Long-Term Additional Staff Support Requests - Community Integrated Living Arrangements (CILA) and Developmental Training (DT)

Department of Human Services
Division of Developmental Disabilities

Information Bulletin
DD.14.037

Long-Term Additional Staff Support Requests - Community Integrated Living Arrangements (CILA) and Developmental Training (DT)
June 30, 2014

Purpose

This Information Bulletin will outline the requirements and process for a provider agency to request, be approved for, deliver, record, and report long-term additional staff supports (53R/53D) for individuals who receive Community Integrated Living Arrangement Program 60D-CILA or Developmental Training Programs 31A or 31U - DT services funded through the Division of Developmental Disabilities' (DDD) Medicaid Waiver services.

Process

Terminology

  • Additional Staff or Intensive Staff Support:  These terms are a general reference for additional staff supports regardless of initial, short term or long term need, or regardless of whether the individual's need is to address medical, behavioral, and physical issues.
  • Intensive Staff Support by direct care staff:  The term additional staff support or additional staff will be used in this Information Bulletin. The delivery of additional staff support by direct care staff is to be specified in the individual's service plan and behavior intervention plan.
  • Depending upon the needs of the individual, the delivery of additional staff support can range from actual contact by providing hand-over-hand guidance, within an arm's length, within line-of-sight, to observing from a distance and providing verbal cues.
  • Initial Additional Staff:  This term is specific to the individual's initial need, request and response (approval/denial) for additional staff supports. The term is used regardless of whether the individual's need is to address medical, behavioral or physical issues.
  • Long-Term Additional Staff:  This term is specific to an individual's need, request and response (approval/denial) to address a need for additional staff supports over an extended period of time. The term is used regardless of whether the individual's need is to address medical, behavioral or physical issues.

Process and Procedure

  1. Eligibility Criteria for Long-Term Additional Staff Support

    The DDD may award long-term additional staff supports to an eligible individual who is authorized for, enrolled in, and receiving services under the DDD's bill codes of 60D CILA or 31A or 31U DT services. Before a long-term additional staff support request can be considered, an initial additional staff support request should be submitted, processed, and approved by the DDD. If additional staff support is needed for multiple individuals within an agency, a separate request must be submitted for each individual. All applications for long-term additional staff supports must be filled out online or typed.

    A request for long-term additional staff supports can be considered when:

    • The individual may have a long-term exceptional and extraordinary medical, physical, and behavioral conditions or issues that require long-term additional staff supports for an extended period of time.
    • An initial additional staff support request has been submitted while the service provider is assessing the individual's needs to address a long-term exceptional and extraordinary medical and behavioral conditions or issues. See Information Bulletin - Initial Additional Staff Support Request.

    Medical issues could include, but are not limited to the following, long-term duration/chronic condition that is unlikely to improve:

    • End stage COPD
    • Hospice care
    • Diabetes requiring insulin use
    • Severe medical complications of diabetes
    • Dementia or Alzheimer's
    • Kidney failure requiring dialysis

    Required additional staff duties for medical issues could include and are limited to:

    • Monitoring a severe medical condition
    • Monitoring a person who requires sedation prior to and/or following medical appointments, treatments, and procedures
    • Interactions with outside medical personnel and professionals
    • Taking the individual to a high number of medical visits or treatments
    • Frequent or complicated medical treatments

    Physical issues could include, but are not limited to the following:

    • Individuals with hearing and vision impairment who communicate through sign and tactile language skills
    • Individuals with cerebral palsy and severe physical limitations who require hand-over-hand assistance
    • Individuals completely dependent on assistance with physical transfers, toileting/incontinence, bathing, feeding, and mobility

    Required additional staff duties for physical issues could include and are limited to:

    • Aid individual in communication program
    • Follow recommendations from physical therapists, occupational therapists, speech/language therapists
    • Perform daily self-care that individuals cannot complete
    • Ensure skin integrity through repositioning schedule for individuals unable to move themselves
    • Assist individual to maintain adequate nutrition and hydration for those dependent on staff for this duty

