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Elizabeth M. Whitehorn, Director

Provider Notice Issued 12/22/2020

 

Date:   December 22, 2020

To:      Long Term Care Providers – Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Medically Complex for the Developmentally Disabled Facilities (MC/DD)

Re:      Additional Guidance on Billing Developmental Training Services in Day Programs during COVID-19 Pandemic

 

 

 

Thisnotice provides additional billing guidance to Intermediate Care Facilities forIndividuals with Intellectual Disabilities (ICF/IID), and Medically Complex forthe Developmentally Disabled Facilities (MC/DD) for billing DevelopmentalTraining services in Day Programs during the COVID-19 pandemic.  Specifically, this notice providesclarification to the November 24, 2020 Provider Notice which allows ICF/IDDs andMC/DDs to provide and bill for Day Program services when their contracted DayProgram service provider is closed or cannot come on site to provide servicesdue to issues related to the COVID-19 pandemic.

EffectiveDate –

Theeffective date for this policy is November 24, 2020, when the initial providernotice was posted.

ICF/IIDand MC/DD providers can receive Day Services payments if their Day Serviceprovider is closed or will not come on site to provide services, and thefacility provides Day Services.

ForNovember services, ICF/IIDs and MC/DDs that provide Day Services should bill witha Service From Date no earlier than November 24, 2020.  A Service From Date other than the first ofthe month will result in the payment being prorated for this portion of themonth.

IfICF/IIDs and MC/DDs billed for Day Program services in September or Octoberwhen their Day Program Service provider was closed or could not come on site toprovide services, those claims should be voided and the payments will berecouped by the State.  Instructions onvoiding claims are located at: Void Instructions.

Claims should not be submitted for payment ifneither the Day Program service provider nor the facility provided Day Programservices due to COVID-19 pandemic issues.

Billingand Payment Issues –

Claimsubmission requirements are the same regardless of the setting in which the DayServices are being provided.  If the Day Services were provided at theICF/IID or MC/DD, the facility should keep the funds rather than passing thefunds on to the Day Service provider.  The payment rate will be the amountthat would have been paid to the Day Service provider. 

ProratedPayments -

Paymentswill be prorated (not paid for the entire monthly amount) if:

              -      the bill is for a partial month (Service From and Through Dates arenot the beginning and end of the month), or

              -      the individual is not scheduled to attend every day.  If aperson was enrolled full time and needs to change to a reduced schedule, adisenrollment form should be submitted to DHS DDD with the date they ended at100% along with an enrollment form with the start date of the reducedattendance level and thepart time percentage listed.  Formsshould be emailed to:  Erica.Rivera@illinois.gov

Ifthe individuals are only allowed to attend the Day Service provider 2-3 daysper week, and the ICF/IID or MC/DD provides the services on the other days, theICF/IID or MC/DD should retain a portion of the payment.

Documentation-

ICFIID’sor MC/DD’s should get correspondence from the Day Service provider statingeither they are not open or will not be coming on site to provideservices.  This documentation should be kept in the resident’s file.

If neither the Day Program service provider nor the facilityprovide Day Program services due to COVID-19 pandemic issues, then servicescannot be billed for payment. Note: Individuals that are not engaged activelyin Day Program services provided by the ICF/IID or MC/DD should not have bills submittedfor services. This support is not meant to cover basic supervision and personalcare.

Healthcare and Family Services and/or the Illinois Department ofHuman Services Division of Developmental Disabilities may audit yourdocumentation at any time. In the event that the required conditions were notmet, Day Service claims will be voided and payments recouped.

Questions regarding thisnotice may be directed to the Bureau of Long Term Care at

1-844-528-8444.

 

Kelly Cunningham, Administrator

Division of Medical Programs​