Billing Guidelines

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Billing Guidelines

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... if service is provided for two consecutive hours in one calendar day ... Can be accumulated for nursing provided to one individual on a single calendar day ... – PowerPoint PPT presentation

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Title: Billing Guidelines

1

Overview of HCS Billing Guidelines
2
Specific Requirements
3-1
3
4.01 Case Management
4.01-1
4
Specific Requirements

Case Management Billable Activity
Interacting face-to-face with the individual to
Identify HCS and non-HCS Program services the
individual may need
Coordinate the provision of service components to
the individual
Monitor the effectiveness of service components
the individual is receiving and the individuals
progress toward achieving the service outcomes
described in the individuals ISP

4.01-1
5
Specific Requirements

Not Billable as Case Management
Travel time
Written documentation
Reviewing records
Drafting ISPs or PDPs
Staff Training/Conferences
Processing service claims
Anything not listed as billable

4.01-1
6
Specific Requirements

Case Management Monthly Unit of Service
A program provider may include only one unit of
service per calendar month on a service claim for
case management except when an individual is
transferring from one program provider to another
(4.01G). In the case of a transfer the service
providers combined increments must not exceed
one unit.

4.01-2
7
Common Errors

Poor Quality Narrative
Vague about type of meeting (face-to-face,
telephone, etc.)
Billing on the first day of the month instead of
actual date service was provided
Billing while individual is in Hospital
Billing for meeting with sleeping individual
Not signing individual out of day habilitation
when activities are interrupted
No Progress Note
Please view the attached case management examples
for both billable and non-billable forms of
documentation. (ADDENDUM B C)

8
No Face-To-Face Contact (NFFC)
ADDENDUM B
9
Case Manager met face-to-face with individual
ADDENDUM B
10
No Face-To-Face Contact (NFFC)
ADDENDUM C
11
Case Manager met face-to-face with individual
guardian
ADDENDUM C
12
4.02 Counseling and Therapies
4.02-1
13
Specific Requirements

Counseling and Therapies
Audiology services
Dietary services
Occupational therapy services
Physical therapy services
Psychology services
Social work services
Speech and language pathology services

4.02-1
14
Specific Requirements

Counseling and Therapies Billable Activity
Interacting face-to-face or by telephone with an
individual to conduct assessments or provide
services within the scope of the service
providers practice
Interacting face-to-face or by telephone with a
person, except a service provider of nursing,
case management, or counseling and therapies,
regarding a counseling and therapies subcomponent
provided to an individual

4.02-1
15
Specific Requirements

Counseling and Therapies Billable Activity
Participating in an IDT meeting
Training a service provider of residential
assistance, day habilitation, respite or
supported employment, or a person other than a
service provider who is involved in serving the
individual, regarding how treatment that is
within the scope of practice of the service
provider of counseling and therapies will be
provided, including training to document the
provision of treatment

4.02-1
16
Specific Requirements

Not Billable as Counseling and Therapies
Travel time
Written documentation
Reviewing records
Drafting ISPs
Staff Training/Conferences
Processing service claims

4.02-2
17
Specific Requirements

Examples of Activity Not Billable
Writing how treatment will be provided
Reviewing a document
Providing services outside the service providers
scope
Scheduling an appointment
Transporting an individual
Traveling to or waiting to provide a subcomponent
Training or interacting about general topics, not
specific to the individual

4.02-2
18
Specific Requirements

Counseling and Therapies Written Documentation
Must meet the general requirements outlined in
3.08
Include the exact begin and end time for the
service event by the service provider making the
written narrative
Include a written narrative of the service event
Must include a written justification in the
individuals ISP for any activity performed by
multiple service providers at the same time for
the same individual

4.02-3
19
Common Errors

No begin and/or end times
No location of service provided
Duplicated progress notes
Reviewing or creating paperwork
Family paying for rate differential
Using location codes as only documentation of
location
No Progress Note
Please view the attached counseling therapies
examples for both billable and non-billable forms
of documentation. (ADDENDUM D E)

