Billing Guidelines

1

Overview of HCS Billing Guidelines
2
Specific Requirements
3-1
3
4.01 Case Management
4.01-1
4
Specific Requirements

• Case Management Billable Activity
• Interacting face-to-face with the individual to
• Identify HCS and non-HCS Program services the
  individual may need
• Coordinate the provision of service components to
  the individual
• Monitor the effectiveness of service components
  the individual is receiving and the individuals
  progress toward achieving the service outcomes
  described in the individuals ISP

4.01-1
5
Specific Requirements

• Not Billable as Case Management
• Travel time
• Written documentation
• Reviewing records
• Drafting ISPs or PDPs
• Staff Training/Conferences
• Processing service claims
• Anything not listed as billable

4.01-1
6
Specific Requirements

• Case Management Monthly Unit of Service
• A program provider may include only one unit of
  service per calendar month on a service claim for
  case management except when an individual is
  transferring from one program provider to another
  (4.01G). In the case of a transfer the service
  providers combined increments must not exceed
  one unit.

4.01-2
7
Common Errors

• Poor Quality Narrative
• Vague about type of meeting (face-to-face,
  telephone, etc.)
• Billing on the first day of the month instead of
  actual date service was provided
• Billing while individual is in Hospital
• Billing for meeting with sleeping individual
• Not signing individual out of day habilitation
  when activities are interrupted
• No Progress Note
• Please view the attached case management examples
  for both billable and non-billable forms of
  documentation. (ADDENDUM B C)

8
No Face-To-Face Contact (NFFC)
ADDENDUM B
9
Case Manager met face-to-face with individual
ADDENDUM B
10
No Face-To-Face Contact (NFFC)
ADDENDUM C
11
Case Manager met face-to-face with individual
guardian
ADDENDUM C
12
4.02 Counseling and Therapies
4.02-1
13
Specific Requirements

• Counseling and Therapies
• Audiology services
• Dietary services
• Occupational therapy services
• Physical therapy services
• Psychology services
• Social work services
• Speech and language pathology services

4.02-1
14
Specific Requirements

• Counseling and Therapies Billable Activity
• Interacting face-to-face or by telephone with an
  individual to conduct assessments or provide
  services within the scope of the service
  providers practice
• Interacting face-to-face or by telephone with a
  person, except a service provider of nursing,
  case management, or counseling and therapies,
  regarding a counseling and therapies subcomponent
  provided to an individual

4.02-1
15
Specific Requirements

• Counseling and Therapies Billable Activity
• Participating in an IDT meeting
• Training a service provider of residential
  assistance, day habilitation, respite or
  supported employment, or a person other than a
  service provider who is involved in serving the
  individual, regarding how treatment that is
  within the scope of practice of the service
  provider of counseling and therapies will be
  provided, including training to document the
  provision of treatment

4.02-1
16
Specific Requirements

• Not Billable as Counseling and Therapies
• Travel time
• Written documentation
• Reviewing records
• Drafting ISPs
• Staff Training/Conferences
• Processing service claims

4.02-2
17
Specific Requirements

• Examples of Activity Not Billable
• Writing how treatment will be provided
• Reviewing a document
• Providing services outside the service providers
  scope
• Scheduling an appointment
• Transporting an individual
• Traveling to or waiting to provide a subcomponent
• Training or interacting about general topics, not
  specific to the individual

4.02-2
18
Specific Requirements

• Counseling and Therapies Written Documentation
• Must meet the general requirements outlined in
  3.08
• Include the exact begin and end time for the
  service event by the service provider making the
  written narrative
• Include a written narrative of the service event
• Must include a written justification in the
  individuals ISP for any activity performed by
  multiple service providers at the same time for
  the same individual

4.02-3
19
Common Errors

• No begin and/or end times
• No location of service provided
• Duplicated progress notes
• Reviewing or creating paperwork
• Family paying for rate differential
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached counseling therapies
  examples for both billable and non-billable forms
  of documentation. (ADDENDUM D E)

20
Non Billable Service (NBS)
ADDENDUM D
21
ADDENDUM D
22
Non Billable Service (NBS)
ADDENDUM E
23
Psychologist wrote a billable note and performed
billable activities
ADDENDUM E
24
4.03 Day Habilitation
4.03-1
25
Specific Requirements

