Medicaid Post Payment Review for Temporary Assistance 53C - FY12 to FY16

Helping Families. Supporting Communities. Empowering Individuals.

Purpose

The IDHS/DDD seeks to ensure that all Temporary Assistance (53C) billings for Home Based Service (HBS) individuals are accurate, justified and meet specified rules and requirements. Per Appendix C of the 1915(c) HCBS Waiver "Temporary assistance may not exceed $2,000 in any single month and may not be authorized for more than two consecutive months or 60 consecutive days."

Basis for Review

The Illinois Department of Human Services, Division of Developmental Disabilities must conduct ongoing annual reviews of Medicaid Waiver programs per the approved Medicaid Waiver Application.

Method of Review

The Bureau of Program Development & Medicaid Administration reviewed all Temporary Assistance awards that were issued during FY 2012 thru November 2015. Awards were selected for further review if they appeared more than once on the log.

Findings

Attached is a table that shows the number of HBS authorizations, Temporary Assistance awards, consecutive awards and multiple awards by fiscal year. DDD Staff found that only 0.74% of HBS consumers have utilized the program, but of those consumers that do utilize the program a significant amount (37%) have used it multiple times.

Actions Taken

Region Staff were given the results of this review and are actively screening applications for consecutive requests. Additionally, the Division is strengthening the language used in the Waiver pertaining to the use of Temporary Assistance as a part of the Waiver renewal process.

Fiscal Year # Authorized
For HBS
Awards
Issued
For 53C
Consecutive
Awards Issued
To Waiver
Participants
Multiple Awards
Issued to Waiver
Participants
% of HBS
Recipients
Received 53C
% of Multiple
53C Awards
% of Consecutive
53C Awards
FY12 5,368 42 1 15 0.78% 35.71% 2.38%
FY13 6,642 41 3 22 0.62% 53.66% 7.32%
FY14 7,399 52 2 24 0.70% 46.15% 3.85%
FY15 7,826 84 3 28 1.07% 33.33% 3.57%
FY16 7,964 42 0 9 0.53% 21.43% 0.00%
Totals 261 9 98 0.74% 37.55% 3.45%