STATE OF ILLINOIS Department of Human Services Developmental Disabilities

1
STATE OF ILLINOISDepartment of Human
Services Developmental Disabilities

• WAIVER TRAINING
• September 2007

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AGENDA

• Introductions
• Overview of Handouts
• Adult Renewal New Childrens Waivers
• Home-Based Support Services (HBS)
• FY08 Changes Related to the Waivers
• Other FY08 Changes
• General Waiver Updates

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Waiver Training

• Overview of Handouts

4
Adult Waiver Renewal and New Childrens Waivers

• Adult Waiver Renewal
• Childrens Residential Waiver (CRW)
• Childrens Support Waiver (CSW)

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Adult Waiver Renewal

• Adult Waiver renewed for five years
• Effective July 1, 2007 June 30, 2012
• Approved capacity is 14,000
• Changes in Covered Services

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Adult Waiver Existing Services

• Individual Service and Support Advocacy
• Residential Habilitation (CILA, CLF)
• Day Habilitation Programs (DT, SEP, regular
  work/sheltered employment, adult day care, at
  home day, other day)
• Therapies (OT, PT, Speech)
• Behavior services
• Adaptive Equipment Home/Vehicle Modifications

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Adult Waiver - Existing Services (cont.)

• Continuing Home-Based Support (HBS) Services
• Service Facilitation
• Personal Support
• Non-Medical Transportation
• Emergency Home Response
• Nursing

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Adult Waiver - Existing Services (cont.)

• Discontinuing HBS Out-of-Home
• Respite (55V)
• Issues with provider standards and quality
  assurance
• Issues with statewide availability
• Very low utilization

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Adult Waiver New Services

• HBS Crisis Services (53C)
• HBS Training (55B) for Unpaid
• Caregivers
• HBS Counseling (55C) for Unpaid
• Caregivers
• Assistive Technology (53T)

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Adult HBS Crisis Services

• Crisis Services are available in the Adult HBS
  Program
• For emergencies due to the absence or incapacity
  of the primary unpaid caregiver
• Requires written prior approval
• Up to 2,000/mo. for up to 2 months for
  additional Personal Support (53C)

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HBS Training/Counseling For Unpaid Caregivers

• Training (55B) and Counseling (55C) are aimed at
  assisting unpaid caregiver to meet needs of the
  participant
• Within monthly allocation
• Available in adult HBS and childrens HBS (in
  the Childrens Support Waiver)

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Assistive Technology (53T)

• Actually a service distinction, rather than a new
  service
• Requires written prior approval through the same
  process as adaptive equipment
• Limited to no more than 15,000 per participant
  every five years (in combination with other
  items/modifications)
• Available to participants in all three DD Waivers

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Childrens Residential WaiverOverview

• New Waiver effective July 1, 2007 for three
  years (through June 30, 2010)
• Approved capacity is 175
• Eligibility criteria
• Covered Services

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Childrens Residential Waiver - Eligibility
Criteria

• Individuals must
• Be between the ages of 3 and 21
• Live in Illinois and receive services in
  Illinois
• Be enrolled in Medicaid (special eligibility
  criteria parents income not counted for
  children)
• Have a developmental disability (either mental
  retardation or a related condition)

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Childrens Residential Waiver Eligibility
Criteria (cont.)

• Individuals must
• Must be assessed as eligible for ICF/MR level of
  service (must need active treatment)
• Must meet priority population criteria as defined
  in Attachment A of the DHS contract
• Children who are wards of the state (DCFS) are
  not eligible

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Childrens Residential Waiver Covered Services

• Child Group Home
• Behavior Intervention and Treatment
• Adaptive Equipment
• Assistive Technology
• Individual Service and Support Advocacy (ISSA)

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Childrens Support Waiver Overview

• Replaced Family Assistance and Support (72D)
  effective July 1, 2007 for three years
• Approved capacity 600
• Designed to be consistent with Adult Waiver,
  especially adult Home-Based Support Services
  (HBS)

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Childrens Support Waiver
Overview

• Transition into adult services, anytime between
  18th and 22nd birthday
• 100 of federal funds garnered will be spent on
  program expansion
• Expect to begin enrolling additional children
  starting in January 2008

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Childrens Support Waiver Eligibility Criteria

• Eligibility criteria are similar to those for
  the Childrens Residential Waiver (age range,
  level of service/need for active treatment,
  urgency of need, Medicaid enrollment, etc.)