• Day Habilitation Billable Activity
• Interacting face-to-face with an individual to
  assist the individual in achieving goals to
• Acquire, retain or improve self-help skills,
  socialization skills or adaptive skills that are
  necessary for the individual to successfully
  reside, integrate and participate in the community

4.03-1
26
Specific Requirements

• DH billable activity
• Reinforce a skill taught in school, counseling or
  therapy
• Develop opportunities for employment in the
  community
• Transport an individual between day habilitation
  sites
• Assist an individual with personal care
  activities
• Participate in IDT meetings

4.03-1
27
Specific Requirements

• Day Habilitation may not be provided in the
  individuals residence unless there is adequate
  justification in the individuals ISP of a severe
  medical condition or serious behavioral issues.

4.03-1
28
Specific Requirements

• Not Billable as Day Habilitation
• Travel time (except from one Day Habilitation
  site to another)
• Written documentation
• Reviewing records
• Drafting ISPs
• Staff Training/Conferences
• Processing service claims
• Assisting an individual for the sole purpose of
  meeting vocational goals

4.03-1 4.03-2
29
Specific Requirements

• May not submit DH service claim for
• An individual who refuses to participate
• An individual who is sleeping
• Assisting an individual in achieving goals not
  documented in their ISP
• More than five units of service in a calendar
  week
• More than 260 units of service per IPC year
• Day habilitation that is funded by another source
  other than HCS

4.03-2
30
Specific Requirements

• Day Habilitation Unit of Service
• A unit of service for Day Habilitation is one day
• One-half unit of service may be billed if service
  is provided for two consecutive hours in one
  calendar day
• Three-quarters unit of service may be billed if
  service is provided for at least three and
  one-half hours (with at least two consecutive
  hours) in one calendar day
• One unit may be billed if at least five hours are
  provided on one consecutive day-two of the five
  hours must be consecutive

4.03-3
31
Specific Requirements

• DH Written Documentation must
• Meet the requirements in 3.08
• Include a description of the DH site
• Include daily exact start and end times
  documented by the person present at the site at
  those times
• Include a written narrative or written summary
• Include a description of the individuals ISP
  goals and outcomes

4.03-3 4.03-4
32
Common Errors

• Individual sleeping
• Not signing individual out of Day Habilitation
  for other services provided (CMM, NU, SHL, etc.)
• No description of service provided (details about
  interactions, activities, behaviors, successes,
  refusals, etc.)
• Daily narrative used for weekly summary
• No habilitation occurring in the day habilitation
  center
• Duplicated Progress notes
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached day habilitation
  examples for both billable and non-billable forms
  of documentation. (ADDENDUM F, G H)

33
No Description of Activities Performed (NDAP)
ADDENDUM F
34
A Unique description of the daily activities
performed were added to the progress note
ADDENDUM F
35
Daily Narrative Used for Weekly Summary (DNUFWS)
ADDENDUM G
36
ADDENDUM G
A weekly summary replaced the daily narrative
with more descriptive training and behavior
documentation
37
Daily Narrative Used for Weekly Summary
(DNUFWS) Service Not Justified in Service Plan
(SNJSP)
ADDENDUM H
38
4.07 Supported Employment
4.07-1
39
Specific Requirements

• Supported Employment Requirements
• Fair Labor Standards Act must be compensated by
  the employer as an employee under this act
• Must be employed at a site where no more than one
  employee or 3 of the employees, whichever is
  greater, has a disability

4.07-1
40
Specific Requirements

• Supported Employment Billable Activity
• Face to face or by telephone with individuals
  supervisor to sustain individual employment
• IDT meetings
• Face to face with individual at work site only

4.07-1
41
Specific Requirements

• Billing Day Habilitation for SE
• Documentation must include name of the
  individual, exact time worked each day, exact
  dates worked each week, name, address and phone
  number of employer and signature of employment
  supervisor, service provider or case manager.

