DD Medicaid Waivers Home-Based Support Services - Service Facilitator Training



Illinois Department of Human Services
Division of Developmental Disabilities
DEVELOPED 2008, REVISED 2015

DD Medicaid Waivers HBS Training

THE PURPOSE OF THIS TRAINING:

This training was first presented in August-September 2008 in a series of sessions across the state. It has been modified forcomputer-based learning through the IDHS OneNet Training module.

Overview of Training

The training is divided into the following general sections:

An Overview of Medicaid Home and Community-Based Waivers

The Division's Waivers must meet Federal statutory requirements that include the following:

An Overview of Medicaid Home and Community-Based Waivers

An Overview of Medicaid Home and Community-Based Waivers

An Overview of Medicaid Home and Community-Based Waivers

Illinois currently has nine Waivers:

DD Children's Support Waiver Amendment

Children's Support Waiver Overview

 program expansion.

Home-Based Support Services (HBS) Overview

Self Direction is Basic to Home-Based Support Services

Home-Based Support Services (continued):

HBS Services: Out-of-Home Respite

HBS One Time Funding-$15,000 over Five Years

Individual Service and Support Advocacy (ISSA)

Individual Service and Support Advocacy (ISSA) - continued

ISSA is provided by Independent Service Coordination (ISC) agencies, which also provide Pre-Admission Screening (PAS) services.

The maximum for ISSA is 25 hours per state fiscal year. Additional hours may be authorized with prior approval.

Additional HBS Services for Adults

Additional HBS Services for Adults (cont.)

In addition to day programs, Adult HBS service options within the monthly service cost maximum, include:

* These require prior approval.

Additional HBS Service for Adults & Children

Another HBS service that is in addition to the service cost maximum is Temporary Assistance (formerly called Crisis Services). Effective 1/11, this service was added for children.

Temporary Assistance requires prior approval.

HBS Service Descriptions

HBS Services - Service Facilitation (55A)

HBS Services - Personal Support (55D)

Examples of professional services that are not included are:

HBS Personal Support (continued)

HBS Personal Support (continued)

If participants choose to hire domestic employees, the following requirements apply:

HBS Personal Support - Domestic Employee Qualifications

HBS Personal Support (continued)

HBS Personal Support - Qualifications for Agency Staff

HBS Personal Support - Qualifications for Agency Staff

Agency staff providing HBS services must receive training on the Office of Inspector General (OIG) abuse/neglect rule (59 Ill. Adm. Code 50) requirements at the time of hire and every two years thereafter.

HBS Personal Support - Qualifications for Agency Staff

Agency staff providing Waiver services to children (individuals ages 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.

HBS Personal Support - Some Guidance

HBS Personal Support - Guidance (cont.)

Behavior Intervention and Treatment (56U)

Behavior Intervention &Treatment (continued)

Behavior Intervention & Treatment Provider Qualifications

Level 1- $77.86/hour Behavior Intervention and Treatment service providers must be either a:

  or

Behavior Intervention & Treatment Provider Qualifications (cont.)

Level 2 - $62.28/hour Behavior Intervention and Treatment service providers must be either a:

or

Behavior Intervention & Treatment Provider Qualifications (cont.)

Rate Level 2 - $62.28/hour (cont.)

Behavior Intervention and Treatment service providers must be either:

or

Behavior Intervention & Treatment Provider Qualifications (cont.)

HBS Training for Unpaid Caregivers (55B)

HBS Counseling for Unpaid Caregivers (55C)

HBS Day Programs for Adults

HBS Day Programs for Adults - Guidance

Temporary Intensive Staffing - DT for Adults (53D)

HBS Nursing for Adults

HBS Temporary Assistance (53C) (formerly Crisis Services) for Adults and Children

HBS Emergency Home Response for Adults (55W)

HBS Emergency Home Response is available for adults within the monthly budget.

It funds installation (rate level 1) and monthly monitoring (rate level 2) of an electronic device to call for help.

Providers must by approved by the Department on Aging and accept the State rate.

HBS Service Facilitation responsibilities include:

HBS Service Facilitation (55A) - Provider Qualifications

HBS Service Facilitation - Initial Activities

When HBS services are first starting, the HBS Service Facilitator should discuss with the participant and family:

HBS Service Facilitation - Initial Activities - Waiver Rights

When HBS services are first starting, the Service Facilitator must explain the participant's rights to the participant and family. These include:

   DHS DDD Appeals Section

   319 E. Madison, Suite 3M

   Springfield, IL 62701

Waiver Appeal Rights (cont.)

HBS Service Facilitation - Initial Responsibilities (cont.)

When HBS services begin, the Service Facilitator explains the participant's responsibilities to the participant /family. These include:

HBS Service Facilitation - Initial Responsibilities (cont.)

HBS Service Facilitation - Initial Responsibilities (cont.)

HBS Service Facilitation - Initial Responsibilities (cont.)

HBS Service Facilitation - Initial Responsibilities (cont.)

