Illinois Department of Human Services
Division of Developmental Disabilities
This Information Bulletin notifies all providers of the implementation of the July 1, 2019 COLA for community services and year end rollover of additional staff supports. We have not received word on our State Plan Amendment in regard to our ICF/DD increases effective August 1, 2019. The State Plan Amendment approval for ICF/DDs also impacts the implementation of SODC day training (31S) rates and reimbursements.
The Department of Healthcare and Family Services recently received word from federal CMS that the Home and Community Based Waiver Technical Amendment for the July 1, 2019 COLA was approved. Division of Developmental Disabilities (DDD) is in the process of implementing the changes necessary to put these rate changes in place.
The DDD has begun the process of adjusting Home and Community Based Waiver rates pursuant to PA 101-0010. Public Act 101-0010 requires the Department of Human Services to increase its rates by 3.5% for community-based providers for persons with developmental disabilities. This change is effective July 1, 2019. These changes will increase expenditures by approximately $30.1 million based on current utilization patterns to the community care services benefit category. Providers shall determine whether to allocate the entirety or a portion of the 3.5 percent to the wages of direct care personnel.
The DDD has posted an updated Current Rates Table which shows the new rates effective July 1, 2019. The Rates Table can be accessed at the following link: https://www.dhs.state.il.us/page.aspx?item=118079
The DDD has updated state-wide rates in the Community Reimbursement Subsystem (CRS). Providers can check for Remittance Reports in MOBIUS dated November 14, 2019 for the first of these payment adjustments on previously billed services and supports. Providers can check for Remittance Reports in MOBIUS dated November 21, 2019 for payment adjustments for previously billed and paid CILA, POS and Day Services.
At this time there is a sub-group of people funded for community services whose rates for previously billed and paid services have yet to be adjusted. DDD is working with MIS/DOiT staff to identify people who had some type of change in services or supports which prevents the DDD from changing their rate(s) retroactively back to July 1, 2019. Once these people's prior rates are identified and adjusted payments will be forthcoming as quickly as possible. This sub-group of people who had any of the following changes after July 1, 2019:
- Switched to a new waiver service such as HBS to CILA, DT to CILA, SODC DT (31S) to CILA, CILA to HBS, etc.
- Switched to a new service provider. It is impossible to reopen a previously closed service authorization without the CRS system taking back ALL paid services for the new service provider AND any paid services for ALL other service providers after the date of authorization for the new service provider.
- Terminated from any DDD funded service or provider including, but not limited to CILA, POS Residential, Day Programs, HBS and/or SODC DT (31S).
- Had a rate change to their individually determined rate or billable authorizations. Under these instances the earliest retroactive rate adjustment which can be made would be the effective date of any of the following change examples include but are not limited to:
- Move to a new CILA or POS residential site;
- Move to a new CILA or POS residential provider;
- Had their ICAP score updated;
- Had their Nursing Services updated;
- The CILA site working capacity changed;
- The night shift changed to/or from Awake or Asleep;
- Additional supports were authorized;
- New billable supports were authorized; or
- The POS residential provider received a new rate.
New Rate Sheets:
For people enrolled in Community Integrated Living Arrangements (CILA) and Purchase of Services (POS) residential programs, the DDD intends to generate new rate sheets for each person and mail them to each provider. The DDD anticipates CILA rate sheets will be sent to the providers in early to mid-December.
For people enrolled in Community Day Services (CDS) only, each person's billable support rate(s) will be adjusted accordingly. New rate sheets will only be generated for people with additional staff supports. CDS Only people who do not have any additional staff supports authorized as either billable 53D or an increased 31U and 31C rate will not receive new rate sheets.
For people authorized to attend a Community Day Service (CDS) who reside in a State Operated Developmental Center (SODC), each person's 31S Rate will be adjusted accordingly effective August 1, 2019. The DDD intends to notify 31S providers of their new rates once the rates have been calculated. It is not necessary to generate individual rate sheets as everyone funded under 31S has the same rate for the CDS they attend.
