Introduction

Introduction

This manual defines the data submission requirements and record formats for the following:

  • Client Case Registration Information:
    • Used for both the REPORTING OF COMMUNITY SERVICES (ROCS) System and the FEE FOR SERVICES System
  • Service Reporting / MH Billing Information:
    • Used for the REPORTING OF COMMUNITY SERVICES (ROCS) System
  • Provider Information:
    • Used for the FEE FOR SERVICES System
  • Service Agreement Information:
    • OBSOLETE - 07/01/2002
  • Client Financial Information:
    • Used for the FEE FOR SERVICES System, residential programs only
  • Fee for Service Billing Information:
    • Used for the FEE FOR SERVICES System
  • Agency Plan Information:
    • Used for the Community Agency Plans System (CAPS) and the REPORTING OF COMMUNITY SERVICES (ROCS) System

ROCS and CAPS data is used by DHS to monitor compliance with the grant agreements negotiated each fiscal year with community agency service providers. ROCS data is also used to monitor that those individuals discharged from DHS State Hospitals are provided linkage to community services and that those discharged to long-term care facilities are provided the mandated follow-up prescribed by statute; and to monitor services funded by federal funds, special contracts, and other methods of funding.

The ROCS System also processes the Mental Health (MH) billing data submitted to DHS for payment under Rule 132 - Mental Health Medicaid Clinic, Rehabilitation, and Targeted Case Management options. The procedures described in the following sections should be used by certified and enrolled participating provider agencies for reporting covered community MH service billing information to the Department of Human Services. The claim must be processed by the Department of Human Services (DHS) and the Department of Healthcare and Family Services (DHFS [formerly DPA]) no later than 2 years from the date on which the service is provided. If the individual has insurance coverage or other third party liability coverage, this information should be reported on the claim transaction.

See Volumes I and II for an explanation of the specific data reported on client case registration and service reporting/MH billing records. The DHS Management Information Services will process the service reporting and the MH billing data submitted by the agencies and will either accept or reject the data. The Department of Healthcare and Family Services must also approve each MH billing claim.

The Fee for Services system is used to collect and submit billing information to DHS for Fee For Service programs provided to clients. This includes:

  • Bogard Specialized Services - These services are provided to members of the Bogard class (per the OBRA 1987 and the Bogard consent decree) who reside in nursing facilities to meet their developmental needs. They are arranged through the Individual Service Coordinator serving the class member, at the request of the individual class member or guardian, and may be provided individually or in groups by traditional or non-traditional providers. Covered services include therapies, day programs, community participation training, activities of daily living training, mobility skills, and transportation.
  • Supported Living Services and Home Based Support Services - These services are provided to eligible clients receiving direct support, respite, Developmental Training, Supported Employment, Adult Day Care, Intervention Planning, Counseling, Therapy, Physical Therapy, Occupational Therapy, Speech Therapy, and transportation. Needed services and providers are chosen by the individual and guardian, with assistance from the Team Leader, the Individual Service & Support Advocate (ISSA), and other members of the service/support team.
  • DD CILA Services - These services are a combination of supports and services individually tailored for an adult with developmental disabilities. The objective of a Community Integrated Living Arrangement (CILA) is to promote optimal independence in daily living and economic self-sufficiency of individuals with a mental disability. Based on their needs, individuals receive services that may include day programs, developmental training, supported employment, therapies, etc.
  • Other Specified Purchase of Service Programs - These services are provided to eligible clients receiving residential support, respite services, etc.

The Provider File will contain any new service providers or changes in previously accepted provider information. Only one transaction per provider will be allowed.

The Client Financial Information File contains information for those clients who are receiving residential service. The financial information is only needed for clients for whom you will be billing for residential programs. The file will contain all new client financial information your agency has for an individual along with any changes to previously accepted client financial information. Only one record per effective month and individual ID will be allowed. This information is used in calculating the reimbursement rate.

The fee for service Billing File will contain transactions for each covered item of service provided to an individual per day. Each billing must have an active client case registration in place; in addition, each residential program billing must have an active client financial information record accepted by DHS. The billing must reflect the services provided for the entire month. Only one record per individual, provider, program, service code/resident location/level, and service date will be allowed. Adjustments to previously accepted billings may also be submitted by the agency on this file. DHS will determine the amount of payment for adjustments.

See Volume III for an explanation of the specific data reported on provider, client financial information, and billing file records. The DHS Management Information Services will process the client information, provider, and service billing data submitted by the agencies and will either accept or reject the data.

Note: All references to fiscal year (FY) will be the State of Illinois fiscal year (July 1 through June 30), unless stated otherwise. The value for fiscal year will be the year for June.

The agency will receive back files with the results of the processed data for each submission. After the processing of your agency's submitted data is complete, the Management Information Services will return files to your agency. Report listings are available which summarize the data processed.

Along with the FEE FOR SERVICE processed billing file, a voucher file will also be returned. The voucher file will contain provider payment information. See Volume III, SECTION 1, for an explanation of the data returned on the transaction records concerning the status of the provider, client financial information, billing records, and information contained in the voucher file.

Any rejected record may be resubmitted to DHS after the error condition has been corrected.

Paper reports are no longer being provided for data submitted for the Reporting of Community Services (ROCS) System and Fee-for-Service processing. Access to reports you formerly received in the mail are available by using Mobius Document Direct via the Internet. Report viewing is limited to your specific provider FEIN. It is the responsibility of each community agency to print reports from Mobius Document Direct, if desired. Reports will be stored for at least six months to allow sufficient time to view/print as needed.

The production file must be received by DHS/MIS by the cut-off date and time to be included in that cycle. If the production file is received after the cutoff date and time, it will be held and processed the following cycle.

You must retain (for a period of 5 years) an auditable record of each record submitted to DHS. This should be the original document as filled out by the staff member reporting service.

DHS reserves the right to review your data collection forms, procedures, processes, etc. to ensure consistency of reporting.