COMMUNITY SUPPORTED LIVING

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5605

Introduced 2/13/2026, by Rep. Anne Stava

SYNOPSIS AS INTRODUCED:

New Act

Creates the Community Supported Living Arrangement Services Act.
Provides that the Department of Human Services, Division of Developmental
Disabilities shall work in coordination with the Department of Healthcare
and Family Services to develop, implement, and operate, and to submit,
through the Department of Healthcare and Family Services, amendments to
the Illinois Adults with Developmental Disabilities Section 1915(c) Home
and Community-Based Services Waiver, subject to approval by the Centers
for Medicare and Medicaid Services. Provides for establishment of provider
licensing, certification, and oversight standards for Community Supported
Living-24 Hour services consistent with existing State authority for
community-based residential services, but with the person's own home not
requiring licensing or Bureau of Accreditation, Licensure and
Certification reviews. Provides for 24-hour availability of trained
personnel for individuals with intense physical, medical, or behavioral
support needs. Contains provisions regarding: covered services;
enrollment; the use of tools such as the Health Risk Screening Tool;
housing independence; staffing and workforce standards; phased
implementation; Person-Centered Plans; dignity of risk; compliance with
mandates; quality assurance; evaluations; a Community Supported Living
Advisory Council; reports; fiscal issues; administrative issues; and other
matters. Effective immediately.
LRB104 19549 KTG 32997 b

A BILL FOR

HB5605
LRB104 19549 KTG 32997 b
1

AN ACT concerning developmental disabilities.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 1.
Short title.
This Act may be cited as the
5
Community Supported Living Arrangement Services Act.

6

Section 2.
Findings; purpose.
7

(a) Findings.
8

(1) Risk of institutionalization and waiver gaps.
9

(A) Many individuals with developmental disabilities
10

in Illinois, particularly individuals with intense
11

physical, medical, or behavioral support needs, are
12

institutionalized because their complex needs cannot be
13

met through Illinois' current home and community-based
14

service system. Other individuals remain at significant
15

risk of institutionalization due to gaps in available home
16

and community-based services and supports. As reflected in
17

recent national data, as of the most recent reporting
18

period, 16 states and the District of Columbia operate no
19

state-run developmental disability institutions, and the
20

majority of remaining states serve fewer than 500
21

individuals in such settings, demonstrating the
22

feasibility of serving individuals with complex support
23

needs in community-based settings when appropriate

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1

services are available.
2

(B) Unnecessary institutionalization violates federal
3

law, departs from generally accepted national standards
4

and research-documented best practices for supporting
5

individuals with developmental disabilities to obtain
6

quality of life outcomes and results in higher public
7

costs on average than home and community-based services.
8

In Illinois, the average annual cost of placement in a
9

State-operated developmental center, the most restrictive
10

and least preferred setting, exceeds $320,000 per
11

individual, compared to approximately $71,328 per
12

individual for services delivered through the Illinois
13

Adults with Developmental Disabilities Home and
14

Community-Based Services Waiver and other services from
15

the Medicaid state plan.
16

(C) Existing Developmental Disabilities Division Home
17

and Community-Based Service waivers in Illinois are not
18

designed to meet the needs of individuals with complex
19

medical, physical, or behavioral support requirements, and
20

do not consistently reflect recognized best practices
21

identified through national research and quality
22

frameworks, including work by the University of
23

Minnesota's Institute on Community Integration and by the
24

Council on Quality and Leadership. These limitations
25

contribute to the continued "placement" of individuals
26

with complex needs in more restrictive and costly

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1

institutional settings, while reducing the funding
2

available to add community infrastructure and to address
3

the waiting list.
4

(D) Assessment tools developed primarily for
5

institutional or congregate service delivery models and
6

grounded in a deficit-based or medical model, may
7

systematically underestimate the support needs of
8

individuals with complex medical, physical, or behavioral
9

conditions who seek to live in their own homes and
10

participate in community life, increasing the risk of
11

service gaps and unnecessary institutionalization. The use
12

of modern, validated assessment tools that measure support
13

intensity and health and safety risk, including structured
14

instruments such as the Health Risk Screening Tool and
15

other validated tools, is necessary to accurately identify
16

medical, behavioral, and supervision risks and the
17

supports and services to address them relevant to safe and
18

inclusive community living.
19

(E) Behavioral assessment findings are frequently
20

documented but not meaningfully incorporated into
21

eligibility determinations or service authorization
22

decisions within Illinois' existing waiver structure. The
23

absence of clear statutory direction requiring
24

consideration of documented behavioral acuity contributes
25

to service denials, prolonged waiting periods, caregiver
26

collapse, crisis intervention, and unnecessary

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institutional placement.
2

(F) Federal Medicaid law and guidance do not approve
3

or require the use of any specific assessment instrument
4

but instead require that assessment methodologies
5

accurately identify individual need and support compliance
6

with health, welfare, and community integration
7

requirements.
8

(G) Inaccurate or incomplete assessment of individual
9

support needs increases the likelihood of service gaps,
10

family caregiving burden, emergency interventions,
11

hospitalization, crisis placement, and
12

institutionalization, resulting in higher long-term public
13

costs and poorer self-determination, health, and quality
14

of life outcomes for individuals.
15

(H) Federal statutes, regulations and guidance require
16

access to integrated community-based services and supports
17

that promote autonomy, dignity, and quality of life
18

outcomes, including but not limited to:
19

(i) the Americans with Disabilities Act (ADA) (42
20

U.S.C. 12101 et seq.);
21

(ii) Olmstead v. L.C., 527 U.S. 581 (1999);
22

(iii) Ligas v. Maram Consent Decree (N.D. Ill.
23

2011);
24

(iv) the federal Home and Community-Based Service
25

Settings and Person-Centered Planning Rule (79 Fed.
26

Reg. 2947; 42 CFR 441.301(c), 441.710);

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(v) the 2024 enhanced integration mandate under
2

Section 504 of the Rehabilitation Act; and
3

(vi) the 2024 Centers for Medicare and Medicaid
4

Services Home and Community-Based Services Final Rule.
5

(I) Federal deinstitutionalization transition
6

programs, including Money Follows the Person, which
7

provides a fiscal incentive to states with an enhanced
8

federal Medicaid match for 365 days following an
9

individual's transition from an institutional setting,
10

exist to support individuals with developmental
11

disabilities and complex support needs in moving to
12

integrated community-based services, including assistance
13

with transition-related costs such as rental deposits,
14

home furnishings, and other allowable start-up expenses.
15

Failure to fully utilize these transition authorities
16

represents a missed opportunity to reduce institutional
17

reliance, increase cost-effective community living options
18

and quality of life outcomes, and advance compliance with
19

federal integration mandates.
20

(J) This Act is intended to be implemented in a manner
21

consistent with federal Medicaid statute and regulations
22

governing Home and Community-Based Services waivers,
23

including requirements applicable to services authorized
24

under Section 1915(c) of the Social Security Act.
25

(2) Legal and policy foundations for community supported
26
living arrangements.

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LRB104 19549 KTG 32997 b
1

(A) Statutory authority.
2

(i) Medicaid Home and Community-Based Services
3

were authorized by Congress in 1981 under Section
4

1915(c) of the Social Security Act (42 U.S.C.
5

1396n(c)) to permit states, subject to federal
6

approval, to furnish community-based services as an
7

alternative to institutional care for individuals who
8

would otherwise require an institutional level of
9

care. Illinois applied for and received federal
10

approval for its Home and Community-Based Services
11

waiver serving adults with developmental disabilities
12

in 1989.
13

(ii) The Section 1915(c) Home and Community-Based
14

Services authority was implemented through federal
15

regulations at 42 CFR Part 441 beginning in 1985 and is
16

administered by the Centers for Medicare and Medicaid
17

Services (CMS). In 1990, Congress enacted the
18

Community Supported Living Arrangements Act as an
19

amendment to the Medicaid Home and Community-Based
20

Services statute, expanding the menu of permissible
21

waiver services to explicitly recognize Community
22

Supported Living Arrangements as a service option, for
23

the first time separating Medicaid funding for
24

community living supports from housing and facilities.
25

Following this statutory amendment, CMS issued service
26

definitions and guidance enabling states to implement

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Community Supported Living Arrangements services
2

within approved 1915(c) waivers.
3

States have since implemented Community Supported
4

Living Arrangements services to support individuals
5

with developmental disabilities in living in their own
6

homes, apartments, family homes, or other integrated
7

community-based residential settings, consistent with
8

nationally recognized best practices promoted by the
9

National Association of State Directors of
10

Developmental Disabilities Services.
11

(iii) Community Supported Living Arrangements
12

Services are an addition to the services that may be
13

funded under Medicaid Home and Community-Based
14

Services waivers. Community Supported Living
15

Arrangements services are not a funding mechanism and
16

are distinct from self-directed service models,
17

including Illinois Home-Based Services. Community
18

Supported Living Arrangements services are intended to
19

operate as certified and provider-delivered,
20

accountable residential support services with
21

accountability for staffing, service delivery, and
22

health and welfare protections in the individual's own
23

home, including their family's home and not in a
24

licensed facility.
25

(iv) Home and community-based services authorized
26

under Section 1915(c) are administered and overseen by

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LRB104 19549 KTG 32997 b
1

the Centers for Medicare and Medicaid Services
2

pursuant to 42 CFR Part 441, which requires compliance
3

with person-centered planning, health and welfare
4

assurances, provider qualifications, service quality,
5

and community integration standards.
6

(B) Federal regulations and integration standards.
7

(i) The 2014 CMS Home and Community-Based Services
8

Settings Rule (79 Fed. Reg. 2947, January 16, 2014; 42
9

CFR 441.301(c)(4)-(5)) requires that services be
10

provided in community-integrated settings that respect
11

individual informed choice, privacy, autonomy, and
12

self-determination.
13

(ii) The 2024 enhanced integration mandate under
14

Section 504 of the Rehabilitation Act strengthens and
15

clarifies the requirement that all entities receiving
16

federal financial assistance provide services to
17

individuals with disabilities in the most integrated
18

setting appropriate to their needs, aligning Section
19

504 enforcement with the integration principles of the
20

Americans with Disabilities Act and Olmstead v. L.C.
21

(iii) The 2024 CMS Home and Community-Based
22

Services Final Rule updates and expands upon the 2014
23

rule by reinforcing requirements for person-centered
24

planning, informed choice (including meaningful
25

opportunity to explore and visit service and housing
26

options), community integration, and quality

HB5605
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LRB104 19549 KTG 32997 b
1

oversight. The rule emphasizes equitable access to
2

integrated housing and employment, strengthened
3

accountability systems, and workforce stabilization to
4

ensure meaningful outcomes that promote independence,
5

inclusion, community belonging, and choice.
6

(3) Supreme Court and consent decree guidance.
7

(A) Olmstead v. L.C., 527 U.S. 581 (1999) The U.S.
8

Supreme Court held that the unjustified segregation of
9

individuals with disabilities constitutes discrimination
10

in violation of the Americans with Disabilities Act (ADA)
11

and that states are required to provide services in the
12

most integrated setting appropriate to the needs of
13

individuals with disabilities, which is a very different
14

standard from the special education standard from 1975 of
15

"least restrictive environment".
16

(B) The Ligas v. Maram Consent Decree (N.D. Ill. 2011)
17

mandates that the State of Illinois ensures meaningful
18

opportunities for individuals with developmental
19

disabilities to transition from institutional settings to
20

community-based living arrangements, and to avoid
21

unnecessary institutionalization, consistent with the
22

requirements of the Americans with Disabilities Act and
23

the principles articulated in Olmstead.
24

(C) Compliance with Olmstead and the Ligas Consent
25

Decree requires the availability of an array of
26

community-based residential service options that can

HB5605
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LRB104 19549 KTG 32997 b
1

support all individuals, including those with complex
2

medical, physical, or behavioral needs in integrated
3

settings of their choice with appropriate safeguards for
4

health and welfare.
5

(4) Person-centered planning and dignity of risk.
6

(A) Person-centered planning, as required under
7

federal Home and Community-Based Services regulations
8

promulgated in 2014 (42 CFR 441.301(c)), is essential to
9

ensure that individuals can make informed choices about
10

their services, supports, and daily lives based upon their
11

individual strengths, preferences, and interests. Such
12

informed choice requires that the service system make
13

available and accessible the full range of federally
14

authorized home- and community-based service options, so
15

that individuals and, when appropriate, their families or
16

representatives, may understand, consider, and select
17

among those options.
18

(B) The principle of dignity of risk recognizes that
19

individuals have the right to make informed decisions,
20

including those involving risk, while maintaining
21

appropriate safeguards for their health, safety, and
22

well-being.
23

(5) Workforce importance and challenges.
24

(A) Well-trained personnel, including direct support
25

professionals, Qualified Intellectual/Developmental
26

Disabilities Professionals, and Independent Service

HB5605
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LRB104 19549 KTG 32997 b
1

Coordinators, are essential to the effective provision of
2

individualized supports that produce measurable quality of
3

life outcomes and ensure provider accountability.
4

(B) Workforce shortages of trained, competent direct
5

support professionals and specialized staff present a
6

significant barrier to achieving the goals of community
7

integration, independence, and person-centered supports
8

for all individuals with developmental disabilities,
9

particularly individuals with complex support needs.
10

(C) Addressing workforce shortages through enhanced
11

training, certification, compensation, and career
12

development pathways is essential to ensure quality,
13

safety, and continuity of services in community settings.
14

(b) Purposes. The purposes of this Act are to:
15

(1) Amend the existing Illinois Adults with Developmental
16
Disabilities Home and Community-Based Services Waiver to:
17