    Behavioral issues could include, but are not limited to the following:

    • Individuals with severe self-Injurious behavior (SIB) who need intense monitoring and interventions to prevent harm
    • Individuals with a history of inappropriate sexual incidents
    • Individuals with physical aggression who require immediate interventions to prevent harm
    • Individuals with chronic elopement
    • Individuals with PICA
    • Individuals who engage in significant property damage
    • Individuals who may become victimized because of their behavioral intrusions
    • Individuals who engage in activities or behaviors which place them or others in great danger (e.g., attempting to exit a moving vehicle, dangerous impulsive behavior such as elopement from a group while in the community)

    Required additional staff duties for behavioral issues could include and are limited to:

    • Implementation of appropriate behavior management interventions as set forth in individual's behavior intervention plan
    • Training of individual to utilize positive replacement behaviors in accordance with behavior intervention plan
    • Prevention of reinforcement of maladaptive behaviors by others who may not be adhering to current behavior intervention plan.
  2. When CILA and DT Additional Staff Support Funding Will Not Be Considered

    • For the reoccurrence of medical conditions and behavioral issues that are not recent and are of a strictly historical nature
    • When there is an absence of current clinical indication that the medical condition and behavioral issue is likely to reoccur
    • To supplement staffing levels funded by the DDD or scheduled by the service provider within the CILA or DT services for unspecified reasons or the general purpose of enriched staffing levels

    While it is understood that additional staff may work with the individual in such areas as keeping them engaged in activities of daily living and community integration, funding for additional staff will only be provided in those instances in which the additional staff support is needed due to the extraordinary medical, physical or behavioral needs of the individual.

  3. Provider Applications for Long-Term Additional Staff Supports

    All long-term additional staff support requests for extended durations are submitted to the appropriate Individual Service Coordination (ISC) Agency which will review and forward the request to the appropriate Region Facilitator or Bureau of Transitional Services (BTS) representative. The PAS/ISC/ISSA agency should complete their review and forward the request within five (5) business days.

    All requests for long-term additional staff supports must include:

    • Cover letter from the provider agency's Executive Director or designee
    • Additional Staff Support and One- or Two-Person CILA Request (IL462-4424). This form must be filled out online or typed.
    • Case Conference Summary (pdf) (IL462-4422). This form must be filled out online or typed.
    • A Behavioral or Medical Questionnaire with required relevant supporting documentation as specified on the questionnaire
    • The service provider will outline the expected duties and responsibilities for the additional staff with the greatest level of detail possible
    • A schedule of when the individual staff will be working. For some individuals the additional staff will be working when the situation calls for it, or when the person is behaving in a known cyclical fashion, or has significant problem behavior such as "I am going to run away tonight", the person is refusing to take their medications, etc.

    NOTE: It is very important for the service provider to delineate specific duties, responsibilities and time-of-day for additional staff supports.

    When long-term additional staff supports may be needed, it is the service provider's responsibility to promptly secure the services of professionals to assess the individual, make recommendations and develop program plans to address the individual's needs, participate in a case conference, and assist in preparing the long-term additional staff support request.

    1. Additional Staff Support and One- or Two-Person CILA Request(IL462-4424)

      • Identify the individual's name, Social Security number, and Medicaid RIN, Requesting Agency Name, Agency FEIN, and Agency ID number
      • Fill in the Date of the Request
      • Check whether the request is for 60D CILA or 31U DT
      • Check "Long-Term" or "Renewal" to indicate whether the request is for an Initial, Long-Term, or Renewal request
      • The CILA or DT provider will print, sign, date and provide an email contact address on the request before forwarding to the PAS/ISC/ISSA agency for review.
    2. Case Conference Process

      Prior to submitting a request for long-term additional staff supports, the individual's support team must convene a case conference, and the QIDP must complete the Case Conference Summary (pdf) (IL462-4422).  The case conference is convened by the QIDP from the provider making the request for long-term additional staff supports. The case conference is required for all long-term additional staff support request to address an individual's extreme medical, physical and behavioral needs.