20
Non Billable Service (NBS)
ADDENDUM D
21
ADDENDUM D
22
Non Billable Service (NBS)
ADDENDUM E
23
Psychologist wrote a billable note and performed
billable activities
ADDENDUM E
24
4.03 Day Habilitation
4.03-1
25
Specific Requirements

Day Habilitation Billable Activity
Interacting face-to-face with an individual to
assist the individual in achieving goals to
Acquire, retain or improve self-help skills,
socialization skills or adaptive skills that are
necessary for the individual to successfully
reside, integrate and participate in the community

4.03-1
26
Specific Requirements

DH billable activity
Reinforce a skill taught in school, counseling or
therapy
Develop opportunities for employment in the
community
Transport an individual between day habilitation
sites
Assist an individual with personal care
activities
Participate in IDT meetings

4.03-1
27
Specific Requirements

Day Habilitation may not be provided in the
individuals residence unless there is adequate
justification in the individuals ISP of a severe
medical condition or serious behavioral issues.

4.03-1
28
Specific Requirements

Not Billable as Day Habilitation
Travel time (except from one Day Habilitation
site to another)
Written documentation
Reviewing records
Drafting ISPs
Staff Training/Conferences
Processing service claims
Assisting an individual for the sole purpose of
meeting vocational goals

4.03-1 4.03-2
29
Specific Requirements

May not submit DH service claim for
An individual who refuses to participate
An individual who is sleeping
Assisting an individual in achieving goals not
documented in their ISP
More than five units of service in a calendar
week
More than 260 units of service per IPC year
Day habilitation that is funded by another source
other than HCS

4.03-2
30
Specific Requirements

Day Habilitation Unit of Service
A unit of service for Day Habilitation is one day
One-half unit of service may be billed if service
is provided for two consecutive hours in one
calendar day
Three-quarters unit of service may be billed if
service is provided for at least three and
one-half hours (with at least two consecutive
hours) in one calendar day
One unit may be billed if at least five hours are
provided on one consecutive day-two of the five
hours must be consecutive

4.03-3
31
Specific Requirements

DH Written Documentation must
Meet the requirements in 3.08
Include a description of the DH site
Include daily exact start and end times
documented by the person present at the site at
those times
Include a written narrative or written summary
Include a description of the individuals ISP
goals and outcomes

4.03-3 4.03-4
32
Common Errors

Individual sleeping
Not signing individual out of Day Habilitation
for other services provided (CMM, NU, SHL, etc.)
No description of service provided (details about
interactions, activities, behaviors, successes,
refusals, etc.)
Daily narrative used for weekly summary
No habilitation occurring in the day habilitation
center
Duplicated Progress notes
Using location codes as only documentation of
location
No Progress Note
Please view the attached day habilitation
examples for both billable and non-billable forms
of documentation. (ADDENDUM F, G H)

33
No Description of Activities Performed (NDAP)
ADDENDUM F
34
A Unique description of the daily activities
performed were added to the progress note
ADDENDUM F
35
Daily Narrative Used for Weekly Summary (DNUFWS)
ADDENDUM G
36
ADDENDUM G
A weekly summary replaced the daily narrative
with more descriptive training and behavior
documentation
37
Daily Narrative Used for Weekly Summary
(DNUFWS) Service Not Justified in Service Plan
(SNJSP)
ADDENDUM H
38
4.07 Supported Employment
4.07-1
39
Specific Requirements

Supported Employment Requirements
Fair Labor Standards Act must be compensated by
the employer as an employee under this act
Must be employed at a site where no more than one
employee or 3 of the employees, whichever is
greater, has a disability

4.07-1
40
Specific Requirements

Supported Employment Billable Activity
Face to face or by telephone with individuals
supervisor to sustain individual employment
IDT meetings
Face to face with individual at work site only

4.07-1
41
Specific Requirements

Billing Day Habilitation for SE
Documentation must include name of the
individual, exact time worked each day, exact
dates worked each week, name, address and phone
number of employer and signature of employment
supervisor, service provider or case manager.