4.07-3
42
Specific Requirements

• Examples of Activities Not Billable under SE
• Interacting with individual when not on duty
• Services provided prior to employment-
• includes assessments, assisting or arranging
  interviews, completing applications and
  transporting

4.07-1 4.07-2
43
Specific Requirements

• Restrictions (SE)
• Program provider cant be employer unless the
  program provider has an approved variance from
  DADS
• An individual receives more than 600 units/150
  hrs per IPC year
• Supported employment is available through another
  source (public school or DARS)

4.07-2 4.07-3
44
Specific Requirements

• Supported Employment Documentation
• Meet requirements set forth in 3.08
• Written narrative in 3.08(B)
• Service Event in 3.06(A)(1)
• Exact Begin and End time
• Evidence not available through school or other
  funding source

4.07-3
45
Common Errors

• Training not occurring at the job site
• Pre-vocational training
• Duplicated progress note
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached Supported Employment
  examples for both billable and non-billable forms
  of documentation. (ADDENDUM I)

46
Non-Billable Service (NBS)
ADDENDUM I
47
The trainer has changed locations of the service.
ADDENDUM I
48
4.04 Nursing
4.04-1
49
Specific Requirements

• Nursing Billable Activity
• Interacting face-to-face or by telephone with an
  individual to provide professional or vocational
  nursing for which there is a documented or
  immediate medical necessity
• Preparing or administering medication or
  treatment ordered by a physician, podiatrist or
  dentist
• Assisting or observing self-administration of
  medication
• Assessing an individuals health status

4.04-1
50
Specific Requirements

• Nursing Billable Activity
• Interacting face-to-face or by telephone with a
  person (other than a service provider of
  nursing, case management, or counseling and
  therapies) regarding the health status of an
  individual
• Instructing, verifying the competency of, or
  supervising an unlicensed person in the
  performance of a task delegated in accordance
  with the rules of the Board of Nurse Examiners
• Participating in an IDT meeting

4.04-1
51
Specific Requirements

• Examples of Non-Billable Activities
• Writing an ITP for an individual
• Activities that do not constitute the practice of
  nursing (transportation, waiting to perform
  billable activities)
• Making appointments
• Instructing on general topics
• Preparing a treatment or medication for
  administration if not face-to-face
• Storing, counting, refilling, reordering or
  delivering medications
• Reviewing documentation

4.04-2
52
Specific Requirements

• Nursing Rule of Thumb
• If it does not require a nursing license to
  perform a task, it is not billable.
• (please disregard the statement regarding
  justification in the ISP)

53
Specific Requirements

• Nursing Unit of Service
• 15 Minute of Service
• A service claim cannot be made for a fraction of
  a unit of service
• Accumulation of Service Times
• Can be accumulated for nursing provided to one
  individual on a single calendar day

4.04-3
54
Specific Requirements

• Nursing Written Documentation
• Must meet the requirements in 3.08
• Include a written narrative of the service event
• Include the exact start and end time of the
  service event documented by the person making the
  written narrative
• Include a description if the medical necessity
  for the activity performed during the service
  event
• For any activity simultaneously performed by more
  than one service provider, include a written
  justification in the individuals ISP for the use
  of more than one service provider

4.04-4
55
Common Errors

• Billing for creating and reviewing paperwork.
• No medical necessity on vitals taken weekly,
  monthly, or quarterly
• No medical necessity shown when residential staff
  calls nurse to administer over the counter
  medication to individual
• No medical necessity for follow-up phone call
• Billing for services without Face-to-Face or
  Telephone contact
• Providing any activity not requiring a nursing
  license
• Poor justification in PDP/ISP for nursing
  services
• Using location codes as only documentation of
  location
• One note used for multiple service events
• No Progress Note
• Please view the attached nursing examples for
  both billable and non-billable forms of
  documentation. (ADDENDUM J K)

56
ADDENDUM J
57
ADDENDUM J
58
ADDENDUM K
59
ADDENDUM K
60
4.05 Residential Assistance
4.05-1
61
Specific Requirements

• Residential Assistance Residential Location
• Own Home/Family Home if no foster/companion
  care, residential support or supervised living is
  provided to the individual
• Foster/Companion Care is not owned or leased by
  the program provider, a service provider provides
  care to the individual and the care provider and
  the individual have the same address

4.05-1 4.05-2
62
Specific Requirements

• Residential Assistance Residential Location
• 3-Person Home the individuals residence is a
  3-person residence and a service provider
  provides residential support or supervised living
  to the individual
• 4-person Home the individuals residence is a
  4-person residence and a service provider
  provides residential support or supervised living
  to the individual

4.05-2
63
Supported Home Living
4.05 Residential Assistance
4.05-3
64
Specific Requirements

