Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.23.003
Purpose:
The Division of Developmental Disabilities (DDD) in collaboration with the Department of Human Services (DHS) and Department of Healthcare and Family Services (HFS) announces operational details of the Live-in Caregiver exemption from the Electronic Visit Verification (EVV) mandate.
Background:
In 2016, the U.S. Congress passed the 21st Century Cures Act, which requires states to implement the use of EVV in all Medicaid-funded personal care services and home health care services. The purpose of implementing EVV is to support the federal government's, as well as Illinois', goal to improve Medicaid program integrity, safeguard against fraud and abuse, improve program oversight, and comply with federal requirements.
This Information Bulletin (IB) defines a Live-in Caregiver, outlines which services are eligible for the Live-in Caregiver exemption, defines and indicates provider responsibilities when declaring Live-in Caregiver status, and lays out operational methods of billing for Live-in Caregiver services.
The Live-in Caregiver exemption will allow services provided by certain Personal Support Workers (PSWs) to bypass the EVV requirement when providing services.
Policy:
Live-in Caregiver definition:
Live-in Caregiver means a caregiver who permanently or for an extended period of time (defined below) resides in the same residence as the customer receiving services. Live-in Caregiver status is determined by meeting requirements established by the U.S. Department of Labor, Internal Revenue Service, and DDD.
IRS requirements:
* A PSW is an individual care provider receiving payments under a qualifying state Medicaid program as defined in IRS notice 2014-7 for care the PSW provides to a customer living in the PSW's home.
U.S. Department of Labor requirements:
- A PSW resides on the customer's premises permanently when the PSW lives, works, and sleeps on the customer's premises seven days per week and therefore has no home of their own.
- A PSW resides on the customer's premises for an extended period of time when the PSW lives, works, and sleeps on the customer's premises for five days per week (120 hours or more). If a PSW spends less than 120 hours per week working and sleeping on the customer's premises but consistently spends five consecutive days or nights residing on the premises, this also constitutes an extended period of time.
Types of Services Eligible or Ineligible for Live-in Caregiver Exemption
Services provided by Live-in Caregivers are often delivered incrementally and without clearly defined start and end times. DDD recognizes the unique challenges of collecting EVV for this type of care and allows providers (as defined above) to exempt Personal Support Workers (PSWs) from EVV if provided by a documented Live-in Caregiver.
Provider Responsibilities
For purposes of this IB, providers are defined as agency based PSW service providers or as the Fiscal Management Services (FMS) entity, also known as ACES$. Agency Based PSW providers and ACES$ are responsible for compiling, maintaining, and validating all records justifying the status of each Live-in Caregiver for DDD verification and auditing. The Live-in Caregiver Attestation Form (Live-In Caregiver Attestation Form English version PDF / Live-In Caregiver Attestation Form Spanish version PDF), located on the EVV website, and all supporting documentation must be collected and validated prior to utilizing the Live-in Caregiver exemption. Documentation must be valid during the time of service and billing dates if EVV is not collected. Providers should review instructions and requirements outlined in the Live-in Caregiver Attestation Form (Live-In Caregiver Attestation Form English version PDF / Live-In Caregiver Attestation Form Spanish version PDF) for additional details.
Attestation forms will be required to be completed annually. If a living arrangement changes prior to the annual submission of the Attestation Form, the Employer of Record (EOR), customer, and/or guardian, if applicable, must notify the PSW provider/ACES$ within 5 days of the change in living arrangement. The notification must be made on the Attestation Form in the section for removing the Live-in Caregiver Exemption. Once notified, the PSW provider/ACES$ will immediately remove the Live-in Caregiver Exemption.
Self-Directed Customer Responsibilities
The EOR, customers, and/or guardians, if applicable, are responsible for compiling, maintaining, and validating all records justifying the status of a Live-in Caregiver to be provided to the provider. The Live-in Caregiver Attestation Form (Live-In Caregiver Attestation Form English version PDF / Live-In Caregiver Attestation Form Spanish version PDF) must then be completed and, with all supporting documentation included, submitted to the PSW provider/ACES$ prior to utilizing the Live-in Caregiver exemption. Any documentation provided with the Attestation Form, that contains an expiration date, must not be expired at the time of submission.
Acceptable documentation of customer and PSW residence (Choose one of the following):
- Copy of current IL State Driver's License, State ID or other Photo ID;
- Vehicle registration or voter registration card;
- Utility or other household bill showing name and address of customer;
- Address on federal or state income tax returns or refunds;
- Bank statement;
- Medicaid records;
- Mail from medical service providers when the address is clearly stated;
- School ID Card (if an address is clearly stated on the ID card); and/or
- Other documentation, upon Division of Developmental Disabilities (DDD) approval.
The PSW provider/ACES$ must maintain records designating the status of Live-in Caregivers. The PSW provider/ACES$ may make the effective date of the Live-in Caregiver exemption as the start of the next pay period. Documentation must be valid during the time of service and billing dates when an exemption of EVV requirements has been approved. The EOR and the PSW provider/ACES$ should review instructions and requirements outlined in the Live-in Caregiver Attestation Form (Live-In Caregiver Attestation Form English version PDF / Live-In Caregiver Attestation Form Spanish version PDF) for additional details.
Claims adjudicated as provided by a Live-in Caregiver without required Live-in Caregiver documentation or EVV records are subject to recoupment. The EOR, customers, and/or guardians, if applicable, are responsible for the validation of Live-in Caregiver documentation. If information is incorrect or falsified or the EOR, customer, and/or guardian, if applicable, fails to notify the PSW provider/ACES$ of a change in living arrangement, the customer could lose their right to self-direct services and be required to use Agency-Based PSW services and/or the case could be turned over to the Illinois State Police Medicaid Fraud Control Unit (ISP - MFCU) to further investigate potential fraud. If Live-in Caregiver documentation is not collected and verified by the PSW provider/ACES$ prior to the approval of the exemption from EVV, liability is with the PSW provider/ACES$. If the living arrangement changes prior to the annual submission of the Attestation Form, the EOR, customer, and/or guardian, if applicable, must notify the PSW provider/ACES$, within 5 days of the change in living arrangement, so they can remove the Live-in Caregiver Exemption. The notification must be made on the Attestation Form in the section for removing the Live-in Caregiver Exemption.
Independent Service Coordination (ISC) Agency Responsibilities
ISC agencies will confirm Live-in Caregiver status during visits throughout the year. If the ISC agency is unable to verify the Live-in Caregiver status during a visit, the ISC must notify the PSW provider/ACES$ as soon as possible, at which point the PSW provider/ACES$ will take the necessary steps as outlined above.
Operational Methods of Billing for Live-in Caregiver Services
Billing providers may submit claims including both Live-in Caregiver services and services requiring EVV records at the same time through the ROCS billing system. PSW services that must comply with EVV will continue to bill services using the 55D program code. The Division is developing a new program code for PSW services that are exempt from EVV requirements. The Division will communicate the new program code once its developed. For the time being, PSW services that are exempt from EVV will bill using the 55D program code.
Customers and PSWs intending to utilize the Live-in Caregiver exemption are encouraged to collect Live-in Caregiver documentation as soon as possible to prepare for the EVV mandated effective date of September 1, 2023.
Attachment(s):
Live-in Caregiver Attestation Forms:
The DDD EVV website will be used to share policies, recorded presentations, etc. If there are questions, please submit them to DHS.DDDEVV@illinois.gov.
Effective Date:
This Information Bulletin is effective 07/20/2023 (Revised 11/20/23)