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Childrens Support Waiver Covered Services

• Services within the 1,246 monthly maximum
• Service Facilitation (55A)
• Personal Support (55D)
• Behavior Intervention and
• Treatment (56U)
• Training (55B) and Counseling
• (55C) for Unpaid Caregivers

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Childrens Support Waiver Covered Services (cont.)

• Services in addition to the monthly maximum -
  prior approval required
• Adaptive equipment (53E)
• Assistive technology (53T)
• Home accessibility modifications
• (53H)
• Vehicle modifications (53V)

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Childrens Support Waiver Covered Services (cont.)

• Individual Service and Support Advocacy (ISSA)
• Covered outside the monthly allocation
• Provides quality assurance and other advocacy
  assistance
• 25 hours per state fiscal year maximum

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Home-Based Support Services (HBS)

• Overview
• Role of Service Facilitator
• Changes in Personal Support
• Role of ACES - fiscal/employer agent

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Home-Based Support Services (HBS) Overview

• HBS continues as an Adult Waiver option
• Childrens HBS (CHBS) is a new program
  (Childrens Support Waiver)
• Monthly HBS maximum for services
• 1,246 for all Childrens HBS participants and
  for Adult HBS participants who are in special
  education
• 1,869 for all other Adult HBS participants

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HBS Overview (cont.)

• Self-Directed - Individuals and families
  choose
• How best to use the monthly budget to meet the
  individuals needs
• What services they want and need
• Which qualified providers they want
• Whether to choose agency-based staff or domestic
  employees to provide services

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HBS Service Facilitation Responsibilities

• Develop and update Individual Service Plan
• Verify service provider qualifications
• Complete Service Agreements/Service
  Authorizations
• Note The total authorized may NOT exceed the
  HBS monthly maximum

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HBS Service Facilitation Responsibilities (cont.)

• If family chooses to hire domestic employees,
  refer employer of record and qualified domestic
  employees to ACES for enrollment and background
  checks
• Ensure Medicaid Waiver provider enrollment with
  DDD for other qualified providers

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HBS Service Facilitation Responsibilities (cont.)

• For domestic employees
• Sign and FAX Service Authorizations to ACES
• FAX employee timesheets to ACES if necessary
• Work with family and ACES to correct problems

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HBS Service Facilitation Responsibilities (cont.)

• Do not submit Service Authorization
  to ACES if provider is not qualified
• Do not submit Service Authorizations to ACES
  if the total authorized (with the Service
  Agreements) exceeds the monthly maximum

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HBS Service Facilitation Guidance

• Minimum of 2 hours/month in Service Agreement,
  instead of 3 hours/month
• Within the monthly maximum
• No other maximum applies
• Can bill for services delivered and documented up
  to the agreed amount in the Service Agreement.

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HBS Personal Support

• Personal Support domestic employee provider
  qualifications
• Age 18 or older
• High school diploma or GED
• Background checks, if hired on or after
  July 1, 2007 (These are done by ACES)

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HBS Personal Support (cont.)

• Personal Support Domestic Employee Provider
  Qualifications (cont.)
• Spouses may not be paid to provide Personal
  Support in adult HBS
• Family members may not be paid to provide
  Personal Support in the Childrens HBS program

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HBS Personal Support (cont.)

• For Childrens HBS
• Family members who may not be paid for Personal
  Support services are
• Parents, guardians, siblings, aunts, uncles,
  first cousins, and grandparents, whether related
  by blood or marriage (in-laws) or through a
  step relationship.

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Fiscal Employer/Agent Role of ACES

• For personal support workers hired by the
  participant/family (domestic employees)
• Conducts required background checks
• Completes provider waiver enrollment
• Handles employer and employee paperwork
• Calculates employer and employee taxes

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Fiscal Employer/Agent Role of ACES (cont.)

