Billing Guidance By Service Type

• Participating in service plan development and monitoring
• Visiting individuals, including travel time
• Completing and filing required documents, such as the annual redetermination of Waiver Eligibility and visiting notes
• Telephone calls on behalf of the individual

• Time spent assessing or determining initial eligibility of an individual for waiver services
• Required follow-up visits during the first 30 days after service initiation
• Time spent providing a service to an individual or family after the individual is no longer receiving the direct waiver service
• QMRP training time or other general activities that are not for the direct benefit of the waiver participant
• Time spent entering billing in ROCS

• Bill daily for every date the individual is present and receiving services in the residential site for at least part of the date (the date is considered to be from midnight to midnight). Use the code: P - present
• Bill daily for intermittent and family CILA services, this also includes dates when only on-call availability of services was provided. Use the code: P - present
• Bill Bedhold Days using the following bedhold codes:
  • F - vacation or family/home visits
  • H - hospitalization
  • C - convalescent care
  • S - State-operated facility stays
  • I - incarceration

• Bill daily for intermittent and family CILA services, this also includes dates when only on-call availability of services was provided. Use the code: P - present
• Bill Bedhold Days using the following bedhold codes:
• F - vacation or family/home visits
• H - hospitalization
• C - convalescent care
• S - State-operated facility stays
• I - incarceration

• Bill daily for intermittent and family CILA services, this also includes dates when only on-call availability of services was provided. Use the code: P - present
• Bill Bedhold Days using the following bedhold codes:
• F - vacation or family/home visits
• H - hospitalization
• C - convalescent care
• S - State-operated facility stays
• I - incarceration

• Bill daily for intermittent and family CILA services, this also includes dates when only on-call availability of services was provided. Use the code: P - present
• Bill Bedhold Days using the following bedhold codes:
• F - vacation or family/home visits
• H - hospitalization
• C - convalescent care
• S - State-operated facility stays
• I - incarceration

• The State designed day program rates to include an absentee factor to pay for a full State Fiscal Year of participation in the first 1,100 hours of billing. An individual may be absent 20 of the expected 240 days without reduction in annual payment amount.
• Only hours when the individual is participating actively in day program activities are billable.

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• Paid supported employment bills will automatically be counted toward the Grant-in Aid Program (390 Program Code) for variance purposes. Billing these fee-for-service program codes and also service reports to program 390 for the same service time is not necessary.
• When Supported Employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities.

Does not include payment for the supervisory activities rendered as a normal part of the business setting.

Examples of time that are not billable include:

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• Paid supported employment bills will automatically be counted toward the Grant-in Aid Program (390 Program Code) for variance purposes. Billing these fee-for-service program codes and also service reports to program 390 for the same service time is not necessary.
• When Supported Employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities.

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• Paid supported employment bills will automatically be counted toward the Grant-in Aid Program (390 Program Code) for variance purposes. Billing these fee-for-service program codes and also service reports to program 390 for the same service time is not necessary.
• When Supported Employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities. 

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• Paid supported employment bills will automatically be counted toward the Grant-in Aid Program (390 Program Code) for variance purposes. Billing these fee-for-service program codes and also service reports to program 390 for the same service time is not necessary.
• When Supported Employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities. 

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• The State designed day program rates to include an absentee factor to pay for a full State Fiscal Year of participation in the first 1,100 hours of billing. An individual may be absent 20 of the expected 240 days without reduction in annual payment amount.
• Only hours when the individual is participating actively in day program activities are billable.

Hours billed may not also be billed to the Department of Aging or the Division of Rehabilitation Services Home Services Program.

Examples of time that are not billable include:

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• The State designed day program rates to include an absentee factor to pay for a full State Fiscal Year of participation in the first 1,100 hours of billing. An individual may be absent 20 of the expected 240 days without reduction in annual payment amount.
• Only hours when the individual is participating actively in day program activities are billable.

Hours billed may not also be billed to the Department of Aging or the Division of Rehabilitation Services Home Services Program.

Examples of time that are not billable include:

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• The State designed day program rates to include an absentee factor to pay for a full State Fiscal Year of participation in the first 1,100 hours of billing. An individual may be absent 20 of the expected 240 days without reduction in annual payment amount.
• Only hours when the individual is participating actively in day program activities are billable.

• Holidays and weekends when the program is closed.
• Time beyond regularly scheduled program hours for special events, such as extended field trips, overnight outings, etc.
• Transportation time, unless the individual's service plan indicates a need for transportation training and the training is being provided.
• Time between arrival and the start of active programming.
• Time after the end of active programming while waiting for transportation.
• Lunchtime, unless the individual's service plan indicates a need for active programming during lunch and the training is being provided.
• Time spent receiving therapy services. Day program hours may not be billed when an individual is receiving direct professional behavior services or other non-day program services.

• For HBS, Behavior Intervention and Treatment is included in the participant's monthly cost limit/individual budget
• Adult Waiver: State fiscal year maximum of 66 hours (including adult HBS).
• Children's Support Waiver (Children's HBS): No fiscal year service maximum.
• Children's Residential Waiver: State fiscal year maximum of 66 hours.

Hours and minutes rounded to the nearest 15 minutes. There are two levels:

Level 1: Licensed clinical psychologists and certified behavior analysts

Level 2: All other qualified providers

• Services that directly benefit the individual, that are within the statewide maximums and the agreed hours in the HBS Service Agreement, if applicable, and that the therapist delivered and documented.
• Indirect services such as writing recommendations, planning and consultations with school personnel are permitted.

• No direct services may be delivered under the Waiver during the typical school day relative to the age of the participant or during times when educational services are being provided.
• Planning for school services and training for school staff may not be included.
• Behavior service hours may not be billed during day program hours, unless the professional is observing the behaviors in the natural environment while the individual is participating as usual in the day program.