(A) add Community Supported Living Arrangements as a
18

residential service category authorized under Section
19

1915(c) of the Social Security Act (42 U.S.C. 1396n(c)),
20

consistent with federal Home and Community-Based Services
21

authority and CMS service definitions and guidance;
22

(B) rename Intermittent Community-Integrated Living
23

Arrangements as Community Supported Living
24

Arrangements-Intermittent; and
25

(C) add CSL-24 as a distinct waiver service option for
26

individuals with complex medical, physical, or behavioral

HB5605
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LRB104 19549 KTG 32997 b
1

support needs, in order to ensure access to a viable
2

community-based living option for individuals whose needs
3

cannot be met through intermittent CSL and who do not want
4

congregate facility-based service models.
5

(2) Enable eligible individuals to live safely and
6
independently in integrated community settings of their choice
7
(including a home they own, lease, rent, or a family home) with
8
up to 2 housemates of their choosing, supported by 24-hour
9
medically or behaviorally competent personnel.
10

This standard is consistent with best-practice guidance
11
from the Council on Quality and Leadership and national
12
outcomes data from the Residential Information Systems Project
13
at the University of Minnesota's Institute on Community
14
Integration, which demonstrate that individuals with
15
developmental disabilities, including those with complex
16
support needs, experience better quality of life outcomes in
17
person-chosen, non-provider-owned living arrangements with
18
three or fewer residents that support health, safety,
19
community integration and belonging, and quality of life than
20
in provider owned, licensed group homes.
21

(3) Ensure services are provided in accordance with
22
federal Home and Community-Based Services authority, CMS
23
regulations, and state rules while promoting person-centered
24
planning, dignity of risk, and full community integration,
25
inclusion and belonging.
26

(4) Support workforce development, ongoing training, and

HB5605
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1
technical assistance, and maintain professional standards and
2
certification of competencies, including a code of ethics for
3
direct support professionals, Qualified
4
Intellectual/Developmental Disabilities Professionals,
5
Independent Service Coordinators, nursing staff, and
6
employment support personnel.
7

(5) Reduce or prevent reliance on institutional or
8
congregate settings while enhancing access to
9
community-integrated life, personal "informed choice", and
10
autonomy.
11

(6) Create capacity-building and high-fidelity community
12
supports that continue to promote and preserve dignity,
13
independence, inclusion, and belonging.
14

(7) Require independent external evaluation of the program
15
(such as by the University of Illinois Chicago or CQL) and
16
limit initial enrollment and geographic scope to ensure
17
quality supports, accountability, and measurable outcomes.
18

(8) Expand Home and Community-Based Services options so
19
Illinoisans with complex or intense support needs can live in
20
integrated community settings with 24-hour supports, rather
21
than in institutions or licensed group homes
22
(community-integrated living arrangements), through the
23
addition of CSL-24 services to the existing Adults with
24
Developmental Disabilities Home and Community-Based Services
25
Waiver.
26

(c) Legislative intent and interpretation. It is the

HB5605
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LRB104 19549 KTG 32997 b
1
intent of the General Assembly that CSL-24 services be
2
available to individuals whose assessed needs cannot be safely
3
or sustainably met through existing waiver services, including
4
Home-Based Services, and that the receipt of limited,
5
intermittent, or insufficient services shall not be construed
6
as evidence that an individual's needs are adequately met.

7

Section 3.
Definitions.
As used in this Act:
8

"CMS" means the Centers for Medicare and Medicaid
9
Services.
10

"Community Supported Living Arrangements services" means,
11
as defined in federal statute and implementing regulations,
12
one or more services provided by a State authorized under this
13
Section to assist an individual with a developmental
14
disability in activities of daily living necessary to enable
15
the individual to live in the individual's own home,
16
apartment, family home, or leased or rented dwelling furnished
17
in a community supported living arrangement setting. Such
18
services may include, but are not limited to:
19

(1) Personal assistance services;
20

(2) Training and habilitation services necessary to
21

support increased community integration, independence, and
22

productivity;
23

(3) Twenty-four-hour emergency assistance, as defined
24

or approved by the Secretary;
25

(4) Assistive technology;

HB5605
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1

(5) Adaptive equipment;
2

(6) Other services approved by the Secretary, except
3

for services excluded under subsection (g) of the
4

authorizing statute; and
5

(7) Support services necessary to enable participation
6

in community activities.
7

The terms "Community Supported Living" and "Community
8
Supported Living Arrangements" are used interchangeably and
9
refer to the same federally authorized service category under
10
Section 1915(c).
11

"Community Supported Living-Intermittent" means the
12
service formerly known as Intermittent Community Integrated
13
Living Arrangement under the Illinois Adults with
14
Developmental Disabilities Home and Community-Based Services
15
Waiver, providing less than 24-hour staff support in an
16
individual's own home or apartment.
17

Community Supported Living-Intermittent services are
18
aligned with Community Supported Living Arrangements authority
19
under 42 U.S.C. 1396n(c) and the Home and Community-Based
20
Services requirements at 42 CFR 441.301 and are intended for
21
individuals whose assessed needs do not require continuous or
22
24-hour supervision or clinical oversight.
23

Community Supported Living-Intermittent services do not
24
include provider responsibility for continuous or 24-hour
25
staffing or clinical oversight.
26

"Community Supported Living-24 Hour" or "CSL-24" means a

HB5605
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1
provider-delivered Community Supported Living Arrangement
2
service, subject to certification, qualification, and
3
oversight requirements established by the Department added to
4
the Illinois Adults with Developmental Disabilities Home and
5
Community-Based Services Waiver, providing continuous, 24-hour
6
availability of trained direct support, supervision, and
7
clinical oversight, as identified in the individual's
8
Person-Centered Plan.
9

CSL-24 services are authorized under Section 1915(c) of
10
the Social Security Act (42 U.S.C. 1396n(c)) and 42 CFR
11
441.301, and are designed to support individuals with intense
12
physical, medical, or complex behavioral support needs to live
13
in their own home, leased or rented apartment, or family home.
14

CSL-24 services include full provider responsibility for
15
health and welfare, staffing, nursing delegation, and
16
behavioral supports as specified in the Person-Centered Plan.
17

CSL-24 services shall not be subject to funding caps
18
applicable to intermittent or congregate residential services
19
and shall be authorized based on validated assessment results,
20
including a required health and safety risk assessment such as
21
the Health Risk Screening Tool, together with a comprehensive
22
Person-Centered Plan developed by a trained Independent
23
Service Coordinator in compliance with federal person-centered
24
planning requirements under the 2014 Home and Community-Based
25
Services Settings Rule.
26

Assessment requirements for CSL-24 services shall be

HB5605
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1
distinct from, and shall not alter assessment or eligibility
2
requirements applicable to other waiver services.
3

CSL-24 services shall not be considered Residential
4
Habilitation, Community-Integrated Living Arrangements, or any
5
congregate residential service model, and shall not be subject
6
to provider-owned or provider-controlled housing, site-based
7
occupancy assumptions, or group residential staffing
8
methodologies.
9

"Intense physical and medical support needs" means the
10
needs of an individual requiring frequent or continuous
11
support, supervision, or nursing intervention or delegation to
12
manage conditions such as seizures, respiratory support,
13
enteral feeding, positioning, medication administration, or
14
other significant health-related interventions, consistent
15
with the Home and Community-Based Services waiver authority
16
under 42 U.S.C. 1396n(c) and 42 CFR 441.301(b)(1)(ii)
17

"Intense and complex behavioral support Needs" means the
18
needs of an individual who requires structured behavioral
19
supports, crisis intervention, or positive behavioral
20
strategies due to challenging or high-risk behaviors that
21
would otherwise result in institutional placement, consistent
22
with service definitions under 42 U.S.C. 1396n(c) and 42 CFR
23
441.301(b)(1)(ii).
24

"Behavioral Acuity" means the presence of significant
25
behavioral support needs that require ongoing supervision,
26
intervention, or specialized supports to ensure health,

HB5605
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LRB104 19549 KTG 32997 b
1
safety, and community stability, as demonstrated through
2
professional assessment, documented behavioral history, or
3
validated behavioral risk or support intensity tools.
4
Behavioral acuity may be demonstrated through professional
5
assessment, documented behavioral history, Functional
6
Behavioral Assessments, Behavior Support Plans, validated
7
behavioral risk or support-intensity tools, documented crisis
8
events, placement disruption, or other evidence indicating
9
moderate to severe behavioral support needs requiring ongoing
10
supervision, intervention, or specialized supports regardless
11
of whether the individual is currently in crisis.
12

"Caregiver collapse" means a situation in which unpaid
13
family or informal caregivers are no longer able to safely or
14
sustainably provide necessary supports due to age, health,
15
exhaustion, or increased support needs of the individual,
16
resulting in heightened risk of crisis or institutional
17
placement.
18

"Person-Centered Plan" means an individualized plan of
19
services developed in accordance with Section 1915(c) of the
20
Social Security Act (42 U.S.C. 1396n(c)) and 42 CFR
21
441.301(c)(1)-(2), led by the individual and reflecting
22
individual's preferences, goals, and desired outcomes.
23

The Person-Centered Plan shall provide sufficient time,
24
information, and support for the individual to explore and
25
make informed choices regarding housing and living
26
arrangements (where they want to live with up to 2

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housemates), required services and supports, providers, and
2
short and long-term goals.
3

"Enhanced Service Coordination" means an increased level
4
of Independent Service Coordination and provider-based case
5
management required for individuals with higher assessed
6
acuity, including increased frequency of monitoring,
7
coordination, documentation, and on-call availability,
8
commensurate with the individual's assessed health, safety,
9
and supervision risks.
10

"Independent Service Coordinator" means an individual
11
employed by an Independent Service Coordination agency under
12
59 Ill. Adm. Code 120.40(a)(6) and consistent with 42 CFR
13
441.301(c), responsible for eligibility determinations,
14
facilitation of person-centered planning, and ongoing service
15
coordination for individuals with developmental disabilities
16
with at least quarterly in-person visits and meetings.
17

"Housing navigator" means an individual or entity
18
designated or contracted by an Independent Service
19
Coordination agency or the Department to assist individuals
20
with developmental disabilities in locating, securing, and
21
maintaining affordable, and, when necessary, accessible,
22
integrated community housing consistent with the individual's
23
preferences and outcomes identified through the
24
person-centered planning process.
25

"Direct support professional" means an individual who
26
meets the training and competency requirements established in

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59 Ill. Adm. Code 119 and Section 10 of the Mental Health and
2
Developmental Disabilities Administrative Act, and who
3
provides habilitation, personal care, or other direct support
4
to individuals with developmental disabilities.
5

"Qualified Intellectual/Developmental Disabilities
6
Professional" means a professional employed by a provider
7
agency who meets qualifications described in 42 CFR
8
483.430(a)(2) and 59 Ill. Adm. Code 115.10, possesses
9
specialized training or experience in supporting individuals
10
with intellectual or developmental disabilities, and is
11
responsible for implementing the Person-Centered Plan, and
12
coordinating services in compliance with federal and state
13
requirements.
14

Coordination of services includes but is not limited to:
15

(1) Planning and coordinating services and staff
16

schedules.
17

(2) Monitoring health, safety, and well-being,
18

including through remote oversight;
19

(3) Arranging transportation and access to community
20

resources.
21

(4) Assisting with financial management, bill payment,
22

or home accessibility modifications.
23

(5) Coordinating healthcare, therapies,
24

prescriptions, medical appointments, supplies, and durable
25

medical equipment.
26

(6) Full responsibility for daily life coordination.

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(7) Providing on-call support for emergencies.
2

On-call support shall be used to ensure safety and
3
continuity of care and shall not override the individual's
4
autonomy or informed choice.
5

"Home and Community-Based Services settings rule" means
6
the final rule issued by the Centers for Medicare and Medicaid
7
Services at 79 Federal Register 2947 (January 16, 2014),
8
codified at 42 CFR 441.301(c)(4)-(5), 441.530(a)(1)(i), and
9
441.710(a)(1)(i), establishing requirements that Home and
10
Community-Based Services settings be integrated in the
11
community and support individual autonomy, privacy, and access
12
to community life and choice of services.
13

"Dignity of risk" means the recognition that individuals
14
with disabilities have the right to make informed choices
15
about their lives, including choices that involve risk,
16
consistent with the autonomy, dignity, and choice provisions
17
of 42 CFR 441.301(c)(4)(i)-(v) and related CMS guidance.
18

"Money Follows the Person" means the federal program
19
authorized under Section 6071 of the Deficit Reduction Act of
20
2005 (42 U.S.C. 1396a note) as extended by Congress which
21
provides enhanced federal matching funds for up to 365 days to
22
assist Medicaid beneficiaries in transitioning from
23
institutional settings to community-based services.
24

"Health Risk Screening Tool" means a validated, nationally
25
recognized health and safety risk assessment tool that is
26
currently used within Illinois' developmental disabilities

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service system to identify medical, behavioral, and
2
environmental risks, including the level of health-related
3
support and monitoring necessary to ensure an individual's
4
health, safety, and welfare in community-based settings or a
5
substantially equivalent successor tool approved by the
6
Department.
7

"Health Risk Screening Tool level of care" means the level
8
of care designation assigned to an individual based on the
9
results of the Health Risk Screening Tool, which identifies
10
Levels of Care 1 through 6. Levels of Care 4 (extensive), 5
11
(pervasive), and 6 (complex) reflect elevated to extreme
12
health and safety risk, indicating the need for enhanced
13
supports, monitoring, or clinical oversight.
14

"Remote support and monitoring technology" means
15
non-intrusive, person-centered technology used to support
16
health, safety, independence, and community living, including
17
but not limited to wearable health monitoring devices,
18
environmental sensors, personal emergency response systems,
19
medication reminders, and two-way communication technologies.
20

Remote support and monitoring technology shall be used
21
only with the informed consent of the individual or the
22
individual's legally authorized representative, shall be
23
integrated into the Person-Centered Plan, and shall not
24
include continuous video surveillance or audio monitoring of
25
private living spaces.
26

"Augmentative and Alternative Communication" means all

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forms of communication other than oral speech that are used to
2
express thoughts, needs, wants, and preferences, including but
3
not limited to speech-generating devices, communication
4
boards, symbol systems, eye-gaze systems, sign language, and
5
other low-tech or high-tech communication methods.
6

Augmentative and Alternative Communication includes the
7
equipment, software, customization, training, and staff
8
support necessary to ensure effective, functional
9
communication across settings, consistent with the Americans
10
with Disabilities Act and Section 504 of the Rehabilitation
11
Act.
12

"Risk of institutionalization" includes circumstances in
13
which existing waiver services are capped, unavailable,
14
intermittently staffed, or otherwise insufficient to safely
15
meet assessed medical, behavioral, or supervision needs,
16
resulting in reliance on unsustainable unpaid caregiving.

