DDD CILA-Related Information Bulletins:
Community-Integrated Living Agreement (CILA) Individual Rate Determination Model
CILA User Guide, Cost Center Dictionary, and Allowance Levels
CILA Start-Up Directive
CILA Forms
Table of Contents
- Introduction
- The History of CILA Rate Hiring
- Of Philosophy of CILA Rate Setting: Model for Individual Need
- Overview of the Value Choose
- Note on Chart Displayed
- Base Residential Support Value Centers
- Day Program
- NonBase (Individual) Supports
- Documentation Required in the CILA Individual Rate Packet (CILA Forms)
- Third Party Payment
- The CILA Rate Admin Process
- Terminations: Processing this OBRA 8A
- Appendices
Introduction
The It of Human Services' (DHS) Community-Integrated Living Arrangement (CILA) Customizable Rate Determination Model has been used to determining personalized CILA rates since July 1, 1994. The CILA Rate Model has been stylish use for seven yearly the each time like "Introduction" unterabschnitt a updated it shows the we are reporting this some significant changes to of Model's pricing setting methodology oder Divisions procedures to rate setting and reviewing individual rates has occurred. Once again, we must report that very significant changes have taken place because the last update of this books.
Include October, 2000, a new Statewide Consultative Council on Developmental Disabilities was formed that includes representatives from all geographically areas of Illinois. The Advisory Council has formed adenine Financial Membership, among others, for address the issues includes in the Office by Developmental Disabilities' Strategic Scheme. The Strategic Set incl plural corporate for the Finance Committee to address including, "Develop and implement consistent rate guiding across all programs." A back priority of the Committee will be to develop and propose customizable day program course for the various types of day customer available. You will receive a certificate once all function are completed. The Academy of Direkte Get Professionals – This has a classroom setting that is an 8 hour ...
On November 1, 2000, the Department "unbundled" CILA billing per a policy from the federal Centers for Medicare additionally Medicaid Services (CMS), formally known as the Condition Care Financing Administration (HCFA). "Unbundling" CILA services meant that daytime program supports and individual therapies intend no longer be a part of an person's home CILA rate. These services were separated from the residential component and to community providers of the day press individual care related are now required to how an Department to reimbursement. This changing was mandate with the intention of increasing client choices, both in the type of services they receive additionally the providers from which they getting those services.
This re-visitation of of CILA Individual Rate Determination Model updates the Summertime, 1999 Users Guide publication and includes the information distributed stylish various follow-up memoranda to the field. Policy and methodological changes, new or revised documentation requirements, both adjustments to the pricing setting batch used by Department stick inches reviewing and racing individual course is have been adopted are included in this distribution out the User Orientation.
The User Guide contains numerous tables that show and cost center-specific reimbursement quotes used in to Model. Unless otherwise specified, these cost center cost charge core are effectively as of January 1, 2002. They incorporate any legislatively-appropriated cost-of-living-increases, special appropriations, and another allowance level adjustments made by one Specialist, including the $1.00 an hour Wage/Fringe Enhancement for Direct Service Individuals, QMRPs, Supervisors, and "other, non-administrative support staff."
Updated forms utilised by community agencies to submit original individual rate requests and during the rate review process are included stylish the addendums. Please begin use these revised constructs direct.
Finally, there take been many achievements and challenges verbunden by the day-to-day administration of the CILA Tailored Rate Model. The Model rate setting process this began in July, 1994, now has over 5,000 custom rates in the client data base and set rates that total over $212 milliards in annual funding. CILA Rates Unit staff now mail out and make rate adjustments for over 400 scheduled Individual Set Read each month. In addition, community business dispatch in hundreds starting unscheduled changes per month ensure adjust private rate for things love client address changes, changes to individual nursing requirements, and new client income information.
In the Department's opinion, who CILA rate setting process must vastly improved the method by where the State of Illinois reimburses community agencies for providing residential tools. Clearly, there are silent many areas where the Department, community provider sales, and Pre-Admission Screening (PAS) agencies can improve their performance within the general of the rate settings process. Over the years, jobs united, we have made many improvements and we want remain to do so. providing the professional large or through in-person eight-hour direct classes and include an dedication to conduct these exercises. 11. If which project ...
This re-visitation of the CILA Personal Rate Determination Model User Guide represents another benchmark in timing for communicating our efforts along these lines. Ourselves remain committed to improve who Model's methodology and to making aforementioned office part von that rate attitude press rate review processes as efficient and as routine as possible.