Time billed may not also be billed to the Division of Mental Health Community Mental Health Medicaid Rehabilitation Option or Clinic Option (MRO/MCO).

Behavior service hours may not be billed during day program hours, unless the professional is observing the behaviors in the natural environment while the individual is participating as usual in the day program.

• Time billed may not also be billed to the Division of Mental Health Community Mental Health Medicaid Rehabilitation Option or Clinic Option (MRO/MCO).
• Behavior service hours may not be billed during day program hours, unless the professional is observing the behaviors in the natural environment while the individual is participating as usual in the day program.

• Time billed may not also be billed to the Division of Mental Health Community Mental Health Medicaid Rehabilitation Option or Clinic Option (MRO/MCO).
• Behavior service hours may not be billed during day program hours, unless the professional is observing the behaviors in the natural environment while the individual is participating as usual in the day program.

• Time billed may not also be billed to the Division of Mental Health Community Mental Health Medicaid Rehabilitation Option or Clinic Option (MRO/MCO).
• Behavior service hours may not be billed during day program hours, unless the professional is observing the behaviors in the natural environment while the individual is participating as usual in the day program.

• The therapist may bill for time spent working directly with the individual or, for occupational and physical therapy, the time a certified/licensed assistant under his or her direct supervision spends working directly with the individual in accordance with the individual service plan. Direct supervision means that the therapist is accessible at all times while the assistant is treating individuals. It also means that the therapist does on-site supervision every four to six sessions to assess progress and revise the treatments as needed.
• Time spent with the individual demonstrating specific interventions to be used by family, direct support and other workers to ensure they will be done properly and frequently enough to be effective.
• Participation in development of the individual service plan.

• Time spent by the therapist supervising assistants.
• Time spent in general staff training
• Evaluations, including evaluations for equipment or fittings, may not be billed to the Division of DD. They must be billed to the Department of Healthcare and Family Services Medicaid State Plan instead.
• Transportation time.
• Time when the individual is receiving therapy services is not billable as day program services.
• Time billed to the Department of Healthcare and Family Services for the service.

• For Home-Based Support Services (HBS), this service is not included in the participant's monthly cost limit/individual budget.
• For all three waivers, a $15,000 maximum per individual per five-year period applies for any combination of adaptive equipment, assistive technology, home modifications and vehicle modifications, as applicable.

• For Home-Based Support Services (HBS), this service is not included in the participant's monthly cost limit/individual budget.
• For all three waivers, a $15,000 maximum per individual per five-year period applies for any combination of adaptive equipment, assistive technology, home modifications and vehicle modifications, as applicable.

• For all three waivers, a $15,000 maximum per individual per five-year period applies for any combination of adaptive equipment, assistive technology, home modifications and vehicle modifications, as applicable.
• Within the five-year maximum, there is also a $5,000 maximum per address for permanent home modifications for rented homes.

• On-site visits
• Face-to-face time
• Service planning & monitoring time
• Provider recruitment
• Enrollment & orientation to the program
• Paperwork & telephone contacts
• Counseling/Training time with the individual, family or informal supports upon request
• Travel time (excluding commuting)
• Advocacy regarding individual's benefits & services (i.e., Medicaid)

• Commute time (to and from worker's home)
• QSP training (training is reimbursed separately)
• General activities (agency reviews not for direct benefit of specific HBS participant, time spent by other agency staff on billing, payroll, etc.)

• Face-to-face time
• Time for participation in ISP meeting
• Time for writing progress notes
• Time for consulting with HBS Service Facilitator

• Time when participant is not present
• Commute time (travel to and from worker's home)

The service planning team, lead by the participant and Service Facilitator, negotiates mutually acceptable rates for this service. The HBS Service Facilitator Agreement form specifies authorized hourly rate and maximum monthly units of service.

For Personal Support Workers hired directly by participant or representative (domestic employees), wages earned are considered taxable income.  Payroll is issued by a Fiscal/Employer Agent (F/EA).  Payment authorization is sent by HBS Service Facilitator to F/EA based on the ISP.  Payment may not be made for certain legally responsible relatives for children.  See Section VII for requirements and restrictions on certain relatives.  http://intranet.dhs/onenet/page.aspx?item=52738

• Face-to-face time
• Participation in ISP Meeting
• Writing Progress Notes
• Time consulting with HBS Service Facilitator about participant

• Time when participant is not present
• Travel time (commute to and from worker's home)

The service planning team, lead by the participant and Service Facilitator, negotiates mutually acceptable rates for this service. The HBS Service Facilitator Agreement form specifies authorized hourly rate and maximum monthly units of service.

For Personal Support Workers hired directly by participant or representative (domestic employees), wages earned are considered taxable income.  Payroll is issued by a Fiscal/Employer Agent (F/EA).  Payment authorization is sent by HBS Service Facilitator to F/EA based on the ISP.  Payment may not be made for certain legally responsible relatives for children.  See Section VII for requirements and restrictions on certain relatives.  http://intranet.dhs/onenet/page.aspx?item=52738

• Face-to-face with HBS participant
• Time spent participating in ISP meeting
• Time spent writing progress notes
• Time spent consulting with HBS Service Facilitator

• Time when participant is not present
• Travel time (commute to and from worker's home)

55W

Level 1: Installation

Level 2: Monthly monitoring Charge

Level 1:  One-time charged billed as Event mode

Level 2: Monthly charge billed as Event mode

• directly benefit the individual
• are within statewide maximums (if applicable)
• within agreed hours in HBS Service Agreement and ISP
• time therapist delivered counseling service, with documentation to support hours being billed