under the Medical Practice Act of 1987 [225 ILCS 60], a nurse licensed under the Nurse Practice Act [225 ILCS 65], or a physician assistant licensed under the Physician Assistant Practice Act of 1987 [225 ILCS 95].

"Mental Disorder" means a congenital or acquired condition affecting the emotional or volitional capacity that predisposes a person to engage in acts of sexual violence.

"Mental Health Professional" or "MHP" means a person who provides mental health services under the overall supervision of the Clinical Director. This could include a physician, a psychiatrist, a psychologist or other clinical staff.

"Mental Health Status 1" is a level of special observation in which one staff person will be assigned to continuously observe and monitor one, and only one, resident. The staff person shall remain no more than 12 feet away. In all instances, the staff person must maintain sight of the resident, including during bathing or using the toilet. No staff person shall be assigned to provide 1:1 observation for a continuous period exceeding two hours without at least a 15-minute period of alternative assignment. At each 15-minute interval, the staff member observing the resident shall enter a note in the resident's clinical file concerning the status and condition of the resident.

"Mental Health Status 2" is a level of special observation in which the resident is observed and monitored by staff every 15 minutes. At each 15-minute interval, the staff member observing the resident shall enter a note in the resident's clinical file concerning the status and condition of the resident.

"Notice of Determination" means notification sent to a service recipient when charges have been established for services (see Section 90 of the Act).

"Physician" means any person licensed by the State of Illinois to practice medicine in all its branches and includes any person holding a temporary license, as provided in the Medical Practice Act of 1987.

"Primary Therapist" means the clinical staff person responsible for implementing the resident's ITP.

"Program" means the Sexually Violent Persons Treatment and Detention Program. The term "Program" encompasses recipients in the secure facility and recipients living in the community on a court-ordered plan of conditional release.

"Program Administrator" means the person within DHS - Division of Mental Health appointed by the Secretary to oversee the Program, or his/her designee.

"Program Director" means the chief administrative officer of the Treatment and Detention Facility, or his/her designee. The designee may be the:

Medical Director;

Assistant Program Director;

Security Director; or

Administrative Officer on Call.

"Program Unit Hearing Officer" means the person designated by the Program Director to hear allegations of minor rule violations that do not result in reassignment of management status.

"Provider Act" means the Sex Offender Evaluation and Treatment Provider Act [225 ILCS 109].

"Psychiatrist" means a physician who has at least 3 years of formal training or primary experience in the diagnosis and treatment of mental illness.

"Psychologist" means a person who is licensed under the Clinical Psychologist Licensing Act [225 ILCS 15], or the Provider Act.

"Psychotropic Medication" means medication whose use for antipsychotic, antidepressant, antimanic, antianxiety, antiandrogenic, behavior modification or behavioral management purposes is listed in the most recent edition of the Physician's Desk Reference (2019 edition) available at www.PDR.net or that are administered for any of these purposes. It also includes those tests and related procedures that are essential for safe and effective administration.

"Recipient" or "Service Recipient" means a person receiving services at the secure residential facility or while on a court-ordered plan of conditional release.

"Resident" means either a detained person or a committed person placed in a facility.

"Residential Unit" means the area of a facility in which residents reside.

"Restriction" means constraining, reducing or eliminating activities of a resident (e.g., setting limits on or removal of certain privileges, behaviors or activities).

"Secretary" means the Secretary of the Department of Human Services, or his/her designee.

"Security Director" means the employee, and his/her designee, responsible for the safety and security of residents, staff, visitors and State property. The designee may be the AOD.

"Sex Offender Evaluation" or "Evaluation" means a sex-offender specific evaluation as that term is used in the Provider Act.

"Sex Offender Evaluator" or "Evaluator" means a person licensed under the Provider Act to conduct sex offender evaluations.

"Sex Offender Specific Treatment" or "Sex Offender Treatment" or "Treatment" means a comprehensive set of planned therapeutic interventions and experiences to reduce the risk of further sexual offending and abusive behaviors by the offender. The treatment must be provided by, or under the supervision of, a person licensed under the Provider Act. Treatment specifically excludes matters such as security, health care, housing, food service, religious accommodations, management status, behavioral intervention and ancillary services.

"Sexual Activity" means an activity involving two or more persons for the sexual gratification of any participant.

"Sexually Violent Person" or "SVP" means a person who has been convicted of a sexually violent offense, has been adjudicated delinquent for a sexually violent offense, or had been found not guilty of a sexually violent offense by reason of insanity and who is dangerous because he/she suffers from a mental disorder that makes it substantially probable that the person will engage in acts of sexual violence. "Sexually violent offense" has the same meaning as set forth in the Act.

"Shift Supervisor" has the same meaning as "Administrative Officer on Duty".

"Special Management Status" means an assigned management status utilized for the safe containment and effective management of a resident who is presenting a risk of harm to self or others. Residents may remain on Special Management Status until the Behavior Committee determines that the resident is no longer a risk to self or others or while criminal charges are being investigated or pending.

"Transferring Authority" means the agency with jurisdiction, as defined in Section 10 of the Act, that had custody and control of the person prior to an order of detention issued under Section 30 of the Act.

"Treatment and Detention Facility" or "TDF" or "Secure Residential Facility" or "Facility" means the secure facility provided by the Department of Corrections and operated by DHS pursuant to Section 50 of the Act for the detention and treatment of persons alleged or determined to be sexually violent and at risk of re-offending.

"Treatment Review Committee" means the committee appointed by the Program Director for the review of orders for the administration of psychotropic medications.

"Treatment Team" means a cross-functional, multi-disciplinary group composed of the resident's team leader and primary therapist, a medical representative, a security representative, and other clinical staff involved in the resident's treatment.

"Victim" means a person against whom an act of sexual violence has been committed and includes a person who has requested notification under the Act or under the Rights of Crime Victims and Witnesses Act [725 ILCS 120].

"Working Day" means Monday through Friday and excludes State holidays and days when the facility may not be fully open due to order of the Governor.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.130 Records

a) Required Admission Documents −

1. When a resident is delivered to the custody of the Department, the following documents shall be requested:

A) Of the court:

i) A copy of the detention order or the court order finding probable cause which orders the person evaluated in a detention facility or the court order that commits the person to the custody of the Department.

ii) A copy of the petition.

iii) All additional matters that the court directs the clerk to transmit.

B) Of the transferring authority:

i) Admissions

Prior to the admission of a new resident, the Department shall request a detention summary from the transferring authority. The Department shall request that the detention summary contain any relevant medical, psychiatric or psychological information in the transferring authority's records to allow Department treatment and evaluation staff to prepare for behavioral or health needs of the resident. The Department shall further request that the transferring authority share the master file, medical file, and clinical and field services information pertaining to the resident as necessary for the proper evaluation and treatment to the resident and for program safety and security. Prior to the admission of a new resident, the Department shall request a copy of the report recommending commitment and/or petition seeking commitment from the Attorney General and/or State's Attorney filing the petition.

ii) Probable Cause

Following a probable cause hearing in which the court enters a finding of probable cause, the Department shall request the Attorney General's Office or appropriate State's Attorney to provide documents in its possession which were provided as required under the Act in support of the transferring authority's recommendation for commitment and/or records gathered by the Attorney General or State's Attorney in preparation for filing the petition seeking commitment. The Department shall further request upon a finding of probable cause that the transferring authority make the resident's criminal history, disciplinary history, mental health records, escape risk and other relevant information accessible to the Department if the Attorney General or State's Attorney has not already provided this information.

iii) Juveniles

Prior to the admission of a juvenile, the Department shall request that the Attorney General or State's Attorney of the appropriate county seek a court order allowing the Attorney General or State's Attorney to provide juvenile records which were provided to the Attorney General or State's Attorney in support of the transferring authority's recommendation for commitment pursuant to the Act to the Department and to further enter an order allowing the transferring authority to make the master file, medical file, and clinical records of the juvenile accessible to the Department for purposes of the juvenile's custody, care and treatment.

iv) Confidentiality

The Department is responsible for maintaining the confidentiality and security of any and all documents and records that are made accessible and/or provided to the Department.

b) Access to Records

1. Records of a resident may be accessed by authorized facility staff, authorized conditional release staff, Department evaluators, and staff from the Illinois Attorney General or other Illinois prosecutorial staff.

2. Records of a resident may be accessed:

A) by the resident and persons authorized by the resident; or

B) as otherwise ordered by a court. The Department may require payment of copying costs for any records it is asked to produce, except that each resident is entitled to receive, upon request, one free copy of his/her clinical file and medical file. The Department shall maintain a record in each resident's clinical file that indicates:

i) The parties who have requested to inspect and/or copy clinical records under the provisions of this subsection (b) and their authorization; and

ii) The clinical records inspected and/or copied under this subsection (b).

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.200 Detention Facility

The Department may utilize a secure residential facility as a detention facility.

a) The Department also approves all Department of Corrections and Department of Juvenile Justice facilities for the detainment of residents until they complete any term of imprisonment imposed for a criminal conviction or finding of delinquency that may run parallel to either an order for detention under Section 30 of the Act or an order of commitment under Section 40 of the Act. While in the Department of Corrections or the Department of Juvenile Justice, the Department with custody shall be responsible for the control, care and custody of the resident.

b) The Department also approves the use of a county jail as a detention facility when there is a written agreement between the Department and the county sheriff authorizing that usage. Any written agreement shall outline responsibilities assigned to both parties. The Department shall determine which detention facilities it will use based upon geographic area, space availability, willingness of the local officials to participate, and adequacy of the facility to meet the needs of the detained person.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.210 Temporary Detention by Court Order

During the course of a trial, or when the detained person or committed person is ordered by the court to be present, the county jail or federal detention facility is approved for use as a temporary detention site. While the detained person is in the county jail or detention facility, the jail or detention facility is responsible for the control, care and custody of the resident.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.220 Evaluator Standards

All evaluators engaged by the Department shall be licensed as sex offender evaluators pursuant to the Provider Act.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.230 Evaluation

An evaluation shall be conducted pursuant to Section 30 of the Act for the purpose of determining whether a detained person meets the criteria for commitment as a sexually violent person under the Act. The evaluation shall comply with 20 Ill. Adm. Code 1905.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.300 Secure Residential Facility

The secure residential facility shall be operated by the Department. Standards for living conditions shall include the following provisions:

a) All double-room assignments shall be screened for appropriateness based on safety, security and treatment considerations.

b) Minimally, each resident room shall be furnished with:

1. A bed securely fastened to the wall and/or floor, with the exception being a medical type bed;

2. Clean bedding, including a mattress, blanket, sheets, pillow and pillow case;

3. A wash basin with running water and flushable toilet facilities (controls may be located outside the room); and

4. Adequate lighting for reading and observation purposes.

c) Rooms shall be located at or above ground level and shall have heat and ventilation consistent with the climate.

d) Each room shall have a single door and may have a food passage. When only a solid door is available, it shall be provided with a vision panel.

e) Cleaning materials shall be made available to residents on an as-needed basis.

f) Personal health and hygiene needs of the resident shall be addressed as follows:

1. A shower and shave shall be offered no less than once every three days.

2. Access to State issued toilet tissue, soap, shampoo, shaving cream, towel, toothbrush, and toothpaste.

3. A weekly exchange of clean facility clothes and bed linens or availability of laundry services at least weekly.

4. False teeth, eye glasses, prosthetic devices and other essential items of personal hygiene and health shall be permitted unless they are a threat to safety or security.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.310 Treatment

a) A resident shall be provided with adequate and humane care and treatment services pursuant to an ITP, which shall be formulated and periodically reviewed by the treatment team with the participation of the resident to the extent feasible and, when appropriate, the resident's guardian. A licensed sex-offender treatment provider shall be responsible for overseeing the implementation of the plan.

b) Although all treatment offerings require informed consent, residents are encouraged to attend scheduled individual and group therapy sessions, objective sexual assessment appointments, and other programming as set forth in the ITP.

c) If the ITP includes the administration of medication, a medical professional may advise the resident, in writing, of the side effects of the medication to the extent the advice is consistent with the nature and frequency of the side effects and the resident's ability to understand the information communicated.

d) Care and treatment shall include the regular use of sign language for any hearing-impaired resident for whom sign language is a primary mode of communication and an interpreter for residents who do not understand English.

e) If the resident refuses to consent to treatment, withdraws from treatment, or demonstrates disinterest in treatment or a lack of progress in treatment, the treatment team may revise the ITP as necessary to encourage and improve the resident's participation in treatment.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.320 Periodic Re-Evaluation

a) The Department shall conduct an evaluation of a committed person not less than once each 12 months for the purpose of determining whether the person may be conditionally released or the person's condition has changed, since the most recent periodic re-examination, to the extent that he/she is no longer a sexually violent person.

b) Any evaluator conducting an evaluation under this Section or Section 55 of the Act shall prepare a written report of the evaluation no later than 30 days after the date of the evaluation. The evaluator shall:

1. send a copy to the DHS - Health Information Department, which will place a copy of the report in the person's clinical file; and

2. provide a copy of the report to the Office of Attorney General or other prosecutorial agency for filing with the court that committed the person.

c) All evaluations conducted by the Department shall comply with Section 10 of the Provider Act and 20 Ill. Adm. Code 1905.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.330 Rights

a) No resident shall be presumed incompetent, nor shall such person be held legally disabled, except as determined by a court. This determination shall be separate from a judicial proceeding held to determine whether a person is subject to commitment as a sexually violent person.

b) Residents shall be provided reasonable opportunities to pursue their religious beliefs and practices, subject to the Program's legitimate concerns regarding security, safety, rehabilitation, facility order, space and resources. A resident who is an adherent or a member of any well-recognized religious denomination, the principles and tenets of which teach reliance upon services by spiritual means through prayer alone for healing by a duly accredited practitioner thereof, shall have the right to choose those services. As appropriate, the parent or guardian of a resident who is a minor, or a guardian of a resident who is not a minor, shall have the right to choose services by spiritual means through prayer for the resident.

c) A resident may volunteer to perform tasks that benefit the resident community as a whole, if the professional responsible for overseeing the implementation of the ITP for the resident determines that the task would be consistent with the ITP. A resident who volunteers to perform a communal task may be compensated through the provision of reward points redeemable at the facility. A resident may be required to perform tasks of a personal housekeeping nature without compensation.

d) Residents may only acquire personal property in accordance with this Part. The Program Director at the facility where the resident is assigned may post these rules or explanations of these rules in a conspicuous location within the facility. Every resident who resides in a secure residential facility shall be permitted to receive, possess and use personal property and shall be provided with a reasonable amount of storage space for that property, except for those limitations provided in Department rules and explained in the Resident Handbook, or as posted by the Program Director.

1. Possession and use of certain classes of property may be restricted by the Program Director when necessary to assure the safety and security of the facility.

2. The professional responsible for overseeing the implementation of a resident's ITP may, with the approval of the Program Director, restrict the right to property when necessary to assure implementation of the ITP, protect the resident or others from harm, or as part of the Resident Behavior Management System.

3. When a resident is discharged from the facility, all of his/her lawful personal property that is in the custody of the facility shall be returned.

4. A resident may use his/her funds as he/she chooses, unless he/she is a minor or prohibited from doing so under a court guardianship order. A resident may deposit, with the Department, or cause to be deposited in his/her name, money. When a resident is discharged from the Department, all of his/her unspent money, including interest on trust fund monies (if any), shall be returned subject to a set-off for any outstanding restitution or repayment as may have been ordered by the Program Director or Behavior Committee.

e) A resident shall be permitted reasonable communication with persons of choice by mail, telephone and visitation. Communications may be reasonably restricted, censored, screened or monitored to protect the resident or others from harm, harassment or intimidation or to ensure implementation of the resident's ITP. The Program Director shall set the times and places for the use of telephones and visits. Communications with attorneys shall not be monitored.

f) Upon admission, or as soon thereafter as the condition of the resident permits, every resident or the parent or guardian of a resident, as appropriate, shall be informed orally and in writing of the rights guaranteed by this Part that are relevant to the nature of the ITP. Every facility shall also post, in the Resident Handbook or conspicuously in common areas, a summary of the rights that are relevant to the services delivered by that facility.

g) The Program Director of each secure residential facility shall adopt in writing policies and procedures deemed necessary for the safe and secure operation of the facility. The policies and procedures may amplify or expand, but shall not restrict or limit, the rights of residents as set forth in this Section.

h) An adult resident, or the resident's guardian, may refuse generally accepted treatment services. Housing assignments, the Resident Behavior Management System and Assignment of Living Status may not be refused.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.340 Medical Care

a) Emergency medical care shall be available to residents 24 hours per day, seven days per week.

b) Residents shall be informed of the facility procedures for obtaining medical or dental services.

c) Persons housed at a secure residential facility shall be provided all necessary medical and dental treatment, with the consent of the parent or guardian where applicable, as prescribed by a facility physician or dentist.

d) A resident who has, or is suspected of having, a communicable disease may be isolated from other residents. This determination shall be made by a physician or medical professional on the basis of medical necessity.

e) In case of critical illness or major surgery, the Program Director shall attempt to notify the person designated by the resident to be contacted in case of an emergency and, when applicable, the parent or guardian.

f) A record of all medical and dental examinations, findings and treatment shall be maintained in the resident's medical file.

g) Administration of Psychotropic Medication

1. Psychotropic medication shall not be administered to any resident without the informed consent of the resident or guardian unless:

A) A psychiatrist or, in the absence of a psychiatrist, a physician has determined that:

i) the resident suffers from a serious mental illness or mental disorder;

ii) the administration of psychotropic medication is in the immediate medical interest of the resident; and

iii) the resident is either gravely disabled or poses an immediate threat of harm to self or others; or

B) The administration of psychotropic medication has been approved by the Treatment Review Committee after a hearing (see subsection (h)). However, no such approval or hearing shall be required when the medication is administered in an emergency situation. An emergency situation exists when the required determinations listed in subsection (g)(1)(A) have been made.

2. Whenever a physician orders the administration of psychotropic medication to a resident in an emergency, the physician shall document in the resident's medical file the facts and underlying reasons supporting the determination that the standards in subsection (g)(1)(A) of this Section have been met.

A) The Program Director shall be notified as soon as practicable.

B) The Chairperson of the Treatment Review Committee shall be notified in writing within three working days.

h) Treatment Review Committee Hearing Procedures

1. The Treatment Review Committee shall be comprised of three members appointed by the Program Director, two of whom shall be mental health professionals and one of whom shall be a physician. One member shall serve as Chairperson of the Committee. None of the Committee members may be involved in the current decision to order the medication. The members of the Committee shall have reviewed this Part and shall be familiar with the procedures created in this Part.