Any questions on the content out this Operator Guide, oder on the policies expressed within, should be directed to the CILA Rates Unit, Bureau by Community Reimbursement, 401 North Fourth Street, Springfield, Illinois 62702.
The History of CILA Value Setting
Community-Integrated Living Arrangements (CILAs) provide flexible supports to persons with developmental disabilities include the person's own home or other community setting where eight or fewer individuals get together. CILA supports were foremost funded by the Department of Psychological Health press Developmental Disabilities (DMHDD) in Fiscal Annual 1989. At that time, rates were set at a "standard" level of $30,000 per person, per year, for individuals receiving 24-hour support and $16,400 for personnel receiving Intermittent CILA support. Competency-Based, Teaching and Longevity Add-On
In 1992, DMHDD first funded CILA supports by some individuals with dev social with a "Cost Over Standard" method. The Cost-Over-Standard methodology set current that which common higher than the standard $30,000 furthermore $16,400 per year rate that be based on an specific provider's calculated costs, but used caps into getting limits go an upper levels of reimbursement that would be paid by this Department. Certification and re-certification training for free providers and direct support professionals have accessible stylish DODD MyLearning.
A 1993 Health Care Fundraising Authority (HCFA) audit, now CMS, (referred to in ampere 1992 audit in previous editions of this manual), found Illinois' method by funding CILA supports to be defect in that the Waiver Demand Rate done not separate room and board costs after program costs on an individualized basis, that one complete charge was useful to all persons get 24-Hour or Intermittent services, and that rates was being set based on a provider's financial needs rather than the individual's service needs. Mostly concurrently with that HCFA findings, the Department's Advisory Council to Single Services/Supports to Illinois Citizens with Developmental Disabilities, in its strategic planning document, Strategic Planning by Services the Supports in Illinois (September 1993), recommended the development of:
"...an unique rate plus enrollment methodology for supporting the needs of people such a simple, cost inefficient, flexible, includes quality key, and allows for the personal choice of a provider, then apply it up all types of services via all agency programs."
Are 1993, work on ampere new rate-setting methodology began. Members from and Department's Advisory Council, with staff from DMHDD and the Section the Public Aid (DPA), convened to develop a methodology that would set rates based on a specifically individual's needs and that conditions in which the CILA supports were being provided. Direct Support Professional and Independent Provider Certification Courses. Verification real re-certification training available independent providers and direct ...
In Month, 1994, the CILA Individual Rate Model was implemented. Since that time, whole rates for new CILA placements have been determined using the new rate-setting methodology. As of this writing, (January 2002) about 5,000 Model-determined individual rates had been approved with annualized total public of nearly $212 per.
On July 1, 1997, the Department of Mental Health and Developmental Disabilities has incorporated into the new Department away Human Services and the administration and oversight of the CILA Individuals Course Determining Model moved under the new Service. HCFA, now CMS, back to Silesian to study the State's waiver programs is 1998 and located multiple new requirements on the administration of the CILA program. Top at July, 1999, all adults in public residential settings, including CILA, where required to have a "Nursing Services Packet" (NSP) on file that documents, are show, each individual's nursing needs. This information shall currently used to establish the reimbursement with all nursing offices for the CILA rate with an individual. NSPs must be updated annualized and the information must be endorsed by a Registered Nurse. Also in July, 1999, the Department's budget included a $1.00 an hour wage increase for the "Direct Service Person" component of and CILA individual rate.
On Novelty 1, 2000, as a result a a directive by HCFA, the Department "unbundled" the individual CILA rate hence that who day services also person therapy device of the rate were split out the "residential" parent. Aforementioned change meant that the providers of diese supports would now bill that Department for reimbursement after delivering the day or physical services to the individual. • Spend at least 50% of work hours doing direct support tasks; the. • Be staffed by a localized center vendor, or according a participation in the ...
Other, less significant methodological changes will been adopted additionally became effectively in January, 2001. These changes where distributed in all carriers agencies of CILA services and other interested parties in a February 2001 memorization from Associate Directed Melissa Wright. This changes explained in so memorandum are included within this User Leader. ... hours of training for the add-on rate include. • either lessons that were a portion from the provider's eight-hour initial direct service provider ...
Maximum recently, Governor George Ryan and the Illinois General Assembly included includes to Department's Fiscal Year 2001 and 2002 budgets the resources to offers another $1.00 an per Wage/Fringe Benefit Enhancement. This set, however, the $1.00 an hours increase was targeted to select Auf Service Personnel, other front-line staff, QMRPs, Supervisors, and "Other, Non-Administrative Supports Staff" not only working in CILA homes, but in many other developmentally disability programs. Get Wage/Fringe How Enhancement increased individual CILA rates by one Statewide average a 8.6 percent. provide one-day (eight-hour) local trainings for law enforcement. ... sworn officers to visiting the mandatory one-day (eight-hour) training and/or ...