4.07-3
42
Specific Requirements

Examples of Activities Not Billable under SE
Interacting with individual when not on duty
Services provided prior to employment-
includes assessments, assisting or arranging
interviews, completing applications and
transporting

4.07-1 4.07-2
43
Specific Requirements

Restrictions (SE)
Program provider cant be employer unless the
program provider has an approved variance from
DADS
An individual receives more than 600 units/150
hrs per IPC year
Supported employment is available through another
source (public school or DARS)

4.07-2 4.07-3
44
Specific Requirements

Supported Employment Documentation
Meet requirements set forth in 3.08
Written narrative in 3.08(B)
Service Event in 3.06(A)(1)
Exact Begin and End time
Evidence not available through school or other
funding source

4.07-3
45
Common Errors

Training not occurring at the job site
Pre-vocational training
Duplicated progress note
Using location codes as only documentation of
location
No Progress Note
Please view the attached Supported Employment
examples for both billable and non-billable forms
of documentation. (ADDENDUM I)

46
Non-Billable Service (NBS)
ADDENDUM I
47
The trainer has changed locations of the service.
ADDENDUM I
48
4.04 Nursing
4.04-1
49
Specific Requirements

Nursing Billable Activity
Interacting face-to-face or by telephone with an
individual to provide professional or vocational
nursing for which there is a documented or
immediate medical necessity
Preparing or administering medication or
treatment ordered by a physician, podiatrist or
dentist
Assisting or observing self-administration of
medication
Assessing an individuals health status

4.04-1
50
Specific Requirements

Nursing Billable Activity
Interacting face-to-face or by telephone with a
person (other than a service provider of
nursing, case management, or counseling and
therapies) regarding the health status of an
individual
Instructing, verifying the competency of, or
supervising an unlicensed person in the
performance of a task delegated in accordance
with the rules of the Board of Nurse Examiners
Participating in an IDT meeting

4.04-1
51
Specific Requirements

Examples of Non-Billable Activities
Writing an ITP for an individual
Activities that do not constitute the practice of
nursing (transportation, waiting to perform
billable activities)
Making appointments
Instructing on general topics
Preparing a treatment or medication for
administration if not face-to-face
Storing, counting, refilling, reordering or
delivering medications
Reviewing documentation

4.04-2
52
Specific Requirements

Nursing Rule of Thumb
If it does not require a nursing license to
perform a task, it is not billable.
(please disregard the statement regarding
justification in the ISP)

53
Specific Requirements

Nursing Unit of Service
15 Minute of Service
A service claim cannot be made for a fraction of
a unit of service
Accumulation of Service Times
Can be accumulated for nursing provided to one
individual on a single calendar day

4.04-3
54
Specific Requirements

Nursing Written Documentation
Must meet the requirements in 3.08
Include a written narrative of the service event
Include the exact start and end time of the
service event documented by the person making the
written narrative
Include a description if the medical necessity
for the activity performed during the service
event
For any activity simultaneously performed by more
than one service provider, include a written
justification in the individuals ISP for the use
of more than one service provider

4.04-4
55
Common Errors

Billing for creating and reviewing paperwork.
No medical necessity on vitals taken weekly,
monthly, or quarterly
No medical necessity shown when residential staff
calls nurse to administer over the counter
medication to individual
No medical necessity for follow-up phone call
Billing for services without Face-to-Face or
Telephone contact
Providing any activity not requiring a nursing
license
Poor justification in PDP/ISP for nursing
services
Using location codes as only documentation of
location
One note used for multiple service events
No Progress Note
Please view the attached nursing examples for
both billable and non-billable forms of
documentation. (ADDENDUM J K)

56
ADDENDUM J
57
ADDENDUM J
58
ADDENDUM K
59
ADDENDUM K
60
4.05 Residential Assistance
4.05-1
61
Specific Requirements

Residential Assistance Residential Location
Own Home/Family Home if no foster/companion
care, residential support or supervised living is
provided to the individual
Foster/Companion Care is not owned or leased by
the program provider, a service provider provides
care to the individual and the care provider and
the individual have the same address