2. The Program Director shall designate a medical professional not involved in the current decision to order psychotropic medication to assist the resident. The assigned medical professional shall have reviewed this Part.

3. The resident and assigned medical professional shall receive written notification of the time and place of the hearing at least 24 hours in advance. The notification shall include the tentative diagnosis and the reasons why the medical staff believes the administration of psychotropic medication is in the best interests of the resident, absent the resident's informed consent to administration of the medication. The assigned medical professional shall meet with the resident prior to the hearing to discuss the procedural and mental health issues involved.

4. The resident shall have the right to attend the hearing unless the Committee determines that it is likely that the person's attendance would subject him/her to substantial risk of serious physical or emotional harm, pose a threat to the health or safety of others, or threaten the overall security of the facility. If such a determination is made, the facts and underlying reasons supporting the determination shall be documented in the resident's medical file. The assigned medical professional shall appear at the hearing regardless of whether the resident appears.

5. The documentation in the medical file referred to in subsection (g)(2) shall be reviewed by the Committee and the Committee may request the psychiatrist's/physician's personal appearance at the hearing.

6. Prior to the hearing, witnesses identified by the resident and the assigned medical professional may be interviewed by the assigned medical professional after consultation with the resident as to appropriate questions to ask. Any such questions shall be asked by the assigned medical professional unless the question is cumulative or irrelevant, or would pose a threat to the safety of others or the security of the facility.

7. Prior to the hearing, the resident and the assigned medical professional may request in writing that witnesses. be interviewed by the Committee and may submit to the Chairperson of the Committee written questions for witnesses. These questions shall be asked by the Committee unless the question is cumulative or irrelevant, or would pose a threat to the health or safety of others or the overall security of the facility. If any witness is not interviewed, a written reason shall be provided.

8. Prior to the hearing, the resident and the assigned medical professional may request in writing that witnesses appear at the hearing. Any such request shall include an explanation of what the witnesses are expected to state. Reasonable efforts shall be made to have the witnesses present at the hearing, unless their testimony or presence would be cumulative or irrelevant, or would pose a threat to the health or safety of others or the overall security of the facility, or for other reasons including, but not limited to, unavailability of the witness or matters relating to facility order. In the event requested witnesses are unavailable to appear at the hearing but are otherwise available, they shall be interviewed by the Committee as provided for in subsections (h)(7) and (9) through (10).

9. At the hearing, the resident and the assigned medical professional may make statements and present documents that are relevant to the proceedings. The assigned medical professional or resident may direct relevant questions to any witnesses appearing at the hearing. The resident may request that the assigned medical professional direct relevant questions to any witnesses appearing at the hearing. The assigned medical professional shall ask those questions unless the question is cumulative or irrelevant, or would pose a threat to the health or safety of others or the overall security of the facility.

10. The Committee shall make such inquiry as it deems necessary. The assigned medical professional and resident shall be informed of any inquiry conducted by the Committee and shall be permitted to direct relevant questions to any witnesses interviewed by the Committee. The assigned medical professional shall consult with the resident regarding any statements made by witnesses interviewed by the Committee and shall comply with requests by the resident to direct relevant questions to those witnesses unless the question is cumulative or irrelevant, or would pose a threat to the health or safety of others or to the overall security of the facility.

11. The Committee shall consider all relevant information and material that has been presented in deciding whether to approve administration of the medication in the absence of the informed consent of the resident.

12. A written decision shall be prepared and signed by all members of the Committee that contains a summary of the hearing and the reasons for approving or disapproving the administration of the medication. Copies of the decision shall be given to the resident, assigned medical professional and Program Director and shall be placed in the resident's medical file. Any decision by the Committee to approve administration of psychotropic medication without the informed consent of the resident shall be based upon a preponderance of the evidence and must be unanimous. The Program Director shall direct the appropriate medical staff to comply with the decision of the Committee.

13. If the Committee approves administration of the medication, the resident shall be placed on an appropriate mental health status (if not already so assigned) and shall also be advised of the opportunity to appeal the decision to the Medical Director by filing a written appeal with the Chairperson within five days after the resident's receipt of the Committee's written decision.

i) Review by Medical Director

1. If the resident appeals the Treatment Review Committee's decision, medical staff shall continue to administer the medication as ordered by the physician and approved by the Committee while awaiting the Medical Director's decision on the appeal.

2. The Chairperson of the Committee shall promptly forward the written notice of appeal to the Medical Director or his/her designee.

3. Within 10 working days after receipt of the written notice of appeal, the Medical Director shall:

A) Review the Committee's decision, make further investigation deemed necessary, and submit a written decision to the Program Director; and

B) Provide a copy of the written decision to the resident, the assigned medical professional and the Chairperson of the Committee and shall place a copy in the resident's medical file.

4. The Program Director shall direct medical staff to comply with the decision of the Medical Director.

j) Periodic Review of Medication

1. Whenever any resident has been receiving psychotropic medication continuously or on a regular basis for a period of six months in the absence of informed consent, the administration of the medication shall be reviewed by the Treatment Review Committee in accordance with subsections (h) and (i). Every six months thereafter, for as long as the medication continues on a regular or continuous basis, the Treatment Review Committee shall review the continued need for the administration of psychotropic medication in the absence of informed consent.

2. Every resident who is receiving psychotropic medication in the absence of informed consent shall be evaluated by a psychiatrist or physician at least every 30 days, and the psychiatrist/physician shall document in the resident's medical file the basis for the decision to continue the medication.

k) Emergency Procedures

Subsequent to the administration of psychotropic medication in an emergency situation pursuant to subsection (g)(1)(A):

1. The basis for the decision to administer the medication on an emergency basis shall be provided to the resident and to the Medical Director for review.

2. A medical professional shall meet with the resident to discuss the reasons why the medication was administered on an emergency basis and to give the resident an opportunity to express any concerns he/she may have regarding the medication.

l) Documentation

Copies of all notifications and written decisions concerning involuntary administration of psychotropic medication shall be placed in the resident's medical file.

m) Parents and Guardians

In the case of a resident who is a minor (under 18) or has a guardian, the parent or guardian shall be sent the documentation and written decisions that are provided to the resident pursuant to this Section and shall be permitted to attend and participate in any proceedings required by this Section. Notice of any Treatment Review Committee hearing shall be promptly sent to the parent or guardian and reasonable attempts shall be made to provide that notice at least 72 hours prior to the hearing.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.345 Emergency Mental Health Care

a) Residents in Need of Emergency Mental Health Care

1. When medical, treatment or security staff believe a resident is in need of emergency mental health care to prevent self injury, the AOD shall be notified.

2. The AOD shall immediately initiate placement of that resident into Mental Health Status 1 and provide continuous observation of the resident.

b) Resident Placement, Property Restriction and Observation Requirements

1. Placement. After placement in Mental Health Status 1 is initiated, and prior to the completion of the one-hour assessment by an MHP, the resident shall be placed in an empty, designated observation room. Following the one-hour mental health assessment, continued room placement of the resident shall be determined by consultation between security staff and the MHP assigning the resident to Mental Health Status 1 or 2. The decision regarding where to place the resident, and his/her movement while on Mental Health Status, shall be based on the level of risk the resident presents, as well as the institutional management challenges presented by the resident once placement is initiated.

2. Property. During initiation, the AOD may limit or restrict the personal or facility-provided property items, including clothing, the resident is permitted to possess. Once the mental health assessment is complete, the MHP assigning Mental Health Status shall indicate the appropriate, allowable personal or facility-provided property. This decision shall be approved by the Program Director.

3. Observation. The resident shall be under continuous visual observation once these procedures regarding Emergency Mental Health Status (EMHS) are initiated, and will remain under continuous visual observation until, in the opinion of an MHP, observation is not necessary.

c) Notification of Clinical Director or Designee

1. As soon as practicable, the AOD will notify the Clinical Director or designee that EMHS was initiated and shall request that an assessment of the resident's behavior be performed by an MHP.

2. If the need to initiate EMHS occurs when there is no MHP on-site, the AOD shall request that the duty nurse perform the assessment.

3. An on-site assessment of the resident's mental health needs shall be performed within one hour after placement in EMHS.

4. If EMHS is initiated after normal business hours, upon completion of the one-hour assessment, the duty nurse shall notify the Clinical Director or designee.

5. In all situations, an MHP will become the lead person in management of the resident through resolution of the crisis. The MHP will determine necessary interventions, including the need for continued observation, the type of observation, the need for a psychiatric consult, and/or any other appropriate mental health interventions. All measures taken shall be documented in the resident's clinical file.

d) Contacting Psychiatrist on Call

1. The Clinical Director or designee may, at his/her discretion, contact the psychiatrist on call and consult with him/her regarding the resident's apparent emergency mental health care needs.

2. The Clinical Director, AOC and psychiatrist on call, within their respective scopes of practice, shall determine the utility of emergency medication; the interval, frequency and type of observation (e.g., medical, general, security); room placement; and permitted property. They shall also direct the security staff and health care staff accordingly.

e) Minimal Standards for Care and Observation

While the resident remains in EMHS, the following are minimal standards for care and observation, unless otherwise directed:

1. The resident will be reassessed by an MHP or the duty nurse every shift while on EMHS.

2. Security and nursing staff shall follow all instructions from the Clinical Director or designee.

3. To assure continuity of care, the MHP or duty nurse shall, every shift, write a summary progress note that includes assessment, care and status of the resident. This note shall be placed in the resident's clinical file.

4. In all cases, the resident shall be evaluated face-to-face by an MHP, within 24 hours after being placed on EMHS, to determine the resident's continuing needs.

5. A resident may not be placed on EMHS for more than 24 hours unless continued by an MHP after conducting a face-to-face assessment of the resident.

6. Residents placed on EMHS shall be restricted to the living unit or healthcare unit and may only leave the unit for medical reasons, court writs, or as otherwise approved by the Program Director. All residents on EMHS shall be provided a 1:1 escort while off the living unit.

7. When a resident has been on Mental Health Status for a continuous period of 72 hours, the Clinical Director or designee shall review the resident's ITP with the facility psychiatrist. If the resident is continued on Mental Health Status, the psychiatrist will conduct a face-to-face evaluation of the resident and, with the treatment team, shall review the ITP weekly for the time the resident remains on Mental Health Status. A resident's ITP shall:

A) address individual behaviors and special needs;

B) address the need for special observation; and

C) provide guidance to staff who provide for the daily care and treatment of the resident.

8. All direct care staff shall follow the specific guidelines set forth in the ITP, including, but not limited to, behavior observation, data collection, documenting intervals, and interaction with the resident and the resident's response. This shall occur while the direct care staff continues to provide all other day-to-day care and treatment of the resident.

f) Incident Reporting Requirements

The AOD will ensure that the staff involved in the incidents leading up to the initiation of EMHS complete incident reports or chart notes as needed before they leave their shift. The shift supervisor shall ensure that all incident reports are delivered to the Program Director before the end of his/her shift.

g) Notification of Resident's Reassignment

1. On the first subsequent business day after a resident reassignment, the Clinical Director or designee shall notify the resident's primary therapist and facility psychiatrist of the reassignment and the behavior necessitating placement on EMHS.

2. On the first business day after placement on EMHS, the Clinical Director, primary therapist, or facility psychiatrist shall review the resident's continuing need for emergency mental health care.

A) If there is evidence of continued risk, the resident shall remain on EMHS. Continued assignment to EMHS shall then be reviewed every business day thereafter until the resident is reassigned to a different management status.

B) If, upon review, there is no evidence of continuing risk, the resident shall be returned to his/her previous management status with recommendations for follow-up treatment.

C) If the Clinical Director, primary therapist or facility psychiatrist determines the resident presents a risk of harm to self or others that is not related to his/her mental health, the resident will temporarily be reassigned to Special Management Status.

D) In the event of a re-assignment of the resident to Special Management Status, the Clinical Director, primary therapist, or facility psychiatrist shall notify the AOC and refer the matter to the Behavior Committee for review.

E) When a resident is temporarily reassigned to Special Management Status, the requirements specified in the Special Management Directive will be followed.

h) Daily Contact with Resident by Primary Therapist

1. While a resident is on EMHS, his/her primary therapist shall have daily, individual contact with that resident. The contact shall, at a minimum, involve:

A) Assessment of the resident's current dangerousness;

B) Mental status and mental health needs; and

C) The coordination of physical or medical needs, as required.

2. The primary therapist shall discuss the events and decisions resulting in the resident's reassignment to EMHS. Those events and decisions shall be viewed in light of the resident's overall ITP and, as appropriate, the ITP shall be modified and additional treatment recommended to reduce the frequency of the resident's reassignment to EMHS. The resident's primary therapist is responsible for ensuring that the resident is offered the following:

A) Daily recreation time as appropriate, based on the resident's mental status and assessed dangerousness;

B) Adequate access to personal hygiene and grooming supplies; and

C) All permitted personal and facility-provided property.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.350 Security

a) Use of Force

1. Force shall be employed only as a last resort or when other means are unavailable or inadequate, and only to the degree reasonably necessary to achieve a permitted purpose. Department staff shall not employ deadly force.

2. Use of force shall be terminated as soon as force is no longer necessary.

3. Medical screening and/or care shall be conducted following any use of force that results in bodily injury.

4. Any form of punishment is prohibited.

b) Force may be used under the following circumstances:

1. To compel compliance with a lawful order given by an employee to ensure the safety and security of the facility.

2. To protect oneself or any other person from physical assaults, injury or death.

3. To prevent escapes from the facility or from the custody of employees in the community.

4. To protect State property or the property of others from unauthorized use, possession, damage or destruction.

5. To prevent or suppress a riot, revolt, mutiny or insurrection, or other serious disturbance.

6. To compel compliance with all orders issued pursuant to the Act.

c) Training

Training in procedures for use of force shall be conducted for all security employees, along with yearly reviews.

d) Movement of Residents

1. Handcuffs, security belts and/or leg irons may be used to restrain any resident when:

A) A person confined pending a review of an incident or in Special Management Status (see Sections 299.650 and 299.690) is moved within the facility;

B) A resident is transported outside the facility; or

C) Determined by the Program Director to be necessary for safety and/or security.

2. The Program Director has ultimate authority regarding the advisability of all writ transportation. Any writ that poses a safety and/or security concern (e.g., due to inclement weather, facility lockdown, or other circumstances) may be cancelled upon direction of the Program Director.

e) Response to Serious Disturbances

1. The Program Director may confine residents temporarily in all or part of the facility when determined necessary in order to maintain security of the facility or for the safety of residents, employees or other persons.

2. The decision to impose a temporary facility confinement shall be reviewed and approved by the Program Administrator, whenever possible, prior to the imposition of the temporary facility confinement, but in any event, promptly thereafter.

3. Continuation of the temporary facility confinement shall be reviewed every 7 days by the Program Director and the Program Administrator.

f) Searches for Contraband

1. Searches of Visitors

A) All persons and items brought onto State property are subject to search. Prominent notices to this effect shall be posted at each facility.

B) A visitor may refuse to submit to a search. However, failure to submit to a search may result in denial, suspension or restriction of visiting privileges.

2. Searches of Residents

A) All residents and their clothing, property, housing and task assignments are subject to search at any time.

B) All residents are subject to testing for alcohol or substance use, including but not limited to urinalysis.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.400 Conditional Release Plans

a) Following notification by the court that a committed person is appropriate for conditional release, the Department shall prepare a plan that identifies the treatment and services that the person will receive in the community. The plan shall address the person's need, if any, for sex offender treatment, ancillary services, monitoring, supervision, surveillance, counseling, medication, community support services, residential services, vocational services, polygraph services, and alcohol or other drug screening. The Department may contract with a county health department, with another public agency and/or with a private agency to provide the treatment and services identified in the plan. The plan shall specify who will be responsible for providing the treatment and services identified in the plan.

b) All sex offender specific treatment provided to a sexually violent person while on conditional release shall be conducted in conformance with standards developed under the Sex Offender Management Board Act [20 ILCS 4026] by a provider licensed under the Provider Act.

c) For a committed person who is to be conditionally released under an initial commitment order or following an order for commitment to a secure facility, the plan shall be presented to the court for its approval within 60 days after the court finding that the person is appropriate for conditional release, unless the Department and the person to be released request additional time to develop the plan.

d) All plans for conditional release shall, at a minimum, contain those conditions set forth in Section 40(b)(5) of the Act. In addition, no person being supervised on conditional release shall reside at the same street address as another sex offender being supervised under the Act or on mandatory supervised release, parole, aftercare release, probation or any other manner of court supervision, except supervision for an offense listed in the Illinois Vehicle Code.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.410 Conditional Release

An order for conditional release places the committed person in the custody and control of the Department, and the person is subject to the conditions set by the court and the rules of the Department. Upon the recommendation of the resident's evaluator or the facility's Clinical Director, the Program Director may file a petition for conditional release on behalf of the resident. The recommendation may be based upon changes in the mental and/or physical condition of the resident, including, but not limited to, changes in the health needs of the resident. Regardless of such recommendation and/or filing, the Department shall, at all times, follow the court's orders regarding the need for secure care.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.420 Community Monitoring

The Department may contract with or utilize the services of county, municipality and/or other public or private entities to provide surveillance, monitoring, polygraph, drug and alcohol screening, and other related services to a person ordered to a plan of conditional release.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.430 Revocation

a) In addition to the methods of revocation outlined in Section 40 of the Act, if the Program Director determines that a released person has violated any condition or rule, and/or that the safety of others requires that conditional release be immediately suspended, he/she may be taken into custody and transported to a secure facility pending judicial review.

b) Within 48 hours after returning a person ordered to conditional release to a secure facility, the Program Director shall prepare a statement showing probable cause for the detention to the Attorney General or State's Attorney with a request that he/she immediately file a petition to revoke the order for conditional release with the committing court.

c) Pending the revocation hearing under Section 40(b)(4) of the Act, a person ordered to a plan of conditional release may be detained in a jail, hospital or facility.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.500 Notification of Victims

a) If the court places a committed person on conditional release under Section 40 or 60 of the Act, or discharges a person under Section 65 of the Act, upon any other court-ordered change in custody status, upon the escape of a resident, upon an inability to locate a person on a plan of conditional release, or upon the death of any detained or committed person, the Department shall notify all of the following who have requested notification under the Act or under the Rights of Crime Victims and Witnesses Act:

1. The victim of the act of sexual violence.

2. An adult member of the victim's family, if the victim died as a result of the act of sexual violence.

3. The victim's parent or legal guardian, if the victim is younger than 18 years.

4. The Department of Corrections (DOC) or the Department of Juvenile Justice (DJJ) as appropriate.

b) The notice to the DOC/DJJ and the persons to be notified shall state the name of the detained or committed person and the date the person was placed on conditional release or discharged, was the subject of a court-ordered change in custody status, died, escaped, or could not be located while on a court-ordered plan of conditional release. The Department shall send the notice, postmarked within one business day after the conditional release, discharge, court-ordered change in custody status, escape, death or inability to locate a person on conditional release, to DOC/DJJ and the last-known address of the persons to be notified under subsection (a).

c) When possible, the Department shall dispatch the notice within one business day after issuance of the court order requiring the preparation of the conditional release plan and a second notice within one business day after the date the court approves the plan of conditional release. When circumstances do not permit advance notice, notice shall be provided as soon as practicable after any conditional release, discharge, court-ordered change in custody status, death, escape, or inability to locate a person on a court-ordered plan of conditional release.

d) The Department shall design and prepare cards for persons specified in subsection (a) to send to the Department. The cards shall have space for persons requesting notification to provide their names and addresses, the name of the person committed under the Act, and any other information the Department determines is necessary. The Department shall provide the cards, without charge, to the Attorney General and State's Attorneys. The Attorney General and State's Attorneys shall provide the cards, without charge, to persons specified in subsection (a). These persons may send completed cards to the Department. All records or portions of records of the Department that relate to mailing addresses of these persons are not part of the resident's file nor subject to inspection or copying under Section 3 of the Freedom of Information Act.

e) The Department may request victim impact statements for use in conducting evaluations and providing sex offender specific treatment and/or ancillary services, as well as in preparing the ITP.

f) The Department may utilize the Statewide Victim and Witness Notification System described in the Rights of Crime Victims and Witnesses Act. That utilization shall, in all respects, constitute compliance with this Part.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.600 Resident Behavior Management System

The Resident Behavior Management System is a milieu treatment program designed to promote a safe and secure environment for treatment, as well as to preserve facility safety and security. Abiding by this Part and the requirements of the living unit and participating in treatment may be encouraged through the use of positive incentives (e.g., increased level of privileges, special activities, etc.). Behavior that violates this Part or the rules of the Program or the living unit shall be discouraged through the withdrawal of positive incentives (e.g., restrictions of privileges and liberties) and redirection to appropriate activities. As determined by the Program Director, the Program may establish differing management levels (e.g., Admission Status, Close Status, Special Management Status, Intermediate C, B and A Status) to provide a greater degree of individualization in the Resident Behavior Management System.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.610 Violations of Criminal Law

When reasonable grounds exist to suspect that a resident has committed a violation of criminal law, that violation shall be reported to the State's Attorney of the county in which the incident occurred or to the appropriate law enforcement agency official. The referral is independent of any action under the Resident Behavior Management System.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.620 Applicability

a) Program and living unit rules are to promote a safe and secure environment for treatment, as well as to preserve facility safety and security. All residents are expected to comply with the Program and living unit rules, as well as all staff orders. In a situation in which one or more residents are not following staff orders, staff will implement security measures to ensure facility safety and security (e.g., staff may direct all residents to their rooms).

b) All residents will be given adequate notice of the Program rules and living unit rules either directly by staff or presumptively by publication of this Part, provision of a handbook, or posted notice in the living units. Residents shall be informed of the rules upon admission. The location specific Program and living unit rules shall be either printed in the handbook or posted on the living units. Changes in rules that do not appear in the handbook shall be posted in the living units. Only those rules of which the residents have received notice may be enforced.

c) Rules apply equally to all residents in similar circumstances. Differences in circumstances are within staff discretion; however, the differences must be documented and applied when determining aggravating and mitigating circumstances surrounding a rule violation.

d) Progressive actions taken to address residents who violate facility rules involve warnings and, if ineffective, formal restrictions. When the severity of the rule violation warrants action be taken for the safety of the resident or others, staff may offer the resident a "cool down" period, which consists of voluntary confinement to the resident's room, or placement of the resident on Temporary Special Management Status pending review by the Behavior Committee. Whenever staff have reason to believe that a resident has violated facility rules, staff shall inform the resident of the specific rules and of the determination that the resident violated the rules, and shall offer one of the following:

1. Warnings

A) For a minor rule violation only, a warning may be issued if:

i) staff determines that:

• the resident is unfamiliar with the rules; or

• the resident's behavior was a technical violation of the rules; and

ii) staff determines that the objective of the rules would not be met by formal behavioral interventions.

B) A warning is to help the resident identify the rule violations, the consequences of the rule violations, and appropriate alternative behaviors. Warnings are to help the resident identify and modify the conduct that led to the rule violations in order to avoid imposition of formal behavioral interventions.

2. An intervention in the form of a "cool down" may be offered by the staff and may be accepted or rejected by the resident. If the intervention is rejected, staff will notify their supervisor immediately for further direction and or assistance. Staff involved in the cool down process shall complete incident reports and forward them to the shift supervisor for review before the end of the shift. Staff shall conduct a wellness check on the resident approximately 15 minutes after placement on a cool down. Within two hours after commencement of the cool down, a supervisor shall conduct an assessment of the resident's behavior to see if the cool down should be terminated or extended. All information gathered during this process shall be documented and may lead to imposition of formal behavioral interventions such as placement on Special Management Status or referral to the Behavior Committee.

3. Temporary assignment to Special Management Status may occur when the AOD has determined that a cool down was not appropriate or effective. Within two working days after being notified of a temporary assignment to Special Management Status, the Behavior Committee shall meet to review the incident and the need to maintain and continue the resident on Temporary Special Management Status. Staff shall conduct a wellness check of the resident approximately 15 minutes after assignment to Temporary Special Management Status. In addition, a mental health assessment shall be completed by a mental health professional within one hour after assignment to Temporary Special Management Status, and again at 12 hours.

e) Residents that may be faced with a change in management status upon the finding of a rule violation (i.e., "major" rule violation or third "minor" rule violation that leads to a reduction in management status/privileges) must be provided an opportunity to appear before the Behavior Committee and are entitled to 24 hours advance notice prior to that appearance. The notice shall be in writing and shall identify:

1. the rules alleged to be violated;

2. the date, approximate time, and location of the alleged violations;

3. a description of the incident/conduct; and

4. any witnesses identified in the incident report.

f) A resident facing a change in management status upon the finding of a rule violation may request that the Behavior Committee interview additional witnesses and, subject to health, safety and security concerns, appear before the Behavior Committee to testify and present documentation. Pending an appearance before the Behavior Committee, a resident may be temporarily assigned to Special Management Status.

g) The decision that a resident has violated a rule shall be based upon the best available evidence and that evidence must show it is more likely than not that the resident violated the rule. Staff may weigh the credibility of witnesses in making the decision. The Behavior Committee will determine the appropriate management status, make treatment recommendations, adjust privileges, or will take any combination of these actions. The decision of the Behavior Committee may be grieved, but may not be addressed as an Attempt to Resolve.

h) The following shall be prohibited from consideration under the Resident Behavior Management System:

1. punishment;

2. restrictions on diet; and

3. access to medical or sanitary facilities, showers, shaving, hygiene products, clothing, bedding, mail, approved religious activities, legal work, or counsel.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.630 Rule Violation

a) Behavior that jeopardizes the safety of the residents, staff or others, or the security of the Program or unit, or presents significant management difficulties is considered a major rule violation. Behavior that violates this Part or the Program or living unit rules, but does not place anyone in jeopardy, compromise the security of the Program or present significant management difficulties, is a minor rule violation. When the classification is unclear, staff has the discretion to determine whether the rule violation is major or minor.

b) A description of behaviors is included as Appendix A.

c) Every resident is presumed to be responsible for any contraband or other property that is prohibited by this Part or by Program and living unit rules when that contraband or property is located on the resident's person, within his/her room, or within areas of housing or task assignment that are under his/her control. If the resident produces evidence that convinces the treatment team that he/she did not commit the rule violation, the resident shall not be given a behavioral intervention.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.640 Preparation and Review of Incident Reports

a) Every employee has the duty to observe the conduct of residents. When staff detect or observe rule violations, they shall order the resident to stop or redirect the resident to appropriate behavior. Residents are required to comply with staff orders.

b) If an employee observes potential rule violations, major or minor, discovers evidence of violation commission, or receives information from a reliable witness of rule violations, he/she shall prepare an incident report.

c) The incident report must be fully completed. The reporting employee shall provide the following information to the extent known or available:

1. The name and identification number of the resident;

2. The place, approximate time, and date of the rule violation;

3. The rule violations that the resident is alleged to have committed;

4. A written statement of the conduct observed;

5. The names of residents, employees and visitors who were witnesses;

6. Any statements by the resident; and

7. The signature of the reporting employee.

d) The Program Director shall promptly review and make a determination regarding all incident reports involving residents and, when appropriate, refer resident incidents to either the Behavior Committee (for major rule violations) or the Program Unit Hearing Officer (for minor rule violations) for review of possible rule violations and make a recommendation. For the purposes of incident report review, the writer or writers of pertinent incident reports will be excluded from the Committee or serving as a Program Unit Hearing Officer.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.650 Assignment to Temporary Special Management Status

a) The Program Director shall determine whether it is necessary to temporarily assign the resident to Special Management Status in accord with this Section, pending a review of the incident report. The decision to place a resident in Temporary Special Management Status (TSMS) may be based, among other matters, on:

1. The aggressiveness of the Resident;

2. The threat posed to the safety and security of the facility;

3. The need to restrict the Resident's access to the general population to protect him or her or others from injury or to conduct the review; and/or

4. The seriousness of the rule violation.

b) Residents placed on TSMS may be housed in their rooms, or living areas, or any other area of the facility designated by the Program Director.

c) Behavior Committee Determination

1. The Behavior Committee shall review the decision to temporarily assign a resident to Special Management Status within two working days, whenever possible, and may:

A) Continue the reassignment pending further investigation. Continued reassignment shall be reviewed within two working days, whenever possible. The Program Director will be notified whenever the resident's temporary reassignment has been continued;

B) Determine that the documented allegations do not meet the threshold for continuation on Special Management Status and return the resident to his/her prior management status;

C) Determine that the resident did engage in the reported rule violations and reassign the resident to Special Management Status; or

D) Determine that the resident did engage in the reported misconduct and reassign the resident to a management status that provides appropriate management, treatment and privileges relative to the resident's needs.

2. Among other matters, the factors listed in subsection (a) may be considered by the Committee in arriving at its decision.

d) A resident who has pending charges from a criminal offense arising from Program rule violations may remain in Special Management Status and be housed in any area designated by the Program Director as a special management area of the facility.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.655 Program Unit Hearing Officer Procedures

a) The Program Unit Hearing Officer shall be either security or clinical staff designated by the Program Director to hear allegations of minor rule violations that do not result in reassignment of management status. Any person who initiated the allegations that serve as the basis for the incident report, or who conducted a formal investigation into those allegations, or who witnessed the incident, or who is otherwise not impartial shall not conduct a hearing on that report.

b) The hearing shall be convened, but need not be concluded, within 14 days after the commission of the rule violation or its discovery, whenever possible, unless the resident is unable to participate in the hearing.

c) The resident shall receive a 24-hour written notice of the allegations and violations being presented against him/her prior to the hearing.

d) The hearing may be continued to obtain additional information or upon the resident's written request based on good cause shown.

e) The resident shall have the right to appear before and address the Program Unit Hearing Officer.

f) The Program Unit Hearing Officer may interview witnesses and review any information relevant to the violation.

g) The Program Unit Hearing Officer may return the report to the Program Director with a recommendation for a hearing before the Behavior Committee.

h) The Program Unit Hearing Officer may decide upon any of the actions authorized in Section 299.665(c)(3), except that he/she may not change the resident's management status.

i) A recommended decision shall be signed by the Program Unit Hearing Officer that contains a summary of oral and written statements and other evidence presented, the decision, and the behavior action implemented. The Program Director shall review the recommendation and render a final decision.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.660 Review of Incident Reports (repealed)

History

• Source: Repealed at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.665 Behavior Committee Procedures

a) Whenever practicable, a resident who is the subject of an incident report shall be allowed to address the Behavior Committee in order to present his/her views regarding the reported incident. This may be denied if it is determined to be clinically contraindicated, would place a resident or others at risk of harm, or would jeopardize the safety or security of the Program.

b) The Behavior Committee shall document its decision and the reason for that decision in the Resident's behavioral record.

c) Violations of facility or living unit rules shall be addressed through specific treatment recommendations and/or referral to ancillary services (e.g., anger management); reassignment of management status; adjustment of privileges; or any combination of these three actions. The Behavior Committee shall determine which interventions are most appropriate.

1. Treatment recommendations and/or ancillary services to address rule violation must be logically related to the rule violation (e.g., anger management for reactive, anger-based aggression), must be available, and must have a reasonable expectation of success.

2. The Behavior Committee may reassign residents to a different management status whenever rule violations indicate that they cannot be effectively managed at their current management status.

3. Although progressive in nature, privileges may be adjusted upon the increased risk of harm or disruption to Program security. Behavioral interventions may include the removal of a privilege that the resident has earned through good behavior. The behavioral interventions should be reasonably related to the rule violation.

d) Upon determination that a resident has violated a facility rule, the Behavior Committee shall determine appropriate management status, determine appropriate treatment recommendations and/or ancillary services, adjust privileges, or take any combination of these actions. The Committee may also establish time limits on the management status, or behavioral intervention, or conditions imposed.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.670 Consequences for Rule Violation (repealed)

History

• Source: Repealed at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.680 Restitution Procedures

a) The Behavior Committee may recommend that the resident make restitution in any amount not to exceed actual out-of-pocket expenses or loss caused by the conduct of the resident. Restitution may include restoration for damage to property or person caused by the resident. The Committee shall determine the amount and the conditions of payment.

b) If the Behavior Committee determines that restitution for damage to property or person is appropriate, it shall ask the resident to agree to authorize disbursement from his/her trust fund or from any other account of the resident or, when appropriate, agree to restore the damaged items to the condition the items were in before the damage occurred.

1. If the resident agrees to make restitution, he/she shall sign an agreement to restore the damaged items or authorize disbursement of funds to either the State or the appropriate individual.

2. If the resident refuses to agree to either restore the damaged items or authorize disbursement of his/ her current funds or future earnings in accordance with the Behavior Committee's determination, the Committee may recommend to the Business Administrator that a hold be placed on the resident's account for the owed amount. The Committee may further recommend to the Business Administrator that commissary privileges and/or award of reward points be suspended, in whole or in part, for a period of time. The Business Administrator is authorized to take such action as he/she deems necessary to recoup payment, including debits to the resident's trust fund.

c) The Behavior Committee may consider the resident's willingness to make restitution when considering any other behavioral intervention.

d) A resident shall not be subjected to greater behavioral intervention because he/she is without funds and therefore unable to make restitution.

e) In the event a resident is released prior to full restitution, arrangements shall be made to address payment of the balance of the authorized restitution by the resident.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.690 Placement in Special Management Status

Residents whose behaviors threaten the safety or security of the facility or who cannot otherwise be effectively managed in their current management status may be confined in their rooms, in their assigned residential units, or relocated to another area of the facility designated by the Program Director. Placement in Special Management Status does not supersede or eliminate any other informal or formal behavioral intervention that has been previously offered by staff, the Program Unit Hearing Officer or the Behavior Committee.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.700 Special Management Status Standards

Standards for living conditions in Special Management Status shall include the following:

a) Residents in SMS shall be permitted personal property as allowed and ordered by the Program Director for safety and security reasons.

b) Notwithstanding the foregoing, residents in SMS shall be permitted access to writing instruments, incoming and outgoing mail, legal mail, their legal materials, courts and legal counsel.

c) Residents in SMS shall receive food comparable to that provided to the general population. Approved religious or medical diets shall not be interrupted.

d) Movement outside the special management area shall be permitted as approved by the Program Director after considering safety and security concerns.

e) Healthcare personnel shall visit residents on SMS as often as necessary to address any health related concerns.

f) Requests by a resident to perform religious rituals or other matters of religious observance shall be accommodated when they do not interfere with the health and safety of residents or staff or otherwise pose a risk to overall safety or security of the facility. When a religious observance request is in conflict with reasonable facility rules, an alternate accommodation may be sought..

g) Each resident in SMS shall be contacted by a member of the clinical staff at least once every seven days, or more often if clinically warranted.

h) Continued involvement in sex offender specific treatment and ancillary services may be permitted on an individual basis, as approved by the Program Director after considering the attendant safety and security concerns.

i) Residents shall be afforded the opportunity for a minimum of one hour exercise outside their rooms per week. However, exercise may be temporarily restricted or suspended, unless medically contraindicated, if the Program Director determines the activity to be a threat to the health or safety of any person or to the overall security of the facility.

j) Residents in SMS shall be permitted a shower and shave not less often than once every three days and shall be provided with clean bedding and clothing at least once per week.

k) Residents in SMS shall be permitted reading materials approved by clinical staff and security staff.

l) Residents in SMS shall not be subjected to excessive heat or cold and shall be provided with adequate ventilation, plumbing facilities and light.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.800 Filing of Grievances

a) A resident shall first attempt to resolve incidents, problems or complaints, other than complaints concerning behavior review proceedings, through filing an Attempt to Resolve (ATR). If a resident is unable to resolve a complaint through the ATR process, or if the complaint concerns a proceeding before the Program Unit Hearing Officer or the Behavior Committee, the resident may file a written grievance on a grievance form that shall be made available in all living units. A grievance shall be filed within one month after the discovery of the incident, occurrence, or problem that gives rise to the grievance or within one month after the receipt of a decision. However, if a resident can demonstrate that a grievance was, for good cause, not timely filed, the grievance shall be considered.

b) The grievance form shall be addressed to the Grievance Examiner and shall be deposited in the living unit mailbox or other designated repository.

c) Staff assistance shall be available for those residents who cannot prepare their grievances unaided, as determined by facility staff.

1. All residents shall be entitled to invoke the grievance procedure regardless of their management status or classification.

2. Each facility shall take reasonable steps to ensure that the grievance procedure is accessible to residents who are impaired or disabled.

d) Residents must be informed of the grievance procedure and may request further information regarding the procedure from their primary therapists.