17

Section 4.
Program established; administration.
18

(a) Administering agency. The Department of Human
19
Services, Division of Developmental Disabilities is designated
20
as the administering agency and shall work in coordination
21
with the Department of Healthcare and Family Services,
22
Illinois' single State Medicaid agency, to develop, implement,
23
and operate, and to submit, through the Department of
24
Healthcare and Family Services, amendments to the Illinois
25
Adults with Developmental Disabilities Section 1915(c) Home

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and Community-Based Services Waiver, subject to approval by
2
the Centers for Medicare and Medicaid Services.
3

The Department of Human Services, Division of
4
Developmental Disabilities shall have delegated authority from
5
the Department of Healthcare and Family Services, consistent
6
with federal and state law and subject to available
7
appropriations, to contract with providers, establish and
8
administer rates, certify and monitor providers, and adopt
9
implementing rules, subject to approval by the Department of
10
Healthcare and Family Services as required for Medicaid
11
compliance and federal financial participation.
12

Provider licensing, certification, and oversight standards
13
for CSL-24 services shall be established by the Department
14
consistent with existing State authority for community-based
15
residential services, but with the person's own home not
16
requiring licensing or Bureau of Accreditation, Licensure and
17
Certification reviews, and approved by the State Medicaid
18
agency as required for federal financial participation.
19

(b) Advisory Council. The Department shall establish and
20
convene a Community Supported Living Advisory Council to
21
advise the Department on implementation, training, quality
22
standards, evaluation findings, and oversight of CSL-24
23
services under this Act, as further described in Section 18 of
24
this Act.
25

(c) Non-interference and independent implementation.
26

(1) Nothing in this Act shall be construed to require

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the modification, redesign, consolidation, suspension, or
2

reevaluation of any existing service, rate methodology,
3

eligibility criteria, assessment process, or
4

administrative rule under the Illinois Adults with
5

Developmental Disabilities Home and Community-Based
6

Services Waiver as a condition of implementing CSL-24
7

services.
8

(2) The Department shall not delay implementation of
9

CSL-24 services due to proposed, pending, or future
10

changes to other waiver services, assessment tools, rate
11

structures, or administrative processes, except as
12

strictly necessary to obtain federal approval specific to
13

CSL-24.
14

(3) CSL-24 services shall be implemented independently
15

of any broader waiver redesign, rate rebasing, assessment
16

reform, or system transformation efforts.
17

(d) Implementation timeline.
18

(1) Within 180 days after the effective date of this
19

Act, as administratively feasible and subject to receipt
20

of any required federal approvals, the Department shall
21

initiate implementation activities specific to CSL-24
22

services, including but not limited to provider
23

qualification standards, service definitions, and
24

administrative rules necessary to operationalize CSL-24.
25

(2) Implementation activities under this subsection
26

shall proceed concurrently with, and not be delayed by,

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unrelated waiver amendments, assessment reforms, rate
2

rebasing efforts, or system redesign initiatives.
3

(3) Nothing in this subsection shall be construed to
4

require implementation prior to receipt of any federal
5

approvals specific to CSL-24, provided that the Department
6

shall pursue such approvals expeditiously.
7

(e) Rate development, cost neutrality, and federal
8
approval.
9

(1) The Department of Human Services, in coordination
10

with the Department of Healthcare and Family Services,
11

shall establish reimbursement rates for CSL-24 services
12

that reflect the intensity, complexity, and continuous
13

responsibility associated with providing twenty-four-hour
14

staffing, health and welfare oversight, nursing
15

delegation, behavioral supports, and provider
16

accountability, as required under this Act.
17

(2) The Department of Human Services and the
18

Department of Healthcare and Family Services shall develop
19

and submit to the Centers for Medicare and Medicaid
20

Services any required waiver amendments, rate
21

methodologies, cost-effectiveness demonstrations, or
22

cost-neutrality analyses necessary to implement CSL-24
23

services in compliance with Section 1915(c) of the Social
24

Security Act and applicable federal regulations.
25

(3) Implementation of CSL-24 services is contingent
26

upon receipt of required federal approvals. Nothing in

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1

this Act shall be construed to require expenditures in
2

excess of amounts authorized under the approved Medicaid
3

waiver or to constitute an unfunded mandate.

4

Section 5.
Eligibility, enrollment, implementation,
5
transition, and evaluation.
6

(a) Target population and eligibility; CSL-24. This
7
Section applies only to CSL-24 services and shall not modify
8
eligibility or access criteria for other waiver services, nor
9
be conditioned upon changes to other waiver services or
10
assessment systems.
11

Eligibility criteria specific to CSL-24 services are used
12
solely to determine service appropriateness and authorization
13
and shall not establish a separate waiver eligibility
14
category, enrollment group, benefit package, or waiver
15
authority.
16

(1) Nothing in this Section shall be construed to
17

require enrollment in CSL-24 services as a condition of
18

accessing other waiver services, or to limit access to
19

less intensive services when appropriate to an
20

individual's assessed needs. Support Needs:
21

(A) The waiver shall serve individuals with
22

documented needs by one or more clinical assessments
23

and qualified professionals, for one or more of the
24

following:
25

(i) Intense physical or medical support needs;

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1

(ii) Intense or complex behavioral support
2

needs; or
3

(iii) Continuous or 24-hour availability of
4

supervision, direct support, or clinical oversight
5

necessary to ensure health, safety, and meaningful
6

community living.
7

(B) Individuals eligible for CSL-24 services shall
8

demonstrate, through validated assessment tools, a
9

need for continuous or 24-hour availability of
10

medical, behavioral, or supervisory supports to
11

prevent institutional placement and to support safe,
12

integrated community living.
13

(C) An individual shall not be deemed ineligible
14

for CSL-24 services solely because the individual is
15

currently receiving Home-Based Services or other
16

waiver services, when such services are insufficient
17

to meet assessed needs or to prevent risk of
18

institutionalization.
19

(2) Risk of Institutionalization; Family Home
20

Eligibility. Individuals shall be eligible if they are at
21

risk of institutionalization or currently residing in:
22

(A) State-operated developmental centers;
23

(B) Intermediate Care Facilities for Individuals
24

with Intellectual/Developmental Disabilities
25

(ICF/MC/DD);
26

(C) Nursing facilities; or

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1

(D) Other institutional or congregate settings.
2

(3) Individuals residing in the family home also
3

qualify if they:
4

(A) Are age 22 or older;
5

(B) Would be eligible for institutional placement
6

in the absence of unpaid family caregiving supports,
7

including where caregiver age, health, or
8

sustainability creates a foreseeable risk of
9

placement; or
10

(C) Desire to live in a home of their own or remain
11

in the family home with individually tailored supports
12

through CSL-24 services.
13

(4) Age and Functional Criteria: Participants must be
14

18 years or older and meet Medicaid institutional
15

level-of-care requirements and applicable waiver-specific
16

functional or medical criteria.
17

Assessment: Eligibility and service authorization
18

shall be determined using validated assessment instruments
19

that accurately identify an individual's medical,
20

behavioral, physical, and supervision support needs
21

necessary for safe, community-based living. The
22

instruments must be administered by professional staff who
23

have been trained with documented competency to perform
24

the assessments.
25

In determining eligibility for CSL-24 services, the
26

Department shall consider documented behavioral acuity,

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1

including but not limited to information derived from
2

Functional Behavioral Assessments, Behavior Support Plans,
3

Health Risk Screening Tool behavioral risk indicators,
4

clinical or psychiatric evaluations, and documented
5

incident, crisis, or placement disruption history.
6

A health and safety risk assessment, such as the
7

Health Risk Screening Tool, or a substantially similar
8

validated instrument, shall be required for all
9

individuals seeking or receiving CSL-24 services, and for
10

individuals applying through or enrolled in the
11

Prioritization of Urgency of Need for Services (PUNS)
12

process where required by the Department.
13

Assessment results shall be used to inform eligibility
14

determinations, service authorization, staffing
15

requirements, and individualized needs-based funding
16

levels.
17

Health Risk Screening Tool results shall not be used
18

as the sole determinant of waiver eligibility and shall be
19

considered in conjunction with person-centered planning,
20

clinical judgment, and other validated assessment
21

information.
22

Individuals with a Health Risk Screening Tool Level of
23

Care of 4, 5, or 6 shall be considered to have significant
24

health and safety risk that must be explicitly considered
25

in eligibility determinations and service planning,
26

including consideration for CSL-24 services.

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An individual shall not be denied access to CSL-24
2

services solely due to the timing or completion status of
3

a Health Risk Screening Tool assessment when other
4

evidence demonstrates comparable health or safety risk.
5

Assessment results shall not be used to require
6

placement in a congregate, provider-controlled, or
7

institutional setting when community-based supports can
8

reasonably meet the individual's assessed needs and such
9

services must be made available for legal compliance with
10

federal laws and court decisions.
11

The Department may utilize additional validated
12

assessment tools, as appropriate, to inform service
13

planning and support intensity. Nothing in this subsection
14

shall be construed to require the use of the Supports
15

Intensity Scale (SIS®) as a condition of eligibility or
16

access to services, provided that the assessment
17

methodology used is validated, nationally recognized, and
18

capable of accurately identifying individual support needs
19

consistent with federal Home and Community-Based Services
20

requirements.
21

No eligibility determination, service authorization,
22

staffing level, or funding decision under this Act shall
23

be reduced, delayed, denied, or conditioned based on the
24

assumed availability of unpaid family caregiving, remote
25

support or monitoring technology, community day services,
26

employment services, or other non-residential supports.

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1

Assessment results, including ICAP and MBI findings,
2

when used solely as supplemental historical context and
3

not as determinative measures, shall be used to inform
4

service intensity and support design and shall not be used
5

as a basis for exclusion or denial of CSL-24 services.
6

(5) Service Packet: Individuals seeking CSL-24
7

services shall submit a complete service packet in the
8

form and manner prescribed by the administering agency.
9

(b) Enrollment priority. Priority determinations under
10
this subsection apply solely to enrollment sequencing when
11
CSL-24 service capacity is temporarily limited and shall not
12
affect Medicaid waiver eligibility, service authorization, or
13
access to other waiver services.
14

Priority shall be applied only among individuals who have
15
already been determined eligible for and authorized to receive
16
CSL-24 services under the Illinois Adults with Developmental
17
Disabilities Home and Community-Based Services Waiver.
18

Priority enrollment shall be given to individuals with
19
intense support needs who:
20

(1) Reside in a family home with a caregiver providing
21
primary unpaid supports that are no longer sustainable,
22
including individuals whose current waiver services (such as
23
Home-Based Services) are inadequate, unavailable, or capped at
24
levels insufficient to meet assessed needs, and who would be
25
at risk of institutionalization without CSL-24 services; or
26

(2) Are currently in State-operated developmental centers,

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1
ICF/MC/DD facilities, nursing facilities, or similar
2
institutional settings and express a desire to live in the
3
community.
4

Once determined eligible for CSL-24 services, individuals
5
shall not be subject to an additional service-specific waiting
6
list beyond temporary capacity limitations addressed through
7
phased implementation.
8

(c) Written notice of acceptance or rejection.
9

(1) Provider agencies shall issue written notice of
10

acceptance or rejection of each complete service packet
11

within 30 calendar days of receipt.
12

(2) Notice shall include:
13

(A) The specific reasons for acceptance or
14

rejection;
15

(B) Identification of any supports required to
16

serve the individual that the provider cannot
17

currently furnish; and
18

(C) Instructions for correction, resubmission, or
19

appeal consistent with state and federal Medicaid
20

requirements.
21

A provider's inability or refusal to serve an individual
22
due to behavioral acuity or support complexity shall not be
23
construed as evidence that the individual is ineligible for
24
CSL-24 services.
25

Nothing in this subsection shall be construed to grant
26
provider agencies authority to determine Medicaid eligibility

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1
or waiver eligibility, which shall remain the responsibility
2
of the administering agency.
3

(d) Phased rollout for quality and capacity reasons.
4
CSL-24 services are established as a permanent service option
5
under the Illinois Adults with Developmental Disabilities Home
6
and Community-Based Services Waiver. Phased implementation is
7
authorized solely for purposes of quality assurance, provider
8
capacity development, workforce readiness, and program
9
evaluation, and shall not be construed as a pilot,
10
demonstration, or temporary program.
11

(1) Phase I-Initiation. The purpose of phase I is to
12

ensure quality implementation and data collection prior to
13

statewide expansion.
14

(A) Initial enrollment shall be limited to no more
15

than 250 participants in 4-5 Independent Service
16

Coordination regions including urban, suburban, and
17

rural areas for the first 3 to 5 years.
18

(B) Providers must be fully certified and
19

credentialed prior to enrollment of participants,
20

demonstrating compliance with Home and Community-Based
21

Services settings requirements, staff training and
22

competency standards, and program quality benchmarks.
23

The initial provider development and capacity-building
24

phase is expected to require 6 to 9 months prior to the
25

enrollment of the first CSL-24 participants.
26

Data collected during Phase I shall inform the

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1

independent external evaluation required for any
2

subsequent expansion.
3

(2) Phase II-IV-Expansion. Expansion shall occur
4

contingent upon:
5

(A) Findings from independent external evaluation
6

and implementation of any recommended modifications
7

for improvement;
8

(B) Demonstrated provider capacity and readiness;
9

and
10

(C) Legislative approval.
11

(e) Transition and grandfathering.
12

(1) Individuals transitioning from other waivers or
13

institutional settings shall receive continuity of care
14

protections, including:
15

(A) No interruption of essential supports during
16

transition;
17

(B) Coordination between current and new
18

providers; and
19

(C) The ability to transition at any time subject
20

to eligibility and priority criteria.
21

(2) Money Follows the Person Utilization Requirement.
22

To the maximum extent permitted under federal law, the
23

Department shall prioritize use of available Money Follows
24

the Person enhanced federal matching funds (approximately
25

75%) for up to 365 days for individuals transitioning from
26

institutional settings into CSL-24 services.

