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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

 

This 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

The effective date for this policy is November 24, 2020, when the initial provider notice was posted.

ICF/IID 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.

For 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 month.

If 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.

Billing and Payment Issues –

Claim 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. 

Prorated Payments -

Payments 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

If 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.

Documentation -

ICFIID’s 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 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.

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

1-844-528-8444.

 

Kelly Cunningham, Administrator

Division of Medical Programs​


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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director