1. The written procedure shall be available to all residents.

2. A resident unable to speak or read the English language may request that the procedure be explained in his/ her own language.

e) Actions or reprisals may not be taken against a resident for using the grievance procedure. A resident may submit a grievance alleging that a reprisal has been made against him/ her.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.810 Grievance Examiner

a) The Program Director shall appoint two or more employees to serve as a Grievance Examiner who shall attempt to resolve problems, complaints and grievances that residents have been unable to resolve through the ATR process.

b) No person who is directly involved in the subject matter of the grievance, who was the Program Unit Hearing Officer, who was a member of the Behavior Committee that heard an incident report concerning the grievance, or who is otherwise not impartial, may serve as the Grievance Examiner reviewing that particular case.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.820 Grievance Procedures

a) A Grievance Examiner shall review grievances at least weekly, provided that one or more grievances have been filed. The Grievance Examiner shall determine whether to process a grievance or return the grievance as not grievable.

b) If the Grievance Examiner determines further clarification is necessary, he/she may meet with the resident.

c) The Grievance Examiner shall consider the grievance and review all findings and recommendations within 15 working days after receipt of the grievance, whenever practicable. The Grievance Examiner shall submit, in writing, to the Program Director, within five working days, the findings and recommendations. The Program Director shall make the decision as to whether the grievance is resolved, denied, upheld or not indicated and shall provide that determination, in writing, to the Grievance Examiner within 10 working days. The Grievance Examiner shall advise the resident of the Program Director's decision, in writing, within 10 working days , whenever possible.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.830 Emergency Grievance Procedures

a) All grievances marked as emergency shall be reviewed by a Grievance Examiner every working day after receipt.

b) The Grievance Examiner shall review and immediately forward all grievances determined to be an emergency to the Program Director.

c) If the Program Director determines that there is a substantial risk of imminent personal injury or other serious or irreparable harm to the resident, or others, the Program Director shall notify the Grievance Examiner that the grievance shall be handled on an emergency basis.

d) The Program Director shall respond to the resident within three working days after receipt of the grievance, indicating what action shall be or has been taken.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.840 Grievance Appeals

a) If, after receiving the decision of the Program Director, the resident is of the opinion that the grievance has not been resolved to his/ her satisfaction, he/ she may appeal in writing to the Program Administrator within 30 days after receipt of the decision. Copies of the Grievance Examiner's report and the Program Director's decision shall be attached.

b) The Program Administrator shall review the grievance and the decision of the Program Director. The Program Administrator may call witnesses or examine records at his/her discretion. The Program Administrator shall make a final determination of the appeal within 45 working days, whenever practicable. The resident shall be sent a written copy of the Program Administrator's decision.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.850 Grievance Records

Records regarding the filing and disposition of grievances shall be collected and maintained by the facility as required by State record retention and confidentiality laws.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.900 Program Evaluation

The Department may evaluate the whole, or any part of, the Program for the purpose of quality assurance and improvement.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.910 Research

This Subpart applies to any person or entity seeking to conduct a research or evaluation study on residents within the Department.

59 Ill. Adm. Code 299.920 Requirements for Submitting Research Proposals

a) Any request to conduct research or an evaluation study involving former or present residents and/or employees, programs or facilities, whether originating inside or outside the Department, shall be in writing and shall be submitted to the Secretary for review and authorization.

b) The person or entity requesting the research or study shall provide the following written documentation prior to approval of the request:

1. A formal research proposal including names and vitae of the researchers; abstract of the project, including purpose, methodology, duration, the number of subjects, amount of time required for each subject, and dissemination plan; and Department resources to be utilized;

2. Approval obtained from a Human Subjects Research Committee and Institutional Review Board, when applicable;

3. A signed Research Agreement that shall contain a statement that any rights of privacy, informed consent, confidentiality and protection from harm are met in accordance with accepted professional and scientific ethics and that the requirements of any applicable Illinois and federal statute or regulation have and will continue to be met; and

4. Any other information deemed necessary to the authorization process.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.930 Criteria for Approval or Denial of Research Proposals

a) The request to conduct research or an evaluation study shall be reviewed to determine if the proposed study is ethical, feasible, methodologically sound, and relevant to the needs and goals of the Department.

b) Requests to conduct research or an evaluation study may be denied for reasons that may include, among other factors, the nature and risk of the research, concern for security, and the level of demand on staff time and Department finances.

c) Research projects involving use of residents in medical, cosmetic, or pharmaceutical experiments shall not be permitted.

59 Ill. Adm. Code 299.940 Requirements for Conducting Research Projects

a) The researcher shall provide periodic reports on the progress of the research project as required. Any changes in the scope or methodology of the project shall be reported.

b) Permission to conduct the current study and any further research may be discontinued for, among other matters, violation of Department rules or security requirements or for violation of applicable Illinois or federal statute or regulations. The factors to be considered in determining whether to discontinue a project shall include, but not be limited to: whether the violation was intentional; the seriousness of the violation; whether the project is placing greater demands on Department resources than originally stated; or whether the project has been expanded beyond the stated purpose and scope of the project.

c) Prior to publication of the results of a research project, the researcher shall provide copies of the material accepted for publication to the Department for informational purposes.

d) Following publication, additional copies may be provided for the Department without cost, if so specified in the signed Research Agreement.

59 Ill. Adm. Code 299.1000 Charges for Services in a Secure Residential Facility

a) The maximum charge for services to be assessed against a recipient, or the estate of a recipient, in a Department-operated secure residential facility, shall be 100% of the average per capita cost of the secure residential facility commencing with Fiscal Year 2019 and recalculated each July 1 thereafter.

b) The maximum charge for services to be assessed against a recipient or the estate of a recipient maintained in the community on a plan of conditional release, shall be 100% of the actual cost of maintaining the recipient in the community under the plan of conditional release ordered by the committing court.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.1010 Payments

a) The maximum rate to be used when filing claims for benefits under Title XVIII of the Social Security Act (Medicare) (42 USC 1395b-1), Title XIX of the Social Security Act (Medicaid) (42 USC 1396a), Veteran's Administration benefits (38 USC 521, 541, 542), Champus/Champva (38 USC 601), and active military is not to exceed the rate set by the Illinois Department of Healthcare and Family Services (HFS), or as approved each year for the respective program. Payments received from a benefit or federal insurance program shall be credited on a dollar for dollar basis for each covered day up to the maximum per capita cost for which the recipient has a liability or the contracted rate established by the provider, whichever is less.

b) All payments received from private hospitalization insurance shall be credited against the person's liability, on a dollar for dollar basis, up to the prevailing maximum charge established in this Section.

c) All payments on behalf of persons from any source shall be credited against Medicaid billings if for the same period of service.

d) If a spouse who is a legal dependent of a recipient is designated as payee of the recipient's benefits and is using those benefits as his/her income, charges shall be established on the total combined income in accordance with the schedule in Table A of this Part.

e) Voluntary payments in excess of required amounts will be accepted from the recipient and from persons not legally responsible.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.1020 Liability for Services Charges

a) Recipients have the primary liability for payment of sums representing charges for services at the prevailing maximum rate determined by the Department, subject to the allowable reserve. Upon the death of the recipient, the estate of the recipient has the primary liability for payment of unpaid sums representing charges for services at the prevailing maximum rate established in Section 299.1000.

b) The recipient or, if deceased, the estate of the recipient retains liability as long as unpaid services charges remain.

c) Income accruing from a trust estate of a person shall be charged the same as other assets. If the income from the trust is not sufficient to meet the maximum cost of services to the person, the Department shall, in those cases in which the trust agreement specifically states that the principal, if needed, may be used, establish charges against both the income and the corpus of the trust.

d) When a person under the age of 22 receives benefits from a federal government agency that are to provide for the recipient's care and maintenance needs, those funds, when the law allows, shall be applied toward the State's cost of providing care, less any applicable personal allowance.

e) If the recipient is also a Medicaid recipient and receives benefits from a federal government agency, the federal funds, less the applicable personal allowance specified in 89 Ill. Adm. Code 113.247, must be applied toward the Medicaid charges in accordance with 42 CFR 435.732. Claims submitted by the Department to HFS shall be reduced by the amount of these net benefits.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.1030 Determination of Ability to Pay Services Charges

a) The Department, in determining the ability of the person to pay services charges, will assemble any necessary information pertaining to his/her financial status and will then set the amount for which the person will be held liable. The person must furnish financial information on admission or as soon thereafter as possible to enable the Department to make a proper determination of the sources available for reimbursement of the cost of services charges. The Department will require the person to update his/her financial information on not less than an annual basis. The liability for payment of services charges shall be based on information available at the time of determination. (The data may include savings, trusts, wills, evidence of indebtedness, evidence of court-ordered payments, and the like.) Each person for whom a determination has been made shall be issued a Notice of Determination, notifying the person of his/her liability. The notice shall be issued even when current determined liability is $0.00.

b) When there is a demonstrated ability to pay, payment for services is an obligation, established by Section 90 of the Act, against the person, guardians, trustees and/or payees.

c) Subsequent review may be initiated by the recipient prior to the annual redetermination due to changes in ability to pay or as a result of an administrative hearing. Service recipients have a duty to inform the Department of any changes in their financial status.

d) The determination of the ability to pay and amount of liability of the person for services charges, up to the prevailing maximum rate, shall be based on all assets and income of the person. After considering the person's legal dependent's financial needs (see subsection (h)), all resources and assets are reduced to the allowable reserve exemption in accordance with subsection (e).

e) The allowable reserve exemption is determined by the amount of assets owned at the time of initiation of services, except that the allowable reserve exemption from all sources cannot exceed that established by HFS (see 89 Ill. Adm. Code 120.382). The service recipient's allowable reserve exemption can only be increased by the unused portions of the monthly personal and clothing allowance or unspent workshop or other monetary incentive funds, such as living skills program funds. Amounts to be paid by the service recipient for services charges may not be deferred to build a reserve to the maximum amount allowed.

f) If the person becomes eligible and is approved for Medicaid, 42 CFR 430 (2016) and HFS rules at 89 Ill. Adm. Code 120.382 govern the allowable reserve and personal and clothing allowance.

g) The Department shall allow deductions from income for a community spouse maintenance needs allowance and a family maintenance needs allowance for each dependent family member who does not have enough income to meet his/her needs. Family members include dependent children under age 21, dependent adult children, dependent parents, or dependent siblings of either spouse, who are living with the community spouse. To determine the amount of the deduction:

1. The deduction for the community spouse maintenance needs allowance, as set forth in 89 Ill. Adm. Code 120.61(d), is equal to the community spouse maintenance needs standard less any non-exempt monthly income of the community spouse. The deduction is allowed only to the extent that income of the spouse who is receiving services at a Department-operated facility is contributed to the community spouse. However, the deduction for the community spouse maintenance needs allowance shall not be less than the amount ordered by the court for support of the community spouse or the amount determined as the result of the fair hearing.

2. The deduction for the family maintenance needs allowance for each dependent family member is equal to one-third of the difference between the family maintenance needs standard and any non-exempt income of the family member as set forth in 89 Ill. Adm. Code 120.61(d).

h) Prior to the assessment of services charges against a recipient, the Department shall review the financial needs of the recipient's legal dependents. The financial needs of these legal dependents shall be based on amounts expended up to an amount equal to the minimum yearly income for which a person would be subject to a charge as shown in Table A of this Part. Any amounts allowed that are not expended for support of legal dependents claimed on the recipient's U.S. Individual Income Tax Return shall be subject to services charges.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.1040 Computing Monthly Costs of Services Charges

The liability of recipients and the estates of recipients for services shall be computed in the following manner:

a) Monthly liability established against a service recipient in order to secure care is determined by multiplying the per diem rate for the secure residential care service provided by the number of actual days of service received by the person during the month. The per diem rate will be recalculated annually.

b) Monthly liability established against a service recipient ordered to conditional release is determined by calculating the actual cost of services provided during that month. The phrase "actual cost" includes both the administrative costs associated with maintaining the service recipient on the conditional release program and the total cost of supporting the person in the community, which includes, but is not limited to:

1. sex offender specific treatment and ancillary services;

2. transportation costs;

3. food and groceries;

4. medical/dental care;

5. housing and utilities;

6. polygraph and/or drug testing;

7. electronic monitoring/surveillance costs;

8. spending cash;

9. cell phone and other methods of maintaining contact; and

10. any other costs incurred specific to the service recipient.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.1050 Allowances for Unusual Expenses and/or Exceptional Circumstances in Determining Ability to Pay Services Charges

a) If an examination or re-examination reveals unusual and/or exceptional circumstances indicating that the recipient's income and assets, as reported on schedules B and C of the Financial Questionnaire, are not an adequate measure to determine ability to pay services charges, allowances for the following unusual and/or exceptional circumstances shall be made in the application of the schedule of charges:

1. Transfer to prison for revocation of probation or subsequent conviction;

2. Provable reduction in income;

3. Additional dependents; and

4. Unforeseen catastrophic expenses.

b) All service recipients requesting allowance under subsection (a) must furnish proof of the unusual and/or exceptional circumstances.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.1060 Petition for Release from or Modification of Services Charges

Any service recipient who has been issued a Notice of Determination of sums due as service charges may petition the Department for a review of that determination. The appeal process is detailed in 89 Ill. Adm. Code 508, with the exception that a petitioner has 90 days to file an appeal request. The petitioner cannot be represented by another service recipient.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.1070 Actions for Collection of Services Charges

a) When it is necessary for the Department to disclose information in order to collect services charges, that disclosure shall be limited to information needed to pursue collection, and the information disclosed shall not be used for any other purpose, nor shall it be redisclosed except in connection with collection activities.

b) Upon request of the Department, the Office of Attorney General, or the State's Attorney of the county in which a service recipient who is liable under the Act for payment of services charges resides, shall institute appropriate legal action against any such recipient, or, within the time provided by law, shall file a claim against the estate of a deceased recipient for unpaid services charges.

c) The court shall order the payment of sums due for services charges for such period or periods as the circumstances require. The order may be:

1. entered against any person; and

2. based upon the proportionate ability of each person to contribute to the payment of sums representing services charges, including the actual charges for services in facilities outside the Department when the Department has paid those charges.

d) Orders for the payment of money may be enforced by garnishment, attachment, contempt and/or any other mechanism authorized by law. In addition, other judgments for the payment of money, pre- and post-judgment interest, and costs may be adjudged against the person.

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.APPENDIX A Rule Violations

Willfully disobeying any rule of the facility is prohibited. Rule violations that do not affect the safety or security of the facility may be deemed minor rule violations and may be addressed by the Program Unit Hearing Officer. Conversely, rule violations that impact the safety and security of the facility are deemed major rule violations and require an appearance before the Behavior Committee to determine the appropriate behavioral intervention.

Aiding and abetting any person in the commission of any of these rule violations; attempting to commit any of these rule violations; soliciting another to commit any of these rule violations; or conspiring to commit any of these rule violations, shall be considered the same as the commission of the rule violation itself.

MAJOR RULE VIOLATIONS

ARSON

Setting fire anywhere outside or inside the facility, the grounds or State vehicles is not allowed.

BATTERY TO ANY PERSON

Causing a person or an object to come into contact with another person in an offensive, provocative or injurious manner, or fighting with a weapon is not allowed.

BRIBERY & EXTORTION

Asking for or receiving anything of value in exchange for protection, to avoid harm or injury, or through coercion is not allowed. Giving or receiving money or anything of value may additionally be deemed trading and trafficking.

CELL PHONE OR COMPUTER/INTERNET USAGE

Receiving, possessing or using a cell phone or internet capable device (this also includes wireless connections such as data, Bluetooth or WIFI) or a similar technology medium is not allowed. In addition, e-mail and social networking is not allowed. Homemade computers are not allowed. Residents are not allowed to create, make, assemble or build a computer or similar device or maintain any device capable of storing electronic data or images.

COMMUNICATION, MISUSE OR POSSESSION OF STAFF PERSONAL INFORMATION OR ITEMS

Seeking or giving out any personal information to another resident, staff member or visitor about a staff member (former or current) of the TDF is not allowed. This includes talking or writing anything of a personal nature about a staff member.

CONCEALMENT OR MISREPRESENTATION OF IDENTITY

Wearing a disguise or a mask, impersonating another, or otherwise concealing one's identity is not allowed. This includes residents refusing to identify themselves with their ID, when requested by an employee, or wearing a hat or wig, make-up or sunglasses inside the facility without authorization.

DAMAGE OR MISUSE OF PROPERTY

Destroying, damaging, defacing, removing, altering, tampering with, or otherwise misusing State property, the property of another person, or the resident's own property, including the obstruction of locks or security devices, is not allowed.

DANGEROUS CONTRABAND

Possessing, manufacturing, introducing, selling, supplying to others, or using without authorization any explosive, acid, caustic material for incendiary devices, ammunition, dangerous chemical, escape material, knife, sharpened instrument, gun, firearm, razor, glass, bludgeon, brass knuckles, any other dangerous or deadly weapon or substance of like character, or any object that is made to appear to be a deadly or dangerous weapon or substance is not allowed.

DANGEROUS DISTURBANCES

Causing, directing or participating in any action, either within the facility or in the community, that may seriously disrupt facility operations or threaten the health or safety of any persons or the condition of property is not allowed. This includes the taking or holding of hostages by force or threat of force.

DISOBEYING A DIRECT ORDER (MAY ALSO BE A MINOR VIOLATION)

Willfully refusing to comply with an order, including the refusal to participate in testing for drug abuse required under Section 45 of the Act, is not allowed.

DRUGS AND DRUG PARAPHERNALIA

Possessing, manufacturing, introducing, selling, giving to others, or receiving alcohol, any intoxicant, inhalant, narcotic, syringe, needle, controlled substance or marijuana, or being under the influence of any of these substances is not allowed. This violation includes medication misuse, e.g., the possession or use of unauthorized amounts of prescribed medication and selling, supplying, or receiving prescribed medication to/from others.

ESCAPE

Leaving or failing to return to lawful custody of the facility without authorization is not allowed.

FIGHTING

Unauthorized fighting with another consenting person, which is not likely to cause serious bodily injury to one or the other, and that does not involve the use of a weapon, is not allowed.

FORGERY

Forging, counterfeiting or reproducing any signature, document, article of identification, money, security or official paper without authorization is not allowed.

HEALTH, SMOKING OR SAFETY VIOLATIONS

Smoking and chewing tobacco of any kind are not allowed in the facility. All eating, living and work areas are to be kept clean and free of items or trash. Tattooing or body piercing is not allowed.

INTERFERING WITH FACILITY OPERATIONS

Behavior that interferes with the smooth and orderly operation of the facility is not allowed. This includes movement to or from the living unit, movement during med line and count, escorted movement, or when a resident is asked to be secured in his/her room, etc. This also includes refusing to accept a room assignment and refusing to follow any drills and/or emergency procedures.