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MFP funds may be used for housing transition costs,
2

start-up expenses, assistive technology, environmental
3

modifications, and other allowable one-time transition
4

supports necessary for safe community living and community
5

belonging.
6

Transition planning shall include coordination with
7

available federal transition funding, including Money
8

Follows the Person, consistent with Section 11 of this
9

Act.
10

(f) Timeline and reporting.
11

(1) The administering agency shall maintain and
12

publish a timeline for waiver submission, provider
13

certification, and phased enrollment.
14

(2) Annual progress reports shall be submitted to the
15

General Assembly and the Department of Healthcare and
16

Family Services and shall include:
17

(A) Number of participants enrolled;
18

(B) Number of transitions completed;
19

(C) Compliance with implementation milestones; and
20

(D) Annual costs and projected savings.
21

Reports shall be segregated by Health Risk Screening
22

Tool Level of Care, documented behavioral acuity or
23

behavioral support needs, age, referral source, prior
24

living arrangement, and referral outcome (accepted,
25

denied, pending), including reasons for denial or delay.

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1

Section 6.
Assessment and level-of-need framework.
2

(a) Scope of application. The assessment and level-of-need
3
framework described in this Section applies only to
4
individuals seeking or receiving CSL-24 services and shall not
5
alter assessment requirements, eligibility criteria, or
6
funding methodologies for other services within the Illinois
7
Adults with Developmental Disabilities Home and
8
Community-Based Services Waiver unless expressly authorized by
9
statute.
10

(b) Comprehensive person-centered assessment. The
11
Department shall ensure that all individuals seeking or
12
receiving CSL-24 services receive a comprehensive,
13
person-centered assessment that accurately identifies
14
functional, behavioral, and supervision support needs
15
necessary for safe community-based living.
16

(c) Required health and safety risk assessment. The
17
Department shall require use of the Health Risk Screening
18
Tool, or a substantially similar validated health and safety
19
risk assessment, for all individuals seeking or receiving
20
services under this Waiver, including individuals applying for
21
or enrolled through the Prioritization of Urgency of Need for
22
Services (PUNS) process.
23

This requirement may be satisfied through the Health Risk
24
Screening Tool or through a substantially similar
25
State-defined risk assessment methodology, provided that such
26
methodology:

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1

(1) identifies health and safety risks across all
2

hours of the day;
3

(2) informs the need for continuous or 24-hour
4

availability of supports;
5

(3) identifies required safeguards, staffing patterns,
6

and clinical oversight;
7

(4) is documented in and integrated into the
8

Person-Centered Plan; and
9

(5) incorporates behavioral risk and support needs
10

identified through Functional Behavioral Assessments,
11

Behavior Support Plans, or other validated behavioral
12

assessment methodologies, and integrates such findings
13

into the Person-Centered Plan.
14

Nothing in this Section shall be construed to require use
15
of a specific proprietary tool, provided the assessment
16
methodology used meets federal Home and Community-Based
17
Services health and welfare assurance requirements.
18

(d) Determination of 24-Hour support needs. Assessment
19
results shall identify health and safety risks across all
20
hours of the day and shall explicitly determine the need for
21
continuous or 24-hour availability of supports where
22
applicable.
23

Assessment results shall explicitly determine the need for
24
continuous or 24-hour availability of supports without
25
presuming congregate, facility-based, or provider-controlled
26
residential placement based solely on acuity or support

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intensity.
2

For individuals with complex medical, physical, or
3
behavioral support needs, the assessment shall identify, at
4
minimum:
5

(1) Medical complexity and nursing-related needs;
6

(2) Behavioral interventions, supervision intensity,
7

and related support needs, including staffing skill level
8

and consistency requirements with no use of seclusion or
9

restraints;
10

(3) Health and welfare risks across all hours of the
11

day; and
12

(4) The need for monitoring, supervision, or clinical
13

supports.
14

(e) Role of technology in risk mitigation. Assessment
15
results, including Health Risk Screening Tool findings, may be
16
used to identify where remote support or monitoring technology
17
could mitigate identified health or safety risks or enhance
18
early detection of changes in condition, when such technology
19
is preferred by the individual and integrated into the
20
Person-Centered Plan.
21

The availability or use of remote support or monitoring
22
technology shall not, by itself, be used to reduce authorized
23
staffing or nursing supports, nor to deny eligibility for
24
CSL-24 services, when in-person supports are otherwise
25
determined to be necessary through person-centered planning.
26

(f) Health Risk Screening Tool Levels of care and

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eligibility consideration. Individuals with a Health Risk
2
Screening Tool Level of Care of 4, 5, or 6 shall be presumed to
3
require consideration of enhanced supports, without presuming
4
congregate or institutional placement.
5

Health Risk Screening Tool Levels of Care 4, 5, or 6 shall
6
be considered in eligibility determinations, service
7
authorization, staffing requirements, service coordination
8
intensity and individualized funding levels, including
9
consideration for CSL-24 services, as identified through the
10
person-centered planning process.
11

Health Risk Screening Tool Levels of Care inform service
12
planning, support intensity, and risk mitigation and do not
13
independently determine Medicaid waiver eligibility.
14

(g) Use of additional assessment tools. The Department may
15
utilize additional validated assessment instruments, including
16
tools that measure support intensity or functional needs, to
17
inform service planning and funding determinations. All staff
18
administering the assessment instruments must be trained and
19
certified as competent to provide the assessments with
20
fidelity.
21

Nothing in this Section shall be construed to require the
22
use of the Supports Intensity Scale (SIS®) as a condition of
23
eligibility or access to services.
24

The use of additional assessment tools shall not result in
25
the disregard or devaluation of documented behavioral acuity,
26
medical risk, or supervision needs identified through other

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validated assessments.
2

(h) Prohibition on reliance on legacy or deficit-based
3
tools. The Department shall not rely solely on legacy or
4
deficit-based assessment tools such as the Inventory for
5
Client and Agency Planning (ICAP), that were developed for
6
institutional or congregate models and do not adequately
7
capture individualized health risk, supervision needs, or
8
24-hour community-based support requirements for any
9
individual with a disability to be a member of their home
10
community with appropriate individualized supports from
11
trained and certified competent staff.
12

(i) Needs-based funding. Funding for Community Supported
13
Living services shall be based on assessed individual need and
14
shall not be determined through averaged, capped, or
15
population-based funding methodologies.
16

Funding determinations shall reflect the risks and
17
safeguards identified through required health and safety risk
18
assessments, including the need for continuous or 24-hour
19
availability of supports.
20

Nothing in this subsection shall be construed to exempt
21
CSL-24 services from federal waiver cost-neutrality
22
requirements, which shall be satisfied through individualized
23
budgets and aggregate cost comparisons as required under
24
Section 1915(c).
25

(j) Prohibition on ICAP-Based rate or staffing
26
determinations for CSL-24. Notwithstanding any other provision

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of law, rule, or waiver methodology, the Inventory for Client
2
and Agency Planning (ICAP) or other legacy or deficit-based
3
instruments shall not be used as the primary basis for
4
determining eligibility, staffing levels, service intensity,
5
or funding for CSL-24 services.
6

No assessment instrument developed primarily for
7
institutional or congregate service models shall be used to
8
deny access to CSL-24 services or to justify placement in a
9
congregate or institutional setting.
10

Behavioral complexity or intensity shall not, by itself,
11
constitute a basis for denial of eligibility, reduction of
12
services, or exclusion from CSL-24 services.
13

(k) Reassessment. Reassessments shall occur at least
14
annually and whenever a participant's needs materially change.
15

(l) Integration with PUNS. The Department shall
16
incorporate Health Risk Screening Tool results into the
17
Prioritization of Urgency of Need for Services (PUNS) process
18
to ensure that individuals with significant health and safety
19
risks are accurately identified and prioritized.
20

A Health Risk Screening Tool Level of Care of 4, 5, or 6
21
shall be recognized as evidence of urgent need due to
22
heightened risk of institutionalization, health deterioration,
23
or caregiver collapse.
24

Behavioral acuity documented through Functional Behavioral
25
Assessments, Behavior Support Plans, Health Risk Screening
26
Tool behavioral risk indicators, documented crisis or

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placement disruption history, or other validated behavioral
2
assessment tools shall be recognized as evidence of urgent
3
need when such needs materially increase the risk of
4
institutionalization, placement disruption, or caregiver
5
collapse.
6

(m) Proprietary tool safeguard. Nothing in this Act shall
7
be construed to require the use of a specific proprietary
8
assessment instrument, provided that any alternative tool used
9
is validated, nationally recognized, and capable of accurately
10
identifying health, safety, and support needs consistent with
11
federal Home and Community-Based Services requirements.

12

Section 7.
Covered services.
13

(a) General principles.
14

(1) The Illinois Adults with Developmental
15

Disabilities Home and Community-Based Services Waiver, as
16

amended by this Act, shall provide a flexible array of
17

home and community-based services designed to meet each
18

participant's individualized needs and preferences as
19

identified in the Person-Centered Plan.
20

(2) Services shall be delivered in accordance with
21

federal Home and Community-Based Services regulations and
22

shall be flexible in type, intensity, and setting to
23

ensure person-centeredness, informed choice, and promote
24

independence, health, and community integration.
25

(3) Providers furnishing CSL-24 services shall

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maintain 24/7 emergency and crisis backup coverage to
2

respond to participant health, safety, or behavioral
3

emergencies, especially for individuals with
4

high-intensity medical or behavioral support needs.
5

(4) Services authorized under CSL-24 shall not be
6

subject to hourly, daily, weekly, or monthly service caps
7

except as required to ensure compliance with federal
8

waiver cost-neutrality requirements, applicable to other
9

waiver services including indirect staffing, on-call
10

coverage, or supervisory limits, and shall be authorized
11

solely based on assessed individual need and the
12

Person-Centered Plan, except as required for federal
13

waiver cost-neutrality compliance.
14

(5) Coordination across residential and day services.
15

Providers of CSL-24 services and Independent Service
16

Coordinators shall coordinate with employment providers,
17

community day providers, and other service entities to
18

ensure continuity of staffing, nursing oversight,
19

behavioral supports, and transportation necessary to
20

support meaningful community participation and belonging
21

throughout the day.
22

Service coordination responsibilities shall not be
23
fragmented in a manner that results in denial of access to
24
employment, community day, or meaningful activities for
25
individuals with complex medical, physical, or behavioral
26
support needs.

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(b) Covered services shall include, but are not limited
2
to, the following:
3

(1) Intensive Individualized Service Coordination.
4

This service builds upon the standard Independent Service
5

Coordination function, providing an enhanced level of
6

support for individuals with complex medical, behavioral,
7

or physical support needs who require frequent, proactive
8

coordination to ensure health, safety, and stability in
9

community settings.
10

(A) Development and ongoing implementation of a
11

comprehensive Person-Centered Plan including:
12

(i) Assistance in accessing and coordinating
13

necessary medical, behavioral, and integrated and
14

inclusive community-based services and supports.
15

(ii) Ongoing monitoring of the individual's
16

health, welfare, and progress toward desired outcomes
17

with increased frequency and intensity as needed to
18

address risks or changes in status.
19

(iii) Coordination of transitions between
20

institutional, congregate settings; or other settings
21

into or within Community living arrangements.
22

(iv) Development and maintenance of a 24-hour
23

individualized backup and emergency response plan to
24

ensure continuity of support, including identification
25

of formal and informal supports.
26

(B) Enhanced service coordination for high-acuity

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individuals. Individuals with a Health Risk Screening
2

