Illinois Department of Human Services
Division of Developmental Disabilities
Personal Support Services in a Hospital Setting
On March 16, 2021, the Centers for Medicare or Medicaid Services (CMS) approved the Division's request for a Waiver Amendment to the Children's Support Waiver (IL0464.R02.09) and on June 24, 2021, CMS approved the Division's request for a Waiver Amendment to the Adult Waiver (IL035.R04.08). Both Waiver Amendments allow Home Based Services (HBS) Personal Support to include services provided in a hospital setting.
NOTE: Personal Support services are allowed in a hospital setting but CANNOT be provided in any other long-term care facility or skilled nursing facility.
NOTE: Personal Support services in a hospital setting is only available to individuals in the Support Waiver for Children and Young Adults with Developmental Disabilities ("Children's Home-Based Services Waiver") and HCBS Waiver for Adults with Developmental Disabilities ("Adult Waiver").
Waiver Service Modification:
The original Personal Support service definition for individuals funded in Illinois through the Children's Home-Based Services (CHBS) and Adult Waiver were modified by adding the following allowance:
Personal Support is being expanded to include supports provided to a participant while hospitalized to foster communication, provide intensive personal care, and/or promote behavioral stabilization for the purpose of smooth transitions or preserve functional abilities. These are services in the plan of care that cannot be provided by facility staff and are not a substitute for services the hospital is obligated to provide through its conditions of participation or under Federal or State law, or under another applicable requirement. Services in the plan of care that cannot be provided by facility staff will be provided by the Personal Support Worker.
- Billing can only be submitted for services provided in a hospital setting, not a long-term care facility or skilled nursing facility.
- Personal Support services provided in a hospital setting must be services already identified in the individual's plan of care and they cannot be services capable of being provided by the hospital staff. The approved categories of services are to foster communication, provide intensive personal care, and/or promote behavioral stabilization for the purpose of smooth transitions or preserve functional abilities.
- Billing for Personal Support services will not change with the addition of this language. If you're using agency based PSW services, they will continue to provide the agreed upon services and bill the Division as appropriate. If you're using self-directed PSW services, you will continue to bill for services through ACES$.
- Your Personal Support services must still fit within your monthly and annual allocation.
Audit Trail Documentation:
- The service provider is responsible for submitting complete and accurate billings and for maintaining appropriately detailed documentation and audit trail information.
- Audit Trail Documentation must include the date, start time, and stop time the services were provided to support the billing. The documentation must be made available to Division staff when conducting an audit or post payment review.
- Service providers must maintain documentation 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.
If you have questions related to Personal Support services provided under the AHBS or CHBS waivers when in a hospital setting, please contact the DDD Waiver Manager at (217) 782-5919.
July 27, 2021.