INTIMIDATION OR THREATS

Expressing, by words, actions or other behavior, an intent to injure any person that creates the reasonable belief that physical, monetary or economic harm to that person or to another will result is not allowed.

PETITIONS AND BUSINESS VENTURES

Writing, signing or circulating a petition without authorization is not allowed. Engaging in a business venture without express authorization from the Program Director is not allowed.

POSSESSION OF MONEY OR CASH EQUIVALENTS

Possessing or causing to be brought into the facility, United States currency/coins or other negotiable instruments is not allowed. This includes credit cards, debit cards, gift cards, money orders, cash, etc.

PROVIDING FALSE INFORMATION TO STAFF

Giving false information, directly or indirectly, in the course of an investigation that would mislead an employee is not allowed.

SEXUAL MISCONDUCT AND SEXUAL CONTACT

Residents are not allowed to have sexual activity or sexual contact or ask for sexual activity with other persons in the facility. Self-gratifying sexual behavior, such as masturbation, can only occur in the privacy and confines of a resident's own room and cannot be done within view of employees or other residents, including the resident's roommate. Touching anyone's genital area over or under the clothing, kissing, hugging, patting, fondling of any sort, including sexual activity, is not allowed. Being in the shower with another resident is not allowed. Sexual talk, sexual horseplay, sexual language and comments that are offensive are not allowed.

STAFF MANIPULATION OR SPLITTING

Attempting to bribe, convince, trick, sway or talk an employee into going against the facility or living unit rules, or the policies and procedures set forth in the Resident Handbook, is not allowed. Going from one employee to another in order to split staff or in order to "shop around" for an answer the resident likes, is not allowed.

STALKING

Willful and repeated following, watching, calling and/or harassing of another resident or employee is not allowed.

STEALING – MAJOR

Taking any items from the facility, another resident or employee without authorization is not allowed. Stealing that threatens the safety or security of the facility is a major rule violation.

TRADING AND TRAFFICKING – MAJOR

The exchange (giving, accepting, loaning or borrowing) of any item, personal items or services is not allowed. Residents may not trade or traffic with any employee, visitor or other resident. Trading or trafficking that threatens the safety or security of the facility is a major rule violation.

TRANSFER OF FUNDS

Causing money to be moved from one resident's trust fund account to another resident's account, or having someone outside of the facility place money in the account of another resident, is not allowed.

UNAUTHORIZED COMMUNICATION

Communicating, without prior authorization, or engaging in unwelcome communication (e.g., by mail, telephone, or through other persons) with any victim or the family of any victim of sexual violence is not allowed. Unapproved or unwanted communication with any employee or the family of an employee, or any person who has requested no further communication must be respected at all times. Sending unauthorized requests or correspondence is not allowed; this includes repeated and/or excessive written requests or correspondence. In addition, written material containing sexual language is not allowed.

UNAUTHORIZED MOVEMENT − MAJOR

Unauthorized movement is being anywhere that is not allowed or being absent from where the resident is supposed to be. Unauthorized movement that threatens the safety or security of the facility is a major rule violation.

UNAUTHORIZED ORGANIZATIONAL ACTIVITY

Engaging or coercing others to engage in unauthorized organizational activities or meetings; displaying, wearing, possessing or using unauthorized organizational insignia or materials; or giving unauthorized organizational signs is not allowed.

UNAUTHORIZED PROPERTY

Possessing, giving, loaning, receiving or using property that a resident has no authorization to have or to receive and that was not issued to him/her through regular procedures, including the unauthorized possession of food or clothing, or the possession of property in excess of that authorized by the facility, is not allowed.

VIOLATING STATE OR FEDERAL LAWS

Committing any act that would constitute a violation of State or federal law is not allowed.

VIOLATION OF RULE – MAJOR

Any other behavior or activity that, in the opinion of the Program Director, Security Director, or Treatment Team, poses a therapeutic, fire, health and/or safety risk is a major rule violation.

MINOR RULE VIOLATIONS

ABUSE OF PRIVILEGES

Violating any rule that governs the use of privileges at the facility is not allowed. This includes, but is not limited to, visits, yard, commissary, telephone, recreational activities, and use of State computers.

CONFERENCE CALLS/3-WAY CALLS

Unauthorized participation in a conference call or 3-way call is not allowed.

CURSING AND YELLING

Swearing, shouting, yelling, cursing, threatening, or saying anything aggressive or offensive to residents or employees is not allowed.

DISPLAYING OR PRACTICING MARTIAL ARTS

Displaying, instructing, or practicing martial arts, such as karate, tae kwon do, kickboxing, jiu jitsu, judo, etc., is not allowed.

FAILURE TO MAINTAIN APPROPRIATE PERSONAL HYGIENE

Residents must always keep themselves clean and groomed. Residents must make sure their clothing and bedding is washed on a regular basis.

FAILURE TO NOTIFY STAFF

Concealing or failing to let an employee know of any rule violation by another resident is a violation of facility rules.

FAILURE TO REPORT

Failure to report for a scheduled group or Program assignment without good cause is not allowed.

GAMBLING

Gambling of any kind is not allowed.

HORSEPLAY

Rowdy, loud or rough play, wrestling, or physical contact is not allowed.

INSOLENCE

Communicating, touching, gesturing or other behavior that harasses, annoys or shows disrespect to any person is not allowed. This includes referring to employees by their first names.

LOITERING

Loitering (to stand idle or linger) is not allowed. Hiding or standing out of staff's view in order to read or hear what an employee is writing or saying is considered loitering.

POSSESSION OF CONTRABAND – MINOR

Possession of contraband is not allowed. Possession of contraband is considered a minor violation if it involves personal property that does not threaten the safety or security of the facility.

ROOM VISITING

Standing, sitting, lying down, etc., outside another resident's door in order to talk or visit is not allowed.

STEALING − MINOR

Taking any items from the facility, another resident or an employee without authorization is not allowed. To be considered a minor violation, the property must not pose a risk to the safety or security of the facility.

TRADING AND TRAFFICKING − MINOR

The exchange (giving, accepting, loaning or borrowing) of any item, personal items, or services is not allowed. A resident may not trade or traffic with any employee, visitor or other resident. To be considered a minor violation, the property must not pose a risk to the safety or security of the facility.

UNAUTHORIZED MOVEMENT – MINOR

Unauthorized movement is being anywhere that is not allowed or being absent from where a resident is supposed to be. Unauthorized movement that does not threaten the safety or security of the facility is a minor rule violation.

VIOLATION OF RULES − MINOR

Willfully disobeying any rule of the facility is prohibited. Any other behavior or activity that, in the opinion of the Program Director, Security Director, or Treatment Team, does not pose a therapeutic, fire, health and/or safety risk is a minor rule violation.

History

• Source: Amended at 44 Ill. Reg. 8246, effective April 28, 2020

59 Ill. Adm. Code 299.TABLE A Responsible Relative Liability

TABLE A

Responsible Relative Liability

Number in Family (including recipient)

Annual Income Range

Family Size

2

3

4

5

6

7

$ 7,000

$ 7,500

$ 5

7,501

8,000

10

8,001

8,500

15

8,501

9,000

20

$ 5

9,001

9,500

25

10

9,501

10,000

30

15

10,001

10,500

35

20

$ 5

10,501

11,000

40

25

10

11,001

11,500

45

30

15

11,501

12,000

50

35

20

$ 5

12,001

12,500

55

40

25

10

12,501

13,000

60

45

30

15

13,001

13,500

65

50

35

20

$ 5

13,501

14,000

70

55

40

25

10

14,001

14,500

75

60

45

30

15

14,501

15,000

80

65

50

35

20

$ 5

15,001

15,500

85

70

55

40

25

10

15,501

16,000

90

75

60

45

30

15

16,001

16,500

95

80

65

50

35

20

16,501

17,000

100

85

70

55

40

25

17,001

17,500

105

90

75

60

45

30

17,501

18,000

110

95

80

65

50

35

18,001

18,500

115

100

85

70

55

40

18,501

19,000

120

105

90

75

60

45

19,001

19,500

125

110

95

80

65

50

19,501

20,000

130

115

100

85

70

55

20,001

20,500

135

120

105

90

75

60

20,501

21,000

140

125

110

95

80

65

21,001

21,500

145

130

115

100

85

70

21,501

22,000

150

135

120

105

90

75

22,001

22,500

155

140

125

110

95

80

22,501

23,000

160

145

130

115

100

85

23,001

23,500

165

150

135

120

105

90

23,501

24,000

170

155

140

125

110

95

24,001

24,500

175

160

145

130

115

100

24,501

25,000

180

165

150

135

120

105

25,001

25,500

185

170

155

140

125

110

25,501

26,000

190

175

160

145

130

115

26,001

26,500

195

180

165

150

135

120

26,501

27,000

200

185

170

155

140

125

27,001

27,500

205

190

175

160

145

130

27,501

28,000

210

195

180

165

150

135

28,001

28,500

215

200

185

170

155

140

28,501

29,000

220

205

190

175

160

145

29,001

29,500

225

210

195

180

165

150

29,501

30,000

230

215

200

185

170

155

30,001

30,500

235

220

205

190

175

160

30,501

31,000

240

225

210

195

180

165

31,001

31,500

245

230

215

200

185

170

31,501

32,000

250

235

220

205

190

175

32,001

32,500

255

240

225

210

195

180

32,501

33,000

260

245

230

215

200

185

33,001

33,500

265

250

235

220

205

190

33,501

34,000

270

255

240

225

210

195

34,001

34,500

275

260

245

230

215

200

34,501

35,000

280

265

250

235

220

205

35,001

35,500

285

270

255

240

225

210

35,501

36,000

290

275

260

245

230

215

36,001

36,500

295

280

265

250

235

220

36,501

37,000

300

285

270

255

240

225

37,001

37,500

305

290

275

260

245

230

37,501

38,000

310

295

280

265

250

235

38,001

38,500

315

300

285

270

255

240

38,501

39,000

320

305

290

275

260

245

39,001

39,500

325

310

295

280

265

250

39,501

40,000

330

315

300

285

270

255

40,001

40,500

335

320

305

290

275

260

40,501

41,000

340

325

310

295

280

265

41,001

41,500

345

330

315

300

285

270

41,501

42,000

350

335

320

305

290

275

42,001

42,500

355

340

325

310

295

280

42,501

43,000

360

345

330

315

300

285

43,001

43,500

365

350

335

320

305

290

43,501

44,000

370

355

340

325

310

295

44,001

44,500

375

360

345

330

315

300

44,501

45,000

380

365

350

335

320

305

45,001

45,500

385

370

355

340

325

310

45,501

46,000

390

375

360

345

330

315

46,001

46,500

395

380

365

350

335

320

46,501

47,000

400

385

370

355

340

325

47,001

47,500

405

390

375

360

345

330

47,501

48,000

410

395

380

365

350

335

48,001

48,500

415

400

385

370

355

340

48,501

49,000

420

405

390

375

360

345

49,001

49,500

425

410

395

380

365

350

49,501

50,000

430

415

400

385

370

355

50,001 & over (continues at $5.00 increments)

More than 7 in a family continues at $5.00 increments

Annual income shall be adjusted gross income as defined in Section 2-203 of the Illinois Income Tax Act [35 ILCS 5]

History

• Source: Added at 44 Ill. Reg. 8246, effective April 28, 2020

Chapter III Guardianship and Advocacy Commission

Part 301 Fee Schedule for the Office of State Guardian

59 Ill. Adm. Code 301.10 Authority and Purpose

a) Authority. The Office of State Guardian exists as a division of the Guardianship and Advocacy Commission created by the Guardianship and Advocacy Act (GAC Act) [20 ILCS 3955] and shall serve as guardian of the person or estate, or both, for a ward when it has been appointed to do so by a court. The GAC Act further charges that the Commission shall evaluate a ward's ability to pay for guardianship services received and charge fees for those services. Section 27-1 of the Probate Act of 1975 [755 ILCS 5] permits a guardian to be awarded reasonable fees for services rendered pursuant to the guardianship appointment, upon approval of the court.

b) Purpose. The purpose of this Part and its fee schedules is to establish the procedures to be used in assessing fees against a ward or a ward's estate. A one-time initial fee shall be assessed for the establishment of the guardianship case. Fees shall be assessed monthly for guardianship services. Additional fees shall be assessed for guardianship petitioning and the sale or management of real or personal property.

History

• Source: Amended at 44 Ill. Reg. 11800, effective June 30, 2020

59 Ill. Adm. Code 301.20 Definitions

Terms are defined as follows for the purpose of this Part, unless the context requires otherwise:

"Account" means a statement in writing of receipts and disbursements from a ward's estate by the guardian during a stated period of time.

"Case Opening" means the internal administrative process used by OSG in establishing a temporary or ongoing guardianship case, including, but not limited to, collecting and reviewing necessary financial, legal, medical or social information pertaining to the ward or the ward's estate; opening bank or other financial accounts on the ward's behalf; assigning OSG representatives to perform guardianship responsibilities for the ward; collecting and receiving property of the ward; creating files, summaries and other documentary information necessary for the management of the ward or the ward's estate; and all other activities related to preparing for and assuming the responsibilities of guardian.

"Commission" or "GAC" means the Guardianship and Advocacy Commission.

"Court" means the probate court having jurisdiction over the ward and/or the estate of a ward.

"Estate" means all property owned by the ward, regardless of whether the Office of State Guardian is guardian of the person or estate of the ward, including, but not limited to, all cash, savings accounts, checking accounts, certificates of deposit, money market accounts, bonds, stocks or other negotiable securities or instruments, mutual fund shares, furniture, automobiles, other tangible personal property, and real estate.

"Fee" or "Fees" means any costs assessed by the Office of State Guardian against a ward or a ward's estate for guardianship services, including case opening fees, monthly guardianship services fees, guardianship petitioning fees, and fees for the sale or management of real or personal property.

"Fee Schedules" mean tables showing the amounts of moneys the ward or the ward's estate may be assessed for guardianship services, not including charges for outside services procured by the guardian.

"Financial Hardship" means that the total value of liquid assets of a living ward would be inadequate to provide or obtain care, assistance, education, training, sustenance, housing, treatment or other goods or services vital to the well being of the ward or his or her dependents, resulting in the risk of harm to the ward or the ward's dependents. Wards residing in independent domestic settings generally fall into this category.

"Guardian" means a court appointed guardian of the person, estate, or both, of a ward, and includes temporary, limited and plenary guardianship.

"Guardianship Petitioning" (see "Petitioning").

"Guardianship Services" means work performed by the Office of State Guardian and its representatives in becoming guardian and all guardianship duties performed thereafter on behalf of a particular ward, including, but not limited to, preparation and filing of periodic reports, inventories, petitions for expenditures, current and final accounts; sale or other disposition of real or personal property; managing all assets of an estate; securing residential placements and transfers; monitoring, evaluation and consent for medical treatment and habilitation programing; appearing for and representing a ward in legal proceedings; procuring other outside services for the benefit of the ward or the ward's estate; and quarterly, annual and other visits as necessary to provide an active guardianship program.

"Inventory" means a detailed list of all property owned by the ward that is filed with the court by the guardian.

"Liquid Assets" mean the portion of a ward's estate comprised of cash, negotiable instruments, or other similar property that is readily convertible to cash and has a readily ascertainable fixed value, including but not limited to savings accounts, checking accounts, certificates of deposit, and money market accounts.

"Notice of Assessment" means a prior written statement mailed, pursuant to the procedures outlined in Section 301.40(b) of this Part, to the ward or other interested party, including the ward's spouse, adult children, parents, adult siblings, and other nearest adult kindred, advising that costs shall be assessed by OSG against a ward or the ward's estate.

"Office of State Guardian" or "OSG" means a division of the Guardianship and Advocacy Commission, acting in its capacity as guardian of the estate, person, or both of a ward.

"Outside Services" means those services not provided by OSG or GAC employees, including the services of attorneys, corporations, agencies, individuals, or other entities retained to represent the interests of a ward or a ward's estate, who may charge the ward's estate for services rendered, subject to court approval. The fees may be in addition to fees assessed pursuant to the OSG fee schedules.

"Petitioning" or "Guardianship Petitioning" means the preparation, filing and litigation of guardianship petitions or petitions for the adjudication of disability of alleged disabled persons pursuant to the Probate Act of 1975 [755 ILCS 5/Art. XIa].

"Property Management" or "Management of Property" means activities related to the discovery, possession, protection, conservation, listing for sale, auction or rental, solicitation of purchase or rental offers, title search, preparation of documents and forms, negotiations, payment of costs, fees, insurance, taxes, and penalties associated with the maintenance, operation, sale, auction or rental, participation in closing or completion of a sale or rental arrangements, and any other activities required in order for Office of State Guardian to protect, maintain or convey any interest of a ward in real or personal property, including a leasehold interest, subject to court approval.

"Ward" means a disabled person as defined by Section 11a-2 of the Probate Act of 1975 [755 ILCS 5/11a-2] who is at least 18 years of age, and for whom the Office of State Guardian has been appointed guardian.

History

• Source: Amended at 36 Ill. Reg. 12090, effective August 1, 2012

59 Ill. Adm. Code 301.30 Assessment of Fees

a) Assessment – In General

1. Except as provided in subsections (c) and (e), all wards with liquid assets on the date of the OSG's appointment shall be assessed a one-time case opening fee for establishment of the case by OSG. Rates are set forth in Section 301.60. Case opening fees shall be assessed for each appointment, including a re-appointment as guardian for the same ward more than 6 months after the termination of a prior appointment, temporary or otherwise, involving similar powers and duties.

2. A monthly fee for guardianship services other than petitioning for appointment of guardians and sale or management of real or personal property shall be assessed against all wards with liquid assets on any day during the month, in accordance with the schedule set forth in Section 301.60. In addition, in all cases in which OSG serves as representative payee under programs administered by the Social Security Administration, the Railroad Retirement Board, or similar programs, or serves as protective payee for the receipt of private pension funds, the fee for providing representative payee services shall be in accordance with Social Security Administration and Railroad Retirement Board regulations and/or guidelines.

3. Fees for guardianship petitioning services shall be assessed upon the entry of a court order finally disposing of the petition for appointment of a guardian, in accordance with the schedule set forth in Section 301.60. Guardianship petitioning fees shall be in addition to case opening fees, monthly guardianship services fees, and fees for the sale or management of real or personal property.

4. Fees for the sale of real or personal property shall be assessed when a sale is completed, or at the time of the final account. If no sale takes place during the OSG's term as guardian, fees for management of real or personal property shall be assessed at the time of the final account, in either case, in accordance with the fee schedule set forth in Section 301.60. Fees for the sale or management of a ward's property shall be in addition to case opening, monthly guardianship services, and guardianship petitioning fees, in accordance with the fee schedule in Section 301.60.