• Issues paychecks to domestic employees
• Files employer taxes
• Website acessfea.org

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Fiscal Employer/Agent Role of ACES (cont.)

• Most common problems
• Lacking or incorrect Service Authorization
• Time on the timesheet exceeds the amount
  authorized in the Service Authorization
• Both of these can be corrected by the Service
  Facilitator working with the employer of record
  and worker

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FY08 Changes Related to the Waivers

• Behavior Intervention and Treatment
• Provider Medicaid Enrollment
• Application Process for Children
• Waiver Appeal Rights now apply to
• participants in the Childrens Waivers

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Behavior Intervention and Treatment (56U) Changes

• Definition of Behavior Intervention and Treatment
  - expanded to include services for both
  children and adults and services specific to
  autism
• Rate changes

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56U Provider Qualifications

• Level 1- 75.96/hour
• Clinical psychologist licensed by the Illinois
  Department of Financial and Professional
  Regulation
• or
• Board-Certified Behavior Analyst (BCBA)
  www.bacb.com

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56U Provider Qualifications (cont.)

• Level 2 - 60.76/hour
• Board-Certified Associate Behavior Analyst
  (BCABA)

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56U Provider Qualifications (cont.)

• Level 2 - 60.76/hour
• Professional with a bachelors degree in a human
  service field who has completed at least 1,500
  hours of training or supervised experience in the
  application of behaviorally-based therapy models
  consistent with best practice and research on
  individuals with autism spectrum disorder

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56U Provider Qualifications (cont.)

• Level 2 - 60.76/hour
• Professional who is certified to provide
  relationship development assessment Information
  is at rdiconnect.com

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56U Provider Qualifications (cont.)

• Level 2 - 60.76/hour
• Early intervention specialist with a
  developmental therapy credential or equivalent
  experience and training
• (Approved to serve participants in the
  Childrens Waivers only)

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56U Service Maximum

• Included in the monthly cost limit for Adult HBS
  and Childrens HBS
• State fiscal year maximum of 66 hours for Adult
  Waiver and Childrens Residential Waiver
  participants
• Increased from 48 hours in FY07
• 66 hour maximum does not apply in the Childrens
  HBS program (Childrens Support Waiver)

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Behavior Intervention and Treatment - Guidance

• Each professional may bill for services he/she
  personally provided to the Waiver participant

46
Provider Medicaid Enrollment

• All providers must enroll as Medicaid Waiver
  providers in order to be paid for services
  delivered
• Provider Medicaid enrollments must be submitted
  to DDD, except domestic employees which go to
  ACES

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Provider Medicaid Enrollment Provider
Types

• Adult DD Waiver - Provider Type 91
• Childrens Support Waiver (CSW) - Provider
  Type 94
• Childrens Residential Waiver (CRW) - Provider
  Type 97

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Provider Medicaid Enrollment Categories
of Service

• 95 Habilitation - Residential, DT, SEP, Personal
  Support
• 47 Service Facilitation
• 55 Non-Medical Transportation (adult HBS)
• 94 Adult Day Care (Adult Waiver)
• 10 Nursing (adult HBS)
• 97 Other professional services
• 32 Home/Vehicle Modifications
• 41 Adaptive Equipment/Assistive Technology
• 98 Emergency Home Response (adult HBS)

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Provider Medicaid Enrollment - If Already
Enrolled in Adult Waiver

• Submit
• An HFS-2243 form for each childrens waiver for
  which you will be providing services.
• Must include correct Provider Type
• Must include correct Categories of
• Service (COS)

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Provider Medicaid Enrollment For New
Providers

• Submit
• An HFS-2243 form for each waiver for which you
  will be providing services
• One Waiver Provider Agreement form (HFS-1413A) -
  covers all 3 waivers
• An IRS W-9 form, if being paid directly by the
  State Comptroller

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Provider Medicaid Enrollment
Transportation (55T)

• Domestic employees who also provide
  transportation (55T) must submit an IRS W-9 form
  to DDD with a note that they want to enroll as a
  transportation provider.
• No change in billing process for 55T (submitted
  through the Service Facilitation agency) and paid
  directly by the State Comptroller

