Illinois Department of Human Services
Division of Developmental Disabilities
The Division of Developmental Disabilities (DDD) is adding an additional service code to Community Day Service under Day Habilitation. The addition of this service code will allow the day program provider to report and DDD to track the delivery of Community Day Services provided in a setting which is site-based or a community location. The new 31C service code will assist with enhancing accountability and reporting of services.
The Division of Developmental Disabilities has made significant changes to the Waiver for Adults with Developmental Disabilities. The currently approved Home and Community Based Waiver has been modified to provide more integration outside of site-based day habilitation services. A new day option was added to enable individuals the opportunity to receive services in small groups in community environments during the day. The Developmental Training service has been modified and approved by Centers for Medicare and Medicaid Services. Developmental Training is now referenced as Community Day Services (CDS). CDS will have the option to be billed under a service code of 31U or 31C. 31U billing will be completed for Community Day Services provided in a Site-Based Setting. 31C billing will be completed for Community Day Services that are provided at a community location which enables the participant to access and participate in relationships, activities and functions of community life.
The Division posted a draft information bulletin introducing the 31C service code. The comments submitted on the draft information bulletin were received and reviewed. As a result of the submitted comments, the Division postponed the 31C go live date to allow service providers the opportunity to make process modifications. To prepare for the go live date, providers must ensure the ROCS 6.04 software version or Third-Party software are updated.
Community Day Service listed in the Adult Waiver as a Day Habilitation service. Providers will have the option to bill this service under a code of 31U or 31C. 31U billing will be completed for Community Day Services provided in a Site-Based Setting. 31C billing will be completed for Community Day Services that are provided at a community location. The same bill code limits and rates exist for 31C as with 31U.
The following are some examples of both on-site and off-site CDS and what to bill through ROCS:
- Rick arrives at the CDS site and begins his training at 9:00 a.m. He participates in activities at the CDS site until 12:00 p.m. He takes a 30-minute lunch. At 12:30 p.m., Rick leaves the CDS site with other participants to walk to the public library. Rick returns to the CDS site at 2:30 p.m. and resumes his training at the facility until he gets picked up at 3:00 p.m. to return home. In this example, 31U would be billed for 9:00 a.m. to 12:00 p.m. (3 hours) and 2:30 p.m. to 3:00 p.m. (30 minutes) for a total of 3.5 hours of 31U and 2 hours (12:30 p.m. to 2:30 p.m.) would be reported as 31C.
- Sally arrives at her site-based Community Day Service setting. She has expressed her desire to learn to access the community on her own. As an initial step, she wants to learn to access the city bus service to shop at the local store. At 9:00 a.m., she departs on the city bus with agency staff. They arrive at the store at 9:45 a.m. Sally completes her shopping and is ready to return to the Community Day Service site. They board the city bus at 11:30 a.m. and arrive at the CDS site at 12:00 p.m. She takes a 30-minute lunch. At 12:30 p.m., she participates in her training program at the Community Day Service site. Sally continues with her CDS site activities until she departs the program at 3:00 p.m. In this example, 31C would be billed for 3 hours (9:00 a.m. to 12:00 p.m.). 31U would be billed for 2.5 hours (12:30 p.m. to 3:00 p.m.).
The 31C service code will become effective April 1, 2019.
- Providers using the ROCS software should ensure download of ROCS 6.04 version to accommodate programming changes to complete billing.
- Providers using Third Party software should ensure system updates. User information can be found on the DHS Website at https://www.dhs.state.il.us/page.aspx?item=60880