Tool Level of Care of 4, 5, or 6, or with documented
3

behavioral acuity as defined in Section 3, shall
4

receive enhanced service coordination, commensurate
5

with assessed acuity and risk, which shall include, at
6

a minimum:
7

(i) Increased frequency of Independent Service
8

Coordinator contact, monitoring, and
9

documentation;
10

(ii) Lower Independent Service Coordinator
11

caseload ratios proportional to the individual's
12

assessed health, safety, and supervision needs;
13

(iii) Proactive coordination of medical,
14

behavioral, nursing, and crisis prevention
15

supports, including coordination across providers
16

and systems of care;
17

(iv) Ongoing review of health and safety
18

risks, mitigation strategies, and required
19

adjustments to services or supports; and
20

(v) Rapid response coordination during changes
21

in condition, hospitalization, emergency
22

department use, behavioral crises, or other
23

destabilizing events.
24

Enhanced Service Coordination under this
25

subsection shall be reflected in rate-setting,
26

staffing expectations, and caseload standards

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applicable to Independent Service Coordination and
2

provider-based case management functions.
3

(2) Housing Navigator Services:
4

(A) assist the individual in identifying,
5

securing, and maintaining affordable and, when needed,
6

accessible community-based housing aligned with the
7

individual's preferences and Person-Centered Plan.
8

(B) Housing Navigator responsibilities include:
9

(i) Identifying available, affordable, and
10

accessible housing options and related supports
11

within the individual's preferred communities.
12

(ii) Assisting individuals and families with
13

completing housing, leasing, and rental assistance
14

applications, including requests for reasonable
15

accommodations.
16

(iii) Developing and maintaining relationships
17

with landlords, property managers, housing
18

developers, public housing authorities, and other
19

community partners to expand integrated housing
20

opportunities.
21

(iv) Coordinating with Independent Service
22

Coordination agencies, service providers, housing
23

authorities, and other local partners to support
24

housing searches, applications, transitions, and
25

ongoing tenancy needs.
26

(v) Providing tenancy-sustaining supports,

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including assistance with lease renewals,
2

communication with landlords, and identification
3

of additional services or interventions needed to
4

maintain housing stability.
5

All housing-related activities shall comply with
6

the federal Home and Community-Based Services Settings
7

Rule (42 CFR 441.301(c)(4)) and the integration
8

principles affirmed in Olmstead v. L.C.
9

(3) Community Supported Living Services, consisting of
10

the following distinct service options:
11

(A) Community Supported Living-Intermittent
12

(formerly Intermittent Community-Integrated Living
13

Arrangement) provides less than 24-hour staff support
14

consistent with existing waiver service parameters.
15

(B) CSL-24.
16

Provides continuous, 24-hour provider responsibility
17

for staffing, supervision, health and welfare, nursing
18

delegation, and behavioral support as identified in the
19

Person-Centered Plan.
20

(4) Behavioral stabilization and crisis prevention.
21

(A) Services shall be based on non-aversive,
22

positive behavioral interventions and trauma-informed
23

care.
24

(B) Restrictive procedures such as seclusion or
25

restraint shall only be used as a last resort, on a
26

temporary and emergency basis and must:

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1

(i) Be based on a comprehensive evaluation and
2

recommendations from a professional who is licensed or
3

certified in behavioral management approaches for
4

people with developmental disabilities;
5

(ii) Be developed using evidence-based or
6

evidence-informed practices;
7

(iii) Be supported by documented justification;
8

and
9

(iv) Be reviewed and approved by an independent
10

human rights committee consistent with State rule and
11

federal CMS guidance.
12

(5) Community integration and companion supports.
13

(A) Assistance that enables active participation
14

in community-integrated activities.
15

(B) One-to-one supports in community settings or
16

home-based supports directly related to community
17

participation, as defined in the Person-Centered Plan.
18

(C) Services authorized under CSL-24 shall not be
19

subject to preset hourly, daily, weekly, or monthly
20

service caps. Service intensity and duration shall be
21

authorized solely based on assessed individual need
22

and documented in the Person-Centered Plan.
23

(D) Communication Access and Augmentative and
24

Alternative Communication Supports. For individuals
25

who rely on Augmentative and Alternative
26

Communication, services shall include one-to-one

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1

staffing or dedicated trained staff for communication
2

support when required to ensure the person's right to
3

effective communication, self-direction, and
4

participation in home, community, employment, or
5

meaningful day activities.
6

Such supports shall include trained direct support
7

professionals or other staff who are competent in the
8

individual's Augmentative and Alternative Communication
9

system and communication strategies, as documented in the
10

Person-Centered Plan.
11

The provision of Augmentative and Alternative
12

Communication devices or technology alone shall not be
13

considered sufficient if the individual requires ongoing
14

or intermittent human support to use the system
15

effectively.
16

(6) Skilled nursing services. Licensed nursing
17

services provided on a part-time or intermittent basis,
18

including:
19

(A) Health assessment and monitoring;
20

(B) Medication management; and
21

(C) Nursing care, including delegation to trained
22

DSPs as allowed under State law and the Nurse Practice
23

Act.
24

(7) Employment and meaningful day supports.
25

(A) Customized employment discovery, profile,
26

plan, job development, systematic instruction, and

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1

long-term supports (in person or virtual) after
2

employment is secured, when indicated, according to
3

the individual's need for support.
4

(B) A Customized Employment Discovery Profile and
5

Plan shall first be provided through the Division of
6

Rehabilitation Services (DRS), as required under
7

federal vocational rehabilitation and CMS Medicaid
8

Home and Community-Based Services regulations, unless
9

there is documentation that DRS cannot begin the
10

process within 30 days, after which the Home and
11

Community-Based Services waiver can pay for those
12

services. Once there is a Customized Employment plan
13

in place, DRS is obligated to provide or purchase job
14

development and at least 180 days of ongoing support,
15

after which funding for long-term supports is
16

transferred to Home and Community-Based Services.
17

(8) Equipment, technology, and environmental
18

modifications.
19

(A) Purchase, rental, or maintenance of items,
20

devices, or systems that increase or maintain
21

functional independence, including but not limited to:
22

(i) Personal emergency response systems, including
23

installation, maintenance, and monthly response center
24

fees, that enable participants to signal a response
25

center to secure help in an emergency.
26

(ii) Home and vehicle accessibility modifications;

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1

physical changes to a private residence, automobile,
2

or van, necessary to accommodate the participant and
3

improve functional access, safety, or independence.
4

(iii) Assistive technology and durable medical
5

equipment, including the purchase or rent of items,
6

devices, or product systems that increase or maintain
7

a person's functional status and level of
8

independence, including design, fitting, adaptation,
9

maintenance and training or technical assistance
10

related to the use of such equipment.
11

(iv) Augmentative and Alternative Communication
12

supports, including speech-generating devices,
13

communication boards, symbol systems, switches and
14

alternative access devices, eye-gaze systems, low-tech
15

and high-tech communication tools, and related
16

software or applications, together with necessary
17

customization, programming, accessories, mounting,
18

maintenance, repair, replacement, and training or
19

technical assistance for the individual and supporting
20

staff, when required to ensure effective
21

communication, informed choice, self-advocacy, health
22

and safety, and participation in home and community
23

life.
24

(v) Disposable medical supplies, including
25

nutritional supplements necessary to maintain or
26

improve an individual's health and functional status,

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1

and to support continued residence in the community.
2

(vi) Standard limitation. Except as provided in
3

subparagraph (vii), the total aggregate cost for
4

adaptive equipment, assistive technology,
5

environmental modifications (including home and
6

vehicle accessibility modifications), remote
7

support-equipment, and related installation,
8

maintenance, repair, and monitoring costs shall not
9

exceed the maximum amount otherwise permitted under
10

the Illinois Adults with Developmental Disabilities
11

Section 1915(c) Home and Community-Based Services
12

Waiver, as approved by CMS, or any successor waiver
13

provisions.
14

(vii) Enhanced limitation for CSL-24. Subject to
15

CMS approval, for individuals authorized to receive
16

CSL-24 services, the limitation described in
17

subparagraph (vi) shall be increased to an aggregate
18

amount equal to 2 times the maximum amount otherwise
19

permitted under the approved waiver, when such
20

modifications, equipment, or technology are necessary
21

to support health, safety, or continued community
22

living and are documented in the Person-Centered Plan.
23

This enhanced limitation applies only to CSL-24 and
24

shall not alter limits applicable to other waiver
25

services.
26

Implementation of this enhanced limitation is

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subject to CMS approval and shall be carried out in a
2

manner consistent with federal waiver cost-neutrality
3

requirements.
4

(viii) Remote Support and Monitoring Technology.
5

For individuals receiving CSL-24 services, remote
6

support and monitoring technology may be authorized as
7

a supplemental support when documented in the
8

Person-Centered Plan and determined to enhance safety,
9

independence, or continuity of care.
10

Remote supports shall not replace required
11

in-person staffing, nursing oversight, or supervision
12

identified through assessment and person-centered
13

planning, but may be used to supplement supports
14

during periods of stability, overnight hours, or
15

transitions, consistent with individual preference and
16

assessed risk.
17

(9) Transportation services. Transportation
18

(accessible as needed) to enable community participation,
19

employment, and access to health care or social
20

activities, as specified in the Person-Centered Plan.
21

(10) Extended State Plan Services. Physical therapy,
22

occupational therapy, and speech-language therapy designed
23

to maintain or improve function and to train support
24

staff, as identified in the Person-Centered Plan.
25

(11) Institutional Transition Supports (MFP-Aligned).
26

For individuals transitioning from institutional settings

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into CSL-24 services, the Department shall ensure
2

coordination between waiver services and the Money Follows
3

the Person program. Transition planning shall begin prior
4

to discharge and include identification and timely access
5

to MFP-funded transition supports unless the individual is
6

determined ineligible for MFP or MFP funding is
7

unavailable.
8

(12) Enhanced community day and meaningful day
9

supports for individuals with complex needs.
10

(A) Community day, employment, and meaningful day
11

services shall be available to individuals receiving
12

Community Supported Living-Intermittent or CSL-24
13

services and shall be designed to support full
14

participation in integrated community life.
15

(B) For individuals with intense physical,
16

medical, or behavioral support needs, community day
17

and meaningful day services shall include, as
18

identified in the Person-Centered Plan:
19

(i) One-to-one or enhanced staffing ratios,
20

including continuous supervision when required for
21

health or safety;
22

(ii) Skilled nursing services or nursing
23

oversight, including medication administration,
24

monitoring, and delegation during day activities;
25

(iii) Behavioral support staff, crisis
26

prevention supports, and positive behavioral

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1

interventions;
2

(iv) Transportation supports, including
3

staff-accompanied transportation when required.
4

(C) These supports shall be considered integral
5

components of community day and meaningful day
6

services and shall not be denied solely because they
7

are not listed as stand-alone services within the
8

waiver.
9

(D) Reimbursement rates for community day and
10

meaningful day services shall include acuity-based
11

rate add-ons to reflect the actual cost of providing
12

one-to-one staffing, nursing supports, and specialized
13

supervision.
14

(E) The Department shall comply with the Americans
15

with Disabilities Act (42 U.S.C. 12101 et seq.) and
16

Section 504 of the Rehabilitation Act of 1973 (29
17

U.S.C. 794), and shall not exclude any individual from
18

community day or meaningful day services on the basis
19

of disability or disability-related support needs. The
20

Department shall provide reasonable modifications,
21

auxiliary aids, services, and supports necessary to
22

ensure equal access to such services.
23

Reasonable modifications shall be provided unless
24

the Department demonstrates that such modifications
25

would fundamentally alter the nature of the service.

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1

Section 8.
Person-centered planning and budgets.
2

(a) Each participant shall have a Person-Centered Plan
3
developed and implemented in accordance with federal Home and
4
Community-Based Services requirements and the 2014 CMS
5
Settings Rule.
6

The Person-Centered Plan shall be led by the participant
7
and facilitated by trained facilitators or navigators using
8
federally recognized person-centered planning principles,
9
including those reflected in the National Center for Advancing
10
Person-Centered Practices and Systems. The Person-Centered
11
Plan process may include friends, family, and other
12
stakeholders and shall:
13

(1) document the participant's goals, preferences,
14

strengths, and desired outcomes;
15

(2) reflect informed choice among available services,
16

supports, and providers; the Person-Centered Plan shall
17

identify communication needs, including the use of
18

Augmentative and Alternative Communication, and shall
19

specify any required staffing supports necessary to ensure
20

effective communication, informed choice, and
21

self-advocacy across all settings;
22

(3) explicitly incorporate the principle of dignity of
23

risk; and
24

(4) identify strategies and safeguards necessary to
25

maintain the participant's health, safety, and well-being
26

while respecting autonomy and choice including nursing

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delegation plans (if applicable), required provider
2

response times, staffing patterns, indirect staffing
3

supports, on-call coverage, and community integration
4

plan.
5

Meaningful day, community participation, and employment
6
integration. For individuals receiving CSL-24 services, the
7
Person-Centered Plan shall include goals and preferences
8
related to meaningful day activities, community participation,
9
or employment, and shall identify the services, staffing,
10
nursing supports, behavioral supports, transportation, and
11
coordination necessary to support participation across the
12
full day.
13

The absence, delay, or limited availability of employment,
14
community day, or meaningful day services shall not be used to
15
deny, delay, reduce, or terminate access to CSL-24 services.
16

(b) Individual budgets. Individual budgets shall be based
17
on the participant's assessed level of need, as determined
18
through validated assessment instruments and the
19
person-centered planning process.
20

(1) Budget determinations shall be informed by
21

required health and safety risk assessments, including the
22

Health Risk Screening Tool or a substantially similar
23

validated instrument, as well as documented behavioral
24

assessment levels, and shall not rely on legacy or
25

deficit-based tools, including the Inventory for Client
26

and Agency Planning (ICAP), as the primary basis for

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1

funding amounts, staffing levels, or service intensity for
2

CSL-24 services.
3

(2) Funding shall not be tied to the individual's
4

location, residence type, or provider-operated setting,
5

but shall be directly linked to the supports and services
6

in the individual's own home, identified in the
7

participant's Person-Centered Plan, to be reviewed at
8

least annually.
9

(3) Budgets for CSL-24 shall not impose direct or
10

indirect service caps other than those necessary to ensure
11

compliance with federal waiver cost-neutrality
12

requirements, including limits on supervisory staffing,
13

indirect staffing, or on-call coverage, when such supports
14

are necessary to address assessed health, safety, or
15

supervision needs and are documented in the
16

Person-Centered Plan.
17

(4) Staff sharing in CSL-24: Person-Centered Plans
18

shall determine whether staff sharing is appropriate based
19

on individual health, safety, and support needs. Overnight
20

staff sharing may be allowed only when it does not
21

compromise individual support, and clear contingency and
22

response protocols are documented in each participant's
23

Person-Centered Plan.
24

(c) Cost parameters and CMS cost-effectiveness.
25

(1) The State shall establish individualized budgets
26

using an approved, needs-based methodology that reflects

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the participant's assessed medical, behavioral, and
2

physical support requirements.
3

(2) Consistent with CMS cost-effectiveness standards
4

for 1915(c) waivers, the State shall ensure that the
5

aggregate costs of services and supports provided to
6

waiver participants do not exceed the aggregate costs of
7

serving an equivalent number of individuals in comparable
8

institutional settings, Intermediate Care Facilities
9

(ICFs/IID).
10

(3) The State shall maintain documentation
11

demonstrating cost neutrality in accordance with CMS
12

requirements, including adherence to the approved
13

cost-neutrality formula, and reporting standards.
14

(d) Annual review and revision. The administering agency
15
shall establish procedures for annual review and revision of
16
the Person-Centered Plan and individual budget to ensure
17
responsiveness to changes in the participant's needs, goals,
18
or circumstances.
19

