Medicaid Waiver Post Payment Review - Personal Support Rates Greater Than $30 per hour

FY19 Month of January 2019

Issue:

The Illinois Department of Human Services, Division of Developmental Disabilities must conduct ongoing annual reviews of Medicaid Waiver programs per the approved Medicaid Waivers. Personal Support services in the Adult and Children Home Based Waivers are paid at a variable rate. Personal Support providers may be either individual providers or agency staff. The rates for personal support services are negotiated within an overall monthly allotment among the individual, family, and providers.

Basis for Review:

As part of its ongoing efforts to ensure the financial integrity of the Waivers and to ensure that Personal Support services are being utilized as intended and paid at a reasonable rate, the DDD Bureau of Program Development & Medicaid Administration staff reviewed PSW provider billings of $30 or more for the month of January 2019.

Method of Review:

The DHS Bureau of Program Development and Medicaid Administration requested a report of accepted Medicaid waiver claims by Personal Support providers paid at a rate of $30 per hour or higher from the Department's Management Information Services section. For the review, DHS staff contacted the agencies of the agency employed Personal Support workers and contacted the Independent Service Coordinator's (ISC's) for the self-directed Personal Support Workers for the following information:

Is the participant in the Children's Support Waiver, and if so, is the Personal Support worker a legally responsible relative? Payment is not made directly or indirectly, to members of the participant's immediate family for those in the Children's Support Waiver.
If the participant is in the Children's Support Waiver and the legally responsible relative is the Personal Support Worker, does the Personal Support Worker reside with the participant?
Does the Personal Support Worker have special qualifications?
Are there special circumstances justifying a higher rate of pay?

Findings

There were 37 personal support providers paid at a rate of $30 or higher in this review.
Of the 37 Personal Support providers, -0- were legally responsible relatives who did not reside with their child receiving Children's Support services.
Of the 37 Personal Support providers, -0- had special qualifications or were paid a higher rate due to special circumstances.
Of the 37 Personal Support providers reviewed, 28 were agency trained DSP certified providers whose agency captures their costs in the 55D rate as directed by DHS.
Of the 37 Personal Support providers reviewed, 1 was providing life coaching services.

This post-payment review revealed 37 paid billings with a rate of $30.00 or more for the month of January 2019.

Number of bills	Rate
2	30.61
1	30.66
2	32.85
1	35.00
2	35.97
1	37.64
2	38.32
23	38.55
2	40.00
1	43.80
37 Total Billings