Bill
HB 5605
Creates CSL-24: 24/7 in-home supports for adults with complex needs to avoid institutionalization, under Illinois HCBS with person-centered planning and oversight.
Effective: Immediately
Purpose
- Establish the Community Supported Living Arrangement (CSL) Services framework within Illinois’ Home and Community-Based Services (HCBS) waiver system for adults with developmental disabilities.
- Create 24-hour CSL services (CSL-24) to support individuals with intense physical, medical, or behavioral needs in their own homes or family homes, with continuous staffing and oversight, aiming to reduce unnecessary institutionalization and expand community-based living options.
Key Provisions
1) Program Establishment and Administration
- Department of Human Services (DHS), Division of Developmental Disabilities (DDD) to administer CSL, in coordination with the Department of Healthcare and Family Services (HFS, Illinois’ Medicaid agency).
- DHS, with HFS, to submit amendments to CMS to authorize CSL under the 1915(c) HCBS waiver.
- CSL-specific provider licensing, certification, and oversight standards to be set by DHS, aligned with existing standards for community-based residential services. CSL-24 will operate in individuals’ own homes and not in licensed facilities, and homes will not require Bureau of Accreditation, Licensure and Certification reviews.
- Creation of a Community Supported Living Advisory Council to guide implementation, training, quality standards, evaluation, and oversight.
2) CSL Services and Definitions
- CSL services are aligned with federal 1915(c) authority and CMS definitions. Two service modalities:
- CSL-Intermittent (formerly CSL-Intermittent/ICLA): less than 24-hour staff support.
- CSL-24 (CSL-24): continuous, 24-hour provider responsibility for staffing, supervision, health/welfare, nursing delegation, and behavioral supports per the Person-Centered Plan (PCP).
- CSL-24 is designed for individuals in their own homes, owned or rented, or family homes, with up to 2 housemates.
- Services include a broad array of supports: personal assistance, training/habilitation, 24-hour emergency response, assistive technology, adaptive equipment, health and welfare protections, and participation support in community life.
- Emphasis on person-centered planning, dignity of risk, community integration, and avoidance of provider-owned housing or congregate models for CSL-24.
3) Assessment, Eligibility, and Funding
- Comprehensive, person-centered assessments for CSL-24 to identify medical, behavioral, and supervision needs.
- Health Risk Screening Tool (HRST) required for all CSL-24 applicants, with care levels 4–6 indicating higher risk and need for enhanced supports; HRST results inform planning but do not alone determine waiver eligibility.
- Prohibitions on relying solely on legacy deficit-based tools (e.g., ICAP) for CSL-24 eligibility or staffing decisions.
- Risk-based, needs-based funding: funding for CSL-24 to reflect individual need, continuous staffing, and safeguards; no automatic caps based on averages, and costs must be cost-neutral within federal waiver rules.
- PUNS integration: HRST results to be incorporated into the Prioritization of Urgency of Need for Services (PUNS) to identify urgent cases.
4) Implementation, Phase-In, and Evaluation
- Phased rollout: Phase I limits enrollment to roughly 250 participants in 4–5 regions for 3–5 years, with provider credentialing completed prior to enrollment (6–9 months for capacity-building).
- Phase II–IV expansion contingent on external evaluation results, provider readiness, and legislative approval.
- Independent external evaluation (e.g., University of Illinois Chicago or Council on Quality and Leadership) to assess program quality and outcomes.
- Ongoing reporting to the General Assembly and HFS, including participants, transitions, costs, savings, and demographic/referral data.
5) Enrollment, Transitions, and Money Follows the Person (MFP)
- Transition continuity protections for individuals moving from institutional settings to CSL-24 (no service interruption; coordinated transitions).
- Priority enrollment for intense-support individuals at risk of institutionalization or currently in institutions, particularly where unpaid family caregiving is unsustainable.
- Maximized use of Money Follows the Person funds for up to 365 days post-transition to cover housing, start-up costs, environmental modifications, assistive tech, etc., where federal rules permit.
6) Services Covered under CSL-24
- Intensive service coordination and PCP development, enhanced coordination for high-acuity individuals, housing navigation, behavioral stabilization, transportation, extended state plan therapies, employment supports, equipment/tech/environmental modifications, and crisis prevention.
- Augmentative and Alternative Communication (AAC) supports, with staff trained to support effective communication.
- Health/nursing services, including delegation to DSPs as allowed by state law, and 24/7 backup coverage.
- Enhanced community day and meaningful day supports tailored to complex needs.
- Restrictions: no perpetual or blanket caps on CSL-24 services; 24-hour coverage required when needed; no reliance on closed-ended institutional settings as default.
Who Is Affected
Timeline and Fiscal
- Implementation to begin within 180 days of enactment, with concurrent activities independent of broader waiver changes.
- Federal waiver amendments and cost-neutrality analyses required; state expenditure is contingent on federal approvals.
- Annual progress reports including costs, enrollment, transitions, and outcomes.
Notes
- CSL-24 is explicitly distinct from provider-owned/group home models and from Congregate residential arrangements.
- The act emphasizes dignity of risk, meaningful community integration, and a rights-based approach under federal rules (Olmstead, Ligas, CMS HCBS Settings Rule, and related guidance).
This bill aims to expand community-based living options for a subset of individuals with complex needs by creating a new CSL-24 service under Illinois’ HCBS waiver, with strong emphasis on person-centered planning, workforce development, and rigorous evaluation.
Compiled from official sources — confirm details with the bill’s official record.
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