Remote Support

Remote Support

Illinois Department of Human Services

Division of Developmental Disabilities

DD.23.007

Background:

NOTE: This service is only available to individuals who receive the following Community Integrated Living Arrangement (CILA) services in the Adult Waiver:

  • CILA - 24 Hour (60D)
  • CILA - Host Family (60D)
  • CILA - Intermittent (61H, 62H,63H)

Definition:

Remote Support includes the use of video, audio, door and window monitoring devices, sensors or other technology which enables an individual to be more independent, or maintain their independence, and less reliant on staff being physically present when receiving CILA supports and services. The use of this service is not intended to replace an individual's ability or right to engage with the community. The use of remote support will be considered on an individual, case-by-case basis when an individual and guardian, if applicable, requests the service and the Independent Service Coordination agency and provider support team agree it is appropriate and meets the health and safety needs of the individual. Remote Support requires prior approval from the Division of Developmental Disabilities (DDD) and may only be used with full consent of the individual, guardian, if applicable, and anyone else residing in the same living space.

There are two parts to Remote Supports: Remote Support Equipment and the ongoing monitoring cost.

Remote Support Equipment (53E):

* Remote Support Equipment includes the cost of consultation, training, installation, equipment (lease or purchase), and/or maintenance/repair service agreements. Funding for Remote Support Equipment is requested using the Adaptive Equipment (53E) bill code. DDD recommends individuals lease the equipment on a monthly lease. If Remote Support Equipment is leased, the funding request must be specific as to any equipment being purchased as a one-time expense and any equipment with an on-going monthly cost. Leased equipment will be authorized as a monthly billable amount under the 53E bill code.

Ongoing Monitoring (53T):

* The ongoing monitoring cost covers the cost of the monitoring provider to monitor the equipment and respond to the individual and/or contact on-call or emergency services as applicable to the situation. Funding for ongoing monitoring and response is requested using the Assistive Technology (53T) bill code. If the cost of leased equipment and monitoring are combined as one cost, the authorization will be under the 53T bill code as a monthly billable amount. Ongoing monitoring and equipment costs will automatically roll over state fiscal years up to the individuals maximum available $15,000 per five-year funding limit for Adaptive Equipment, Assistive Technology, Remote Supports, Minor Home and Vehicle Modifications. NOTE: For 24 hour or Host Family CILA providers, there is no reduction in the rate paid to the provider when Remote Supports are implemented. Therefore, the 24 hour CILA provider will cover the ongoing monitoring costs. ICILA customers are authorized to use Remote Support funding for ongoing monitoring.

Location:

The type of equipment and where it is placed will depend upon the needs and wishes of the individual(s) and their guardian(s), if applicable, the layout and construction of the home, and the company selected by the individual(s) or guardian(s) to provide the equipment. Video equipment for remote support monitoring cannot be placed in invasive areas such as bedrooms or bathrooms in accordance with 42 CFR Section 441.301(c)(4)(iii) for 1915(c) and 42 CFR Section 441.710(a)(1)(iii) for 1915(i). The installation of video/audio equipment in the home will be done at the direction of the individual(s). If the home is shared with others, the equipment will be installed in such a manner that it does not invade others' privacy. The remote device is controlled by the waiver individual and can be turned on or off as needed.

Backup System:

Electronic Equipment and Monitoring companies must ensure they have a backup system in place for all locations receiving remote supports in cases of power, internet, and/or equipment outages. Once the remote supports equipment has lost functionality, the service provider must either restore remote support services or have a person who can be at the residence within 15 minutes to provide the necessary supervisory function. The process should be clearly defined in the contract and only one provider (CILA or Remote Support) can bill for services at a time. An ICILA provider may bill for services while a Remote Support provider is billing for services only in response to an emergency that requires in person staff.

Request Process and Procedures:

The individual and guardian, if applicable, requesting Remote Support services will work with their ISC agency, residential services provider, and Remote Support provider to determine if Remote Supports will meet the health and safety needs of the individual by completing an assessment.

