DDD Draft Notice of Revision of Home Based Service Agreement Form

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.19.00x

Purpose:

The purpose of this Information Bulletin is to notify Home-Based Services providers, families and stake holders of a revision of the Service Agreement form to include the total of services authorized in the agreement. The purpose of this change is to ensure that all services are being provided within the monthly allotment for individuals in the Adult HBS program and within the monthly and annual budget allotment maximums for individuals in the Children's HBS program.

Background:

The DDD billing system has billing edits that will not allow the billing for services that exceed the cost of Home-Based Services maximum combined monthly and annual allotments. If services are billed over the allotment, the system will reject the billing and the provider will not be paid. The Division has noted a significant increase in the number of billing rejections due to the cost of the services being billed exceeding the budget allotment. This is putting a hardship on the HBS Providers and ACES$ Financial Management Services, the Fiscal intermediary for individuals that employ personal support workers in the participant-directed personal support program.

The Division has revised the Service Agreement form to help individuals and their families/representatives budget the services and supports needed.

The Division will develop service agreement training for Self-Directed Assistance (SDA) providers, waiver participants, employers of record and other representatives. More information about the training will be provided in the future.

Process:

The new service agreement should be used when new services are added or there is a change in the amount of services being authorized. In the event DHS/Division of Developmental Disabilities modifies any individual bill code rate, the participant's service agreement will have to be updated to accommodate the bill code rate as the HBS participant's monthly and annual allotment (available funding) will not change. The form must include a total of all services that are authorized. The maximum amount of services cannot exceed the monthly budget allotment for the Adult HBS program or the monthly and annual allotment for the Children's HBS program. Independent Service Coordination (ISC) agencies must receive a copy of the Service Agreement for monitoring purposes and will maintain a copy of all Service Agreements in their records for three years

All providers must receive a copy of the new service agreement within 5 business days from any changes. Changes in service agreements where the individual exercises employer authority are shared with the fiscal intermediary (ACES$) when services to be provided change. When the individual exercises employer authority, changes to services must be reflected in a new service agreement and shared with the fiscal intermediary (ACES$). The Employer of Record or the guardian will be responsible for distributing the form to the Independent Service Coordination (ISC) agency, each provider and ACES$ if participant-directed personal support services are being used. If the individual/family purchases Self-Directed Assistance, the family may request that the SDA provider distribute the new Service Agreement to all required entities.

The Independent Service Coordinator (ISC) is responsible for implementing the plan and monitoring its on-going implementation and effectiveness. If the ISC determines the service plan, including all services and service amounts identified in the Service Agreement, are not meeting the individual's assessed needs, the ISC shall work with the individual, family and guardian to ensure the plan is modified as necessary. If conflicts arise with providers over person centered plan issues, the Independent Service Coordinator (ISC) must assist with resolving such conflicts.

See the following link for Problem and Conflict Resolution: Addressing Issues, Solving Problems, Troubleshooting:

http://www.dhs.state.il.us/page.aspx?item=56643

If it is determined through the Problem and Conflict Resolution that a provider billed over the authorized amount, the Division will notify the provider that they must delete the unauthorized billing. In rare cases, if the ISC and Fiscal Employer Agency (ACES$) have determined and documented that an HBS participant and/or their family, guardian or employer and record are not able to satisfactorily direct the Home Based Services, with or without the help of a Self-Directed Assistant (SDA.), the Division may involuntarily terminate self-directed services. If this occurs, the HBS participant and family will be notified of the decision and will have the right to appeal the termination.

Please see links below for Guidelines and Instructions for completing the HBS Service Agreement:

Effective Date

This Information Bulletin is effective immediately once it is posted as final.