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
notice provides additional billing guidance to Intermediate Care Facilities for
Individuals with Intellectual Disabilities (ICF/IID), and Medically Complex for
the Developmentally Disabled Facilities (MC/DD) for billing Developmental
Training services in Day Programs during the COVID-19 pandemic. Specifically, this notice provides
clarification to the November 24, 2020 Provider Notice which allows ICF/IDDs and
MC/DDs to provide and bill for Day Program services when their contracted Day
Program service provider is closed or cannot come on site to provide services
due to issues related to the COVID-19 pandemic.
effective date for this policy is November 24, 2020, when the initial provider
notice was posted.
and MC/DD providers can receive Day Services payments if their Day Service
provider is closed or will not come on site to provide services, and the
facility provides Day Services.
November services, ICF/IIDs and MC/DDs that provide Day Services should bill with
a Service From Date no earlier than November 24, 2020. A Service From Date other than the first of
the month will result in the payment being prorated for this portion of the
ICF/IIDs and MC/DDs billed for Day Program services in September or October
when their Day Program Service provider was closed or could not come on site to
provide services, those claims should be voided and the payments will be
recouped by the State. Instructions on
voiding claims are located at: Void Instructions.
Claims should not be submitted for payment if
neither the Day Program service provider nor the facility provided Day Program
services due to COVID-19 pandemic issues.
and Payment Issues –
submission requirements are the same regardless of the setting in which the Day
Services are being provided. If the Day Services were provided at the
ICF/IID or MC/DD, the facility should keep the funds rather than passing the
funds on to the Day Service provider. The payment rate will be the amount
that would have been paid to the Day Service provider.
will be prorated (not paid for the entire monthly amount) if:
the bill is for a partial month (Service From and Through Dates are
not the beginning and end of the month), or
the individual is not scheduled to attend every day. If a
person was enrolled full time and needs to change to a reduced schedule, a
disenrollment form should be submitted to DHS DDD with the date they ended at
100% along with an enrollment form with the start date of the reduced
attendance level and the
part time percentage listed. Forms
should be emailed to: Erica.Rivera@illinois.gov
the individuals are only allowed to attend the Day Service provider 2-3 days
per week, and the ICF/IID or MC/DD provides the services on the other days, the
ICF/IID or MC/DD should retain a portion of the payment.
or MC/DD’s should get correspondence from the Day Service provider stating
either they are not open or will not be coming on site to provide
services. This documentation should be kept in the resident’s file.
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: Individuals that are not engaged actively
in Day Program services provided by the ICF/IID or MC/DD should not have bills submitted
for services. This support is not meant to cover basic supervision and personal
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.
Questions regarding this
notice may be directed to the Bureau of Long Term Care at
Kelly Cunningham, Administrator
Division of Medical Programs