The Remote Support services must enable the individual to be more independent and less reliant on in-person staff.

  1. The ISC staff is responsible for submitting the Remote Support Request Cover SheetPDF to the Division of Developmental Disabilities [on the DDD website under forms]. The ISC staff will work with the provider or individual to complete the paperwork as appropriate.
  2. Submit a cover letter explaining the Remote Supports being requested. The explanation should address if other Waiver services (Adaptive Equipment, Assistive Technology, minor Home Modifications or Vehicle Modifications) are to be used in conjunction with Remote Support services.
  3. Secure and attach a minimum of two (2) bids/estimates for the items to be purchased or for the work to be done from different contractors/vendors.
    1. A bid can be submitted from any supplier, vendor, or contractor of the CILA agency or individual's choosing. A bid or estimate can be accepted from any supplier, vendor, or contractor. The supplier, vendor, or contractor does not have to be an enrolled Medicaid vendor at the time a bid is submitted but MUST be an enrolled Medicaid vendor before any equipment or services are provided to or contracted by the individual, their guardian, if applicable, and/or CILA provider.
    2. Failure of a contractor, supplier, or vendor to enroll as a Medicaid vendor through the IMPACT system with DDD will result in no payment for any equipment or services.
    3. Bids/estimates MUST be detailed enough to identify the various parts of a request when multiple Remote Supports are included in one request. For example, if a single contractor is to provide equipment and monitor the equipment, it can be one bid/estimate. The equipment needs a sub-total cost specified and the monitoring activities also have to have a sub-total cost specified within the one bid. Also, if two different providers are being used to provide the service, they can be combined into a single bid as previously described.
    4. If an individual or CILA provider is unable to receive two bids, they must provide proof they attempted to receive more than one bid and why they weren't able to receive more than one bid.
    5. The second bid requirement is waived when remote supports are already being provided for other people living in the CILA site AND the "new" remote supports are for a new person utilizing or connecting to existing remote support equipment at the CILA site.
    6. If the home is being modified in order to install Remote Support equipment, where the location is covered by a Rental Agreement, the packet must contain prior approval from the landlord that:
      1. modifications to the property can be made; and
      2. assure no increase in rental cost because of the modification, an
      3. agree the property must NOT be returned to its previous condition after the modification is complete and/or the individual terminates their lease and removes any remote support equipment which may have been installed in or attached to any part of the premises.
  4. The ISC must edit the individual's Personal Plan identifying the need/desire for Remote Supports and submit the edited Plan with the packet.
  5. Once received, DDD Regions staff will review the request. DDD staff will follow up with questions, as appropriate or needed, to the ISC agency.
  6. When a request is approved, the Division will award the least expensive estimate or bid provided in the request.
  7. The award for Remote Support will clearly identify any and all amounts which are being authorized as a one-time billable amount under the 53E bill code for remote support equipment. On-going, recurring remote monitoring payments will be authorized under the 53T bill code and will specify the maximum monthly billable amount, total annual amount and authorization end date when and if the individual will exhaust their $15,000 per five-year maximum benefits.
  8. If approved, DDD will also issue an award letter to the:
    1. CILA Agency
    2. The ISC agency is copied on all awards.
  9. An individual may select a provider who is not the lowest bidder, however, the individual is responsible for paying any cost difference if they exceed their service limit.
  10. If the request is denied, DDD will issue a denial letter to the individual, CILA agency, and ISC agency. The individual has the right to appeal the decision.

In situations when the CILA Agency chooses to install Remote Support equipment and pay the expense of the equipment and/or ongoing monitoring without using the individual's waiver funding, the below procedures must be followed:

  1. The provider agency must secure the consent and approval of the individual, guardians, if applicable, and notify the ISC agency.
  2. The Remote Support request process and procedures (outlined above) must be followed. The Remote Support Request Cover SheetPDF should show a zero cost in the "Low Bid Cost" section of the form.
  3. The CILA Agency cannot now nor in the future choose to pass the expense on to the individual(s) who reside at the home until all equipment is removed and the process outlined above is followed anew.

