• Attend a movie with the person to practice coping skills to manage their social anxiety
• Go with the person to a community event to reduce their social isolation
• Play a board game with the person to enhance their fine motor skills
• Provide verbal instructions or cues to the person to help them complete a task
• Assist or supervise the person with tasks such as laundry, light housekeeping, meal preparation and shopping (for more information, see the secondary information section).

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.

  The case manager/care coordinator works with the person to complete ICLS Planning Form, DHS-3751 to communicate to the ICLS provider the specific service components the person will receive.

  On the form, the case manager/care coordinator must:

  • Identify the person’s individual goals the ICLS service is intended to support.
  • Describe and provide detail about the type of supports the person will receive within a minimum of two ICLS service components.
  • Calculate the total amount of units and cost of ICLS services the person will receive each week.

  The person, case manager/care coordinator and provider must sign the completed form. Then, the case manager/care coordinator must provide a copy to the person and provider. The case manager/care coordinator is responsible to review and update the form at least annually.

  If the person is currently receiving ICLS services, the case manager/care coordinator must review the need for ICLS services at the next scheduled review to ensure the person’s need meets the requirement of at least two ICLS components. If the person does not meet the minimum requirement, the case manager/care coordinator cannot reauthorize ICLS. Instead, they must authorize the service that meets the person’s identified need.

  Both the lead agency and provider must keep a copy of the completed and signed form. The ICLS planning form can be used to meet the provider signature requirements for the support plan. For more information, refer to CBSM – Provider signature requirements for HCBS support plans.