4.05-1 4.05-2
62
Specific Requirements

Residential Assistance Residential Location
3-Person Home the individuals residence is a
3-person residence and a service provider
provides residential support or supervised living
to the individual
4-person Home the individuals residence is a
4-person residence and a service provider
provides residential support or supervised living
to the individual

4.05-2
63
Supported Home Living
4.05 Residential Assistance
4.05-3
64
Specific Requirements

Supported Home Living Billable Activity
Interacting face-to-face with the individual
to assist with activities of daily living
to assist with ambulation and mobility
to reinforce counseling and therapy subcomponents
to assist with administration of medication or
tasks delegated by an RN
to conduct habilitation activities
to secure transportation for the individual
to supervise the individuals safety and security

4.05-3
65
Specific Requirements

Supported Home Living Billable Activity
Interacting face-to-face or by telephone with an
individual or an involved person regarding an
incident that directly affects the individuals
health or safety
Performing one of the following activities that
does not involve interacting face-to-face with an
individual shopping for the individual, planning
or preparing meals for the individual,
housekeeping for the individual, procuring or
preparing the individuals medication or securing
transportation for the individual.
Participating in an IDT meeting

4.05-4
66
Specific Requirements

Supported Home Living claims may not be submitted
for
An individual whose IPC does not have a
residential location of own home/family home
Transporting an individual from one DH or SE site
to another

4.05-5
67
Specific Requirements

Supported Home Living Unit of Service
15 Minute of Service may not include fraction
of service
Calculating transportation use Method A or
Method B (can only use one method on a single
calendar day)

4.05-6
68
Specific Requirements

Supported Home Living Written Documentation
Must meet requirements of 3.08
Includes a written narrative of the service event
Includes exact begin and end time of the service
event documented by the service provider making
the written narrative
If not face-to-face, justification must be in the
individuals ISP. The activity must be described
in the written narrative
For any activity simultaneously performed,
justification must be included in the
individuals ISP

4.05-9
69
Specific Requirements

SHL Transportation Written Documentation
Name of the individual being transported
Day, month and year the transportation was
provided
Place of departure and destination for the
individual being transported
Notation of which method was used to calculate
transportation time
Begin and end time for each transportation time

4.05-9 4.05-10
70
Specific Requirements

SHL Transportation Written Documentation contd
Total minutes of each transportation time
Signature of the service provider
The unit of service for a service claim resulting
from each service time and
Any service times accumulated to make a unit of
service for a service claim
Attachment F Supported Home Living
Transportation Billing Log Example

4.05-10
71
Transportation Method A
a. Transportation time of 120 minutes
(700am-900am) with 6 passengers (Dorothy 5
others) and 1 service provider for Trip A SERVICE
TIME (1 X 120) 6 20 minutes b.
Transportation time of 90 minutes (300pm-430pm)
with 5 passengers (Dorothy 4 others) and 1
service provider SERVICE TIME (1 X 90) 5 18
minutes 20 min 18 min 38 minutes
(accumulation) According to Attachment C 38
minutes 3 Units Billed (accumulation) 1 Unit
(20 min) 1 Unit (18 min) 2 Units Billed (no
accumulation)
72
Transportation Method B

Transportation time for Dorothy N. Kansas
a. Transportation time of 15 minutes
(700am-715am) with one passenger (Dorothy only)
and 1 service provider
SERVICE TIME (1 X 15) 1 15 minutes
b. Transportation time of 15 minutes
(715am-730am) with two passengers (Dorothy and
Little) and 1 service provider
SERVICE TIME (1 X 15) 2 7.5 minutes
c. Transportation time of 15 minutes
(730am-900am) with three passengers (Dorothy,
Little and Mary) and 1 service provider
SERVICE TIME (1 X 90) 3 30 minutes
15 min 7.5 min 30 min 52.5
minutes
According to Attachment C 52.5 minutes
3 Units