• Supported Home Living Billable Activity
• Interacting face-to-face with the individual
• to assist with activities of daily living
• to assist with ambulation and mobility
• to reinforce counseling and therapy subcomponents
• to assist with administration of medication or
  tasks delegated by an RN
• to conduct habilitation activities
• to secure transportation for the individual
• to supervise the individuals safety and security

4.05-3
65
Specific Requirements

• Supported Home Living Billable Activity
• Interacting face-to-face or by telephone with an
  individual or an involved person regarding an
  incident that directly affects the individuals
  health or safety
• Performing one of the following activities that
  does not involve interacting face-to-face with an
  individual shopping for the individual, planning
  or preparing meals for the individual,
  housekeeping for the individual, procuring or
  preparing the individuals medication or securing
  transportation for the individual.
• Participating in an IDT meeting

4.05-4
66
Specific Requirements

• Supported Home Living claims may not be submitted
  for
• An individual whose IPC does not have a
  residential location of own home/family home
• Transporting an individual from one DH or SE site
  to another

4.05-5
67
Specific Requirements

• Supported Home Living Unit of Service
• 15 Minute of Service may not include fraction
  of service
• Calculating transportation use Method A or
  Method B (can only use one method on a single
  calendar day)

4.05-6
68
Specific Requirements

• Supported Home Living Written Documentation
• Must meet requirements of 3.08
• Includes a written narrative of the service event
• Includes exact begin and end time of the service
  event documented by the service provider making
  the written narrative
• If not face-to-face, justification must be in the
  individuals ISP. The activity must be described
  in the written narrative
• For any activity simultaneously performed,
  justification must be included in the
  individuals ISP

4.05-9
69
Specific Requirements

• SHL Transportation Written Documentation
• Name of the individual being transported
• Day, month and year the transportation was
  provided
• Place of departure and destination for the
  individual being transported
• Notation of which method was used to calculate
  transportation time
• Begin and end time for each transportation time

4.05-9 4.05-10
70
Specific Requirements

• SHL Transportation Written Documentation contd
• Total minutes of each transportation time
• Signature of the service provider
• The unit of service for a service claim resulting
  from each service time and
• Any service times accumulated to make a unit of
  service for a service claim
• Attachment F Supported Home Living
  Transportation Billing Log Example

4.05-10
71
Transportation Method A
a. Transportation time of 120 minutes
(700am-900am) with 6 passengers (Dorothy 5
others) and 1 service provider for Trip A SERVICE
TIME (1 X 120) 6 20 minutes b.
Transportation time of 90 minutes (300pm-430pm)
with 5 passengers (Dorothy 4 others) and 1
service provider SERVICE TIME (1 X 90) 5 18
minutes 20 min 18 min 38 minutes
(accumulation) According to Attachment C 38
minutes 3 Units Billed (accumulation) 1 Unit
(20 min) 1 Unit (18 min) 2 Units Billed (no
accumulation)
72
Transportation Method B

• Transportation time for Dorothy N. Kansas
• a. Transportation time of 15 minutes
  (700am-715am) with one passenger (Dorothy only)
  and 1 service provider
• SERVICE TIME (1 X 15) 1 15 minutes
• b. Transportation time of 15 minutes
  (715am-730am) with two passengers (Dorothy and
  Little) and 1 service provider
• SERVICE TIME (1 X 15) 2 7.5 minutes
• c. Transportation time of 15 minutes
  (730am-900am) with three passengers (Dorothy,
  Little and Mary) and 1 service provider
• SERVICE TIME (1 X 90) 3 30 minutes
• 15 min 7.5 min 30 min 52.5
  minutes
• According to Attachment C 52.5 minutes
  3 Units

73
Common Errors

• Overlapping times with other services
• Transportation method completed incorrectly
• Time not divided evenly between two or more
  individuals receiving services at the same time
• Non-qualified Service Provider (Proof of
  residence, etc.)
• No justification for receiving SHL in DH facility
• No begin and/or end times on documentation
• No location of services provided on documentation
• Duplicated progress note
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached Supported Home Living
  examples for both billable and non-billable forms
  of documentation. (ADDENDUM L)