5. No fees for guardianship services shall be assessed on estates if OSG determines that financial hardship would result for the ward.

b) Assessments – Valuation of Property. When OSG seeks to assess fees for the management of property that is not sold during the course of administration of a ward's estate, the value of the property in question shall be estimated by any reasonable methods acceptable to the court. Unless specifically ordered by the court to do so, OSG shall not retain an appraiser at estate expense to establish the value of a ward's property if the appraisal is not otherwise required for responsible management of the estate.

c) Assessments – Court Approval. All fee assessments made by OSG shall be subject to court approval.

d) Assessments – On Exhausted Estates

1. In estates that may be exhausted by existing claims, OGS may petition for its fees in spite of the fact that the granting of these fees by the court might result in some or all of these claims going totally or partially unpaid.

2. Proper notice of the petition for fees shall be mailed to each known claimant before the hearing is to take place.

e) Assessments – On Entitlements. Fees shall not be assessed on income or support derived from Medicaid or TANF. Income or support derived from Social Security and Medicare shall be subject to OSG fee assessment unless the funds have been expressly earmarked for another purpose.

History

• Source: Amended at 44 Ill. Reg. 11800, effective June 30, 2020

59 Ill. Adm. Code 301.40 Notice

a) Notice – In General. A ward or a ward's estate shall not be charged for guardianship services unless the ward is given prior written notice pursuant to the procedure set forth below.

b) Notice – Procedure to be Used. Prior to requesting court approval for the assessment or collection of fees, a written notice shall be given to the ward, advising the ward that the ward or the ward's estate will be charged for guardianship services. This notice shall be delivered to the ward in person or by mail at least 10 calendar days prior to the collection of fees. The notice shall be issued in all cases where fees may be assessed by OSG. A single notice of assessment is sufficient for the purpose of this Part, so long as the notice describes the type of fee that OSG may assess and the amount of the fee.

History

• Source: Amended at 24 Ill. Reg. 13016, effective August 21, 2000

59 Ill. Adm. Code 301.50 Collection of Fees

a) Pay Collection and Liability for Payment – In General. Office of State Guardian shall take reasonable steps to collect fees from parties holding estate funds when fees have been assessed. Liability for fee payment shall be limited to the ward's estate.

b) Collection of Case Opening Fees. Case opening fees shall be collected by OSG upon the entry of the court's order approving its petition for fees.

c) Collection of Monthly Guardianship Fees. Monthly fees shall be collected by OSG on a regular basis at the time the fees are assessed, after entry of an order appointing OSG but only when prior court approval has been obtained to collect the fee on an ongoing basis. The petition for court approval will be filed at the earliest reasonable opportunity.

d) Collection of Monthly Representative Payee Fees. In all cases which OSG serves as representative payee under programs administered by the Social Security Administration, the Railroad Retirement Board, or similar programs, or serves as protective payee for the receipt of private pension funds, the fee for providing representative payee services shall be in accordance with Social Security Administration and Railroad Retirement Board regulations.

e) Collection of Fees For Guardianship Petitioning. Fees for guardianship petitioning shall be collected after the entry of the order appointing the guardian or other final disposition of the petition, or at the time of the next or final accounting.

f) Collection of Fees for Management of Property. Fees for the management of a ward's real property shall be incurred at the time of the next or final account.

g) Collection of Fees for the Sale of Property. Fees for the sale of a ward's real or personal property shall be collected after the sale is completed.

h) Collection of Fees for Preparation and Filing of State or Federal Income Tax Returns. Fees for the preparation and filing of a ward's State or federal income tax return shall be assessed at the time of filing of the tax return, for each tax year in which a return is filed, and collected after the tax return is prepared and court approval has been obtained to collect the fee. Court approval should be obtained at the earliest reasonable opportunity.

i) Collection of Fees for the Settlement of a Personal Injury Cause of Action. Fees for the settlement of a ward's personal injury cause of action shall be collected at the time of the approval of the settlement by the probate court.

j) Collection of Fees for the Establishment of a Recognized Trust for the Purpose of Protecting or Conserving the Ward's Financial Estate. Fees for establishing a recognized trust for the purpose of conserving a ward's guardianship estate or protecting the ward's assets, and for petitioning the court for the approval of the trust, shall be collected at the time of the approval of the establishment of the trust by the probate court.

k) Collection – Hardship and Waiver. No fees shall be collected if financial hardship to the ward would result. OSG may waive or reduce fees assessed if the costs of collection would far exceed the fees due.

l) Collection – Impact on Creditors. OSG may collect fees even when claims of creditors of the ward may be compromised, so long as no financial hardship to the ward or the ward's dependents would result.

History

• Source: Amended at 44 Ill. Reg. 11800, effective June 30, 2020

59 Ill. Adm. Code 301.60 Fee Schedules

a) Statutory Authority for Assessment of Fees. The Commission, under Section 5(i) of the GAC Act, is given the power to collect fees for its legal and guardianship services.

b) Procedure for Changing Fee Schedule. The following fees constitute a base rate as of July 1, 2020. The fees included in this schedule shall automatically increase on the first day of each State fiscal year thereafter in accordance with the increase, if any, in the consumer price index (urban consumers, Chicago Metro Area, as published by the Bureau of Labor Statistics https://www.bls.gov/cpi/regional-resources.htm), but in no event more than 5% per year. Any changes in the fees based on CPI changes will be reflected in the Part and will be made available to the public by GAC at http://gac.illinois.gov.

c) Schedule for the Assessment of One-Time Case Opening Fees

Guardianship of the Person

$500

Guardianship of the Estate

$750

Guardianship of the Person and Estate

$1000

d) Schedule for the Assessment of Monthly Guardianship Services Fees

Person Cases

$250

Estate Cases:

Total Value of

Liquid Assets

Monthly Fee

$24,999 and below

$300

$25,000 and above

Usual, customary and reasonable fees, for public or appointed guardians in the county where the case is filed

3. Representative Payee Cases

The monthly fee will be in compliance with current Social Security and Railroad Retirement regulations and/or guidelines.

e) Assessment of Guardianship Petitioning Fees $500

f) Real and Personal Property

1. Assessment of Fees for the Sale of Real Property $1,000

2. Management of real property, for property not sold, shall be limited to costs incurred.

3. Schedule for the Assessment of Fees for the Sale of Personal Property

Net Sale Value of Property

or Estimated Value

Fee

Amount

$3,000 − 9,999

$150

10,000 or above

2% of the net sale value of property

g) Schedule for the Preparation and Filing of State or Federal Income Tax Returns

1. For each federal Income Tax return filed $100

2. For each state Income Tax return filed $50

h) Schedule for the Settlement of a Personal Injury Cause of Action

For each personal injury cause of action

approved by the probate court $500

i) Schedule for the Establishment of a Recognized Trust for the Purpose of Protecting or Conserving the Ward's Financial Estate and Petitioning the Court for Establishment of the Trust

For each trust approved by the

probate court $500

History

• Source: Amended at 44 Ill. Reg. 11800, effective June 30, 2020

59 Ill. Adm. Code 310.10 Authority and Purpose

a) Authority

The Human Rights Authority exists as a division of the Guardianship and Advocacy Commission created by the Guardianship and Advocacy Act [20 ILCS 3955] and shall consist of as many regional authorities as the Commission may see fit to appoint pursuant to Section 5(a) of the Act.

b) Purpose

Each regional authority shall investigate all nonfrivolous complaints within its authority and competence alleging that the rights of an eligible person have been violated and may conduct investigations upon its own initiative if it has reason to believe the rights of a person have been violated. For purposes of this Part, criteria for investigation will include, but not be limited to, violations of the Mental Health and Developmental Disabilities Code [405 ILCS 5], Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110], Nursing Home Care Act [210 ILCS 45], Mental Treatment for Incarcerated Persons Act [405 ILCS 15], Specialized Living Centers Act [405 ILCS 25], Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705], Juvenile Court Act of 1987 [705 ILCS 405], Unified Code of Corrections [730 ILCS 5], and Youth Mental Health Protection Act [405 ILCS 48].

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.20 General Provisions

a) Definitions of Terms − As used in this Part, unless the context requires otherwise:

"Act" means the Guardianship and Advocacy Act [20 ILCS 3955].

"Chairperson" means the Chairperson of a Regional Human Rights Authority.

"Commission" means the Guardianship and Advocacy Commission.

"Complainant" means any person or entity who files a complaint with an authority or member of an authority.

"Complaint" means any allegation that the rights of an eligible person have been or may have been violated which is initiated by or communicated to a regional authority.

"Director" means the Director of the Commission.

"Eligible Person" means an individual who has received, is receiving, has requested, or may be in need of mental health services, is a person with a "developmental disability" as defined in the federal Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15002(8)), or any "person with one or more disabilities" as defined in the Rehabilitation of Persons with Disabilities Act [20 ILCS 2405].

"Frivolous" means a factual allegation which, if true, has no legal consequence nor implies any violation of a right established by law.

"Guardian" means a court-appointed guardian of the person or estate.

"HRA Committee" means the Commissioners appointed by the Chairperson of the Guardianship and Advocacy Commission to oversee the Human Rights Authority program and to propose HRA policy to the Commission.

"Personally Identifiable Data" means any record, document, paper, material, description or other information that discloses the identity of an eligible person or the person's family.

"Person" means an individual, corporation, partnership, association, unincorporated organization, sole proprietorship, limited liability company, or a government or any subdivision, agency, or instrumentality of that government;

"Program Director" means the person designated by the Director to coordinate the activities of all regional authorities.

"Regional Authority" means a regional Human Rights Authority.

"Regional Coordinator" means the person designated by the Program Director to assist a specific regional authority in its activities.

"Rights" includes but is not limited to all rights, benefits, and privileges guaranteed by law, the constitution of the State of Illinois, and the constitution of the United States.

"Service Provider" means any public or private facility, center, hospital, clinic, program, or any other person devoted in whole or in part to providing services to eligible persons.

"Services" includes examination, diagnosis, evaluation, treatment, care, training, psychotherapy, pharmaceuticals, after-care, habilitation, rehabilitation, and related activities provided for an eligible person.

b) Computation of Time

In computing any period of time prescribed in this Part, the date of the event from which such period begins to run shall not be included. If the last day of the period so computed shall fall on a Saturday, Sunday, or State holiday, the time period shall continue to run until the next day that is not a Saturday, Sunday or State holiday.

c) Severability

If any provision of this Part is determined by a court or other body of competent jurisdiction to be invalid, the remaining provisions shall continue in full force and effect.

d) Rules Exclusive

All procedures or activities employed by a regional authority in exercising its statutorily defined powers and duties shall be governed by this Part. No regional authority shall adopt policy unless approved by the Commission. The Commission may disapprove, pursuant to Section 5(c) of the Act, any action taken by a regional authority contrary to the provisions of this Part.

e) Petition by a Regional Authority for Rule Change

A regional authority may request that the Commission promulgate, amend, or repeal a rule in this Part by submitting a written petition to the Program Director setting forth the particular rulemaking action desired and the reasons in support of that action. The Program Director shall forward, within 10 days, the petition, together with any observation or comments, to the Director who shall, upon consideration, forward a recommendation on the petition to the Commission. Should the Director propose to amend or adopt a rule, the Director shall forward the recommendation to the Chairperson of each regional authority at the same time it is sent to the Commission.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.30 Membership and Organization

a) Membership

Each regional authority shall consist of at least seven and no more than nine members appointed by the Director. All actions taken by the Director to appoint or remove members shall be reported to the Commission at the next scheduled Commission meeting.

b) Duration of Term

Members of the regional authorities shall serve for a term of three years. No member shall serve for more than two consecutive three-year terms. After a one-year absence, if a vacancy occurs on a regional authority, the Director may appoint a former member who satisfactorily served prior terms of appointment.

c) Removal of Member

1. The Director may remove any member of a regional authority for incompetence, neglect of duty, or malfeasance in office.

2. A regional authority shall recommend to the Director the removal of one of its members if:

A) the regional authority has given written notice to the member of its intention to recommend removal and the reason for the removal;

B) the member is given an opportunity at the next regularly scheduled meeting of the authority to explain, either orally or in writing, why a recommendation of removal shall not be made;

C) a majority vote of the regional authority members in attendance and constituting a quorum of the regional authority at a regularly scheduled or special meeting, for good cause shown, votes to recommend the member's removal; and

D) a written request for removal is made to the Director with a statement of the reasons for the removal, together with any explanation offered by the member to the members of the regional authority; a copy of the request shall also be forwarded to the member.

3. A member who misses three consecutive meetings shall be notified by the regional authority that failure to attend the next meeting, unless for reasons beyond the member's control, may result in a request for the member's removal.

d) Vacancies

Vacancies in regional authorities shall be filled in the same manner as an original appointment. A person appointed to fill a vacancy shall serve for the remainder of the unexpired term. If the remainder of the unexpired term is fewer than 23 months, the person shall be eligible for two additional three-year terms consecutive to the expiration of the unexpired term.

e) Compensation

Members of the regional authorities shall serve without compensation but shall be reimbursed for actual expenses incurred in the performance of their duties in accordance with 80 Ill. Adm. Code 2800.

f) Officers

At its annual meeting each regional authority shall elect a chairperson, vice-chairperson and any other officers it deems necessary.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.40 Meetings

a) Annual Meeting

The annual meeting of each regional authority shall convene in the final quarter of the fiscal year, i.e., April, May, and June, for the purpose of electing officers and for any other business that may be brought before it. Should circumstances arise to prevent holding the annual meeting, the next immediate meeting held by the regional authority shall become the annual meeting.

b) Regular Meetings

Each regional authority shall meet not less than once every two months.

c) Special Meetings

Meetings may also be held upon call of the Chairperson of the regional authority or upon written request of a majority of appointed members of the regional authority.

d) Quorum

A majority of appointed members shall constitute a quorum.

e) Voting on Actions

Except as provided in Section 310.50(c) and 310.70(c)(3) and (e), no action shall be taken at any meeting of a regional authority except upon a majority vote of the members in attendance and constituting a quorum.

f) Notice

Each regional authority shall give public notice of its schedule of regular meetings at the beginning of each calendar year, including the dates, times, and places of meetings, if known. Public notice of any special meeting or reconvened regular meeting shall be given at least 48 hours before the meeting. However, this requirement of public notice of reconvened meetings does not apply to a meeting reconvened within 24 hours when announcement of the time and place of the reconvened meeting was made at the original meeting and there is no change in agenda. Public notice shall be given by posting a copy of the notice at the Commission's offices located in Springfield and Chicago, the regional authority's regional office, and the building where the meeting is to be held. In addition, an authority shall provide notice of its meetings to any newspaper or radio or television station that requests notice.

g) Minutes

Minutes of each meeting shall be recorded by the secretary of the authority or designee and a copy retained by the regional authority. The minutes, except as provided by Section 310.80(d), shall be available within seven days after their approval for public inspection at the Commission's offices located in Springfield and Chicago, and the regional authority's regional office.

h) Location of the Meeting Place

Each regional authority shall conduct meetings at locations within its regional boundaries so as to facilitate participation by the regional authority members and residents of the region.

i) Accessibility of Meeting Place

Each regional authority shall conduct its meetings at facilities that are accessible to individuals with disabilities.

j) Public Comment

A portion of each meeting shall be set aside for comments or questions by nonmembers. The time for comments or questions shall be limited to five minutes per person unless additional time is allowed by the regional authority for good cause.

k) Open Meetings Act

The meetings of all regional authorities shall be conducted in compliance with the provisions of the Open Meetings Act [5 ILCS 120] governing meetings of State advisory boards or bodies that do not have authority to make binding recommendations or determinations or to take any other substantive action and the Act.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.45 Attendance By Means Other Than Physical Presence

a) A member of a regional authority may attend a closed meeting of the regional authority by video or audio conference, if available.

b) A member of a regional authority may attend an open meeting of the regional authority by video or audio conference, if available, when the member is unable to physically attend because of personal illness or disability, reasons related to employment, other regional authority business, a family or other emergency, travel-related barriers to in-person attendance, inclement weather, or unexpected childcare obligations, provided that the member who wishes to attend the meeting by video or audio conference notifies the disability rights manager of the regional authority before the meeting or as soon as possible thereafter if advance notice is not practical.

c) Any member attending a meeting by means other than physical presence as authorized by this Section is present for purposes of this Part.

d) Nothing in this Section requires a regional authority to make video or audio conference capabilities available for its meetings.

History

• Source: Added at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.50 Complaints

a) Recording Complaints

Every complaint received by a regional authority shall be recorded in the Human Rights Authority's database.

b) Disposition of Complaints

1. Acceptance

Except as provided in subsection (c), a decision to investigate a complaint shall be made upon the majority vote of the members in attendance and constituting a quorum at a regularly scheduled or special meeting.

2. Non-Acceptance

If a regional authority determines that a complaint does not involve the rights of an eligible person, is frivolous, or is beyond the scope of the regional authority's competence, the regional authority shall not open the investigation.

3. Postponement

A) If the regional authority determines that its investigation of a complaint would jeopardize pending disciplinary, civil, or criminal proceedings, the regional authority's investigation shall be postponed until the proceeding is concluded.

B) If the regional authority determines that a member has a conflict of interest that may create the appearance of a conflict for the regional authority as a whole under Section 310.90(f), the regional authority's investigation shall be postponed until the Director authorizes another regional authority to conduct the investigation pursuant to Section 310.60(b).

c) Emergency Complaints

If it appears necessary for the welfare or protection of the rights of an eligible person, a regional authority may conduct an investigation with the approval of the chairperson and two other members of the regional authority. A proposed investigation shall be presented for ratification by a majority vote of the members present and constituting a quorum at the next regularly scheduled or special meeting.

d) Notice to Complainant

A regional authority shall provide a written notice to the complainant that states:

1. a brief summary of the complaint and number assigned to it; and

2. that the regional authority will conduct an investigation; or

3. that the regional authority will not conduct an investigation and the reasons for that decision.

e) Complainant's Confidentiality

The regional authority shall keep each complainant's name confidential from outside sources. If a member of the public or an outside agency requests the name of the complainant, the regional authority shall forward that request to the complainant who shall make the decision regarding disclosure.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.60 Investigations

a) Policy

All investigations instituted by a regional authority shall be conducted in a timely, thorough, and impartial manner to assess the action or omission complained of and, if appropriate, make recommendations based upon that assessment.

b) Jurisdiction

Unless otherwise directed by the Director, a regional authority may conduct an investigation into the violations of an eligible person's rights only if the violation is alleged to have occurred within its regional boundaries.

c) Approved Investigatory Methods

A regional authority may invoke any of the following investigative tools:

1. Site visits;

2. Interviews with any person, including in private;

3. Analysis of pertinent information;

4. Public hearings; and

5. Referral to an appropriate federal, state, or local governmental unit. Any relevant information obtained through such referral shall be included in the regional authority's final report.

d) Hearings

A regional authority may conduct hearings and compel by subpoena the attendance and testimony of such witnesses and the production of such materials as are necessary or desirable for its investigation. Advance notice of hearings will be made to the Program Director within 24 hours after the regional authority makes the decision to hold a hearing.

