Get Dd Cila Individualized Rate Model - Illinois Department Of Human ... - Dhs State Il

The DD CILA Individualized Rate Model is a crucial form for requesting funding for individuals in Community Integrated Living Arrangements (CILA). Filling out this form accurately ensures that necessary financial supports are allocated effectively. This guide provides step-by-step instructions to assist users in completing this form online.

Follow the steps to complete the DD CILA Individualized Rate Model efficiently.

1. Click ‘Get Form’ button to obtain the DD CILA Individualized Rate Model and open it in your preferred editor.
2. Fill out the individual, provider, and PAS/ISSA information sections clearly. This includes entering the name of the person for whom the rate is being determined, their address, date of birth, Social Security number, and Medicaid recipient identification number.
3. Provide the name of the CILA provider agency, its DHS prefix and ID number, and the Federal Employer Identification Number (FEIN). Additionally, specify the DHS network responsible for the placement.
4. Document the pertinent rate type and residence location prior to CILA placement by marking the appropriate options provided.
5. Indicate the capacity type and total residential capacity in the designated fields, including the names of other residents if applicable.
6. Complete the individual information section, including the ICAP summary score and the evaluation date.
7. If transportation requests, day programs, or additional non-base supports are necessary, fill out those sections according to the instructions provided in the form.
8. Review all entered information for accuracy and completeness, ensuring all required attachments are included, such as the ISP and assessments.
9. Once all sections are filled out, save your changes, download or print the form as needed, and submit it to the appropriate authorities.

Complete your DD CILA Individualized Rate Model online to ensure timely and accurate funding support.