74
ADDENDUM L
75
ADDENDUM L
76
Foster Care
4.05 Residential Assistance
4.05-11
77
Specific Requirements

• Foster Care Requirements of Setting
• The program provider may not lease or own the
  residence
• The individual receiving care must have a
  residence in which no more than three persons
  receive foster/companion care, a non-HCS Program
  service similar to foster/companion care and
• If the individual is a minor, the parent or
  step-parent may not provide this service

4.05-11
78
Specific Requirements

• Foster Care Requirements of Setting
• The service provider must have the same residence
  as the individual and
• Ensure that foster/companion care is provided to
  an individual when necessary

4.05-11
79
Specific Requirements

• Foster Care Unit of Service
• Unit of service is one day
• May not be for more than one day
• May not have a fraction of a unit of service

4.05-14
80
Specific Requirements

• Foster Care Billable Activity
• Assisting the individual with activities of daily
  living (bathing, dressing, personal hygiene,
  eating, meal planning and preparation and
  housekeeping)
• Assisting the individual with ambulation and
  mobility
• Reinforcing any counseling and therapy
  subcomponent provided to the individual
• Assisting with the administration of the
  individuals medication or to perform a task
  delegated by an RN

4.05-11 4.05-12
81
Specific Requirements

• Foster Care Billable Activity
• Conducting habilitation activities that train the
  individual to
• Develop or improve skills that allow the
  individual to live more independently
• Develop socially valued behaviors
• Integrate into community activities
• Use natural supports and typical community
  services available to the public
• Participate in leisure activities

4.05-12
82
Specific Requirements

• Foster Care Written Documentation
• Must meet the requirements in 3.08
• Must include a description of the location of the
  individuals residence and
• Include a written narrative of the calendar day
  or a written summary of the calendar week

4.05-14 4.05-15
83
Specific Requirements

• Foster Care Service Claim for an Individual on a
  Visit with Family or Friend
• A program provider may submit a service claim
  for an individual who is on a visit with a family
  member or friend away from their residence if the
  visit is for at least a calendar day. If the
  visit is for more than 14 consecutive calendar
  days, the program provider may submit a service
  claim for only 14 calendar days of the visit.

4.05-15
84
Specific Requirements

• Foster Care Service Claim for an Individual on a
  Visit with Family or Friend Written Documentation
• Written documentation must include the
  individuals name, the dates the individual was
  visiting the family member or friend, the
  location of the visit and the date and signature
  of the service provider.

4.05-15
85
Common Errors

• Failure to discharge individual while in the
  hospital
• Weekly summary exceeds seven days
• Duplicated progress note
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached Foster Care examples for
  both billable and non-billable forms of
  documentation. (ADDENDUM M, N O)

86
ADDENDUM M
Duplicated Progress Note (DPN)
Documentation Indicates Individual Should be
Discharged (DIISD)
87
ADDENDUM M
Replaced Duplicate notes with notes providing
evidence of unique activities performed
Noted that this date was not billed
88
ADDENDUM N
Documentation Indicates Individual Should be
Discharged (DIISD)
Documentation Signed Prior to Service Delivery
(DSPSD)
89
ADDENDUM N
Documentation Changed to Reflect Individuals
Absence
Documentation Signed Following Service Delivery
90
ADDENDUM O
91
Under NO circumstances may a person provide
foster care services to their minor child!
ADDENDUM O
92
Residential Support Services
4.05 Residential Assistance
4.05-16
93
Specific Requirements

• Residential Support Requirements of Setting
• The residence must be a Three or Four person
  residence
• The program provider may not have the same
  residence as the individual
• The service provider must be available to provide
  residential support to an individual as needed
  and
• The service provider must be present and awake in
  the residence when the individual is present in
  the residence

4.05-16
94
Specific Requirements

• Residential Support Service Provider Shifts
• No more than Five Extended Shifts per Month
  (Extended Shift a combined period of time more
  than 16 hours during a 24 hour period)
• Off Duty Requirement--Must be off duty for at
  least 8 hours before working another shift
• No Shifts of More than 24 Hours

4.05-16
95
Specific Requirements

• Residential Support Billable Activity
• Assisting the individual with activities of daily
  living (bathing, dressing, personal hygiene,
  eating, meal planning and preparation and
  housekeeping)
• Assisting the individual with ambulation and
  mobility
• Reinforcing any counseling and therapy
  subcomponent provided to the individual
• Assisting with the administration of the
  individuals medication or to perform a task
  delegated by an RN

