UPDATED V.4 – COVID-19 Community Day Services (CDS) & Residential Rates and Reimbursement

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.22.009

Purpose:

This Information Bulletin replaces policy/guidance previously given in DD.20.025, DD.20.008, and DDD.21.011.

The Illinois Department of Human Services (IDHS) Division of Developmental Disabilities (DDD) is committed to protecting individuals with developmental disabilities in Illinois. This communication is intended to provide updated guidance on Rates, Billing, and Payments for the Division of Developmental Disabilities (DDD) services.

For more information please contact:

POS: Nikki Carnes at nikki.carnes2@illinois.gov .

CILA & CDS: Diane Garbin at diane.garbin@illinois.gov

Overarching:

The Division is clarifying temporary changes implemented during the COVID-19 pandemic to assist agencies to operate. The changes are allowed only during effective dates as defined by the Division.

Documentation and Signatures:

1. If an individual or guardian, if applicable, refuses to meet in person in accordance with guidance below, a verbal or email approval will be acceptable for a period of 90 days.
2. The verbal or e-mail signature must be documented in the signature are of the document by including a date, time, how the signature was received ("verbal" or "e-mail"), reason for a non-original signature, name and signature of the person who is documenting the verbal or e-mail signature.
3. Original signatures must be received within 90 days of the date the verbal or e-mail signature was received and accepted.
4. Many form providers such as Adobe have the ability to insert a digital or electronic signature. A digital signature is authorized to be used when the signer uses a digital certificate issued by a certificate authority with the appropriate public key infrastructure (PKI). There are online sources for obtaining a digital certificate. As a reminder, a document can't be changed once the original signer uses their digital signature to sign the document.

Remote Activities/Services:

1. It is expected all waiver services are to be provided in person since 7/1/21. However, there are some services where it is acceptable for them to be conducted remotely via electronic, by phone, and/or video communication in accordance with the guidance below.
2. These services include Behavior Intervention and Treatment (56U), Occupational Therapy (52O), Speech Therapy (52S), Counseling - Individual (57U), Counseling - Group (57G), Therapy - Individual (58U), and Therapy - Group (58G).
3. Individual/Family/Guardian/Provider Choice:
   1. Individual, guardian (if applicable), and family choices should be respected. Some individuals may choose not to meet in person. This may be due to the presence of household members with at-risk health conditions or for other reasons. The option of virtual services should continue to be available to families throughout all phases of the pandemic based on the choice and safety of the individual. This should be documented in the provider's notes.
   2. In the event an individual, family/guardian, or provider staff does not feel comfortable with a visit due to the conditions in a home or in the community, the individual, family/guardian should discuss any issues/concerns with the provider to determine if a remote visit is warranted. If all agree a remote visit is warranted, then this should be documented in the provider's notes.
   3. If a situation in a specific residential setting indicates a face-to-face visit cannot be safely accommodated at a specific point in time, the residential provider agency will work with the service provider and individual to find an alternate location, date/time, or method to conduct the visit.
   4. The ISC should be notified when remote visits are being conducted so they can monitor to ensure the individual doesn't become isolated.
4. Any time remote activities/services are provided instead of in person, proper documentation must be kept. Documentation must include date of service, start time, end time, individual(s) participating in the service, method for providing service, and reason service wasn't provided in person.

Community Integrated Living Arrangements (CILA):

1. A 7% rate increase went into effect on October 1, 2021 and will remain in effect until June 30, 2022.
2. If you are a CILA provider who is in an emergency situation where an alternative site must be used to protect the health and safety of individuals served, please submit required forms to BALC and reach out to Kathy Ward with DDD. BALC forms are posted on the DDD COVID-19 webpage.
3. If you are a CILA provider who is in an emergency situation and you need to temporarily evacuate individuals from their home into another home you operate and it will exceed the maximum allowable occupancy of the evacuation destination site, please submit required forms to BALC and reach out to Kathy Ward with DDD. BALC forms are posted on the DDD COVID-19 webpage.

Individual Choice to continue Enhanced Residential (formerly At-Home) Day Program:

1. Enhanced Residential Day program (37U) was no longer automatically authorized after 7/1/21. Prior approval must be sought using the Alternative Day Program Request Form and process for individuals interested in continuing to be authorized for and participate in utilizing 37U due to the following:
   • Concerns about return to a regular CDS program in response to COVID-19; or
   • Desire to spend more time at the residential site, either part-time or full-time. The expectation is there will be individualized programming that is community integrated during 37U.
2. The CILA provider in cooperation with the ISC case manager will be required to complete an Alternative Day Program Request Form for Enhanced Residential Day program.
   • Note: The decision to receive 37U is the individual's, and guardian, if applicable, choice, not for the benefit of the residential provider.
3. When completing the "Request for Alternative Day Programs Form (IL462-0285)PDF", the individual, with the assistance of the provider and/or ISC, should choose the first option in Section 3 of the form. Additionally, there must be an individualized explanation as to the individual's use of Enhanced Residential Day program.
4. The DDD recognizes that some individuals across an agency may need access to 37U due to the following reasons (not exhaustive):
   • The individual's CDS program has closed and/or does not have capacity to have individuals return.
   • The individual's residential provider also operates their CDS program, and it is not operating at full capacity for reasons such as safety, staffing levels or other identified reasons.
5. Providers supporting individuals in need of temporary authorization for 37U should reach out directly to the Division, by email, including a cc to their ISC, to discuss options. These emails can be directed to joy.decker@illinois.gov.
6. The Division has been issuing time limited blanket approval for the identified CILA site(s) or agency since July 2021.
   • All time limited blanket approvals for Enhanced Residential Day program ended on February 28, 2022.
7. On 7/1/21, ISCs began conducting in person visits in accordance with the Information Bulletin posted regarding the restarting of in person ISC visits to ensure the individual's choice is being respected in this decision.

NOTE:

The service requests for Additional Staff Support (53R) resumed a prior approval process effective 7/1/21. Individuals who were approved for 53R to be used with Enhanced Residential Day program will maintain the service until they return to regular CDS (31U/31C) services.

Community Living Facilities - (CLF) 67D & 67E:

1. Enhanced Residential Day program (37U) was no longer automatically authorized effective 7/1/21. After this date, prior approval must be sought for individuals interested in utilizing 37U due to the following:
   • Concerns about return to a regular CDS program in response to COVID-19
   • Desire to spend more time at the residential site, either part-time or full-time. The expectation is there will be individualized programming that is community integrated.
2. The ISC case manager will be required to complete a request for Enhanced Residential Day program. Note: The decision to receive 37U is the individual's, and guardian, if applicable, choice, not for the benefit of the residential provider.
3. When completing the "Request for Alternative Day Programs Form (IL462-0285)PDF", the individual, with the assistance of the provider and/or ISC, should choose the first option in Section 3 of the form. Additionally, there must be an individualized explanation as to the individual's use of Enhanced Residential Day program.
4. The DDD recognizes that some individuals across an agency may need access to 37U due to the following reasons (not exhaustive):
   • The individual's CDS program has closed and/or does not have capacity to have individuals return.
5. Providers supporting individuals in this situation should reach out directly to the Division, by email, including a cc to their ISC, to discuss options. These emails can be directed to joy.decker@illinois.gov.
6. The Division will request the following:
   • Reason for a blanket request for Enhanced Residential Day program to be provided by individual's CLF site(s) or agency.
   • Timeline for transition to CDS or the individual's chosen day activities.
7. The Division has been issuing time limited blanket approval for the identified CLF site(s) or agency since July 2021.
   • All time limited blanket approvals for Enhanced Residential Day Services ended on February 28, 2022.
8. On 7/1/21, ISCs began conducting in person visits in accordance with the Information Bulletin posted regarding the restarting of in person ISC visits to ensure the individual's choice is being respected in this decision.

NOTE:

• As the ISCs are providing in person services, they will prioritize their visits with individuals who have requested to continue receiving 37U services.
• For individuals who previously requested Enhanced Residential Day program through the Request for Alternative Day Program Process and were authorized for 37U prior to or during the COVID-19 pandemic, they will continue to be authorized for 37U and won't have to apply again.

The service requests for Additional Staff Support (53R) will resume to a prior approval process effective 7/1/21. Individuals who were approved for 53R to be used with Enhanced Residential Day program will maintain the service until they return to regular CDS (31U/31C) services.

Community Day Services (CDS) Multiple Types 31C, 31U, 31V, 31S, 35U, 37U, 39U, 39G:

1. CDS services (31U/31C) were authorized to reopen fully effective September 1, 2020. Please follow guidance posted in DDD Information Bulletins for guidance specific to these services.
2. As a reminder, 37U billing counts against the individual's 1200-hour service limit for all day program services.
3. Supported Employment - Individual (36U) and Supported Employment - Group (33G and 36G) should only be billed if the person is engaged in community-integrated employment (CIE) or actively seeking or preparing for CIE.
4. The 15% rate increase given to 31C and 31U will remain in effect until March 31, 2022.

ICF/DD & ICF/DD Day Programs (formerly Developmental Training, also known as CDS):

The Illinois Department of Healthcare and Family Services (HFS) has provided rate information and billing specifics both for additional residential funding, as well as CDS payment during this time.

The information contained herein should not be considered a substitute for the appropriate official statutes, rules, regulations, or the advice of legal counsel.

Effective Date:

03/31/22