(e) Support adjustments without relocation.
20

(1) Changes in a participant's medical, behavioral,
21

physical, or communication needs shall not require
22

relocation from the participant's chosen home, including a
23

family home, apartment, or leased residence.
24

(2) When needs decrease or increase, the Department
25

shall adjust services, staffing levels, nursing supports,
26

assistive technology, or other accommodations necessary to

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maintain the individual safely in their existing home
2

whenever possible.
3

(3) Increased support needs shall not be used as
4

justification to require placement in a congregate,
5

provider-controlled, or institutional setting.
6

(4) Relocation may occur only when requested by the
7

participant or when all reasonable support adjustments
8

have been exhausted and continuation in the current
9

setting would pose a documented, unavoidable risk that
10

cannot be mitigated through additional services and
11

assistive technology.
12

(5) Increased support needs, staffing intensity, or
13

service cost shall not be used as justification for
14

relocation, waiver termination, or placement in a
15

congregate or institutional setting.
16

(6) Changes in an individual's communication needs,
17

including increased reliance on Augmentative and
18

Alternative Communication, shall be addressed through
19

adjustments to staffing, training, or supports and shall
20

not be used as justification for service reduction,
21

denial, or relocation.
22

(f) Participant-Initiated Revisions. Participants shall
23
have the right to request revisions to their Person-Centered
24
Plan or individual budget at any time when there is a change in
25
their condition, circumstances, or personal preferences. The
26
administering agency shall respond to such requests in a

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timely manner and provide written notice of approval or
2
denial, including the reason for the determination and
3
instructions for appeal.
4

(g) Independent Service Coordination Oversight.
5
Independent Service Coordinators shall conduct at least
6
quarterly reviews of Person-Centered Plan implementation for
7
individuals receiving CSL-24 services, including verification
8
that authorized staffing levels, indirect supports, and
9
on-call coverage are being provided as approved and that risk
10
mitigation strategies are effective. Findings shall be
11
documented and used to inform service adjustments when needed.

12

Section 9.
Provider requirements and selection.
The
13
Department shall implement an initial, phased deployment of
14
CSL-24 services with a limited number of qualified providers,
15
not to exceed 7, that demonstrate expertise and a documented
16
success record with the Department of supporting individuals
17
with complex medical or behavioral needs in small, integrated
18
community settings serving 4 or fewer individuals.
19

Nothing in this Section shall be construed to limit future
20
expansion of qualified providers upon demonstration of
21
provider readiness, workforce capacity, and compliance with
22
program standards.
23

This initial provider limitation is intended solely to
24
ensure quality, workforce readiness, and fidelity to
25
person-centered, community-based service provision during

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early implementation and shall not be used to restrict
2
long-term access, participant choice, long-term provider
3
participation, geographic access, or statewide availability of
4
CSL-24 services. This initial implementation shall apply only
5
to CSL-24 services and shall not limit access to Community
6
Supported Living-Intermittent services.
7

(a) Provider independence and housing ownership.
8

(1) No provider of community-based services under
9

Community Supported Living Arrangements -Intermittent or
10

CSL-24 shall own, lease, manage, or otherwise exercise
11

control over the housing or residential setting in which a
12

participant resides, except as permitted under federal
13

Home and Community-Based Services regulations where the
14

participant retains full tenant rights, meaningful choice,
15

and the ability to select and change service providers
16

independent of housing.
17

(2) Housing and services shall be functionally
18

independent to ensure participants' rights to privacy,
19

autonomy, and control over their living environment and to
20

avoid risk of institutionalization.
21

(b) Provider qualification, certification and selection.
22

(1) All providers shall meet the qualification
23

standards established by the administering agency and
24

shall demonstrate capacity to deliver services consistent
25

with person-centered planning, informed choice, and
26

community integration requirements with demonstrated

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compliance with the federal Home and Community-Based
2

Services Settings Rule.
3

Qualification standards shall include but not be
4

limited to:
5

(A) Minimum quality and performance standards;
6

(B) Criminal background and registry checks;
7

(C) Evidence-based clinical and nursing protocols;
8

(D) Staffing ratios and competency standards;
9

(E) Emergency response and backup coverage plans;
10

and
11

(F) Medication administration and delegation
12

protocols.
13

(2) Participants shall have the right to select from
14

qualified providers and to change providers without
15

penalty.
16

(3) The administering agency may limit participation
17

in CSL-24 services to providers that demonstrate
18

specialized competency in supporting individuals with
19

complex medical, physical, or behavioral needs, including
20

nursing delegation, crisis response, and high-acuity
21

staffing capacity, without limiting participant choice
22

among qualified providers.
23

(4) Participant Choice of Provider. Nothing in this
24

Section shall be construed to permit assignment of a
25

provider without the informed choice and consent of the
26

participant or the participant's legally authorized

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representative, consistent with federal Home and
2

Community-Based Services requirements.
3

(c) Compliance and corrective action. The administering
4
agency shall establish monitoring procedures to ensure
5
provider compliance with federal and state Home and
6
Community-Based Services settings requirements, the ADA,
7
Section 504, and all terms of this Act.
8

(1) Providers found to be out of compliance shall be
9

required to implement a corrective action plan within a
10

defined timeframe.
11

(2) Failure to achieve compliance within the required
12

period after notice and opportunity to correct may result
13

in suspension, termination, or decertification of the
14

provider's participation in the program.
15

(3) Participants affected by provider suspension or
16

termination shall receive timely notice and assistance
17

with transition to another qualified provider of their
18

choice (if desired) to ensure continuity of care and
19

compliance with Olmstead v. L.C. and the Ligas Consent
20

Decree.
21

(d) Transparency and public reporting. The administering
22
agency shall maintain and publish an annual report and online
23
public registry of all approved providers, including:
24

(1) current compliance status with Home and
25

Community-Based Services settings and program
26

requirements;

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(2) corrective action plans and resolution status,
2

where applicable;
3

(3) any enforcement actions, suspensions, or
4

terminations taken during the reporting period.
5

This information shall be publicly accessible and
6
regularly updated to promote accountability, quality
7
improvement, and informed participant choice.
8

The administering agency shall annually report provider
9
capacity limitations, including the number of individuals
10
denied services due to staffing, nursing, or acuity-related
11
constraints, geographic gaps in provider availability, and
12
recommended corrective actions.
13

(e) Temporary suspension of new admissions.
14

(1) If a provider is determined to be out of
15

compliance with Home and Community-Based Services
16

requirements, participant rights, or quality standards,
17

the administering agency may impose a temporary suspension
18

of new admissions following notice and in accordance with
19

applicable due process requirements.
20

(2) The suspension shall remain in effect until the
21

provider demonstrates full compliance through verification
22

by the agency or its designee.
23

(3) During such suspension, the agency shall ensure
24

that participants currently served by the provider
25

continue to receive all necessary supports without
26

disruption.

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(f) Provider expansion criteria. The administering agency
2
shall establish objective criteria and a transparent process
3
for expanding provider participation in CSL-24 services beyond
4
the initial implementation phase.
5

Such criteria shall consider, at a minimum:
6

(1) demonstrated unmet participant need;
7

(2) geographic access and equity;
8

(3) provider performance and compliance history; and
9

(4) workforce capacity and readiness.
10

Nothing in this subsection shall require expansion beyond
11
the Department's administrative capacity but the Department
12
shall ensure that provider participation is not permanently
13
limited where unmet need exists.

14

Section 10.
Workforce development, training and retention.
15
All workforce standards, staffing ratios, caseload
16
requirements, training obligations, wage enhancements, and
17
workforce-related provisions set forth in this Section apply
18
solely to CSL-24 services and shall be implemented subject to
19
federal approval, waiver authority, and available
20
appropriations.
21

Nothing in this Section shall be construed to require
22
modification of workforce standards, staffing ratios, wages,
23
or caseloads applicable to any other waiver service or
24
program.
25

(a) Staffing ratios and caseloads.

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(1) The administering agency shall establish minimum
2

direct support professional to participant ratios, based
3

on participant acuity, including medical, physical, and
4

behavioral support needs.
5

(2) For high-acuity participants, ratios shall be
6

lower as needed to ensure health, safety, and quality
7

services and supports and quality of life outcomes.
8

(3) Nursing supports:
9

(A) Participants requiring skilled health care
10

supports shall have access to licensed nursing
11

services for assessment, monitoring, training, and
12

delegation of health-related tasks in accordance with
13

the Illinois Nurse Practice Act and Medicaid
14

requirements.
15

(B) Nursing coverage levels shall be determined
16

through the person-centered planning process and
17

informed by validated assessment tools including
18

required health and safety risk assessments such as
19

Health Risk Screening Tool, to ensure appropriate
20

RN/LPN availability for both direct and indirect
21

clinical oversight.
22

(C) Providers shall maintain sufficient nursing
23

capacity to ensure timely response to changes in
24

condition, medication management, and emergency
25

situations.
26

(D) When nursing delegation is used, DSPs must

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receive competency-based training and supervision by a
2

qualified nurse, consistent with delegation rules and
3

participant safety requirements.
4

(4) Qualified Intellectual/Developmental Disabilities
5

Professionals shall have caseloads commensurate with
6

participant acuity. Individuals with Health Risk Screening
7

Tool Levels of Care 4, 5, or 6 shall require lower
8

Qualified Intellectual Disabilities Professional caseload
9

ratios to ensure adequate oversight, coordination, and
10

accountability for health, safety, and quality of life
11

outcomes, with caseload limits to be established in rule
12

and not to exceed a range of 4 to 7 participants unless the
13

Department documents justification based on assessed
14

acuity and risk.
15

(5) Providers shall maintain sufficient staffing to
16

ensure 24/7 coverage, including direct support and paid
17

indirect supports and coordination such as planning,
18

monitoring, emergency response, staff coordination,
19

emergency backup staff, and service scheduling.
20

(6) Staff sharing and overnight support:
21

(A) Staff sharing is permissible only when
22

consistent with each participant's Person-Centered
23

Plan and individual risk assessment.
24

(B) Overnight staff may support more than one
25

participant in a household only if:
26

(i) All individuals are asleep;

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(ii) Health and safety monitoring is assured;
2

and
3

(iii) Emergency response protocols enable
4

immediate assistance.
5

(b) Initial competency-based training and certification.
6

(1) All direct support professionals, Qualified
7

Intellectual Disabilities Professionals, and Independent
8

Service Coordinators shall complete mandatory,
9

competency-based initial training and certification prior
10

to providing services.
11

(2) The training shall be based on nationally
12

recognized standards, including the College of Direct
13

Support, the National Alliance for Direct Support
14

Professionals Code of Ethics, and the National Center on
15

Advancing Person-Centered Practices and Systems
16

curriculum.
17

(3) Initial training shall include, at a minimum, the
18

following core areas:
19

(A) Person-centered thinking, planning, and
20

implementation, consistent with National Center on
21

Advancing Person-Centered Practices and Systems and
22

CMS Home and Community-Based Services regulations;
23

(B) Positive behavioral supports and non-aversive
24

crisis prevention, including functional behavior
25

understanding and de-escalation strategies;
26

(C) Health, safety, and nursing supports,

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including:
2

(i) Nursing delegation and medication
3

administration;
4

(ii) Health risk screening and monitoring
5

using validated health and safety risk
6

assessments, such as the Health Risk Screening
7

Tool;
8

(iii) Prevention and recognition of the "Fatal
9

Five", the 5 leading causes of preventable death
10

among individuals with developmental disabilities,
11

consistent with nationally recognized clinical
12

guidance;
13

(iv) Emergency response and procedures,
14

including fire safety, medical emergencies, and
15

natural disasters;
16

(v) Indirect supports and coordination,
17

including service monitoring, scheduling, and
18

communication across providers;
19

(vi) Participant rights and Home and
20

Community-Based Services compliance, including
21

privacy, autonomy, choice, and community
22

integration consistent with 42 CFR 441.301(c)(4);
23

(vii) Any additional topics required by the
24

administering agency for compliance with state and
25

federal standards.
26

(c) Annual refresher training and competency assessment.