      If convenient and appropriate, the case conference can occur at such time as the individual's service team is scheduled for the annual review.

      When the case conference members determine other recommendations, follow-up and/or referrals are necessary to provide adequate information, or assess the individual's need, then those recommendations, follow-up and referrals should be "in process" and completed prior to submitting a request for long-term additional staff supports.

      A request for long-term additional staff supports for severe behavioral issues require the submission of synthesized data showing the frequency and severity of the behavior within a minimum of the most recent two-month period prior to submitting the request for long-term additional staff supports.

      The QIDP is responsible for inviting the required participants as well as other key participants as determined necessary based on the individual's need. Participants may participate either in person or via conference call.

      If a required or key participant is absolutely unable to attend, he or she may submit verbal or written comments to the QIDP prior to the case conference. The QIDP will either distribute the written comments prior to the case conference or verbally report the comments during the case conference.

       The case conference is to be scheduled in advance of the initial hours of 53R/53D being exhausted. Ideally, the case conference is convened within the first 20-30 days of an initial award of 53R/53D.

      The QIDP is responsible for completing the Case Conference Summary (pdf) (IL462-4422) within two (2) business days following the case conference. Upon completion of the Case Conference Summary it is to be distributed (preferably electronically) to all participants. Participants have two (2) business days to provide any comments or corrections.

      The CILA and DT provider can apply to the DDD for additional staff supports for long-term exceptional or extraordinary medical, physical and behavioral issues by submitting either:

      • The Determination of Medical Needs Questionnaire with required current and relevant supporting documentation for medical or physical issues
      • The Determination of Behavioral Needs Questionnaire with required current and relevant supporting documentation for behavioral issues.
      • Both questionnaires require support documentation and synthesized summary data to be considered a complete request. Supporting documentation that is not current or relevant to the individual's current circumstances for requesting long-term additional staff supports should be excluded. The information submitted is to substantiate the individual's long-term exceptional and extraordinary medical, physical or behavioral need.

      When submitting a review/renewal long-term additional staff support request, the supporting documentation must be relevant to the time between the previous award for additional staff supports and submitting the current request

    3. Case Conference Participants

      Any request for long-term additional staff supports requires a case conference consisting of the individual's service team. The service team is required to consist of the following participants:

      • The individual served (as appropriate)
      • The Individual's Guardian (if applicable)
      • Family Member (Authorized by Individual or Guardian)
      • The Individual's QIDP with the Provider Agency
      • Provider Agency Management Representative
      • PAS/ISC/ISSA Representative
      • DDD Representative (See Note below)
      • CART and/or SST if involved
      • Other Provider Agency Staff
      • Behavior Analyst
      • Therapists
      • Medical Professionals

      NOTE: The participation of a DDD representative during a case conference in no way obligates, commits, or otherwise binds the DDD fund a request or recommendation made by the individual's team.

    4. Components of the Case Conference Summary

      • Name and SSN of the individual needing additional staff supports
      • Agency Name, FEIN and Agency ID Number requesting staff supports
      • Specify whether the request is for 60D CILA and/or 31U Developmental Training
      • Date of Case Conference
      • List of the participants including name, title and whether the person participated in person, electronically (phone or video), or provided written comments.If the individual is excluded from the case conference, the QIDP is required to explain why the individual was excluded
      • Statement of Need - A brief explanation of the individual's critical medical, physical, and behavioral needs.  Include data documenting the frequency, duration, and intensity of these needs for the two months prior to submission.
      • Summary of Current Status -A statement of strategies currently in use, individual's response to strategies, data, and projected challenges

      Summary of Team discussion & recommendations:

      • Statement of whether to continue or modify current strategies to resolve the individual's issues;
      • Statement of the development or modification of a positive behavior support plan;
      • Statement as to need for referral and/or follow up with other professionals such as medical, psychiatric, tests or evaluations;
      • Statement as to need for referral to CART and/or SST. Include copy of CART and/or SST referral when referrals have been made;
      • Statement on the continued need of additional staff supports;
      • Follow up steps or person responsible: List any follow up actions recommended by the team; the name of the person responsible; time frame for completion; and if completion is required prior to submitting a request for additional staff supports;
      • Signature and Distribution Date by the Provider Agency QIDP
    5. Synthesized Summary Data

      Provide a summary of data that has been synthesized to concisely outline the individual's need for additional staff support. The data should be in summary format with key descriptors. The use of tables with analyzed data, graphs or charts may be beneficial. When possible, provide three (3) months of data when submitting a long-term additional staff support request for the first time. A minimum of two (2) months of data is required when submitting the long-term additional staff support request for the first time. A Renewal/Review of a long-term additional staff support request requires synthesized summary data from the time period between the previous award and when the Renewal/Review Request is being submitted.

      The data summary should not to exceed three pages and should address the following:

      • Targeted Behaviors:  Specifically define each behavior being addressed in support of the request for additional staff supports;
      • Antecedents:  Specify any known or suspected triggers that precede or cause the behavior; activities or events taking place immediately prior to the behavior; interactions with other people (clients and staff) immediately prior to the behavior; any verbalization, body movement, emotion, reaction, ritual, etc. by the individual prior to the behavior;
      • Frequency of behavior:  Identify the number of attempts to engage in the behavior or activity that are successful and the number of attempts to engage in the behavior or activity that are not successful due to staff intervention;
      • Severity of behavior: causes injury to self or others; requires medical intervention; requires police intervention; requires psychiatric hospitalization; high risk (safety) outcomes; property damage.
      • Additional impact on others from the behavior:  emotional distress; restriction of rights; safety risks; impact on house mates, community members or neighbors.

      Synthesized summary data includes compiling, tracking, analyzing, trending, graphing and/or analyzing the data contained in incident reports, daily reports, goal reporting, behavior tracking, case notes, etc. Synthesized summary data is to be summarized in a concise written narrative. Synthesized summary data can be presented in a graphic display such as a line graph, bar chart, and summary tally tables. Some examples of synthesized summary data can be found at: www.dhs.state.il.us/page.aspx?item=XYZ.  IP ADDRESS IS ONLY A PLACE SAVER - Requires Item Number to be added when posted.

  4. Evaluation of Long-Term Additional Staff Support Requests 

    The DDD shall evaluate all requests for long-term additional staff supports and respond with a written award or denial letter to the requesting CILA or DT service provider within 15 business days from the date of receipt of a complete and properly submitted request.

    A request submitted with unsynthesized data consisting of copied incident reports, daily reports, goal reporting, behavior tracking, case notes, etc., will not be accepted and will result in the request being returned as incomplete. Please see examples of synthesized data above. Requests submitted with data and documentation that is not current to the most recent time period after the last award will also be returned as incomplete.

    At the discretion of the Region Facilitator or Bureau of Transition Services (BTS) Representative, if the missing or incomplete information appears to be minor and easily corrected, the facilitator or representative may request, via email to the service provider, the missing information. An email notification for missing information must include a deadline for receiving the requested information. If not received by the specified date on the email, the additional staff support request will be returned as incomplete. Once the required information is obtained, the requesting CILA or DT service provider may re-submit the request to the Region Facilitator or BTS Representative.