4.05-17
96
Specific Requirements

• Residential Support Billable Activity
• Conducting habilitation activities that train the
  individual to
• Develop or improve skills that allow the
  individual to live more independently
• Develop socially valued behaviors
• Integrate into community activities
• Use natural supports and typical community
  services available to the public
• Participate in leisure activities

4.05-17
97
Specific Requirements

• Residential Support Unit of Service
• Unit of service is one day
• A service claim may not be for more than one day
• A service claim may not include a fraction of a
  unit of service

4.05-19
98
Specific Requirements

• Residential Support Written Documentation
• Must meet the requirements in 3.08
• Must include a description of the location of the
  individuals residence
• Must include at least two written narratives (one
  by the service provider who is on duty while the
  individual is awake and one by the service
  provider who is on duty while the individual is
  asleep)
• Must include the begin and end time of the shift
  worked by the service provider making the written
  narrative

4.05-20
99
Specific Requirements

• Residential Support Service Claim for an
  Individual on a Visit with Family or Friend
• A program provider may submit a service claim for
  an individual who is on a visit with a family
  member or friend away from their residence if the
  visit is for at least a calendar day. If the
  visit is for more than 14 consecutive calendar
  days, the program provider may submit a service
  claim for only 14 calendar days of the visit.

4.05-20
100
Specific Requirements

• Service Claim for an Individual on a Visit with
  Family or Friend Written Documentation
• Written documentation must include the
  individuals name, the dates the individual was
  visiting the family member or friend, the
  location of the visit and the date and signature
  of the service provider.

4.05-21
101
Common Errors

• No Shift Changes
• Day Habilitation is NOT a shift change
• More than five extended shifts per month
• Gaps in coverage while individual is in residence
• Working longer than 24 hour shifts
• Failure to discharge individual while in the
  hospital
• Duplicated progress notes
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached Residential Support
  Services examples for both billable and
  non-billable forms of documentation. (ADDENDUM P)

102
ADDENDUM P
No Shift Change (NSC)
103
ADDENDUM P
A different staff member performed services for
Dorothy on these times and dates.
104
Supervised Living
4.05 Residential Assistance
4.05-22
105
Specific Requirements

• Supervised Living Requirements of Setting
• The residence must be a 3 or 4-person residence
• The service provider must be available to provide
  residential support to an individual as needed
  and
• The service provider must be present in the
  residence when the individual is present in the
  residence

4.05-22
106
Specific Requirements

• Supervised Living Billable Activity
• Assisting the individual with activities of daily
  living (bathing, dressing, personal hygiene,
  eating, meal planning and preparation and
  housekeeping)
• Assisting the individual with ambulation and
  mobility
• Reinforcing any counseling and therapy
  subcomponent provided to the individual
• Assisting with the administration of the
  individuals medication or to perform a task
  delegated by an RN

4.05-22
107
Specific Requirements

• Supervised Living Billable Activity
• Conducting habilitation activities that train the
  individual to
• Develop or improve skills that allow the
  individual to live more independently
• Develop socially valued behaviors
• Integrate into community activities
• Use natural supports and typical community
  services available to the public
• Participate in leisure activities

4.05-22 4.05-23
108
Specific Requirements

• Supervised Living Unit of Service
• Unit of service is one day
• A service claim may not be for more than one day
• A service claim may not include a fraction of a
  unit of service

4.05-24
109
Specific Requirements

• Supervised Living Written Documentation
• Must meet the requirements in 3.08
• Must include a description of the location of the
  individuals residence
• Must include at least one written narrative made
  by the service provider who is on duty while the
  individual was awake and
• Must include the begin and end time of the shift
  worked by the service provider making the written
  narrative

4.05-25
110
Specific Requirements

• Supervised Living Service Claim for an Individual
  on a Visit with Family or Friend
• A program provider may submit a service claim for
  an individual who is on a visit with a family
  member or friend away from their residence if the
  visit is for at least a calendar day. If the
  visit is for more than 14 consecutive calendar
  days, the program provider may submit a service
  claim for only 14 calendar days of the visit.

