Illinois Department of Human Services
Division of Developmental Disabilities
This Information Bulletin informs Division of Developmental Disabilities (DDD) providers of the elimination of automatically collecting earned income from individuals who are funded for DDD services and supports and have a Third-Party Liability Calculation to their "Topline" residential rate.
Historically, the DDD has used a portion of an individual's reported earned and unearned income to calculate the individual's Third-Party Liability (TPL) Calculation, which is also known as the "offset". The TPL is deducted from payments made by the DDD to the service provider and the service provider collects the specified TPL amount from the individual's earned and unearned income for full payment of the individual's services and supports.
As of July 1, 2021, the DDD no longer utilizes an individual's reported earned income in determining an individual's TPL Calculation for any residential programs including CILA (60D), CLFs (67D, 67E & 670), CGH (17D), and CCI (19D).
The TPL Calculation and collection of an individual's un-earned income (SSA, SSI, SSDI, etc.) is not changing and the provider should continue to collect the individual's TPL for un-earned income as applicable. The individual should continue to receive their $60.00 Personal Needs Allowance from un-earned income as they have in the past.
As of January 1, 2022, the rate methodology has changed for Host Family CILA (HFCILA) and Intermittent CILA (ICILA). For these rate methodologies, the room and board components are no longer included. A provider agency or host family, depending on who controls the residential site, can collect a portion of the individual's earned and unearned income to cover the cost of room and board. Please see the Intermittent CILA (ICILA) Services and Supports Clarification of Program Scope and Billing IB - REVISED and Host Family CILA IB - REVISED for specifics on how to calculate the max allowed room and board for these services.
Earned income is defined as earnings as wages and/or payment for services paid to an individual after applicable taxes and/or other lawful deductions. Earned income can be earned from an employer, individual, or day program.
- The following responsibilities apply to residential programs including CILA (60D), CLFs (67D, 67E & 670), CGH (17D), and CCI (19D) except as determined for HFCILA and ICILA.
- All residential providers are required to immediately inform all applicable parts of their agency, including the individuals they serve, of the changes outlined in this Information Bulletin.
- All residential providers are required to immediately develop or amend existing agency policies and procedures and to implement and train applicable staff on new and/or updated internal policies and procedures to assure compliance with the implementation of this Information Bulletin prior to July 1, 2021.
- An individual's earned income is the individual's property and may not be collected, garnished, billed, claimed or in any way attached by a DDD provider. This includes and is not limited to any services or supports considered as any part of the DDD's reimbursement to providers for services and/or supports both within and outside of Home and Community Based Services (HCBS) Waivers.
- However, if a provider makes an agreed upon purchase on behalf of an individual, the provider can bill the individual for the purchase made on their behalf. The amount billed to the individual can't exceed the amount of the purchase.
- Providers cannot collect any part of an individual's earned income after July 1, 2021. The DDD will increase the payments to providers for the TPL Calculation previously deducted due to an individual's reported earned income.
- Though providers are not going to collect earned income from individuals, providers should continue to report earned income through ROCS billing.
- Providers should continue to support individuals who work to maintain Medicaid eligibility.
- Note: Individuals continue to be entitled to receive their Personal Needs Allowance (PNA) from their unearned income. Providers should support individuals to maintain their individual funds as defined in the Individual Funds Management Information Bulletin.
- Note: The management of an individual's personal funds is subject to specific requirements that must be followed by provider agencies including the creation of individual accounts. These requirements can be found in the Individual Funds Management Information Bulletin.
- The DDD and the Department of Innovation and Technology (DoIT) have the programming developed to change the TPL Calculation to exclude earned income and will put it into production prior to provider's billing for July 2021 services.
- When submitting billing for July 2021 services, residential providers will see on their ROCS billing the bottom-line rates and Third-Party Liability which includes earned income for individuals who have earned income previously reported in ROCS. When providers receive their ROCS file back after billing July 2021 residential services, each individual's bottom-line rate and Third-Party Liability Calculation will be updated to exclude the individual's reported earned income.
- MOBIUS Remittance Reports for billed July 2021 services will show the correct remittance amount.
- MOBIUS Remittance Reports for July and August 2021 advance payments will show TPL and advance payments which include the earned income Offset.
- CILA Providers on Advance and Reconcile will also see the July and August 2021 advance payments with the individual's earned income as part of the TPL Calculation. The reconciliation payments after billing for each month will show the corrected TPL and bottom-line rate. Advance Payments for 60D should show the correct bill rate excluding any reported earned income on the Agency's MOBIUS Remittance Reports beginning September 2021. NOTE: Advance and Reconcile is no longer an option as of January 1, 2022.
The information contained herein should not be considered a substitute for the appropriate official statutes, rules, regulations, or the advice of legal counsel.