    The DDD's review of a request for long-term additional staff supports in a CILA or DT setting will include the following in the request:

    • Exceptional or extraordinary medical, physical, and behavioral needs that give rise to the request
    • Synthesized summary data on the exceptional or extraordinary maladaptive behaviors (documenting frequency and severity of exceptional needs) Projected continuation of the individual's exceptional or extraordinary medical, physical or behavioral needs
    • Relevant assessments, evaluations, reports, test results, and recommendations by professional staff and consultants, including psychiatrists, psychologists, medical professionals, therapists, behavior analysts, counselors in Clinical and Administrative Review Team (CART) and Service Support Team (SST)
    • Interventions and programming previously implemented by the service provider to address the individual's exceptional or extraordinary needs
    • The individual's response to programming previously implemented by the service provider to address the exceptional or extraordinary needs
    • The requesting agency's willingness, ability and efforts to implement recommendations by professional staff, consultants, CART and SST
    • Duties and responsibilities assigned to the CILA or DT additional staff support person
    • Time-of-day the additional staff support person will be required to provide additional support services

    When reviewing a request for long-term additional staff supports, the DDD will evaluate the service provider's delineation of specific duties, responsibilities and time-of-day for additional staff supports and assess the DSP's duties and responsibilities.

    The DDD will not credit additional staff support duties, responsibilities and time-of-day when calculating the award of additional 53R/53D long-term staff support hours when that do not specify hen the tasks are repetitive or of short duration. For example, an individual who requires toileting or changing should have a frequency specified such as every two hours, four times per day, etc.

    The DDD may recommend and may require the local CART and SST become a part of the individual's team as a part of or condition of any response to a request for long-term additional staff supports.

  5. Calculation and Award of Long-Term Additional Staff Support 

    The DDD will issue an initial award for staff supports of up to 750 hours for 53R and 53D up to 230 hours. The DDD will not be responsible for backdating effective dates or a lapse in funding while a request is being processed, the request is incomplete or while waiting for missing or incomplete information to be provided.

    When processing a complete request for long-term additional staff supports, the DDD may consider an award of an incremental amount of 53R and 53D hours to cover the time from the expiration of a previous additional staff support request, and before a final decision is rendered on the current request for long-term additional staff supports. This option is not available when an incomplete request is submitted, or when the DDD is waiting on a service provider to respond to a request for clarified, additional or revised data and information.

    The DDD no longer incorporates additional staff support hours into an individual's CILA 60D or DT 31A/31U rate. Individuals whose CILA or DT additional staff support hours have previously been included in their 60D or 31A/31U rate will have those additional staff support hours switched to the Purchase-of-Service 53R/53D authorization and billing process. A review date will be established by the DDD at the time the additional staff support hours are switched.

    It will be the service provider's responsibility to complete and submit a renewal/review long-term staff support request to the appropriate ISSA agency which will then forward the request to the Region Facilitator or BTS representative to continue additional staff supports after the scheduled review date.

    The DDD will calculate long-term additional staff supports by evaluating approved additional staff support hours as requested and detailed by the service provider. Approved additional staff support hours as determined by the DDD will be the person's total long-term additional staff support need.

    When a long-term additional staff support request involves more than one person at a CILA site, or specific staffing levels are needed at a CILA site to meet the extraordinary medical, physical or behavioral needs of the individuals living at the site, the DDD may calculate long-term  staff supports via a Matrix analysis for the CILA site. A Matrix analysis requires the CILA provider to include a staff schedule for the CILA site documenting the total number of staff (including additional staff) typically assigned to the site to meet the needs of the individual's living at the CILA site.

    If additional staff supports are warranted for staffing levels at a CILA using a Matrix analysis, the award of additional staff support hours will be issued via additional staff supports added to, and included in, the individual's CILA funding. The service provider will be held responsible for always staffing the CILA site at the specified staffing levels.

    Almost all individuals in CILA already have available individual staff support hours funded in their CILA rate as determined by the CILA Model. The CILA Model currently calculates a variable number of individual staff support hours depending upon the individual's ICAP score. The number of individual staff support hours funded for each individual by the CILA Model can be found on each person's CILA Rate Sheet in the left hand column under "Model Funded Individual DSP Supports." The individual's "individual" DSP staff hours as determined by the CILA Model and funded by the DDD are above the base staff level for the CILA site.