For people authorized for Intermediate Care Facilities for Intellectual Disabilities (ICF/ID) and ICF/ID Community Day Services (CDS) the DDD will update the ICF/ID and ICF/ID CDS rates with the Illinois Department of Healthcare and Family Services (HFS) once the State Plan Amendment is approved by the federal Centers for Medicare and Medicaid Services. Changes for ICF/ID and ICF/IDs CDS are scheduled to be implemented effective August 1, 2019. New ICF/ID facility and ICF/ID day services rate sheets will be generated after completion of implementing any rate changes.
Additional Staff Supports:
The DDD followed the same process as we have for the past six years. The new authorizations for additional staff supports were entered into the billing and payment system in early July. As a reminder to providers who serve people with additional staff supports ALL long-term additional staff supports will automatically roll over to fiscal year 2020. Any person who was awarded initial additional staff supports in May or June will also have an automatic reauthorization of their initial additional staff supports beginning July 1, 2019. Providers should continue to deliver additional staff supports as warranted by the person's needs.
For people who were awarded an initial additional staff supports between July 1, 2018 and April 30, 2019 their additional staff support authorization ended June 30, 2019. If a provider feels they need to continue additional staff supports for a person the provider will need to reapply for a new authorization of initial additional staff supports to be awarded after July 1, 2019.
Adult Home-Based Services:
HBS participants have a Monthly Allocation established by 405 ILCS 80/2-6. An increase in any Statewide Rate will result in a reduction in the amount of services the HBS participant can purchase against their monthly/yearly allocation. This reduction of services will hold true until the next SSI rate increase on January 1, 2020.
It is not possible for an HBS service agreement to be revised retroactively if the budget has been expended, as services have already been delivered, billed, and paid. Some HBS participants have completed service agreements currently in place in accordance with the approved FY19 rates and are utilizing services to the maximum extent allowable within their allotted monthly budget. In this case, the provider of the service will NOT get reimbursed for the rate difference.
As a reminder to all people enrolled in Adult Home-Based Services (AHBS), with the above-mentioned rate changes each person needs to review and UPDATE as necessary their current service and financial plan to ensure they do not exceed your monthly maximum allocation.
If you utilize self-directed services, the update of your service and financial plan is required if you utilize any services or supports outside of the 55D bill code AND you have individually hired the 55D worker. Again, if the ONLY services or supports you purchase are 55D AND you have negotiated the rate with the person providing the 55D supports you should not have to make any changes to your service or financial plan.
If you utilize HBS self-directed services AND you purchase:
- self-directed assistance (SDA) bill code 55A; or
- 55D supports from an agency (not ACCESS as your fiscal intermediary), or
- any of the following day program supports using the bill codes 31U, 31C, 30U, 39U, 39G; or
- Senior Day Services, bill code 35U rate is tied to the Illinois Department on Aging (IDOA) rate methodology and IDOA Waiver. The new 35U bill rate will be $20.09 and is effective December 1, 2019 and not effective July 1, 2019; or
- any other billable supports such as nursing (55N or 55P, transportation (55T), behavior intervention (56U & 56G), behavior counseling (57U or 57G), or behavior therapy (58U or 58G);
you MUST update your service and financial plan with the applicable new rates for all HBS services starting July 1, 2019.
HBS Emergency Home Response (55W) is tied to the Department of Aging rate methodology. Only the 55W Level 1 (Installation Rate) is changing effective December 1, 2019. The 55W Level 2 Monthly Monitoring Fee remains unchanged at $28.00 per month. This means existing HBS service and financial plans do not need to be adjusted for Emergency Home Response (55W).
Please remember that this 3.5 percent increase will not increase your HBS monthly allowance level. The HBS maximum allowance levels are updated annually January 1 and are tied to the increase as set by the Social Security Administration. The new HBS monthly allowance levels to go into effect January 1, 2020 are posted at: https://www.dhs.state.il.us/page.aspx?item=120556
For questions on any of these issues, please contact the DDD Region Staff in your geographic area. You may access the list of Region Staff at: https://www.dhs.state.il.us/page.aspx?item=48541.
The information contained herein should not be considered a substitute for the appropriate official statutes, rules, regulations, or the advice of legal counsel.
July 1, 2019