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Application Process For Children - Clinical

• Children seeking services must have an active
  PUNS record
• PAS determines waiver clinical eligibility and
  submits packet to Network
• DDD reviews and mails Award Letter, if authorized
  for funding

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Application Process For Children - Financial

• PAS helps family with completion of Medicaid
  financial application, collection of required
  documentation and submits for review
• Special Medicaid financial eligibility rules
  Parents income information is collected but
  waived for children up to age 19

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Waiver Appeal Rights

• Waiver participants have the right to appeal
  adverse decisions under Medicaid, including
• Determination of ineligibility, denial
• of services, and discharge/suspension/
• reduction of waiver services

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Waiver Appeal Rights (cont.)

• Waiver rule (59 Ill. Adm. Code 120) describes
  requirements and process. Note address change
• HFS Bureau of Administrative Hearings
• 401 South Clinton 6th Floor
• Chicago IL 60607

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Waiver Appeal Rights (cont.)

• Waiver participants have the right to a written
  notice of any adverse action.
• Notices must include
•  1) The action to be taken
•  2) The reason and policy basis for the action  
• 3) A complete statement of the individual's
  right
• to appeal, including the provider's
  grievance
• process, Department review and Department
• of Healthcare and Family Services hearing.

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Other FY08 Changes

• Temporary Intensive Staffing (in DT - 53D in
  CILA - 53R)
• FY08 Contract Attachment A Changes

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Other FY08 Changes Temporary Intensive Staffing

• Replaces Transitional Staffing (53S)
• Requires prior approval and written
  award letter
• For adults in HBS, 53D is within the monthly
  maximum

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Temporary Intensive Staffing (cont.)

• Temporary Intensive Staffing in DT (31A/31U) must
  be billed using 53D
• Temporary Intensive Staffing in CILA (60D only)
  must be billed using 53R

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FY08 Contract Attachment A Changes

• DHS contract required for agencies providing
  Service Facilitation and/or Personal Support
• Enhanced agency staff training requirements
• CANTS process required for agencies providing
  waiver services to children

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Contract Attachment A Changes (cont.)

• All contracted agencies providing providing
  waiver services must train staff on OIG
  abuse/neglect rule (Rule 50) requirements at the
  time of hire and every two years thereafter

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Contract Attachment A Changes (cont.)

• For agencies providing Waiver services to
  individuals 17 or younger
• DCFS CANTS process
• Staff training in DCFS abuse/neglect
• reporting

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DCFS CANTS Process

• CANTS - Department Of Children and Family
  Services (DCFS) background check of the Child
  Abuse and Neglect Tracking System
• Agencies must conduct a CANTS check on all
  employees providing waiver services to children
  aged 17 and younger (no charge to provider)

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DCFS CANTS Process (cont.)

• DCFS licensed providers contact the regional DCFS
  office that licenses their programs for
  information on CANTS checks

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DCFS CANTS Process (cont.)

• Non-DCFS licensed providers can obtain the
  required form by downloading (printing) the
  background check form (CFS 689) from the DCFS
  website at  www.state.il.us/dcfs

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DCFS CANTS Process (cont.)

• All CANTS forms mailed to
• DCFS
• 406 E. Monroe, Station 30,
• Springfield, IL 62701
• Allow approximately two weeks for a reply

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Changes for Agencies Providing Waiver Services to
Children Staff Training

• Staff providing waiver services to individuals
  aged 17 and younger must receive training in DCFS
  reporting requirements for allegations of abuse,
  neglect or exploitation at the time of hire and
  every two years thereafter

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Contract Attachment A Changes for Personal
Support Child Group Home Agencies

• Requirements
• DSP training
• Background checks (criminal, Health
• Care Workers Registry, CANTS)

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DHS Contract Attachment A Website

• For details on DHS contract changes
• www.dhs.state.il.us/serviceProviders/
• grantsContracts/CSA08/attachments.asp

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General Waiver Updates

• Policy Updates
• Prior Approval Process
• Audit Trail/Documentation Requirements
• Prioritization of Urgency of Need for Services
  database (PUNS)
• Application for Service Authorization
• STAR form

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Waiver Policy Updates

• Bedhold Policy
• Policy in Long Term Care or Hospital
• Policy on Day Program Transportation
• Day Program Payment Policy

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Bedhold Policy

• A Bedhold day is a day when the individual is
  absent from the CILA or other residential setting
  from midnight to midnight
• Residential providers must bill either present or
  bedhold for every date

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Bedhold Policy (cont.)