73
Common Errors

Overlapping times with other services
Transportation method completed incorrectly
Time not divided evenly between two or more
individuals receiving services at the same time
Non-qualified Service Provider (Proof of
residence, etc.)
No justification for receiving SHL in DH facility
No begin and/or end times on documentation
No location of services provided on documentation
Duplicated progress note
Using location codes as only documentation of
location
No Progress Note
Please view the attached Supported Home Living
examples for both billable and non-billable forms
of documentation. (ADDENDUM L)

74
ADDENDUM L
75
ADDENDUM L
76
Foster Care
4.05 Residential Assistance
4.05-11
77
Specific Requirements

Foster Care Requirements of Setting
The program provider may not lease or own the
residence
The individual receiving care must have a
residence in which no more than three persons
receive foster/companion care, a non-HCS Program
service similar to foster/companion care and
If the individual is a minor, the parent or
step-parent may not provide this service

4.05-11
78
Specific Requirements

Foster Care Requirements of Setting
The service provider must have the same residence
as the individual and
Ensure that foster/companion care is provided to
an individual when necessary

4.05-11
79
Specific Requirements

Foster Care Unit of Service
Unit of service is one day
May not be for more than one day
May not have a fraction of a unit of service

4.05-14
80
Specific Requirements

Foster Care Billable Activity
Assisting the individual with activities of daily
living (bathing, dressing, personal hygiene,
eating, meal planning and preparation and
housekeeping)
Assisting the individual with ambulation and
mobility
Reinforcing any counseling and therapy
subcomponent provided to the individual
Assisting with the administration of the
individuals medication or to perform a task
delegated by an RN

4.05-11 4.05-12
81
Specific Requirements

Foster Care Billable Activity
Conducting habilitation activities that train the
individual to
Develop or improve skills that allow the
individual to live more independently
Develop socially valued behaviors
Integrate into community activities
Use natural supports and typical community
services available to the public
Participate in leisure activities

4.05-12
82
Specific Requirements

Foster Care Written Documentation
Must meet the requirements in 3.08
Must include a description of the location of the
individuals residence and
Include a written narrative of the calendar day
or a written summary of the calendar week

4.05-14 4.05-15
83
Specific Requirements

Foster Care Service Claim for an Individual on a
Visit with Family or Friend
A program provider may submit a service claim
for an individual who is on a visit with a family
member or friend away from their residence if the
visit is for at least a calendar day. If the
visit is for more than 14 consecutive calendar
days, the program provider may submit a service
claim for only 14 calendar days of the visit.

4.05-15
84
Specific Requirements

Foster Care Service Claim for an Individual on a
Visit with Family or Friend Written Documentation
Written documentation must include the
individuals name, the dates the individual was
visiting the family member or friend, the
location of the visit and the date and signature
of the service provider.

4.05-15
85
Common Errors

Failure to discharge individual while in the
hospital
Weekly summary exceeds seven days
Duplicated progress note
Using location codes as only documentation of
location
No Progress Note
Please view the attached Foster Care examples for
both billable and non-billable forms of
documentation. (ADDENDUM M, N O)

86
ADDENDUM M
Duplicated Progress Note (DPN)
Documentation Indicates Individual Should be
Discharged (DIISD)
87
ADDENDUM M
Replaced Duplicate notes with notes providing
evidence of unique activities performed
Noted that this date was not billed
88
ADDENDUM N
Documentation Indicates Individual Should be
Discharged (DIISD)
Documentation Signed Prior to Service Delivery
(DSPSD)
89
ADDENDUM N
Documentation Changed to Reflect Individuals
Absence
Documentation Signed Following Service Delivery
90
ADDENDUM O
91
Under NO circumstances may a person provide
foster care services to their minor child!
ADDENDUM O
92
Residential Support Services
4.05 Residential Assistance
4.05-16
93
Specific Requirements