The DHS webpage lists additional information on the request process to Adaptive Equipment, Assistive Technology, Remote Support, Minor Home and Vehicle Modifications.

Service Limits:

Remote Support is limited to individuals who are funded through 60D CILA, 61H, 62H, and 63H Intermittent CILA bill codes. Remote Support is not available for individuals who receive home-based services, day program only services, CLF, ICF/IDD, or SODC.

There is a $15,000 maximum per individual per five-year period for any combination of Adaptive Equipment/Assistive Technology, Home Modifications, Vehicle Modifications, Remote Support - Equipment (which includes consultation, training, installation, equipment costs (lease or purchase), and/or maintenance/repair service agreements) and any monthly monitoring costs for Remote Support.

NOTE: For 24 hour or Host Family CILA providers, there is no reduction in the rate paid to the provider when Remote Supports are implemented. Therefore, the 24 hour CILA provider will cover the ongoing monitoring costs.

Awards for Remote Support will limit the individual's available maximums for future requests of Adaptive Equipment, Assistive Technology, Home Modifications, Vehicle Modifications and other Remote Support services for the term/time the Remote Supports are contracted and/or provided.

All items shall meet applicable standards of manufacture, design and installation. All purchased items shall be the property of the individual or the individual's family.

In a CILA setting where more than one individual is receiving Remote Support and one or more of the individuals leave the CILA setting or terminate CILA supports, the division or replacement of shared equipment will be addressed on a case-by-case basis.

AGENCY CONTROLLED CILA HOME MODIFICATIONS:

Each agency controlled CILA has a one-time lifetime $15,000 to use on home modifications. This may include fire safety issues such as sprinklers, interconnected alarm systems, emergency secondary egress windows and/or accessibility modifications that would benefit all individuals living in the CILA. These home modifications which are needed for a CILA home that is agency controlled do not count against any one individual. The individual's name is used to account for the funding, but it doesn't count against the individual's available funding for Adaptive Equipment, Assistive Technology, Minor Home or Vehicle Modifications or Remote Support service limits.

The Bureau of Reimbursement and Program Support tracks all Adaptive Equipment, Assistive Technology, Remote Support, Home and Vehicle Modification requests and awards. We also track whether or not the awarded amount counts against the individual's service limit. If anyone has a question of an individual's available funding, please contact Mike Vespa at Michael.vespa@illinois.gov.

Remote Support Provider Qualifications:

The Provider Type for this waiver service falls under Electronic Communication Equipment and Monitoring Company.

The provider of remote supports must be capable of responding to numerous, simultaneous signals for help from multiple people and/or locations as outlined in their remote support plans.

The monitoring company's equipment must include a backup power supply. The remote support system must also include a method for collecting data and generating reports with, at a minimum, a date and time stamp for each alert sent by the remote support equipment as well as an identifying code specific to the person and/or site supported.

The monitoring company is required to have a backup system in place that includes an audible and visual signal when primary Remote Support equipment has lost power and/or the ability to transmit data. In such cases, the remote support company must ensure the service provider is notified of the failure so they can initiate their backup responsibilities as outlined in the contract and as appropriate. The CILA service providers responsibilities are not meant to replace those of the Remote Support provider.

The monitoring company must maintain detailed technical and operations manuals that describe remote support elements including remote support equipment installation, functioning and testing; emergency response protocols; and record keeping and reporting procedures. The electronic communication equipment company and monitoring company don't need to be the same company.