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(1) All direct support professionals, Qualified
2

Intellectual/Developmental Disabilities Professionals,
3

and Independent Service Coordinators shall complete annual
4

refresher training and competency assessments designed to
5

reinforce and update essential skills with improved best
6

practices and advances in assistive technology.
7

(2) Annual training shall include, at a minimum,
8

instruction in the following areas:
9

(A) Person-centered practices, including review of
10

plan implementation and progress toward individualized
11

outcomes;
12

(B) Health and safety, including updates to Health
13

Risk Screening Tool assessments, medication
14

administration, infection control, and emergency
15

response procedures;
16

(C) Positive behavioral supports and
17

trauma-informed care;
18

(D) Community participation, belonging, and
19

development of relationships and natural (unpaid)
20

supports;
21

(E) Development of profiles and strategies for
22

meaningful community day activities and customized
23

employment;
24

(F) Advances in assistive technology and
25

applications that support increased independence and
26

self-determination;

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(G) Participant rights, appeals, and advocacy,
2

including access to ombuds and grievance procedures;
3

(H) Incident reporting and abuse prevention,
4

including identification, mandatory reporting
5

requirements, and documentation protocols;
6

(I) Compliance with the Home and Community-Based
7

Services Settings Rule, reinforcing autonomy,
8

integration, privacy, and informed choice; and
9

(J) Emerging topics, as identified by the
10

administering agency, including new regulatory
11

updates, assistive technology, or communication
12

supports.
13

(d) Workforce stabilization, retention, and incentives.
14
The administering agency shall implement programs to promote
15
workforce competencies, stability, and retention, through
16
competency-based training and performance standards,
17
including:
18

(1) Wage enhancements and salary floors for direct
19

support professionals and Qualified
20

Intellectual/Developmental Disabilities Professionals
21

serving high-acuity CSL-24 participants.
22

(2) Tuition reimbursement, credentialing support, and
23

professional development opportunities.
24

(3) Career ladder and mentorship programs.
25

(4) Other incentives designed to recruit, retain, and
26

maintain a competent, high-quality workforce in community

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supported living settings to ensure provider
2

accountability for participants' health, safety, and
3

quality of life outcomes.
4

Any wage enhancements or salary floors referenced in this
5
subsection shall be implemented solely through approved
6
reimbursement rates and shall not create obligations beyond
7
those authorized under the approved Medicaid waiver.
8

(e) Oversight and compliance. The administering agency
9
shall:
10

(1) monitor adherence to staffing ratios, Qualified
11

Intellectual Disabilities Professional caseload limits,
12

and 24/7 coverage requirements;
13

(2) ensure completion of all training and refresher
14

requirements;
15

(3) monitor workforce retention and vacancy rates; and
16

(4) report annually to the General Assembly and the
17

public, with CSL-24-specific data, on staffing levels,
18

caseload compliance, nursing coverage, training
19

completion, vacancy rates, and workforce stability
20

outcomes.
21

(f) Alignment with Person-Centered Plans and Home and
22
Community-Based Services requirements. All staffing, training,
23
and retention policies under this Section shall be implemented
24
in a manner that ensures:
25

(1) full adherence to each participant's
26

Person-Centered Plan, including opportunities to

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experience choices, make informed choices, individualized
2

goals and outcomes, risk and benefit decisions, and
3

required supports;
4

(2) provision of indirect supports and coordination,
5

such as scheduling, monitoring, emergency response, and
6

service management, in accordance with participant needs;
7

and
8

(3) compliance with federal Home and Community-Based
9

Services rules, including integration, autonomy, privacy,
10

and access to community life.

11

Section 11.
Rate-setting and finance.
Upfront funding
12
authorization is required for implementation of CSL-24
13
services, including training and infrastructure investments.
14

(a) Rate Methodology. Enhanced rates, staffing ratios,
15
nursing supports, and workforce standards described in this
16
Act shall apply to CSL-24 services and shall be tiered based on
17
assessed acuity.
18

Rate methodologies shall explicitly account for enhanced
19
service coordination requirements for individuals with higher
20
assessed health and safety risk (Health Risk Screening Tool
21
Levels of Care 4, 5, or 6), or intensive behavioral support
22
needs, including lower caseload ratios, increased monitoring,
23
and on-call availability.
24

The administering agency shall establish a rate-setting
25
methodology that:

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(1) funds services based on each participant's
2

Person-Centered Plan, including all direct and paid
3

indirect supports required to achieve goals and maintain
4

health and safety;
5

(2) Residential staffing, supervision, and funding for
6

CSL-24 services shall not be reduced, offset, or
7

conditioned upon assumptions of participation in community
8

day services, employment services, or other
9

non-residential waiver services;
10

(3) compensates Qualified Intellectual Disabilities
11

Professionals, Independent Service Coordinators, DSPs, and
12

nursing staff appropriately, reflecting staff training,
13

certification level, supervision responsibilities, and the
14

intensity of coordination and oversight required by
15

assessed acuity;
16

(4) day support cost inclusion. Rates shall account
17

for the full cost of participation in community day and
18

meaningful day activities for individuals with complex
19

needs, including staffing, nursing oversight,
20

transportation, and supervision required during
21

non-residential hours without reducing residential funding
22

levels. Participation in employment, community day, or
23

meaningful day services shall not be required as a
24

condition of maintaining CSL-24 services, nor shall the
25

cost of such services be used to reduce residential,
26

nursing, or coordination funding authorized under an

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individual's Person-Centered Plan; and
2

(5) remote support and monitoring technology costs.
3

Costs associated with approved remote support and
4

monitoring technology, including equipment, installation,
5

maintenance, and response services, shall be treated as
6

allowable waiver expenses when authorized in the
7

Person-Centered Plan and shall not be offset by reductions
8

in staffing or nursing supports.
9

(b) Rates and staffing assumptions for CSL-24 services may
10
not be reduced through administrative rule, provider guidance,
11
or operational policy in a manner inconsistent with
12
individualized Person-Centered Plans without express statutory
13
authorization.
14

(c) For purposes of federal Medicaid cost neutrality,
15
CSL-24 services shall be evaluated against the cost of
16
institutional and congregate care settings from which
17
participants would otherwise receive services, including
18
ICF/IID facilities, and nursing facilities, and not against
19
average per-participant waiver costs for lower-acuity
20
populations.
21

(d) Fiscal Justification for Enhanced Environmental
22
Modifications. The Department shall recognize that enhanced
23
funding for home accessibility and environmental modifications
24
for individuals receiving CSL-24 services is a cost-effective
25
accommodation that reduces hospitalization, emergency
26
interventions, caregiver collapse, and reliance on

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institutional placement, and supports compliance with federal
2
community integration mandates and Medicaid cost-neutrality
3
requirements.
4

The enhanced limitation authorized under Section 7 shall
5
be incorporated into the waiver amendment submitted to the
6
Centers for Medicare and Medicaid Services and shall not be
7
reduced, restricted, or eliminated through administrative
8
rule, rate methodology, provider guidance, or waiver
9
operational policy absent express statutory authorization.
10

Any reduction of the enhanced limitation applicable to
11
CSL-24 services shall require express legislative
12
authorization and may not be implemented solely through
13
administrative rule, provider guidance, or waiver operational
14
policy.
15

(e) Medical necessity of environmental and home
16
accessibility modifications. Environmental and home
17
accessibility modifications authorized for CSL-24 services
18
shall be considered medically necessary habilitative supports
19
and shall not be reduced, delayed, or denied for reasons of
20
budgetary convenience where such action would reasonably be
21
expected to increase the risk of hospitalization, property
22
damage, personal injury, direct support professional or other
23
caregiver collapse, or institutional placement.
24

(f) Funding and State match.
25

(1) The administering agency shall implement rates in
26

accordance with CMS waiver approval; the state match and

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funding requirements shall follow federal and state
2

regulations.
3

(2) All rates must support quality, safety, and the
4

provision of person-centered, community-based services
5

consistent with federal Home and Community-Based Services
6

requirements.
7

(3) The Department shall consider the use of Money
8

Follows the Person funding as a transition financing tool
9

that supports waiver cost-effectiveness and reduces
10

reliance on high-cost institutional care.
11

(g) Workforce-Linked Incentives.
12

(1) Rates may include provisions for wage enhancements
13

or salary floors for DSPs serving high-acuity
14

participants.
15

(2) Rates must support training, credentialing, and
16

retention programs to maintain a competent, high-quality
17

workforce, or equivalent ongoing funding must be
18

separately available for these purposes.
19

(h) Budget Oversight.
20

(1) The administering agency shall periodically review
21

and adjust rates to ensure that
22

(A) funding levels are sufficient to meet
23

participant needs;
24

(B) Home and Community-Based Services compliance
25

is maintained;
26

(C) Measurable outcomes in health, safety, and

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community integration are achieved; and
2

(D) Reinvested savings are fully utilized to
3

strengthen community-based supports and prevent
4

institutional placement.
5

(2) Rate Adequacy Review for CSL-24. In conducting
6

reviews under this subsection, the administering agency
7

shall specifically evaluate CSL-24 reimbursement rates to
8

ensure continued alignment with documented participant
9

health, safety, staffing, and clinical support needs,
10

including workforce-related costs and acuity-driven
11

service intensity.
12

Such review shall not rely solely on historical averages,
13
cost containment targets, or assumptions derived from
14
lower-acuity waiver services.

15

Section 12.
Quality assurance, monitoring, safeguards, and
16
evaluations.
17

(a) Participant rights and appeals.
18

(1) Participants shall have the right to appeal any
19

denial of eligibility, service authorization, or change to
20

services, including changes to Person-Centered Plans or
21

budgets.
22

(2) Restrictive interventions, if ever necessary,
23

shall require prior external review and approval by a
24

human rights committee and documentation consistent with
25

federal Home and Community-Based Services rules and best

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practices, except in documented emergency situations where
2

post-incident review is required.
3

(3) Participants shall have access to an independent
4

ombuds or advocacy system to:
5

(A) Support individual rights;
6

(B) Ensure due process and fair hearings; and
7

(C) Provide assistance during appeals or
8

grievances.
9

(b) Monitoring and compliance
10

(1) Providers shall be subject to regular monitoring
11

and audits to ensure compliance with:
12

(A) Federal Home and Community-Based Services
13

settings rules and the definitions of Community
14

Supported Living Arrangements services, including full
15

and faithful implementation of each individual's
16

Person-Centered Plan;
17

(B) State licensing and regulatory requirements;
18

and
19

(C) Program standards established under this Act.
20

Monitoring shall include review of staffing levels,
21

service delivery, communication supports, nursing
22

oversight, and safeguards identified in the
23

Person-Centered Plan to verify that authorized services
24

are delivered as approved.
25

(2) Providers shall implement health and safety
26

oversight, including:

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(A) Clinical audits.
2

(B) Nursing competency checks.
3

(C) Medication administration oversight.
4

(D) Emergency response protocols.
5

(3) Providers shall maintain incident reporting and
6

abuse prevention systems consistent with state law and
7

federal Home and Community-Based Services assurances, and
8

participants shall have access to independent ombuds or
9

advocacy services to protect rights and ensure
10

accountability.
11

(4) Corrective action plans shall be required for
12

providers found out of compliance, including potential
13

suspension, termination, or decertification when
14

deficiencies pose a risk to health, safety, or participant
15

rights.
16

(5) Providers shall maintain and submit documentation
17

demonstrating adherence to person-centered practices,
18

staffing requirements, training, and safety protocols.
19

(6) The administering agency shall track key
20

performance indicators to monitor program operations and
21

provider compliance. These indicators shall inform
22

oversight, corrective action, and quality improvement
23

efforts. Performance metrics shall be tracked and reviewed
24

annually, including:
25

(A) DSP, behavioral interventionists and nurse
26

vacancy rates.

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(B) Provider compliance findings and corrective
2

actions.
3

(C) Participant safety incidents and resolutions;
4

and
5

(D) Participant satisfaction and quality of life
6

indicators.
7

(E) Number of participants receiving CSL-24
8

services, by assessed acuity level using validated
9

assessment methodologies.
10

(7) The administering agency shall track and publicly
11

report the number of individuals receiving CSL-24 who are
12

denied access to community day or meaningful day services
13

or customized employment due to staffing, nursing, or
14

support needs, including the reason for denial and length
15

of delay, and shall identify corrective actions to address
16

service gaps.
17

(c) External evaluation and metrics.
18

(1) The administering agency shall contract with an
19

independent evaluator (such as University of Illinois
20

Chicago or CQL) to assess program effectiveness and
21

quality of life outcomes.
22

(2) Evaluation metrics shall include, at a minimum:
23

(A) CQL 21 Personal Outcome Measures or equivalent
24

quality of life metrics;
25

(B) Health outcomes, including rates of
26

hospitalization, emergency department utilization, and

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preventable medical events, including indicators
2

associated with preventable morbidity and mortality
3

commonly referred to in national best practice as the
4

"Fatal Five," or comparable evidence-based risk
5

frameworks used to identify leading causes of
6

preventable death among individuals with developmental
7

disabilities;
8

(C) Community integration outcomes, including
9

participation, social inclusion and belonging, and
10

employment;
11

(D) Institutional placements avoided, including
12

transitions from State-operated developmental centers,
13

Intermediate Care Facilities, nursing facilities, or
14

other congregate settings;
15

(E) Service utilization and acuity measures based
16

on validated assessment tools;
17

(F) Use and effectiveness of Specialized Service
18

Teams where applicable;
19

(G) Number of individuals transitioned from
20

Short-Term Stabilization Homes;
21

(H) Access to and outcomes from mental and
22

behavioral health services;
23

(I) Changes in utilization of Medicaid-funded
24

health care services, including primary care, mental
25

health services, emergency department visits, and
26

hospitalizations;

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(J) Enhanced quality of life outcomes, including
2

self-determination, stability, and meaningful daily
3

activity;
4

(K) Participant and family satisfaction;
5

(L) Workforce stability and competency; and
6

(M) Cost per participant compared to institutional
7

care.
8

(3) Evaluation schedule:
9

(A) Annual formative review: Ongoing assessment of
10

program operations, staffing, and outcome trends.
11

(B) Year 3 evaluation: Assess impact on
12

institutionalization census rates, participant health
13

outcomes, program costs, and overall effectiveness.
14

(C) Year 5 comprehensive evaluation: Assess
15

long-term impact on institutionalization, health and
16

quality of life outcomes, and costs; provide
17

recommendations for program improvements and statewide
18

expansion.
19

(d) Data Collection and Public Reporting.
20

(1) The administering agency shall publish annual
21

public reports that include:
22

(A) Acceptance, rejection, and termination rates
23

of service providers, including a summary of the
24

reasons for which individuals were rejected or
25

terminated.
26

(B) Waitlist counts and demographics.