4.05-25
111
Specific Requirements

• Service Claim for an Individual on a Visit with
  Family or Friend Written Documentation
• Written documentation must include the
  individuals name, the dates the individual was
  visiting the family member or friend, the
  location of the visit and the date and signature
  of the service provider.

4.05-26
112
Common Errors

• No evidence of coverage while consumer is
  sleeping
• Failure to discharge consumer while in the
  hospital
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached Supervised Living
  examples for both billable and non-billable forms
  of documentation. (ADDENDUM Q)

113
Non Billable Service (NBS)
ADDENDUM Q
114
Staff documented during the time which the
individual was awake.
ADDENDUM Q
115
4.06 Respite
4.06-1
116
Specific Requirements

• Respite
• Temporary Provision of Assistance-
• Service provider does not provide foster care,
  residential support or supervised living to the
  individual

4.06-1
117
Specific Requirements

• Respite
• Room and Board-
• If respite is provided in a setting other than
  the individuals residence, the program provider
  must provide room and board

4.06-1
118
Specific Requirements

• Respite Billable Activity
• Assisting the individual with activities of daily
  living
• Assisting the individual with ambulation and
  mobility
• Reinforcing any counseling and therapy provided
  to the individual
• Assisting with the administration of the
  individuals medication or to perform a task
  delegated by an RN

4.06-1 4.06-2
119
Specific Requirements

• Respite must be provided
• Residence
• In the individuals residence
• In a 3-person or 4-person residence
• In the residence of another person (other than a
  three-person or four-person residence) where no
  more than Three persons are receiving HCS Program
  services or non-HCS Program services that are
  similar to HCS

4.06-2 4.06-3
120
Specific Requirements

• 2. Non Residence
• Respite may be provided in a setting that is not
  the residence of any person if there are no more
  than six persons receiving HCS Program services
  or non-HCS Program services that are similar to
  HCS.

4.06-3
121
Specific Requirements

• Submitting a Service Claim for Respite
• Quarter-hour Respite
• Provision of less than 10 hours in one calendar
  day in any location
• Daily Respite
• Provision of 10 or more hours in a location
  other than the individuals residence
• Quarter-hour or Daily Respite
• Provision of 10 or more hours in an individuals
  residence

4.06-3 4.06-4
122
Specific Requirements

• Respite Written Documentation
• Quarter-hour Respite
• Meet requirements in 3.08
• Written narrative
• Exact begin/end time
• Written justification in ISP for more than one
  service provider

4.06-5 4.06-6
123
Specific Requirements

• Respite Written Documentation contd
• Daily Respite
• Meet requirements in 3.08
• Location
• Written narrative
• Exact begin/end time

4.06-6
124
Common Errors

• Location of service not on documentation
• Billing more than 10 hours for respite occurring
  out of the individuals home
• Individual lives alone without a live-in
  caregiver
• No begin and/or end times
• Non Qualified Service Provider (Proof of
  residence, etc.)
• Duplicated progress note
• Using location codes as only documentation of
  location
• No Progress Note
• Please view the attached Respite examples for
  both billable and non-billable forms of
  documentation. (ADDENDUM R)

125
Billed More Units Than Allowed (BMUTA)
ADDENDUM R
126
Changed Units Billed to the 10 allowed for either
Respite (RE) or Respite Hourly (REH) when
provided outside of the individuals residence
ADDENDUM R
127
Community Services Staff

• Manager
• Anthony Howes [phone] Anthony.howes_at_dads.st
  ate.tx.us
• Team Leaders
• Willie Mae Jones [phone] Willie.jones.2_at_dad
  s.state.tx.us
• Sam Montgomery [phone] David.montgomery_at_dad
  s.state.tx.us
• Valerie Roberts Booth [phone] Valerie.rober
  ts_at_dads.state.tx.us
• Julia Solis [phone] Julia.solis_at_dads.state
  .tx.us
• Roberta Thomas [phone] Roberta.thomas_at_dads
  .state.tx.us
• Misti Ackermann [phone] Misti.ackermann_at_dad
  s.state.tx.us
• Program Specialists
• Vivian Griffor [phone] Vivian.griffor_at_dads
  .state.tx.us
• Vacant [phone]
• Fax [phone]
• General Information [phone] Billing
  Payment Hotline

128
Questions?

• You may ask any additional questions you might
  have at this time
• You may also call or email us with any questions
  you might have at a later date

129

• THANK YOU!