It is very important that if a family chooses to hire domestic employees, the Service Facilitator refer the employer and employees immediately to the Fiscal/Employer Agent (F/EA) for enrollment. The payroll for domestic employees cannot be issued before the date the F/EA obtains an Employer ID Number (EIN or FEIN) and the domestic employee passes certain background checks.

HBS Service Facilitation - Individual Service Plan

HBS Service Facilitation - Ongoing - Provider Enrollment

HBS Service Facilitation - Ongoing - Prior Approval

For services and items that require prior approval, the Service Facilitator must submit a prior approval request (forms are Appendices to the Waiver Manual) with required documentation to DDD Network staff after the planning team has identified and documented the need for the item/service.

If approved, an official award letter or other written notice will be issued. Please see the DD Waiver Manual for more instructions.

Waiver HBS Services Subject to Prior Approval

HBS Service Facilitation -Ongoing - Monitoring

HBS Service Facilitation -Ongoing - Budget

HBS Service Facilitation - HBS Service Agreements

HBS Service Facilitation - F/EA Service Authorizations

HBS Service Facilitation - F/EA Service Authorizations (cont.)

HBS Service Facilitation - F/EA Service Authorizations (cont.)

HBS Service Facilitation - Correcting Billing Errors

HBS Service Facilitation - Correcting Billing Errors

If the individual is over budget (Reject Code 71), please:

HBS Service Facilitation -Transition

HBS Service Facilitation -Transition (cont.)

HBS Service Facilitation -Transition (cont.)

When a child transitions to adult HBS services, the Service Facilitator coordinates the termination date on the Service Termination Approval Request (STAR) form for the Children's HBS with the start date for the new services (adult HBS) with all providers. If any provider bills for CHBS services after the agreed termination date, the bill may reject or it could block the new adult service authorizations.

HBS Service Facilitation - Guidance

What Is A Fiscal Employer/Agent?

Fiscal Employer/Agent (F/EA) - Responsibilities of ACES$ and PPL

For Personal Support workers hired by the participant/family (domestic employees), the F/EA does the following:

For more information, go to http://www.acessfea.org/ or http://www.fms.publicpartnerships.com

Fiscal Employer/Agent - Responsibilities of F/EA (cont.)

Fiscal Employer/Agent - ACES$ and PPL (cont.)

The most common problems that affect the ability of the F/EA to issue payroll in a timely manner are:

These can all be corrected by the Service Facilitator working with the employer of record, the worker, and the F/EA (either ACES$ or PPL).

Provider Enrollment - IMPACT Enrollment Types

When enrolling on-line, DD Waiver providers must specify their IMPACT enrollment type and "associate" with DHS, Division of Developmental Disabilities for DD Waiver services.

Options include: Facility/Agency/Organization (FAO), Typical or Atypical Agency, Typical or Atypical Individual, Rendering Service Provider, Individual Sole Proprietor & Group. 

Providers must specify what services and specialties they will provide. Please see: http://www.dhs.state.il.us/page.aspx?item=47336 for more information on services and specialties.

Provider Enrollment - Service Types

Provider Enrollment - Non-Medical Transportation

Provider Enrollment - National Provider ID # (NPI)

Payment policy in Long Term Care or Hospital (cont.)

There are Three Exceptions to this policy:

Exception #1 is Service Facilitation (55A).

Exception #2 is ISSA (50D).

Exception #3 is Behavior Intervention & Treatment (56U).

Audit Trail/Documentation Requirements

Audit Trail/Documentation Requirements (cont.)

Service Facilitators must also document:

Audit Trail/Documentation Requirements (cont.)

DCFS CANTS Background Checks - Process

Non-DCFS licensed providers can download the required background check form (CFS 689) from the DCFS website at:  www.state.il.us/dcfs.

A link to the form is also on the DHS website at www.dhs.state.il.us , as an appendix to the DD Waiver Manual.

DCFS CANTS Process (cont.)

DCFS CANTS - Waiver Requests (Public Act 097-0441)

Resources

Chicago Region: (312) 814-8327

Greater IL Region: (217) 782-9692

OR

For DD region staff direct telephone numbers, go to the DHS website, www.dhs.state.il.us. Click on "About DHS", then click on "Divisions", then click on "Developmental Disabilities", then click on "Contacts for Services".

Resources

Commonly needed numbers for the Division of Developmental Disabilities are:

The line drawings use in this computer-based learning module were done by Martha Perske, a nationally-known artist.

CBL Certification

Congratulations on completing the CBL training! You have earned 1.5 hours of continuing education credit (CEs). Documentation of completing this CBL should be made on an agency-developed sign-in/out sheet or form attesting that the entire CBL was viewed. Documentation of completing this CBL and for documenting the CEs should be made on an agency-developed sign-in/out sheet or form attesting that the entire CBL was viewed. The training completion agency-developed sheet or form is to be maintained at the agency as part of the employee(s) training record. Documentation must include:

If you have questions about the information in this training, contact: DHS.BQM@illinois.gov