Home and Community Based Services
Billing Rules Chart Guide 12-17-09
| HCBS Waiver Billing Rules Chart Guide Effective 2-01-10 | Waiver Services | FSS, SBS, RS | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Code: X =yes; 0 =no | 1 to 4 | additional rules | ICC | IIH-B | CRS - B | SBS | RS | FSS | Group Work | ||||||
| B=Bundled | |||||||||||||||
| Required service | X |
0 |
0 |
0 |
0 |
0 |
0 |
||||||||
| Supports child goal | X |
X |
X |
X |
X |
X |
X |
||||||||
| Document in Service Plans & Progress Notes | X |
X |
X |
X |
X |
X |
X |
||||||||
| Monthly case payment | X1 |
0 |
0 |
0 |
0 |
0 |
0 |
||||||||
| Bundled | 0 |
X2 |
X2 |
0 |
0 |
0 |
0 |
||||||||
| Fee for service/date of service | 0 |
0 |
0 |
X |
X |
X |
X |
||||||||
| Billing increments | monthly |
hourly |
hourly |
15 min |
15 min |
15 min |
15 min. |
||||||||
| Frequency requirement | 6xMo. |
0 |
0 |
0 |
0 |
0 |
0 |
||||||||
| Contact duration minimum requirement | 15 min. |
30 min3 |
30 min3 |
30 min |
30 min |
30 min |
30 min. |
||||||||
| Rounding daily down per 15 min. | 0 |
X |
X |
X |
X |
X |
X |
||||||||
| Face to face contact billable | X |
X |
X |
X |
X |
X |
X |
||||||||
| Telephone contact billable | 0 |
0 |
X4 |
0 |
0 |
0 |
0 |
||||||||
| Continuous minimum contact required to bill | X |
X |
X |
X |
X |
X |
X |
||||||||
| Maximum allowable billable contact hours per day per family | 0 |
0 |
0 |
0 |
6 hrs. |
0 |
0 |
||||||||
| Please refer to HCBS Waiver Guidance Document on-line for additional details. | |||||||||||||||
| Who can recieve billable services (must relate to child's goal/objectives) | ICC | IIH-B | CS-B | SKS | RS | FSS | |||||||||
| Waiver children as indicated in service plan goals and objectives | X |
X |
X |
X |
X |
0 |
|||||||||
| Waiver parents/routine caregivers as indicated in service plan objectives | X |
X |
X |
X |
0 |
X |
|||||||||
| Waiver child's siblings who are indicated in the service plan objectives | 0 |
X |
X |
X |
0 |
0 |
|||||||||
| Collaterals indicated in the service plan objectives | X |
0 |
0 |
0 |
0 |
0 |
|||||||||
| Additional billing rules | |||||||||||||||
| ICC: | |||||||||||||||
| 1 ICC monthly case payment: full & half month, start up, hospitalizations, jail-detention, residential assessment or substance abuse tx programs | |||||||||||||||
| Bundled services: | |||||||||||||||
| 2 Bundled IIH & bundled telephone and face to face CRS: reimbursement for an average of 65 IIH and/or CRS contacts per slot included in the monthly case payment | |||||||||||||||
| 3 Bundled IIH and bundled face to face CRS: Billed monthly per two 30 minute contacts totaling one hour for tracking (pending $.25 rate approval) | |||||||||||||||
| CRS: | |||||||||||||||
| 4 Bundled CRS telephone calls: billable for up to 12 phone contacts annually per slot of a minimum of 15 min. each contact (pending $.25 rate approval) | |||||||||||||||
| Group Work: | |||||||||||||||
| See Chapter 600.4 of Waiver Guidance Document for additional billing rules for group work | |||||||||||||||