The case manager/care coordinator must complete ICLS Planning Form, DHS-3751 to provide guidance and instruction to the ICLS provider about the needs of the person for each applicable service component. People receiving ICLS services must receive assistance and/or support in a minimum of two of the six ICLS service components.

Active cognitive support

This component of ICLS includes supports to help the person with cognitive challenges and issues that are important to them. For more information, refer to the service amount section on this page.

Examples

Under this component, an ICLS provider can:

• Help problem-solve the person’s concerns related to daily living.
• Provide assurance to the person.
• Observe and redirect to address the person’s cognitive, orientation or other behavioral concerns.
• Provide check-ins to identify problems and resolve concerns.

Adaptive support service

This component of ICLS includes supports to help the person adopt ways to meet their needs. The supports encourage self-sufficiency and reduce reliance on human assistance.

Examples

Under this component, an ICLS provider can:

• Provide verbal, visual and/or touch guidance to help the person complete a task.
• Develop and demonstrate cues or reminder tools (e.g., calendars, lists).
• Help the person understand assistive technology directions or instructions to maintain independence.
• Practice strategies and similar support methods that promote continued self-sufficiency.

ADLs

This component of ICLS includes supports to help the person with ADLs.

Examples

Under this component, an ICLS provider can:

• Provide reminders or cuing systems to complete ADLs.
• Cue and/or provide intermittent physical assistance with dressing, grooming, eating, toileting, mobility, transferring and positioning.
• Cue and/or provide continual supervision and physical assistance with bathing, as needed.

Note: ICLS is not an appropriate service to meet a person’s need for constant supervision or physical assistance with ADLs throughout the task, except for bathing. Personal care assistance (PCA) is the service designed to meet this level of need for ADL assistance. For additional information, refer to CBSM – PCA.

Household management

This component of ICLS includes supports to help the person manage their home.

Examples

Under this component, an ICLS provider can:

• Help with cleaning, meal planning/preparation and shopping for household and personal needs.
• Help with budgeting and money management.
• Help with communications (e.g., sorting mail, accessing email, making phone calls, scheduling appointments).
• Provide transportation when it is integral to ICLS household management goals and when community resources and/or informal supports are not available; refer to the transportation section on this page for more information.

Health, safety and wellness

This component of ICLS includes supports to help the person maintain their overall well-being.

Examples

Under this component, an ICLS provider can:

• Identify changes in the person’s health needs and notify the case manager and/or informal caregivers as needed.
• Coordinate or implement changes to mitigate environmental risks in the home.
• Provide reminders about and assistance with exercises and other health maintenance or improvement activities.
• Provide medication assistance (e.g., medication refills, reminders, administration, preparation).
• Monitor the person’s health according to written instructions from a licensed health professional and report any significant changes as instructed.
• Use medical equipment devices or adaptive technology according to written instructions from a licensed health professional.

Community engagement

This component of ICLS includes supports to help the person have meaningful integration and participation in their community.

Examples

Under this component, an ICLS provider can:

• Help the person access activities, services and resources that facilitate meaningful community integration and participation.
• Help the person develop and/or maintain their informal support system.
• Provide transportation when it is integral to ICLS community engagement goals and community resources and/or when informal supports are not available; refer to the transportation section on this page for more information.

• Lives in their own home (refer to CBSM – Requirements for a person’s own home).
• Does not receive 24-hour supervision.
• Would otherwise require extensive, routine supervision in the absence of this service.

2. The person lives with a primary caregiver who would otherwise require extensive support in the absence of this service to secure help in the event of an emergency.

Non-equipment

This service covers the following non-equipment services:

• Immediate response for assistance at the person’s home.
• On-call counseling and problem solving.

Equipment

This service covers the following equipment services:

• Personal emergency response system (PERS) installation and testing.
• PERS device and monitoring.

Assist or supervise the person with tasks such as laundry, light housekeeping, meal preparation and shopping (for more information, see the secondary information section).

Tasks

The adult companion may only assist or supervise the person with tasks such as laundry, light housekeeping, meal preparation and shopping while the companion helps the person work toward a therapeutic or community integration goal. For example, the companion may shop with the person to practice budgeting skills. The companion cannot perform these tasks as distinct services.

Transportation

AC and EW

Under Alternative Care (AC) and the Elderly Waiver (EW), an adult companion provider who is also an MHCP-enrolled waiver/AC transportation provider can bill for both adult companion services and transportation when they are provided on the same day. The provider may not bill adult companion services and transportation at the same time.

BI, CAC and CADI

Adult companion no longer applies to people on disability waivers as of Jan. 1, 2022.

Night supervision services: Overnight assistance and supervision provided by a staff in the person’s own home when the person has an assessed need in one of the covered services areas.

For information about own home requirements, refer to CBSM – Requirements for a person’s own home.

A person is eligible to receive night supervision services if they:

1. Live in their own home.

2. Are assessed to need overnight assistance and supervision in at least one of the following areas:

• Implementation of the person’s positive support programming and transition plans.
• Reinforcement of skill development supports (e.g., individualized home supports).
• Assistance with activities of daily living (ADLs).
• Assistance with instrumental activities of daily living (IADLs).

Night supervision services include an asleep or awake staff in the person’s own home performing an activity listed in the eligibility section.