Residential Support Requirements of Setting
The residence must be a Three or Four person
residence
The program provider may not have the same
residence as the individual
The service provider must be available to provide
residential support to an individual as needed
and
The service provider must be present and awake in
the residence when the individual is present in
the residence

4.05-16
94
Specific Requirements

Residential Support Service Provider Shifts
No more than Five Extended Shifts per Month
(Extended Shift a combined period of time more
than 16 hours during a 24 hour period)
Off Duty Requirement--Must be off duty for at
least 8 hours before working another shift
No Shifts of More than 24 Hours

4.05-16
95
Specific Requirements

Residential Support Billable Activity
Assisting the individual with activities of daily
living (bathing, dressing, personal hygiene,
eating, meal planning and preparation and
housekeeping)
Assisting the individual with ambulation and
mobility
Reinforcing any counseling and therapy
subcomponent provided to the individual
Assisting with the administration of the
individuals medication or to perform a task
delegated by an RN

4.05-17
96
Specific Requirements

Residential Support Billable Activity
Conducting habilitation activities that train the
individual to
Develop or improve skills that allow the
individual to live more independently
Develop socially valued behaviors
Integrate into community activities
Use natural supports and typical community
services available to the public
Participate in leisure activities

4.05-17
97
Specific Requirements

Residential Support Unit of Service
Unit of service is one day
A service claim may not be for more than one day
A service claim may not include a fraction of a
unit of service

4.05-19
98
Specific Requirements

Residential Support Written Documentation
Must meet the requirements in 3.08
Must include a description of the location of the
individuals residence
Must include at least two written narratives (one
by the service provider who is on duty while the
individual is awake and one by the service
provider who is on duty while the individual is
asleep)
Must include the begin and end time of the shift
worked by the service provider making the written
narrative

4.05-20
99
Specific Requirements

Residential Support Service Claim for an
Individual on a Visit with Family or Friend
A program provider may submit a service claim for
an individual who is on a visit with a family
member or friend away from their residence if the
visit is for at least a calendar day. If the
visit is for more than 14 consecutive calendar
days, the program provider may submit a service
claim for only 14 calendar days of the visit.

4.05-20
100
Specific Requirements

Service Claim for an Individual on a Visit with
Family or Friend Written Documentation
Written documentation must include the
individuals name, the dates the individual was
visiting the family member or friend, the
location of the visit and the date and signature
of the service provider.

4.05-21
101
Common Errors

No Shift Changes
Day Habilitation is NOT a shift change
More than five extended shifts per month
Gaps in coverage while individual is in residence
Working longer than 24 hour shifts
Failure to discharge individual while in the
hospital
Duplicated progress notes
Using location codes as only documentation of
location
No Progress Note
Please view the attached Residential Support
Services examples for both billable and
non-billable forms of documentation. (ADDENDUM P)

102
ADDENDUM P
No Shift Change (NSC)
103
ADDENDUM P
A different staff member performed services for
Dorothy on these times and dates.
104
Supervised Living
4.05 Residential Assistance
4.05-22
105
Specific Requirements

Supervised Living Requirements of Setting
The residence must be a 3 or 4-person residence
The service provider must be available to provide
residential support to an individual as needed
and
The service provider must be present in the
residence when the individual is present in the
residence

4.05-22
106
Specific Requirements

Supervised Living Billable Activity
Assisting the individual with activities of daily
living (bathing, dressing, personal hygiene,
eating, meal planning and preparation and
housekeeping)
Assisting the individual with ambulation and
mobility
Reinforcing any counseling and therapy
subcomponent provided to the individual
Assisting with the administration of the
individuals medication or to perform a task
delegated by an RN

4.05-22
107
Specific Requirements

Supervised Living Billable Activity
Conducting habilitation activities that train the
individual to
Develop or improve skills that allow the
individual to live more independently
Develop socially valued behaviors
Integrate into community activities
Use natural supports and typical community
services available to the public
Participate in leisure activities

4.05-22 4.05-23
108
Specific Requirements

Supervised Living Unit of Service
Unit of service is one day
A service claim may not be for more than one day
A service claim may not include a fraction of a
unit of service