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(C) Aggregate outcome data, service utilization,
2

fiscal information, participant demographics,
3

enrollment counts, and service mix.
4

(D) Health and community integration outcomes.
5

(E) Findings from external evaluations.
6

(F) The number of individuals transitioning from
7

State-operated developmental centers, nursing
8

facilities, and other institutional settings into
9

CSL-24 services using Money Follows the Person
10

funding, including the average time from referral to
11

community living to living in the community.
12

(2) Reports shall be submitted annually to:
13

(A) The General Assembly; and
14

(B) The Department of Healthcare and Family
15

Services.
16

(e) Legislative Oversight and Corrective Action Reporting.
17
If annual reporting demonstrates a pattern of denials, delays,
18
or service gaps for individuals with documented medical or
19
behavioral acuity, the Department shall report to the General
20
Assembly the corrective actions taken and any recommended
21
statutory or administrative changes necessary to ensure
22
compliance with federal integration and Home and
23
Community-Based Services requirements.

24

Section 13.
Participant rights and protections.
25

(a) There shall be a guarantee of a process and time for

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informed choice and consent, meaningful and effective
2
communication, dignity and human rights, access to personal
3
property, control over daily schedules, and protections from
4
isolation or restrictive practices in all services and
5
settings established under this Act.
6

(b) The right to dignity of risk shall be protected,
7
including the right to make informed decisions, to refuse
8
services, and to appeal decisions without retaliation.
9

(c) Individualized restrictive procedure protocols and
10
prior external review are required before any restrictive
11
intervention, except in documented emergency situations
12
subject to post-incident review, and emphasize non-aversive,
13
trauma-informed practices.
14

(d) Participants shall retain all rights guaranteed under
15
the Mental Health and Developmental Disabilities Code and the
16
Mental Health and Developmental Disabilities Confidentiality
17
Act, including rights to dignity, autonomy, due process,
18
informed consent, and the confidentiality of personal and
19
medical information. These rights shall apply fully to all
20
Community Supported Living-Intermittent and CSL-24 services,
21
providers, and settings established under this Act.
22

(e) There shall be privacy protections for remote
23
supports. Any use of remote support or monitoring technology
24
shall comply with federal Home and Community-Based Services
25
privacy, autonomy, and dignity requirements. Individuals shall
26
have the right to decline or discontinue use of such

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technology at any time without penalty or loss of services.

2

Section 14.
Housing and settings requirements,
3

(a) Community-integrated housing.
4

(1) Waiver services, with assistance from the Housing
5

Navigator and Independent Service Coordinator, shall
6

support individuals to live in affordable, accessible when
7

needed, integrated, community-based housing that the
8

individual owns, leases, rents, or otherwise controls,
9

consistent with the individual's preferences and
10

Person-Centered Plan.
11

(2) Participants shall have freedom of movement and
12

access to community life comparable to that of individuals
13

without disabilities. Housing arrangements shall ensure
14

full tenant rights, including control over:
15

(A) Leases and utilities;
16

(B) Visitors;
17

(C) Daily schedules and activities;
18

(D) Privacy and personal property, including
19

telephones and computers; and
20

(E) Choice of one or 2 housemates, if desired.
21

(3) Participants shall have the right to use assistive
22

technology, adaptive equipment, and communication or
23

mobility devices of their choice in their home and
24

community, consistent with their Person-Centered Plan.
25

(4) Housing shall not be owned, leased, or otherwise

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controlled by the service provider, consistent with the
2

federal Home and Community-Based Services Settings Rule,
3

to prevent replication of institutional or congregate
4

models. Housing arrangements for CSL-24 participants shall
5

not be structured, clustered, or financed in a manner that
6

replicates congregate residential models or limits
7

individual choice of residence.
8

Nothing in this subsection shall be construed to
9

prohibit a provider from providing or coordinating
10

services in a residence that is owned, leased, or
11

controlled by the participant or the participant's family.
12

(5) CSL-24 services shall not be provided in settings
13

designed, financed, or operated in a manner that
14

functionally replicates congregate or institutional
15

residential models, including clustered housing
16

arrangements established primarily for programmatic
17

convenience rather than individual choice.
18

(b) Accessible and affordable housing.
19

(1) The administering agency shall encourage
20

collaboration with the Illinois Housing Development
21

Authority (IHDA) and other housing authorities to identify
22

and secure accessible, affordable housing for
23

participants.
24

(2) Housing supports may include home modifications,
25

accessibility improvements, or rental assistance as needed
26

to enable safe, independent living, and shall include

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1

reasonable accommodations required under the Americans
2

with Disabilities Act and Section 504 of the
3

Rehabilitation Act.
4

(c) Integration with person-centered planning. Housing
5
choices shall be incorporated into the Person-Centered Plan,
6
ensuring that participants' preferences, goals, and community
7
integration needs are fully considered.
8

(d) Stability and responsiveness to changing needs.
9

(1) Housing arrangements established under this waiver
10

shall not require a participant to relocate solely due to
11

changes in medical, physical, behavioral, or support
12

needs, except at the request of the participant or where
13

continuation would pose an unavoidable and documented risk
14

that cannot be mitigated through reasonable supports.
15

(2) When a participant's needs change, the waiver
16

services, including the Person-Centered Plan team, shall
17

adjust supports, staffing levels, and accommodations
18

necessary to maintain the individual's chosen home
19

whenever possible.
20

(3) Housing-related supports and services shall be
21

reviewed at least annually, and more frequently upon the
22

request of the participant when significant changes in
23

needs occur.
24

(4) The administering agency shall ensure that service
25

providers prioritize continuity of housing, individualized
26

supports, and avoidance of displacement.

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(e) Family Home Protections.
2

(1) A family home shall be recognized as a permissible
3

and fully integrated community setting for CSL-24
4

services.
5

(2) Receipt of CSL-24 services shall not require a
6

parent, guardian, or family member to vacate the home as a
7

condition of service authorization.
8

(3) The presence of family members in the home shall
9

not be construed as incompatible with provider
10

responsibility for health and welfare when roles and
11

responsibilities are clearly defined in the
12

Person-Centered Plan.

13

Section 15.
Transition rules; continuity of care.
14

(a) The Department shall establish rules governing the
15
voluntary transition of individuals currently receiving
16
services in Community-Integrated Living Arrangements,
17
Intermediate Care Facilities, nursing facilities, or other
18
Medicaid waivers into CSL-24 services. Such rules shall
19
include continuity of care protections, individualized
20
transition planning requirements, and applicable notice and
21
appeal rights to ensure uninterrupted services and safeguards
22
for health and welfare.
23

(b) Individuals shall be permitted to request a change in
24
waiver services, subject to applicable eligibility criteria
25
and available service capacity. Individuals shall not be

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penalized, deprioritized, or otherwise disadvantaged solely
2
due to prior waiver enrollment, current service type, or
3
previous residence when seeking access to CSL-24 services.

4

Section 16.
Federal/CMS alignment and waiver authority.
5

(a) The Department of Healthcare and Family Services and
6
the Department of Human Services are authorized to submit
7
amendments to the Illinois Adults with Developmental
8
Disabilities 1915(c) Home and Community-Based Services Waiver
9
to add CSL-24 services and to rename Intermittent
10
Community-Integrated Living Arrangements as Community
11
Supported Living-Intermittent, consistent with federal Home
12
and Community-Based Services requirements and subject to
13
public notice, stakeholder input, and comment prior to CMS
14
submission.
15

(b) Notwithstanding any other provision of law, rule, or
16
waiver methodology, the provisions of this Act governing
17
CSL-24 services shall supersede any conflicting requirements
18
applicable to congregate, facility-based, or intermittent
19
residential services under the Illinois Adults with
20
Developmental Disabilities Home and Community-Based Services
21
Waiver and shall be implemented independently and without
22
delay due to unrelated waiver modifications, except where CMS
23
approval requires specific sequencing for CSL-24.

24

Section 17.
Workforce and recruitment strategy.

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(a) Funding shall be provided for DSP training for complex
2
medical and behavioral supports, including competency-based
3
curricula, loan repayment or bonus programs, and wage
4
incentives.
5

(b) Funding shall be provided for training for nurses,
6
Independent Service Coordinators, and Qualified Intellectual
7
Disabilities Professionals as described in Section 10.
8

(c) The administering agency shall develop and maintain a
9
workforce shortage contingency plan, including overtime
10
protocols, cross-training strategies, and training pipelines
11
with community colleges or accredited programs, and to report
12
annually on workforce capacity and implementation status.

13

Section 18.
Rulemaking, Interagency coordination and
14
advisory body.
15

(a) Rulemaking Authority. The Department of Human
16
Services, Division of Developmental Disabilities is authorized
17
to adopt rules and binding program standards necessary to
18
implement this Act and the related waiver amendments, in
19
accordance with the Illinois Administrative Procedure Act,
20
including public notice and comment.
21

(b) Community Supported Living Advisory Council.
22

(1) The Department shall establish a Community
23

Supported Living Advisory Council to provide ongoing,
24

structured oversight and guidance on the design,
25

implementation, operation, and evaluation of CSL-24

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services under this Act and the related Medicaid waiver
2

amendments.
3

The Advisory Council shall advise the Department and
4

the Department of Healthcare and Family Services on:
5

(A) Waiver design, submission, and CMS approval
6

strategy;
7

(B) Implementation timelines and provider
8

readiness;
9

(C) Workforce standards, training requirements,
10

and retention strategies;
11

(D) Assessment, eligibility, and service
12

authorization policies;
13

(E) Quality assurance, health and safety
14

safeguards, and rights protections;
15

(F) Housing and community integration compliance;
16

and
17

(G) Program outcomes, cost-effectiveness, and
18

system impact.
19

The Advisory Council's role shall be ongoing and shall
20

continue throughout the life of the waiver, meeting at
21

least quarterly, and more frequently in year one, unless
22

modified by statute.
23

(2) The Advisory Council shall include, at a minimum:
24

(A) Self-advocates receiving or eligible for
25

Community Supported Living-Intermittent and CSL-24
26

community-based services;

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(B) Family members of individuals with complex
2

medical, physical, or behavioral support needs;
3

(C) Clinicians with expertise in complex medical
4

supports, behavioral health, nursing delegation, or
5

health risk management;
6

(D) Independent Service Coordinators with
7

experience supporting high-acuity individuals in
8

integrated community living;
9

(E) Disability rights and advocacy organizations;
10

(F) Provider representatives with demonstrated
11

experience supporting individuals with complex needs
12

in non-congregate, community-based settings;
13

(G) Labor representatives representing direct
14

support professionals or nursing staff; and
15

(H) Academic or research representatives,
16

including from the University of Illinois Chicago or
17

comparable institutions with expertise in disability
18

policy, outcomes, or evaluation.
19

To ensure independence and avoid provider dominance,
20

no more than 49% of Council members shall be employees of,
21

or representatives for, provider organizations.
22

(3) Authority, duties, and access to information. The
23

Advisory Council shall:
24

(A) Review and provide written recommendations on
25

proposed waiver amendments, rules, provider standards,
26

and guidance related to CSL-24 services;

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(B) Review implementation data, quality metrics,
2

incident trends, workforce indicators, and service
3

access data;
4

(C) Advise on corrective actions, policy
5

adjustments, or system improvements necessary to
6

ensure compliance with federal Home and
7

Community-Based Services requirements, the ADA,
8

Section 504, Olmstead, and the Ligas Consent Decree;
9

(D) Request and receive from the Department and
10

the Department of Healthcare and Family Services
11

within reasonable timeframes, any non-confidential
12

data reasonably necessary to carry out its duties,
13

including aggregate utilization, cost, and outcome
14

data; and
15

(E) Issue non-binding public recommendations to
16

the Department and the General Assembly.
17

The Department shall provide a written response to
18

formal recommendations issued by the Advisory Council
19

within 90 days, including any planned actions or reasons
20

for non-adoption.
21

(4) Meetings, Reporting, and Transparency.
22

(A) The Advisory Council shall meet at least
23

quarterly, with additional meetings as necessary
24

during waiver submission and initial implementation.
25

(B) The Department shall provide staff support and
26

ensure timely access to materials necessary for

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meaningful participation.
2

(C) The Advisory Council shall submit an annual
3

written report no later than March 31 of each year to:
4

(i) The Governor;
5

(ii) The General Assembly;
6

(iii) The Department of Human Services; and
7

(iv) The Department of Healthcare and Family
8

Services.
9

(D) The annual report shall summarize:
10

(i) Implementation progress;
11

(ii) Identified system barriers or risks;
12

(iii) Recommendations for improvement;
13

(iv) Workforce and provider capacity concerns;
14

and
15

(v) Outcomes related to health, safety,
16

community integration, and avoidance of
17

institutionalization.
18

(E) Reports shall be made publicly available, with
19

appropriate protections for individual privacy.
20

(F) The Department shall provide a written
21

response to the Advisory Council's annual
22

recommendations within 90 days, identifying actions
23

taken, actions planned, or reasons for non-adoption.
24

(5) Conflict of interest and ethics. All members shall
25

comply with applicable State ethics, disclosure, and
26

conflict-of-interest requirements, including annual

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disclosure of financial or organizational interests
2

related to services covered under this Act.

3

Section 19.
Fiscal impact.
The Department of Healthcare
4
and Family Services and the Department of Human Services,
5
Division of Developmental Disabilities shall provide a fiscal
6
impact statement estimating first 3 years of program costs,
7
including start-up (IT, provider competencies, and capacity),
8
ongoing provider rates, administrative and oversight costs,
9
and projected savings from reduced institutional care.

10

Section 20.
Implementation timelines.
Initial provider
11
selection and enrollment in training shall occur within 4
12
months following CMS approval, subject to provider readiness
13
and certification requirements.

14

Section 99.
Effective date.
This Act takes effect upon
15
becoming law.

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