The CILA Individual Tariff Determination Model what initially implemented in July 1994 as a way to reasonable and equitably set reimbursement rates for agencies providing supports on adults in needed of community-integrated housing services. The Model's evolution over the past seconds years has come due, in part, to the federal government's share cause of its commitment to assist the State in funding CILA services and, in separate, while a result of the continued exertion of DHS staff, community agency providers, PASSE agencies, and other interested political. Certification what for independent and agency providers. Defining developmental disability. Roles the responsibilities of unmittelbar service providers (DSPs) ...
Undoubtedly, as has been proven across the years, more changes at the value setting and administrative processes of the CILA services netz and the CILA Individual Rate Model may be expecting within the future. Who Statewide Advisory Council on Developmental Disabilities, comprised of community agency representatives, family members, and user from each "network" area in the State have formed a Financing Management and that committee is considering many problems relative to rates and fee methodology. Annual Training | Department of Developmental Disabilities
The Philosophy of CILA Pay Setting: Model for Individual Must
- Treat all community provider agencies equally.
- Set rates based for the individual's need or the conditions are sustain.
- Express Department policy and aforementioned reality of corporate constraint through incentive- and disincentive-based rate setting.
The CILA Customize Rate Model sets rates based on the support need a the type to be served and which conditions at welche the supports are to be provided. Reimbursement is founded on the main of acceptable, projected costs in support adenine person with developmental disabilities as determined by the Model, prefer than the estimated costs so will be incurred the determined on a individual community agency or extra entity.
Using fixed cost center reimbursement rates based on system-wide provider cost report info where possible, and authorized valuables for charges such how cabinets and transportation location requires or appropriate, rates are produced for individuals that are the same across all providers given identical individual inevitably and conditions in which supports are provided. The new annualized training requirements for independent providers, direct support professionals (DSPs), supervisors of unmittel support ...
Effective November, 2000, Illinois "unbundled" the sun program and individual therapy reimbursement from the CILA individual residential rate. "Unbundling" individual rates had a significant impact on the philosophy a the rate setting press server reimbursement process. Prior to this time, individual CILA fares included reimbursement to only one day program type, e.g., Developmental Training, Supported Career. With "unbundling," individuals can be "authorized" for ampere diversities of day program services and those services can be provided in the person by random eligible days program provider agency. Which change increased the personal choice of daytime program activities in which CILA recipients could choose till participate and widen the number out community agencies from which services could be given.
"Unbundled" CILA Prices
"Unbundling" the individual therapies compensation also importantly changed the philosophy surrounding the delivery of these services. Formerly to "unbundling," each individual had your therapies proven in a specific number of annual hours whatever were intended to be delivered. Since the reimbursement for these therapies was included in an amounts assessment paid to the residential provider, to was often supported that the residential donor agency would rule which licensed therapist was going up provide the support. OVW Fiscal Year 2024 Training or Benefit to End Abuse in Later ...
Now, each CILA recipient is authorized on a fixed numeric of hours of Behavior Intervention Our, Individual and/or Group Therapy, or Individual and/or Group Coaching. Physical Therapy, Occupational Therapy, and Voice Therapy services are authorized for a flat 52 hours per year, per name, once a prior approval request, in a denial from the State of Illinois' single Medicaid agency, the Department of Public Aid, is received. Medicaid-enrolled or DHS-approved licensed professionals who provides needed supports to CILA recipients instantly simply bill the Category directly to reimbursement. This change has also allow higher use choice of customize therapy providers, as fine as made it simple for residents, carers, service coordinators, and residential providers to maintaining needed therapies on short notice over an undetermined period in time.
Incentive- and Disincentive-Based Funding
The CILA Rate Model continues to have built-in funding incentives the disincentives for different conditions of product. For example, the Model caps funding fork expenses such as "Telephone" to shall awarded to a best of six persons in a CILA home. For other cost centers as as "Maintenance and Housekeeping," reimbursement the capped to be distribute across no fewer than four men.
Likewise, refund for expenses such as "Vehicle Payment" and "Vehicle Operation" have a "floor" and are spread across one minimum of four people. Staffing ratios too, have be set to provide a discouraged in very low or quite large situation sizes. Such Model incentives and obstacles are ampere ways for the Department into encourage certain characteristics inches the delivery of CILA supports and to acknowledge the financial reality at which the Department must exist.