1. Calling a Hearing

A hearing may be called only upon a majority vote of the members in attendance and constituting a quorum at a regularly scheduled or special meeting.

2. Notice of Hearing

Notice shall be given of the date, time, location, and subject of the hearing in the same manner provided in Section 310.40(f).

3. Witnesses

A regional authority may request any person with relevant information testify at a hearing.

A) Requesting or Requiring Witnesses to Appear

Witnesses shall be invited to attend. If the regional authority deems it appropriate, then a witness may be subpoenaed pursuant to Section 310.60(f) of this Part.

B) Documents

A witness may be requested to bring any relevant documents that a regional authority would be entitled to inspect and copy.

4. Conduct of Hearings

A) All hearings conducted by a regional authority shall be open to the public except those parts of hearings at which the disclosure of information is contrary to Section 310.80 of this Part;

B) The hearing shall be conducted by such persons as the regional authority may designate;

C) The hearing shall be conducted as an objective and informal fact-finding process;

D) Any questioning of witnesses shall be conducted by the persons designated by the regional authority;

E) Each witness shall have the right to be accompanied by a family member, friend, or other representative, including counsel if desired, who shall be permitted to advise and counsel the witness at any time;

F) Each witness shall be permitted to make an oral statement at the conclusion of the witness' testimony within reasonable time limitations;

G) Each witness shall be permitted to submit any type of written statement or document for the regional authority's consideration;

H) Prior to a hearing, any person may request to be considered by the regional authority as a possible witness, or submit the names of other persons having information relevant to the investigation to the regional authority for consideration as possible witnesses; however, the persons designated to conduct the hearing shall have sole discretion to decide who will be called as witnesses;

I) An accurate record, which may be taken by recording or other appropriate means, may be kept of the proceedings of any hearing. In any event, a summary or minutes of the proceedings shall be prepared and kept by the regional authority. Witnesses shall be provided transcripts of their testimony, if available, upon written request to the chairperson of the regional authority at a reasonable charge. The record need not be transcribed or printed, except as provided herein, unless the regional authority shall so determine;

J) A witness may listen to any recording made of their testimony at the regional authority's offices or purchase a duplicate recording at cost;

K) Any decisions as to the mode of proceeding not covered by this Part shall be in the discretion of the persons designated by the regional authority to preside over the hearing; and

L) All hearings shall be held in facilities accessible to persons with disabilities.

e) Obtaining records

1. When conducting an investigation or monitoring issues concerning the rights of an eligible person, a regional authority will first attempt to obtain records containing data that identifies an eligible person with the written authorization of a person entitled to inspect and copy the eligible person's record.

2. If written authorizations are not secured, circumstances make obtaining timely authorization impractical, or an insufficient number of records are obtainable with written authorizations, then a regional authority shall request the production of masked records as provided under Section 18 of the Act and Section 8 of the Mental Health and Developmental Disability Confidentiality Act unless personally identifiable information cannot be removed without imposing an unreasonable burden.

3. If removing personally identifiable information from records in a manner that permits the collection of facts relevant to an investigation would impose an unreasonable burden, a regional authority may inspect and copy records containing data that identifies an eligible person without written authorization, so long as the regional authority has notified, in writing, a person entitled to inspect and copy the records:

A) that the regional authority is conducting an investigation or monitoring an issue;

B) of the nature and purpose of the investigation or monitoring;

C) of the need to inspect and copy the records; and

D) the person notified has not objected after notice has been sent.

4. If a service provider contends that removing personally identifiable information from records would be unreasonably burdensome, then the service provider shall provide to a regional authority the name, address, and any other contact information it possesses for any person entitled to this notice.

f) Subpoenas

A regional authority may compel by subpoena a witness' attendance when informal attempts to obtain such attendance are unsuccessful or impractical as set forth in Section 310.60(d)(3)(A) of this Part. All subpoenas shall be prepared by the Commission's General Counsel or their designee to ensure proper legal form.

1. Subpoena Duces Tecum

Any subpoena requiring the attendance and testimony of a witness may also require that documents within the possession or control of that person be produced at the hearing.

2. Time of Service

Subpoenas shall be served upon a person personally or by certified mail. Unless the regional authority makes a finding that a witness may leave the jurisdiction or be unavailable in the future requiring the immediate testimony of a witness, then a subpoena personally served shall be served no less than seven days prior to the date for appearance or, if served by mail, postmarked no later than ten days prior to the date for appearance.

3. Enforcement

Whenever any person knowingly fails or refuses to comply with a subpoena issued in accordance with these rules, a regional authority may request the Director to take such action or institute judicial proceedings to enforce the subpoena as necessary to secure compliance with the terms of the subpoena.

g) Notification of Status of Investigation

1. Acceptance

If the regional authority decides to investigate a complaint, it shall notify the service provider of its intention to investigate the complaint unless it believes that the advance notice will unduly hinder the investigation or make it ineffectual. When a regional authority notifies the service provider of its intention to investigate, it shall send the service provider a written notice which states a brief summary of the complaint and the number assigned to it.

2. The service provider shall be given at least ten days' prior written notice of each public meeting at which the service provider's complaint is on the agenda. Such notification shall also state that the service provider will be given an opportunity to comment.

3. Confidentiality

Whenever a complaint is reviewed at a regular or special meeting, the name of the service provider shall not be made public until

A) the complaint has been officially accepted; and

B) the facility has been notified of the investigation.

4. Status

Upon the request of the complainant, the provider, or any eligible person, the regional authority or regional coordinator shall inform them of actions taken in the course of the investigation. Such status may be discussed at any regular or special meetings of the regional authority subject to Sections 310.70(c) and (d) of this Part. Any matter so discussed shall be considered discussion only and shall not be binding or regarded as a finding or recommendation of the regional authority.

5. Program Director

The regional authority or regional coordinator shall inform the Program Director monthly of the status of an ongoing investigation.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.70 Recommendations and Findings

a) Report of Findings

Upon completion of an investigation, a regional authority shall prepare a proposed report of findings, including recommendations where appropriate, to be presented for discussion at the next regular meeting or any special meeting that is called to discuss the proposed report.

b) Review by Program Director

At least ten days prior to the date set by a regional authority for consideration of a proposed report of findings, a copy of the proposed report and any recommendations shall be forwarded to the Program Director for review. A regional authority shall not adopt a proposed report that has been forwarded to the Program Director fewer than 10 days prior to the meeting unless the Program Director determines that findings of fact and recommendations are clearly specified and supported by the record.

c) Consideration and Adoption of Report by Regional Authority

1. Except as provided in subsection (c)(3) below, the proposed report of findings and any recommendations shall be considered and adopted by a regional authority only at a regularly scheduled or special meeting upon majority vote of the members in attendance and constituting a quorum.

2. If the regional authority votes to close the meeting to the public, each member's vote on that question shall be publicly stated at the time of the vote, recorded, and entered into the meeting minutes. Citations to the specific exception contained in Section 2 of the Open Meetings Act [5 ILCS 120] that authorizes the closing of the meeting to the public and to Section 21 of the Act shall also be publicly stated at the time of the vote and shall be recorded and entered into the minutes of the meeting.

3. In the event that there is not quorum present and where the chairperson and a majority of those present deem it necessary to immediately send the report of findings to the service provider, a poll of those not present may be taken for purposes of obtaining a majority vote. The decision shall be presented for ratification at the next meeting at which a quorum is present.

4. Within ten days of its adoption, the report and any recommendations shall be sent to the providers investigated with notification of the statutory obligation to submit a response to the authority within thirty days from the date of receipt. This same notification shall inform the provider that the report may be made public after this 30-day response period pursuant to Section 19 and 26 of the Act and of their right under Section 26 of the Act to object to the findings and recommendations of the regional authority. At the same time, a copy of the report and any recommendations shall be sent to the Program Director. The complainant and any eligible person shall, within ten days after the completion of the investigation, be notified of the outcome of the investigation and any action taken thereon.

5. Upon request, the regional authority should assist a provider in interpreting the report of findings and any recommendations.

d) Public Release of Reports

1. The regional authority may make public its report of findings, and any recommendations, upon a majority vote of the members in attendance and constituting a quorum at a regularly scheduled or special meeting.

2. If the State agency, service provider, or other person investigated has made a reply, the reply shall be attached to the report of findings and recommendations and made public.

3. If the State agency, service provider, or other person investigated has made an objection, it shall be attached to the report of findings and any recommendations and made public only if the provider requests.

4. If no reply has been received within the statutory 30-day review period, the report of findings and any recommendations may be made public.

5. The provider and complainant shall be notified in writing within 10 days after the case is officially closed.

e) Closure

A case shall be closed upon a majority vote of the members in attendance and constituting a quorum at a regularly scheduled or special meeting. In the event that there is no quorum present and where the chairperson and a majority of those present deem it necessary to immediately close the case, a poll of those not present may be taken for purposes of obtaining a majority vote. The decision shall be presented for ratification at the next meeting at which a quorum is present.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.80 Confidentiality

a) Policy

Each regional authority shall conduct its meetings and investigations and keep its records in compliance with the requirements of confidentiality as enumerated in subsections (b) through (f) in order to uphold the dignity and privacy of eligible persons and their families, except as otherwise required by law.

b) Prohibition Against Disclosure of Personally Identifiable Data

No regional authority may disclose to any person any materials which identify an eligible person unless the eligible person or a person entitled to inspect or copy the eligible person's records consents to such disclosure, except if and to the extent that disclosure may be necessary for the appointment of a guardian for the eligible person. Any such consent shall be informed and in writing.

c) Prohibition Against Disclosure at Meetings or Hearings

1. No member shall intentionally identify an eligible person or their family during any meeting or hearing open to the public unless the eligible person or a legally authorized representative consents to disclosure pursuant to subsection (b).

2. Every nonmember scheduled to testify at a hearing or wishing to speak at a meeting concerning the alleged violations of an eligible person's rights shall be instructed to use a specific, non-descriptive identifier (e.g., number) when referring to an eligible person or the person's family.

d) Closed Meetings and Hearings

To the extent permitted by the Open Meetings Act, a regional authority may conduct closed meetings and hearings, or close a portion of a meeting or hearing, if necessary to ensure confidentiality or protect the rights of any eligible person or provider of services or other person. A verbatim recording of the closed meeting, hearing, or portion of meeting or hearing must be created. The recording, minutes, and records of such closed meetings shall not be made public. However, the regional authority shall make public a summary, which shall not contain personally identifiable data, of any closed meeting or hearing.

e) Each member's vote on holding a meeting closed to the public and citations to the specific exception contained in Section 2 of the Open Meetings Act [5 ILCS 120/2] that authorizes closing the meeting and to Section 21 of the Act shall be publicly disclosed at the time of the vote and shall be recorded and entered into the minutes of the meeting.

f) Redaction of Personally Identifiable Data from Public Reports or Records

Reference shall not be made to any name, description, or other information that would serve to identify an eligible person or the eligible person's family in any public report issued by the regional authority or any minutes or other summaries of meetings or hearings open to the public, unless the use of such personally identifiable data is consented to by the eligible person or a person entitled to inspect and copy the eligible person's records.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

59 Ill. Adm. Code 310.90 Limitations

a) When a regional authority receives a complaint alleging that the rights of an eligible person have been violated in the region in which the authority sits, the authority shall investigate unless it determines that the complaint is frivolous or beyond the scope of its authority or competence. If the Director finds that a conflict of interest exists, the Director may instruct a different regional authority to conduct the investigation. Any action taken by a regional authority is subject to the review and approval of the Commission. The Commission, acting on a request from the Director, may disapprove any action of a regional authority, in which case the regional authority shall cease such action.

b) If a majority of a regional authority wishes to pursue such disapproved action, a written appeal may be submitted to the Chairperson of the Commission with a copy to the Director. No action under appeal shall be taken by the regional authority until a written response is received from the Commission allowing the pursuit of the action.

c) Incurring Obligation

No regional authority shall retain or agree to retain the services of any person, expend or agree to expend any funds, or incur or agree to incur a financial obligation without the prior written approval of the Director or a designee.

d) Legal Action

The authority to institute legal proceedings rests solely with the Director.

e) Testimony

All requests for HRA testimony and all prepared HRA testimony shall be submitted to and reviewed by the Program Director prior to its presentation to any legislative or regulatory body.

f) Conflict of Interest

A potential conflict of interest arises when a regional authority receives or initiates a complaint involving the dependent or relative of a regional authority member or authority staff or a service provider with whom a regional authority member or authority staff has a financial or business association or when a complainant is represented by a regional authority member or authority staff before any governmental body. To avoid any appearance of impropriety and resolve any potential conflict, the regional authority member or authority staff subject to the potential conflict shall not participate in any aspect of the handling of the complaint by the regional authority. Where individual conflicts may make achieving a quorum to act on a complaint impracticable or create the appearance of a conflict of interest for the regional authority as a whole, then the regional authority may be deemed to have a conflict of interest.

History

• Source: Amended at 50 Ill. Reg. 717, effective January 1, 2026

Chapter III Guardianship and Advocacy Commission

Part 350 Legal Advocacy Service

59 Ill. Adm. Code 350.100 Authority and Purpose

a) Authority

The Legal Advocacy Service is a division of the Guardianship and Advocacy Commission and is statutorily charged with the duty to make available legal counsel to persons with disabilities in judicial proceedings arising out of the Mental Health and Developmental Disabilities Code, or related laws, local, State, or federal. [20 ILCS 3955/10] The Guardianship and Advocacy Act [20 ILCS 3955] (the Act) further charges that the Commission shall evaluate an eligible person's ability to pay for legal advocacy services received and charge fees for those services.

b) Purpose

The purpose of this Part is to establish the procedures to be used in assessing fees for legal advocacy services.

History

• Source: Amended at 24 Ill. Reg. 11264, effective August 1, 2000

59 Ill. Adm. Code 350.105 Definitions

The following definitions shall apply to this Part:

"Adjusted income" is the difference between income and the following expenses: child care and court-ordered child support payments, special education services for the client or dependents, for example: speech pathology and audiology, psychological services, physical and occupational therapy, recreation, early identification and assessment of disabilities in children, counseling services, medical services, transportation, school health services, social work services, and parent counseling and training, expenses related to obtaining or maintaining employment which are not reimbursed by the employer, medical or dental expenses, including equipment costs (wheelchairs, guidedogs, etc.), expenses of attendant care, and 20 percent of salary to cover expenses for taxes, social security and mandatory retirement deductions.

"Eligible clients" are "individuals who have received, are receiving, have requested, or may be in need of mental health services", or are "developmentally disabled" as defined in the federal Developmental Disabilities Services and Facilities Construction Act (42 USC 6001(7)), or any "person with one or more disabilities" as defined in the Disabled Persons Rehabilitation Act [20 ILCS 2405], as provided in Section 2(g) of the Guardianship and Advocacy Act [20 ILCS 3955/2(g)].

"Family unit" means the client, the spouse, dependents, and parents of minor clients.

"Income" means all financial assistance or resources, but not non-liquid assets, available to the client. Assets that will be regarded as financial resources in calculating income include cash, savings, checking accounts, stocks, bonds, and pensions.

"Legal services" or "legal advocacy services" means legal counsel and representation to eligible persons in judicial proceedings arising out of the Mental Health and Developmental Disabilities Code [405 ILCS 5], including but not limited to admission, civil commitment, and legal competency and discharge, and to enforce rights or duties arising out of any mental health or related laws, local, State, or federal.

"Minor" means a person under 18 years of age.

"Non-liquid assets" means real estate and that personal property which does not meet the definition of income.

History

• Source: Amended at 24 Ill. Reg. 11264, effective August 1, 2000

59 Ill. Adm. Code 350.110 Legal Services Without Charge

The Legal Advocacy Service shall provide free services to persons otherwise "eligible" for legal services:

a) whose income is limited to Supplemental Security Income (SSI), Social Security, Temporary Assistance to Needy Families (TANF), or general assistance benefits; or

b) whose adjusted income does not exceed 150% of the federal poverty level for nonfarm families (64 Fed. Reg. 13428, March 18, 1999); or

c) pursuant to a court appointment or determination of indigency.

History

• Source: Amended at 24 Ill. Reg. 11264, effective August 1, 2000

59 Ill. Adm. Code 350.115 Fees for Legal Services

a) Referral Procedure

Eligible clients whose adjusted income makes them ineligible for free legal services (other than an initial consultation) shall have contacted a member of the private bar to arrange representation. If requested by the client or the client's legal representative, the Legal Advocacy Service shall refer the client to a member of the private bar drawn from a list provided by the Illinois or local bar association, or maintained by the Legal Advocacy Service. Upon finding that the client was unable to make an arrangement for representation by a member of the private bar, Legal Advocacy Service shall charge the client for legal services in accordance with the sliding fee schedule set forth in Section 350.120 of this Part.

b) Emergency Problems

A referral need not be made where the client presents an emergency problem which would likely result in immediate or irreparable injury, loss, or damage to the claim of the client due to the lapse of time necessary to make a referral.

59 Ill. Adm. Code 350.120 Sliding Fee Schedule (see Appendix A)

a) The Legal Advocacy Service shall charge $40 an hour for each hour spent at court or administrative hearings and $30 for each hour otherwise spent in preparation or other representation of a client whose adjusted income exceeds, but is less than or equal to twice, 150% of the federal poverty level.

b) The Legal Advocacy Service shall charge $50 an hour for each hour spent at court or administrative hearings and $40 for each hour spent in preparation or other representation of a client whose adjusted income exceeds twice, but is less than or equal to three times, 150% of the federal poverty level.

c) The Legal Advocacy Service shall charge $60 an hour for each hour spent at court or administrative hearings and $50 for each hour spent in preparation or other representation of a client whose adjusted income exceeds three times 150% of the federal poverty level.

History

• Source: Amended at 24 Ill. Reg. 11264, effective August 1, 2000

59 Ill. Adm. Code 350.125 Maximum Fees

No client shall be charged fees exceeding 5% of his adjusted income for legal services within each 12 month period.