• Bedhold Codes
• F-Family/Friends Visit
• H-Hospitalization general/psychiatric
  
• C-Convalescent Care
• S-Short-Term Admission (SODC)
• I- Incarceration

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Policy in a Long Term Care Facility (LTC) or
Hospital

• Waiver is a community-based alternative to
  institutional services
• Therefore individuals may not receive waiver
  services while in a hospital or long term care
  facility (LTC)
• LTC includes ICF/DD, nursing facility and
  State-Operated Facilities

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Policy in Long Term Care (LTC) or Hospital
(cont.)

• Exception 1 to LTC/Hospital Policy
• Service Facilitation (55A)
• To notify other providers of LTC or
• hospital stay
• To assist with discharge and return
• home, if needed

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Policy in a Long Term Care (LTC) or Hospital
(cont.)

• Exception 2 to LTC/Hospital Policy
• Behavior Intervention (56U)
• To plan for behavioral interventions,
• if needed, so that the individual can
• return home

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Policy on Transportation to and from Day Programs

• Family fees and HBS Transportation (55T) billing
  are not allowed.
• Transportation is the responsibility of day
  program provider and is included in the day
  program rate

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Day Program Payment Policy Update

• Day Programs
• 1,100 hours is the State Fiscal Year maximum
• 115 hours per month maximum for any combination
  of Day Programs

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Day Program Payment Policy Update

• Day Programs
• Recommend 92 hours per month if the individual is
  in adult Home-Based Support Services

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Prior Approval Required for

• Home/Vehicle Modifications, Adaptive
  Equipment/Assistive Technology
• Therapies (OT, PT, Speech)
• Adult HBS Crisis Services
• Supported Employment (SEP)
• Adult Day Care, At Home Day, and Other Day
• Temporary Intensive Staffing

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How to Request Prior Approval

• Submit request and any required attachments to
  Network staff
• If approved, DDD will mail an official award
  letter or other written notice

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Audit Trail/Documentation Requirements

• Waiver providers must document
• Who provided service
• Who was served
• Type of service delivered
• Amount of service
• Date and time services began
• Date and time services ended

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Audit Trail/Documentation Requirements (cont.)

• DHS will continue to conduct documentation
  reviews
• DDD will recoup payment for bills that lack
  adequate documentation of service delivery
• Services must be included in the individuals
  Service Plan

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PUNS Update

• Prioritization of Urgency of Need for Services
  database (PUNS) identifies people who need
  services
• PUNS is maintained by PAS agencies
• PUNS has 15,441 individuals identified as of
  7/23/07
• 11,041 with unmet needs

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Application for Service Authorization Update

• Application for Individual Service Authorization
  revised to reflect FY08 waiver changes
• New attachment Individual/Guardian Information
  form

86
STAR Form Update

• STAR Form - Service Termination Approval Request
• Revised to reflect FY08 changes
• Must be submitted to Network staff to
• terminate fee-for-service program
• authorizations

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Contact Information

• Chicago Network Direct Lines or [phone]
• Greater IL Network Direct Lines or (217)
  524-2515
• OR
• www.dhs.state.il.us/mhdd/dd/ Click on Contacts
  for Services for network staff telephone numbers

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Contact Information (cont.)

• Connie Sims - policy questions (217)
  782-5883
• Marie Havens - policy questions (217)
  782-9536
• Dave Adden policy questions (217)
  524-0848
• Jan Thompson policy questions (217)
  782-5918
• Rich Behl - 56U provider qualifications (217)
  557-9112
• George Elder provider enrollment (217)
  782-3719