Remote Support Provider Requirements:

  1. The contractor(s) and/or vendor(s) who will be providing Remote Support equipment and/or ongoing monitoring MUST either be, or become, enrolled as a Remote Support vendor through the Medicaid IMPACT system and with DDD prior to any contract between the individual, CILA agency and/or contractor(s)/vendor(s) for Remote Support is enacted. Provider enrollment for Remote Supports can be found at: Remote Supports for CILA clients - Developmental Disabilities.
  2. The contractor(s)/vendor(s) also MUST remain an enrolled Medicaid vendor through IMPACT and DDD for the duration of the term Remote Support is to be provided. Any contractor(s)/vendor(s) failing to maintain Medicaid vendor status through IMPACT with DDD will immediately notify the individual, their guardian, if applicable, and/or the CILA agency of their disenrollment as a Medicaid vendor and their need to terminate Remote Support services with the provider.
  3. No Remote Support contractor(s)/vendor(s) are eligible for payments under DDD's Adult Home and Community Support Waiver unless they are and maintain Medicaid vendor status through IMPACT with DDD. Payments from DDD will stop upon a Remote Support contractor(s)/vendor(s) Medicaid disenrollment even though Remote Support may continue to be provided after Medicaid disenrollment.
  4. The Remote Support contractor(s)/vendor(s) must agree to download Reporting of Community Services (ROCS) software from the State of Illinois Department of Innovation and Technology (DoIT).
  5. The Remote Support contractor(s)/vendor(s) must agree to bill applicable Bill Code(s) and amount(s) for the provision of Remote Support equipment and/or ongoing monitoring through the ROCS service reporting software after the equipment and/or ongoing monitoring have been delivered, installed and/or provided as instructed by DDD.
  6. The Remote Support contractor(s)/vendor(s) must agree to provide the individual, guardian, if applicable, and CILA agency a MINIMUM of 90 days written advance notice before implementing any price/cost change for on-going billable supports and/or equipment. The individual, guardian, if applicable, and CILA agency must provide DDD with written acceptance of all on-going price/cost changes. DDD will issue an updated Remote Support Award for any on-going price/cost changes with the effective date the new price/cost may be billed and an updated expiration date of when the individual may exhaust available funding for Remote Supports. The Remote Support provider may not bill for any increase until an updated Remote Support Award is issued by DDD.
  7. The Remote Support contractor(s)/vendor(s) must agree to allow the individual to terminate Remote Supports without penalty or additional cost prior to the end of the contracted period if the termination occurs due to a change in their circumstances and is no fault of their own.

Billing:

  1. The provider must be enrolled in IMPACT to be reimbursed for providing Remote Support.
  2. The individual must have received prior approval to receive Remote Support.
  3. Billing through the ROCS software for reimbursement of Remote Support can ONLY be done AFTER the delivery and/or installation of Remote Support equipment.
  4. When billing through ROCS, the vendor is always the supplier or contractor's FEIN. The payment can be directed to a different payee if the agency entering the ROCS billing enters the FEIN of the payment recipient in the "Alternate Payee" filed in ROCS.
  5. If the CILA provider is billing through the ROCS system for the vendor or contractor, then the vendor/contractor has to complete and sign the Payee Designation/Authorization Form (IL462-1180)PDF. This form MUST be retained by the CILA provider in their records.

NOTE: There are two sections to the form - one if a CILA provider is to bill for another provider and the second is if the payment is to be redirected to any payee other than the provider.

  1. The provider will submit billing through the Reporting of Community Services (ROCS) billing system using Program Code 53E or 53T. DDD will likely add a new Program Code for Remote Support in the future but in an effort to get the service available more timely, you will be using these Program Codes.
  2. In a situation where there are multiple individuals within a single household using Remote Support, the provider will only bill for the Remote Support services being used by the individual. If the Remote Support services are equally being used by all individuals in the household, the cost will be spread evenly among all of them and billed appropriately.
  3. Billing will be submitted monthly through ROCS.

Billing Guidance:

Remote Support may be awarded as a one-time and/or monthly billable service(s) and may be authorized as either of the following Program Codes.

Remote Supports

Program Code 53E or 53T
Max Allowed A $15000 maximum per individual per 5-year period applies for any combination of adaptive equipment, assistive technology, remote support, home modifications, and/or vehicle modifications as applicable.
Units Event Mode
Billable Refer to the Information Bulletin of Service Authorization and Prior Approval for additional information.

If you have questions related to Remote Supports, please contact Mike Vespa at Michael.vespa@illinois.gov or (217) 782-2914.

Effective Date:

10/10/23