    After evaluating the request for long-term additional staff supports, if the approved individual staff support hours exceed the individual staff supports already funded through the CILA Model the additional staff support hours will be awarded through the 53R bill code process.

    Additional staff support hours will only be awarded when the approved individual staff support hours exceed the individual staff supports funded through the CILA Model. Approved additional staff support hours determined to be at or below the individual staff supports funded through the CILA Model will be considered already funded.

    Example: An individual is determined by the DDD to need 600 individual support staff hours based on the long-term additional staff support request submitted. The person lives in a four-person CILA with an ICAP of 36. The CILA Model calculates 2,597 DSP staff hours for Prime, Non-Prime, and Night Shift staff as this person's CILA funding. This person's portion of base staff coverage is 1,733 DSP hours. This leaves 864 DSP hours (2,597 - 1,733 = 864) available as individual staff supports already funded through the CILA Model rate. In this example the CILA Model funding shows the additional support staff needs of this person are already funded by the CILA Model and no additional billable staff supports would be awarded.

    The maximum award for all additional staff supports for an individual in 31A/31U DT services cannot exceed 1,200 hours in any state fiscal year.  This maximum is funded by the DDD as Rule 119 stipulates the required minimum operation for a developmental training provider is 240 days and a mimum of 5 hours per day.

    Individuals who are authorized for 31U DT services as a part of their Home-Based Support Services (HBS) must document in their HBS service and financial plans for the utilization of 53D supports prior to the DDD awarding 53D staff supports or a service provider delivering and billing 53D supports.

    When approved by the DDD, long-term additional staff support hours will be:

    • Awarded through the 53R/53D bill code process
    • Approval for long-term additional staff (53R/53D) hours will be set to cover a minimum or maximum period of time. The minimum time is six months and the maximum is one calendar year
    • When the expiration date crosses the state fiscal year the award will be authorized in two (2) amounts. One increment will cover the period of time of the award to the end of the current state fiscal year. The second increment will cover the time period beginning at the start of the state fiscal year until the expiration or end date of the additional staff supports. Second increments of approved additional staff supports will be authorized at the beginning of the following state fiscal year from which it was awarded
    • The DDD will not award additional CILA or DT long-term additional staff support hours if the service provider uses or bills the approved 53R/53D hours before the specified time period expires.
    • The DDD shall review and potentially adjust a current award for additional staff supports when an individual has a sudden change in their medical or physical status or shows spikes or increased maladaptive behaviors and who may need additional long-term staff support hours awarded. It is the service provider's responsibility to initiate a reevaluation of the individual's medical, physical or behavioral needs in a timely manner when such a change occurs.
  6. Delivery of All Additional Staff Supports

    Upon approval by the DDD of long-term additional staff support, the service provider will be responsible to ensure documentation is recorded to verify the provision of additional staff support services.  When authorized, long-term additional staff supports:

    • Must be provided by a staff person who is specifically assigned to and trained on the individual's service and behavior plan;
    • The manner in which additional staff supports are to be delivered must be specified in the individual's service and behavior plan, such as hand-over-hand guidance, within arm's length, within line-of-sight, within a certain proximity to the individual, etc.;
    • The assigned additional staff person should not have or perform other duties or responsibilities above or beyond the individual for any time which is to be billed for additional supports;
    • The assigned additional staff person must document the completion of assigned additional staff duties and responsibilities in the individual's record for any amount of time that 53R/53D is billed for additional supports. The method of documentation should be as simple as possible such as counting the frequency of a behavior or summarizing the individual's activities in the case notes at the end of a shift
  7. Service Reporting and Billing of All Additional Staff Supports

    Billing for CILA (60D) and/or Developmental Training (31U or 31A) additional staff support hours are entered in ROCS only after the 53R/53D service has been provided to the individual.

    Providers billing for 53R/D hours must maintain an auditable record of the additional staff assigned to an individual who delivered the staff support services.

