Illinois Department of Human Services
Division of Developmental Disabilities
The Centers for Medicare and Medicaid Services (CMS) approved Illinois' request to amend the 1915(c) Home and Community-Based Services (HCBS) waivers with the Emergency Preparedness and Response Appendix K in order to respond to the COVID-19 pandemic, effective August 31, 2020. This IB is intended to provide guidance regarding this new waiver service, Virtual Day Services (VDS), approved through this Appendix K Amendment. The VDS option is tied to the Appendix K and will expire upon Appendix K expiration. The Division of Developmental Disabilities (DDD) will be using this opportunity to evaluate the viability of making this a permanent waiver service.
Previously, the DDD Adult Waiver did not offer virtual services to provide habilitative services for individuals with I/DD. Due to the current COVID-19 pandemic, the DDD had the opportunity to request and develop this new waiver service through the State's Appendix K submission.
The DDD has developed a VDS User Guide (pdf). Providers should view the VDS User Guide prior to implementing VDS.
Virtual Day Services (VDS), which is Program Code 31V, assists with the acquisition, retention, or improvement in self-help, socialization and adaptive skills. It also assists to mitigate the risks individuals may experience from social isolation which include loneliness, skill atrophy, memory decline, personal hygiene deterioration and physical/mental health deterioration. VDS programming must be person-centered and take into consideration the individual's personal interests and needs.
VDS can only be provided by a CURRENT Community Day Services (CDS) provider certified by the Bureau of Accreditation, Licensure and Certification (BALC). Virtual supports may take place in an individual's private residence, a residential setting owned, operated or controlled by a provider agency, or any other setting where the individual is able to connect virtually with an electronic device and participate in the programming.
An individual may receive up to 45 hours per month and 520 hours per year, on a special ad hoc basis, or as specified in the individual's person-centered plan. A "virtual support" takes place over video between a VDS staff member and an individual(s). VDS can be provided to no more than 10 individuals per activity unless the programming is enhanced by additional people. Examples of situations where more than 10 participants might be appropriate include exercise classes where interpersonal communication is not involved or gameplay sessions where "teams" of individuals are playing against one another. As a general rule, if the session envisions or requires direct communication between participants and the leader, no more than 10 individuals are allowed.
The following are examples of VDS Programming:
- Activities related to the development of hobbies or leisure/cultural interests or to promote personal health and wellness (e.g. yoga class, meditation group, etc.)
- Activities related to training and education for self-determination and self-advocacy
- Activities that encourage interaction among individuals who do not reside together
- Activities that encourage discussion of current events
- Activities that encourage exploration of the individual's community
- VDS providers, regardless of their location, use video to provide VDS services. The individual must be located where they are able to effectively participate in the scheduled activities with as few distractions as possible.
- If needed, VDS providers should develop audio options or include closed captioning with video to accommodate individuals whose disabilities impair their ability to participate by video alone, such as individuals with vision or hearing-impairments.
- VDS must be an interactive and/or active learning environment.
- Use of video-teleconference software can include Microsoft's Skype, Adobe's Connect, Google's Hangout or Classroom, WebEx, Go-to-Meeting, Zoom, etc.
- The individual and VDS provider must have the hardware (computer, tablet or cell phone with video capability with speakers and microphone or headset, etc.) and video-teleconference software required for the communication to be two-way and real-time.
- A VDS facilitator must always be present during active programming.
- A guest speaker is authorized as long as a VDS facilitator is present and leading/moderating the program.
Process to request VDS
- Virtual Day Services is available to DDD Adult Waiver participants who reside in waiver funded Community Living Facilities (CLF 16 bed or under), CILAs, receive Home Based Supports, or are Day Program Only.
- If an individual would like to attend VDS, the ISC will work with the individual to edit their Personal Plan.
- The individual (family and/or provider if applicable) must work with the ISC to gather required documentation and complete the request for Prior Approval. See Section VIII, Service Authorization and Prior Approval of the Waiver Manual for prior approval requirements.
- The ISC will submit the Prior Approval request to the Division using form: "Alternative Day Program Request (pdf)" Form (IL462-0285).
- The Division will approve the request and issue a Change Letter and new rate sheet.
- The VDS provider completes a provider signature page of the Personal Plan to reflect the new service. Additionally, the provider will develop or update the Implementation Strategy.
- For Home Based Services (HBS) participants, the individual, Self-Directed Assistants (SDA) and/or Employer of Record (EOR) will need to update their Service Authorizations to include VDS and ensure all services can be provided within their monthly budget.
- For those individuals utilizing both At-Home Day Program (37U) and VDS (31V), there must be acknowledgement from both the VDS and 37U provider that there will be sharing of the 1100 hours.
- The VDS provider should only bill those hours that are provided as defined above.
- VDS has a monthly maximum of 45 hours per month and an annual maximum of 520 hours per fiscal year.
- State fiscal year maximum of 1,100 hours for any combination of day programs. Monthly maximum is 115 hours for any combination of day programs.
- Individuals receiving 31V are not authorized to additionally receive Temporary Intensive Staffing - Day Program (53D).
- Billing for this service can only happen while the individual is actively participating in the VDS activity.
- Examples of time that are not billable include:
- Anytime when the service is not being provided.
- VDS facilitator time between arrival to the virtual setting and the start of active programming.
- VDS activities should not be billed and provided during an individual's lunch hours unless there is programming occurring. Break times can be scheduled as part of the program, but these break times are not billable.
- Individuals can't receive any other waiver services (such as therapy, counseling, etc.) during the time the VDS provider is billing, with the exception of At-Home Day Program (37U).
- The service provider is responsible for submitting complete and accurate billings and for maintaining appropriately detailed documentation and audit trail information. Service providers must maintain documentation on file for at least six years from the date of service to establish an audit trail. Audit trail documentation and notes are subject to review by state staff or their designees. Documentation includes:
- VDS attendance records must be completed daily and must include the number of hours each individual was actively involved in program activities during the day based on start and end times. VDS cannot be billed at the same time other waiver services (such as therapy, counseling, etc.) are being delivered and paid.
- VDS can be billed during the same time as 37U, however, it will reduce the annual total amount of service hours (1100 hours) more quickly.
- The service provider must be prepared to submit to the Division a list of VDS sessions it provided to individuals if requested. The list must state the topic of the session, the length of time of the session, the individuals who participated and a brief statement of the outcome(s). This may be requested through an audit, post payment review or on an as needed basis.
In order to bill for VDS (31V), CDS providers must download and install ROCS 6.08. ROCS 6.08 and instructions can be found here: https://www.dhs.state.il.us/page.aspx?item=60904 .
Providers who use a 3rd Party version of ROCS need to access the IT requirements for modifying your 3rd Party ROCS at the following link: https://www.dhs.state.il.us/page.aspx?item=60880 .
October 1, 2020. Revised 10/09/2020.