59 Ill. Adm. Code 350.130 Postponement of Fee Payment

a) Postponement in Fee generating/Contingent Fee Cases.

The Director of the Legal Advocacy Service is authorized to postpone payment of fees for legal services in accordance with the sliding fee schedule set forth in Section 350.120 of this Part in cases in which an attorney's fee may be awarded or in which a contingent fee agreement can be negotiated. The Director shall consider

1. the need of the client for legal services in the client's region of the State, with particular consideration to the client's special difficulties of access to legal services,

2. Legal Advocacy Service staff resources and expertise,

3. the availability of other sources of legal assistance in the particular category of cases or matters,

4. the relative importance of the client's legal problems compared to other clients,

5. the general effect of the resolution of the client's case on other eligible clients,

6. the susceptibility of the client's problem to solution through legal processes,

7. whether legal efforts will complement other efforts to solve the client's problem.

b) Postponement in OASDI/SSI cases

Payment of fees for legal services shall be postponed in claims involving Old Age, Survivors and Disability Insurance (OASDI) and Supplemental Security Income (SSI). Attorney fees shall be based on the award allowed by the forum before which the Legal Advocacy Service rendered services on behalf of a client, and in no event shall a client be charged a fee which is in excess of such an award where it is prohibited by law.

59 Ill. Adm. Code 350.135 Payment of Fees

a) Written Notice

No client shall be charged a fee for legal services unless given written notice that fees will be charged prior to the provision of legal assistance.

b) Billing

The Legal Advocacy Service shall bill the client for legal services rendered at least every six months, except as provided in Section 350.130 of this Part.

c) Suspension of Services for Nonpayment

Legal services shall be terminated or suspended if the client does not remit payment within six months after billing, consistent with Rule 1.16 of the Illinois Rules of Professional Conduct (Supreme Court Rules, RPC 1.116). The Legal Advocacy Service Director shall determine whether legal services shall be terminated or suspended and notify the client in writing. At the request of the client or the client's legal representative, the Director of the Commission shall review the Legal Advocacy Service Director's decision, render a written decision, and notify the client within 30 days. At the request of the client or the client's legal representative, the Commission Chairperson shall review the Director of the Commission's decision, render a written decision and notify the client within 30 days. The client and the client's legal representative may submit additional information to the Director of the Commission and Chairperson during their review.

History

• Source: Amended at 24 Ill. Reg. 11264, effective August 1, 2000

59 Ill. Adm. Code 350.APPENDIX A Sliding Fee Schedule for Legal Services

Fee (Court/non-court time)

-0-

$40/$30

$50/$40

$60/$50

Size of Family Unit

Maximum Income

Maximum Income

Maximum Income

Maximum Income

1.........................................

$ 12,360

$ 24,720

$ 37,080

$ 37,081+

2.........................................

16,590

33,180

49,770

49,771+

3.........................................

20,820

41,640

62,460

62,461+

4.........................................

25,050

50,100

75,150

75,151+

5.........................................

29,280

58,560

87,840

87,841+

6.........................................

33,510

67,020

100,530

100,531+

7.........................................

37,740

75,480

113,220

113,221+

8.........................................

41,970*

83,940*

125,910*

125,911*

• For family units with more than 8 members, add $2820 for each additional member in a family.

History

• Source: Amended at 24 Ill. Reg. 11264, effective August 1, 2000

Chapter IV Illinois Council on Developmental Disabilities

Part 400 State Plan, Awards and Administrative Requirements

59 Ill. Adm. Code 400.10 Purpose

The Illinois Council on Developmental Disabilities (Council) receives funds under the Basic State Grant Program through the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 USC 6000). Pursuant to that Act, the Council develops a State Plan that sets forth the advocacy, capacity building and systemic change activities related to the priorities in the Act that will be implemented by the Council. Priorities generally include, but are not limited to, education, housing, employment, transportation, child care, recreation, health, early intervention and other community supports that affect the quality of life of individuals with developmental disabilities. This Part explains the State Plan activities, grants and other administrative requirements.

59 Ill. Adm. Code 400.20 Definitions

As used in this Part:

"Act" means the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 USC 6000) that is the federal enabling and funding statute for the Council.

"Council" means the Illinois Council on Developmental Disabilities.

"Developmental Disability" means a severe, chronic disability of an individual that:

is attributable to a mental or physical impairment or combination of mental and physical impairments;

is manifested before the person attains age 22;

is likely to continue indefinitely;

results in substantial functional limitations in 3 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. Infants and young children birth to age 9, inclusive, who have a substantial developmental delay or specific congenital or acquired condition, may be considered to have a developmental disability without meeting 3 or more of the areas of major life activity if the individual without services and supports has a high probability of meeting those criteria later in life.

"Director" means the Director of the Illinois Council on Developmental Disabilities.

"Executive Committee" means the Executive Committee of the Council, which is comprised of 7 Council members, 3 of whom are elected annually by the membership at-large and 3 of whom are appointed by the chairperson of the Council. The chairperson of the Council is a member of the Executive Committee.

"Grant" means an investment made by the Council to implement the State Plan performance targets or goals through a variety of activities whose primary purpose is to advance the mission of the Council and the purposes of the Act.

Grants may be awarded through a competitive process as explained in this Part;

Grants may be awarded on a non-competitive basis when the project requires the specialized knowledge, capacity, and experience of a potential grantee, and the emerging nature of the project precludes the Council from going through a timely development, review and selection process due to the emerging nature of the project; and

Grants as awarded by the Council are not subject to the provisions or requirements of the Illinois Procurement Code (see 30 ILCS 500/1-10).

"Grant Agreement" means a prescribed form containing the provisions governing the grant award between the Council and the grantee. The grant agreement must contain signatures of the involved parties certifying agreement to the contract.

"Grantee" means the agency, individual or organization that is the recipient of Council grant funds to address performance targets or goals in the State Plan.

"Performance Targets" means, for purposes of the Council's State Plan, the advocacy, systems change or capacity building activities the Council is committed to achieving at the conclusion of the time period for the State Plan.

"Priorities" means the areas of importance in the Act, including, but not limited to, quality assurance, education, early intervention, child care, health, employment, housing, transportation, recreation and other community supports that affect the quality of life of individuals with developmental disabilities.

"Project Period" means the length of time the project is funded by the Council.

"Proposal" means the application a prospective grantee submits to the Council for funding consideration.

"Proposer" means an applicant for Council grant fund opportunities.

"State Plan" means the plan required by the Act that is developed by the Council and approved by the United States Department of Health and Human Services (HHS), Administration on Developmental Disabilities.

59 Ill. Adm. Code 400.30 State Plan Implementation

The Council, through its members, staff, consultants, contractors, subcontractors and grantees, conducts or supports programs, projects and activities that carry out its overall responsibilities under the Act. The State Plan is developed by the Council and approved by the Council's federal funding authority, HHS-Administration on Developmental Disabilities. The Council implements the State Plan by conducting initiatives that support advocacy, capacity building and systemic change activities, including, but not limited to:

a) Outreach activities to identify individuals with developmental disabilities and their families to assist them to obtain community services, individualized supports or other forms of assistance.

b) Training for people with developmental disabilities, their families, personnel and volunteers on obtaining or providing community services, individualized supports or other forms of assistance.

c) Technical assistance to assist the private and public sectors in achieving and contributing to a consumer and family directed system of community services.

d) Supporting and educating communities, businesses and organizations to respond positively to individuals with developmental disabilities and their families.

e) Coordinating with other councils, committees and programs addressing similar issues to benefit people with developmental disabilities.

f) Barrier elimination and system design and redesign to promote access and use of community services by people with developmental disabilities.

g) Coalition development and citizen participation activities that educate the public about the capabilities, preferences and needs of people with developmental disabilities to enhance the policy agenda of the Council.

h) Supporting and conducting studies, gathering information and developing model policies and other information, and making recommendations directly to federal and State policymakers, including members of Congress, the Illinois General Assembly and the Governor.

i) Demonstrating new approaches to services and supports generally on a time limited basis to show new approaches to serving individuals with developmental disabilities as part of an overall strategy for systemic change.

j) Other activities that may support the overall mission of the Council, as identified in the Act.

59 Ill. Adm. Code 400.40 Purpose of Grants

To implement the activities described in Section 400.30, the Council may award grants to qualifying agencies, individuals and organizations. All funding decisions are made by the Council or by the Executive Committee, as provided in this Part and the Council's bylaws. In general, the Council uses an outcome-based framework in developing the State Plan and funding opportunities and in the development, review, selection, implementation and monitoring of grants. The purpose of grants, how to apply for grants, information considered in the review and selection process, procedures used to make the awards, post-award monitoring, and other requirements are explained in this Part.

59 Ill. Adm. Code 400.50 Form of Application

a) When funds are available to the Council, the Council shall seek to award the funds consistent with the purposes of the Act, the State Plan, and this Part.

b) The Council provides notice to the public of the availability of these funding opportunities (i.e., with the exception of non-competitive grants) through, but not limited to, the Council's mailing list, website and other State and local agency websites.

c) The Council will prescribe the form and substance, establish the response date, and impose any funding limitations for proposals.

d) All communications relating to the availability of grant funds, the application form, or the process defined in Section 400.60 shall be sent to the Investment Coordinator, Illinois Council on Developmental Disabilities, 830 South Spring Street, Springfield, Illinois 62704.

59 Ill. Adm. Code 400.60 Review and Selection Process

a) Council staff shall initially review all proposals to identify any history of compliance issues with previous or current grant agreement terms, previous performance in programmatic or fiscal areas, and other indicators relevant to evaluating the applicant's ability to successfully complete the project.

b) Proposals are reviewed, by teams comprised of Council members and staff and may include other experts in the field of developmental disabilities (e.g., experts who possess knowledge about the subject matter at hand that would be helpful for the team to reach a decision) who make recommendations for awards to the Council or the Executive Committee, as described in Section 400.40.

c) Awards shall be made in accordance with the following criteria, which are equally weighted:

1. The performance targets or goals are clear and demonstrate that the project will assist the Council in meeting its State Plan performance target;

2. The proposal's implementation plan is clear and will lead to the achievement of the project's performance targets;

3. The proposal sufficiently demonstrates that the applicant has the commitment, capacity and expertise sufficient to achieve the project's performance targets; and

4. The cost or budget to achieve the project's performance targets appears reasonable in view of the proposed goals of the project.

d) The Council reserves the following rights regarding the funding of grants.

1. Negotiate and adjust funding levels during the review process;

2. Not fund any applications it receives (e.g., proposals do not adequately address all criteria in subsection (c), or the Council needs to further clarify and refine its performance target or goals in the funding opportunity); or

3. Not fund any applications it receives because circumstances have changed (e.g., the purpose of the funding opportunity no longer addresses federal or State policy or a situation has evolved that makes an award inconsistent with the purposes of the Act, State law, or regulations).

e) All proposers will be advised in writing of the Council's award decisions as soon as practicable, but not later than two weeks from the date of the Council's action on the team's recommendations.

f) Any agencies, individuals or organization who failed to receive a grant award may appeal that decision.

59 Ill. Adm. Code 400.65 Appeals

Any agency, individual or organization who failed to receive a grant award may appeal that decision only on the grounds of fraud or conflict of interest. In cases of an agency, individual or organization who received notice of suspension or termination that was based on failure to comply with the terms and conditions of a grant, an agency, individual or organization may appeal that decision. Appeals cannot be made in cases where the Council has had a partial or total loss of federal funding or the General Assembly fails to appropriate or otherwise make available funds to the Council.

a) A written request for appeal that includes a clear, concise documentation of fraud or conflict of interest must be received by the chairperson of the Council within 30 calendar days after the denial or written notice;

b) Within 90 days after receipt of the appeal, the Executive Committee shall convene a meeting and review the documentation submitted by the agency, individual, or organization. Any Executive Committee member who was involved during the development, review or selection process will recuse him or herself from participation in reviewing the appeal. Any Executive Committee member who is affiliated with the individual, agency, or organization requesting the appeal will recuse him or herself. The Executive Committee will decide:

1. No fraud or conflict of interest occurred;

2. Fraud or conflict of interest is evident and the original action should be overturned; or

3. There is evidence that the action to suspend or terminate should be overturned.

c) The decision of the Executive Committee is final. The Executive Committee will advise the agency, individual, or organization of their decision in writing within 10 calendar days after their decision. The Executive Committee will notify the full Council of the appeal and will report on their final decision.

59 Ill. Adm. Code 400.70 Awards, Grant Agreements, Conditions and Disbursement of Grant Funds

a) When a grant has been awarded, the grantee and the Council shall execute an agreement. The agreement shall be executed between the grantee and the Council's Director, or the Director's designee, on behalf of the Council.

b) Disbursement of grant funds. Notwithstanding selection for a grant award pursuant to this Part, disbursement of grant funds is contingent upon the submission of a fully executed grant agreement.

c) The grant agreement will be drafted by the Council and shall contain appropriate substantive provisions, including, but not limited to, the following:

1. A recitation of legal authority pursuant to which the agreement is made;

2. An identification of the project scope and schedule, including a specified time period for the grantee's performance and the work or services to be performed or conducted by the grantee;

3. An identification of the grant amount;

4. A promise by the grantee not to assign or transfer any of the rights, duties or obligations of the grantee without the prior written consent of the Council;

5. A promise by the grantee not to amend the agreement without the written consent of the Council; and

6. A covenant that the grantee shall expend the grant amount and any accrued interest only for the purposes of the project as stated in the agreement and approved by the Council.

d) A grantee may not start a project until the grant agreement has been fully executed by the grantee and the Council's Director or the Director's designee. No funds will be approved for payment for costs incurred before the full execution of the grant agreement. The fully executed grant agreement will be filed by the Council with the Office of the Illinois Comptroller within 30 days after the last signature.

e) Grantees shall comply with any conditions and requirements specified in the Act, this Part, the Council's award letter and the grant agreement.

f) Grantees shall submit regular fiscal and programmatic reports that document the grantee's performance under the grant agreement. The Council will provide grantees with guidelines and forms regarding the preparation of fiscal and programmatic reports for all awards.

g) Grantees shall make available to Council staff or their authorized agents all financial records and other reporting documentation relating to the grant award.

59 Ill. Adm. Code 400.80 Administrative and Reporting Requirements

a) Grant monitoring – The Council monitors the progress of grant-funded projects and expenditures through a variety of mechanisms, including, but not limited to, communications with grantees; periodic site visits by Council staff; payment requests; written reports; and final expenditure reports submitted by grantees. Grantees must permit any agent authorized by the Council, upon presentation of credentials, in accordance with constitutional limitations on administrative searches, to have full access to and the right to examine any documents, papers and records of the grantee relating to the Council's grant.

b) Audits – All grantees that receive Council grant funds shall comply with the Council's requirements concerning audits as outlined in this subsection. The Council will provide grantees with guidelines regarding audit requirements for all awards. In general:

1. All grantees are asked to submit a copy of routinely performed audits.

2. The Council may arrange and pay for limited scope audits or financial reviews of grantees expending $100,000 or less in Council funds.

3. Any governmental or non-profit agency required to undergo a Single Audit pursuant to the Single Audit Act Amendments of 1996 may include the Council’s portion of the audit in the proposed budget. For-profit grantees expending $500,000 in funds solely from the Council are required to procure an audit of the project.

c) Recordkeeping – The grantee shall maintain program and fiscal records related to each grant award for a period of 5 years following the end of the grant agreement. These records shall include a fiscal accounting for all funds in accordance with any generally accepted governmental accounting principles. However, if any claim, litigation, audit or other action has begun before the expiration date of the 5-year period, the records shall be retained until the completion of the action and resolution of all issues that arise from it.

59 Ill. Adm. Code 400.90 Project Revisions and Extensions

Budget revisions within the overall award amount, project revisions, and extensions of projects beyond the original time frame can be negotiated and must be approved by Council staff in advance of implementation of any revisions. Revisions to the grantee's performance targets must have Council approval before implementation.

59 Ill. Adm. Code 400.100 Investment Completion

a) Grantees must submit to the Council a final report that includes a description of the grantee's performance of the project and a detailed list of expenditures, including match funds, if applicable, in relation to the approved budget. Variances in budget lines must be explained in the report.

b) Grantees shall submit copies of any audits they have had completed during the time period that Council funds were expended. Failure to submit audits may impact future Council consideration of proposals from the grantee.

59 Ill. Adm. Code 400.110 Suspension and Termination

a) Suspension – If a grantee fails to comply with the terms and conditions of the grant award and agreement, the Council shall, after written notice to the grantee, suspend the grant and withhold further payments and prohibit the grantee from incurring additional obligations of grant funds, pending resolution of the issues or termination. The Council may require submission of a written plan of action to address the issues in dispute. Grantee payments will resume upon resolution of the issues in dispute.

b) Termination – The grant may be terminated for the following reasons:

1. If partial or total loss of federal funding occurs, or the Illinois General Assembly fails to appropriate or otherwise make available funds to the Council, the Council may make proportional or total cuts to all grants. In that event, the Council will give written notice to grantees setting forth the effective date of full or partial termination, or, if a change in funding is required, setting forth the change in funding and changes in the approved budget.

2. If the Council determines that the grantee has failed to comply with the terms and conditions of the grant award and grant agreement, the Council may terminate the grant in whole, or in part, at any time upon written notice to the grantee. Circumstances that could result in termination of a grant include, but are not limited to: failure to submit required reports; failure to maintain required records; misuse of equipment purchased with grant funds; falsification or misrepresentation of information to the Council; and failure to resolve issues in dispute during suspension. Written notice of termination of the grant shall contain the reasons for termination and the effective date.

3. Recapture of grant funds. All grants awarded under this Part shall be governed by the Illinois Grant Funds Recovery Act [30 ILCS 705]. Funds awarded for projects must be used exclusively for the purposes stated in the approved proposal and expended in accordance with the approved budget and grant agreement. If the grantee fails to comply with the terms of the grant agreement, the Council reserves the right to require appropriate proportional repayment of funds up to the entire amount of the grant.

59 Ill. Adm. Code 400.120 General Provisions – Allowable Expenses

Expenses must meet the following criteria in order for payment from Council funds to be allowed:

a) Be necessary and reasonable to carry out the performance targets, goals and intent of the approved grant;

b) Be authorized under the approved budget and not prohibited by this Part or federal, State or local laws or regulations;

c) Conform to any specifications set forth in the approved project or this Part and grant monitoring procedures;

d) Not be used to supplant non-federal funds for already existing services; and

e) Not exceed the total approved budget amount for Council funds.