    The service provider will be responsible to ensure documentation to verify the provision of additional staff support services. The DDD and others may evaluate additional staff supports through, but not limited to, the following:

    • Individual progress notes
    • Staff schedules
    • Agency payroll records
    • Follow-up reports from professionals, consultants, ISSA, CART, and SST

    The maximum billing for 53R is 24 hours for any given day the person is not attending a day program or participating in an "At-Home" day services such as a Saturday, Sunday or a holiday.  The maximum billing for 53D is 5 hours for any day the person attends a certified DT site which qualifies for 31A or 31U billing.  The annual maximum for 53D as funded by the DDD is 1,200 hours annually and five (5) hours per day being the minimum number of hours of operation.  Some DT providers operate longer hours, but the DDD does not fund additional staff supports for longer hours of operation.

    Service providers found inappropriately billing 53R/53D will result in the DDD recovering payments for undocumented Additional Staff Support hours and may also be sanctioned by the DDD. Sanctions may range from prohibited future billing of 53R/53D to revocation of the service provider's CILA license, DT certification, and contract with the Department of Human Services.

    1. CILA Additional Staff Supports (53R) 

      The individual must be reported as "P" for present in CILA to be able to bill for 53R hours. If 53R is billed on a bed hold or day absent in 60D CILA, it will result in the 53R billing being rejected or recouped.

      • If additional support staff is required around-the-clock, or all hours, then the maximum 53R hours that may be billed is 19 hours (Monday - Friday) and 24 hours Saturday, Sunday, or holidays when the individual would NOT be participating in any type of day program.
      • If additional support staff is required for "awake" hours in a CILA, then the maximum 53R hours that may be billed is 11 hours (Monday - Friday) and 16 hours Saturday, Sunday, or holidays when the individual would not be participating in any type of day program
    2. DT Additional Staff Supports (53D)

      The maximum 53D hours that may be billed daily for an individual in a developmental training program is five (5) hours. The provider must have reported 31A or 31U hours in DT during their first 220 days of operation to be able to bill for 53D hours. Billed 53D hours cannot exceed the lowest of either five (5) hours or the billed 31A/31U hours for any day during the provider's first 220 days of operation in a state fiscal year. Billed 53D hours that are greater than the reported 31A/31U hours during the provider's first 220 days of operation will result in the 53D to be rejected or recouped.  The DT provider may only bill for 53D without corresponding 31U or 31A hours after 220 days of operation during any state fiscal year. Billable additional staff supports (53D) are not awarded for or are to be billed when the individual is attending any other day program other than 31U or 31A.

      A service provider delivering and/or billing 53D supports for an individual who is authorized for 31U DT services as a part of their Home-Based Support Services (HBS) must not bill more 53D staff supports than are documented in the individual's HBS service and financial plans.

  8. Monitoring of all Additional Staff Supports 

    The DDD and/or PAS/ISC/ISSA may review initial and/or long term additional staff support through, but not limited to, the following:

    • Direct observation of the individual and additional staff
    • Individual progress notes
    • Staff schedules
    • Agency payroll records (DDD Only)
    • Follow-up reports from professionals, consultants, ISSA, CART, and SST

    The DDD and/or PAS/ISC/ISSA agency may conduct random, unannounced on-site visits to provide an objective oversight, provide feed-back guidance and monitor:

    • Delivery of approved additional staff support for the individual
    • Individual's response to and continued need for additional staff supports
    • Effectiveness of additional staff supports in preventing, controlling or deflecting incidents.

    In the event the PAS/ISC/ISSA agency has any concerns associated with the implementation of the additional staff support, they will follow the protocol laid out in "Problem and Conflict Resolution: Addressing Issues, Solving Problems, Troubleshooting" an attachment to Information Bulletin DD.11.010 - "ISSA Guidelines: Problem and Conflict Resolution."

