Date: November 24, 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: Update on Billing Developmental Training Services in Day Programs during COVID-19 Pandemic
This notice updates Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), and Medically Complex for the Developmentally Disabled Facilities (MC/DD) on requirements for billing Developmental Training services in Day Programs during the COVID-19 pandemic. Previous information provided on billing issues include:
- A March 30, 2020 Provider Notice detailing a temporary rate increase and Day Program services billing instructions while Day Program providers were closed.
- A DHS DDD Information Bulletin informing providers of the discontinuation of both the temporary rate increase and the ability to bill for Day Program services when residents did not attend and receive services. This bulletin was issued in conjunction with the reopening of Day Program service providers.
Day Program Service Billing Update:
If residents cannot attend their offsite Day Program service provider due to issues connected to the COVID-19 pandemic, ICF/IIDs and MC/DDs will be allowed, on a temporary basis, to bill for Day Program services when the following provisions are met and documented. This documentation should be maintained in the resident file as support for auditing purposes.
- The offsite Day Program service provider will temporarily be allowed to provide services at the ICF/IID or MC/DD when meeting the following provisions:
o Payments for Day Program services will continue to be passed on to the Day Program service provider as specified in administrative rule.
- If the offsite Day Program service provider cannot provide services at the facility due to COVID-19 pandemic issues, the IFD/IID or MC/DD provider is temporarily allowed to provide Day Program services onsite when meeting the following provisions:
o The ICF/IID or MC/DD provider must document the reason why the resident cannot attend their offsite Day Program service provider, and
o The ICF/IID or MC/DD provider must document the reason why they cannot allow the Day Program service provider to come onsite to provide treatment, and
o The ICF/IID or MC/DD provider must provide the Day Program services (at an equivalent level as what was provided by an off-site provider) onsite utilizing facility staff. In this instance, the facility would keep the Day Program service payments.
If neither the Day Program service provider nor the facility provide Day Program services due to COVID-19 pandemic issues, then services cannot be billed for payment. Note: Bills for individuals who are not actively engaged in Day Program services provided by the ICF/IID or MC/DD should not be submitted. This support is not meant to cover basic supervision and personal care.
Healthcare and Family Services and/or the Illinois Department of Human Services Division of Developmental Disabilities may audit your documentation at any time. In the event that the required conditions were not met, Day Service claims will be voided and payments recouped.
As a reminder, payments for Day Program service providers are required to be passed on to the appropriate Day Program agency within 10 days as specified in administrative rule at
Questions regarding this notice may be directed to the Bureau of Long Term Care at
Interim Medicaid Administrator