4.05-24
109
Specific Requirements

Supervised Living Written Documentation
Must meet the requirements in 3.08
Must include a description of the location of the
individuals residence
Must include at least one written narrative made
by the service provider who is on duty while the
individual was awake and
Must include the begin and end time of the shift
worked by the service provider making the written
narrative

4.05-25
110
Specific Requirements

Supervised Living Service Claim for an Individual
on a Visit with Family or Friend
A program provider may submit a service claim for
an individual who is on a visit with a family
member or friend away from their residence if the
visit is for at least a calendar day. If the
visit is for more than 14 consecutive calendar
days, the program provider may submit a service
claim for only 14 calendar days of the visit.

4.05-25
111
Specific Requirements

Service Claim for an Individual on a Visit with
Family or Friend Written Documentation
Written documentation must include the
individuals name, the dates the individual was
visiting the family member or friend, the
location of the visit and the date and signature
of the service provider.

4.05-26
112
Common Errors

No evidence of coverage while consumer is
sleeping
Failure to discharge consumer while in the
hospital
Using location codes as only documentation of
location
No Progress Note
Please view the attached Supervised Living
examples for both billable and non-billable forms
of documentation. (ADDENDUM Q)

113
Non Billable Service (NBS)
ADDENDUM Q
114
Staff documented during the time which the
individual was awake.
ADDENDUM Q
115
4.06 Respite
4.06-1
116
Specific Requirements

Respite
Temporary Provision of Assistance-
Service provider does not provide foster care,
residential support or supervised living to the
individual

4.06-1
117
Specific Requirements

Respite
Room and Board-
If respite is provided in a setting other than
the individuals residence, the program provider
must provide room and board

4.06-1
118
Specific Requirements

Respite Billable Activity
Assisting the individual with activities of daily
living
Assisting the individual with ambulation and
mobility
Reinforcing any counseling and therapy provided
to the individual
Assisting with the administration of the
individuals medication or to perform a task
delegated by an RN

4.06-1 4.06-2
119
Specific Requirements

Respite must be provided
Residence
In the individuals residence
In a 3-person or 4-person residence
In the residence of another person (other than a
three-person or four-person residence) where no
more than Three persons are receiving HCS Program
services or non-HCS Program services that are
similar to HCS

4.06-2 4.06-3
120
Specific Requirements

2. Non Residence
Respite may be provided in a setting that is not
the residence of any person if there are no more
than six persons receiving HCS Program services
or non-HCS Program services that are similar to
HCS.

4.06-3
121
Specific Requirements

Submitting a Service Claim for Respite
Quarter-hour Respite
Provision of less than 10 hours in one calendar
day in any location
Daily Respite
Provision of 10 or more hours in a location
other than the individuals residence
Quarter-hour or Daily Respite
Provision of 10 or more hours in an individuals
residence

4.06-3 4.06-4
122
Specific Requirements

Respite Written Documentation
Quarter-hour Respite
Meet requirements in 3.08
Written narrative
Exact begin/end time
Written justification in ISP for more than one
service provider

4.06-5 4.06-6
123
Specific Requirements

Respite Written Documentation contd
Daily Respite
Meet requirements in 3.08
Location
Written narrative
Exact begin/end time

4.06-6
124
Common Errors

Location of service not on documentation
Billing more than 10 hours for respite occurring
out of the individuals home
Individual lives alone without a live-in
caregiver
No begin and/or end times
Non Qualified Service Provider (Proof of
residence, etc.)
Duplicated progress note
Using location codes as only documentation of
location
No Progress Note
Please view the attached Respite examples for
both billable and non-billable forms of
documentation. (ADDENDUM R)

125
Billed More Units Than Allowed (BMUTA)
ADDENDUM R
126
Changed Units Billed to the 10 allowed for either
Respite (RE) or Respite Hourly (REH) when
provided outside of the individuals residence
ADDENDUM R
127
Community Services Staff