    The DDD shall systemically evaluate billing of 53R/53D. The evaluation of 53R/53D billing could require service providers to supply documentation of the provision of CILA or DT additional staff support services.

    Service providers found inappropriately billing 53R/53D will result in the DDD recovering payments for undocumented additional staff support hours and may also be sanctioned by the DDD. Sanctions may range from prohibited future billing of 53R/53D to revocation of the service provider's CILA license, DT certification, and/or contract with the Department of Human Services.

  9. Expiration and Renewal of Long-Term Additional Staff Supports 

    The award of additional staff support is limited to the number of billable hours as specified on the 53R and/or 53D award, or as specified on the individual's CILA rate sheet.

    All 53R and/or 53D awards issued prior to July 1, 2013 and additional staff support hours of 53R and/or 53D awarded during state FY14 will expire at the end of the state's fiscal year, June 30, 2014. Awards for 53R and/or 53D issued during FY14 will be a cumulative and will total previously awarded 53R/53D hours in addition to any hours awarded during FY14.

    Beginning in FY15 (July 1, 2014), when this IB is disseminated, all awards for 53R and/or 53D will stipulate the number of 53R and/or 53D hours awarded for the state fiscal year in which it is awarded.  Any remaining 53R/53D hours will expire at the end of the state fiscal year in which they are awarded. Unbilled 53R/53D hours will NOT carry-over to a subsequent state fiscal year.

    When 53R/53D is awarded for a period of time that crosses from one fiscal year to another it will be divided into appropriate portions to cover each time period for each fiscal year. For example, an individual awarded 1,000 hours of 53R to cover a one year period of additional staff supports beginning on April 1 will receive 250 hours (April through June) in the current fiscal year and will receive 750 hours (July through March) at the beginning of the next fiscal year. In this example the end of the additional staff support award period is March of the following calendar year.

    Before the end of any additional staff support award period, if the service provider believes the individual continues to require additional staff supports it is incumbent upon the service provider to submit the appropriate request to the appropriate PAS/ISC/ISSA agency who will forward to the request to their Region Facilitator or BTS Representative. It is strongly recommended the service provider have their completed renewal request submitted to the PAS/ISC/ISSA agency at least 60 days prior to the end of the award period.

    1. Renewal Process

      The renewal of long-term additional staff supports shall include current data, documentation, and assessments to support the request including the current ISP and BIP.

      A case conference must be convened prior to requesting a renewal of long-term additional staff supports.  If convenient and appropriate, the case conference can occur at such time as the individual's service team is scheduled for the annual review. The request shall consist of the following:

      • Cover letter from the provider agency's Executive Director or designee
      • Additional Staff Request and One- or Two-Person CILA Request (pdf) (IL462-4424). This form must be filled out online or typed
      • Case Conference Summary (pdf) (IL462-4422). This form must be filled out online or typed.
      • Synthesized summary data covering the current time period for which additional staff supports were previously awarded ONLY if updated or modified since originally submitted:
        • Individual Service Plan
        • Behavior Plan
        • Fading Plan

      Individuals whose additional staff support hours are included in their 60D or 31A/31U rate will have those additional staff support hours transition to the Purchase-of-Service 53R/53D authorization and billing if additional staff supports are renewed beyond the specified expiration date.

      The DDD will only notify CILA and DT providers of the change and effective date the change occurs with the initial switch from additional staff supports included in an individual's rate to the 53R/53D bill process. An expiration date for the additional staff supports will also be established at the time the additional staff support hours are switched to the 53R/53D bill process.

      It will be the service provider's responsibility to complete and submit a renewal/review long-term additional staff support request to the appropriate ISSA agency to continue additional staff supports before a scheduled expiration date.

      The DDD will not award additional staff support hours if the service provider uses and/or bills the approved 53R/53D hours before the scheduled time period expires. As stated before, it is the service provider's responsibility to initiate a reevaluation of the individual's medical, physical and/or behavioral needs in a timely manner when a change occurs before the scheduled expiration of any additional staff support.