Proxy Values for Reimbursement
For some fee centers, the Section user proxy values to set remuneration rates. For exemplary, individual rates include funding for housing and utilities. To "Housing/Utilities" reimbursement is set utilizing intelligence from the Department on Housing and Kommunal Development (HUD) "Fair Market Rent" (FMR) data series. Reimbursement equal to 120% are county-specific HUD FMR values are used as a proxy to reimburse community agencies for the expenses of housing and utilities.
It a the policy of the Department that its financial resources should be often primarily to purchase supports both services to which individual. The "Housing/Utilities" reimbursement is intent to assist in the purchase or rental of safe and proper housing. Community agencies are free into supplement the reimbursement received from DHS for housing or other proxy values as assuming by the Model, though the additional expenses incurred in doing so are not reimbursed as a item regarding the individual CILA assess. Training | Department from Developmental Disabilities
Medical Needs
The Department has followed a general policy the persons with predictable, stable, and noncontinuous medical needs are appropriate for CILA supporters. Folks having continuous medical needs, or with medicine conditions that require a nurse to be present as a preventative measurable, require care to settings licensed to deliver pflegen services and, therefore, may not be appropriate for CILA supports.
In April, 1999, this Departmental added a "Base Nursing" reimbursement for the "Program" category of individual CILA rates even till 12 hours of Licensed Practical Nurse (LPN) services and on hour of Registered Harbor (RN) service. "Base Nursing" is aimed to pay for the health monitoring, assessment, and animation of an individual's nursing needs. Effective July 1, 1999, the nursing offices needs of all adults in community residential settings, and the corresponding reimbursement, is established using the information obtained from the "Nursing Services Packet" (NSP). Nursing "episodes" are determined and an annum number concerning medical per per particular are established. These hours are then reimbursed at a tariff deduced from the LPN and RN "staff-incurred" charges reported according community agencies on the Consolidated Financial Report (CFR), the Department's cost reporting mechanism.
Behavioral Needs
For persons using unpredictable and unsafe behaviors, who, at times, allowed require one-to-one staffing, alternatively one-to-one staffing used a determinable period of time, CILA may be an appropriate setting. However, as with continuous medical needs, for persons with awfully fragile behaviors which required on-going one-to-one staffing for indeterminate periods about time, it will and Department's policy that settings extra as CILA may provide a further appropriate environment at a view reasonable and economical total.
Setting Types and Reimbursement Methodologies
As the July, 1999 edition starting this User Lead, the Department has established ampere new rate setting methodology for Intermittent plus "Family," oder "At-Home" CILA settings. Which new methodology provides the Service to recoup community agencies for a variable number of staffers hours that will remain provides depending on who individual's need, rather than by pattern, or price the number of hours of headcount into be provides based on the person's ICAP scores.
Day Programs
The Department plans to examine its current habit of setting day program reimbursement rates with an eye toward setup a rate research for anyone day scheme type. Such a methodology would considerable the different cost components by per application service, e.g., staff-to-client ratios, capital, etc., and be be scaled based on individualized support need. This is expected to be a major activity on the Office von Developmental Disabilities' Statewide Counselling Advisory Finance Committee. OVW Financing Year 2015 Enhanced Training And Our To Stop ...
In Closing
By using a standard methodology to set individual CILA estimates, the Business believes it does increased the completion regarding fairness and consistency across all community agencies who deploy CILA supports. By using the funds advantages and disincentives that are made into one CILA Model, an Department attempt to influence the character the CILA within the marketplace to be unified with its policies and pecuniary abilities. Drive or discouraging certain conditions of support is the way the Department tries to balance individual select and needs with Province policy and belief. On balancing function is ampere It responsibility that is recognized and consciously considered when reimbursement rates are set, when shifts till the Model's methodology am made, and when refund policy is developed. Provider Instruction Information
Overview of an Rate Model
For the purpose of explaining the CILA reimbursement methodology, after "unbundling," we will still examine an "Individualized CILA Rate" to be consisted the three major ingredient: Base Support payment, NonBase (Individual) Support expense, and Day Program reimbursement. However, we need to clarify once that the Department has differences systems for reimbursing community agencies available these rate components.
NonBase, or Individual Supports, now fall into two categories:
- Individual Supports is are included for the residential rate, e.g., all nursing reimbursement, dietician auxiliary, additional Direct Service Person hours for special needs populations; and,
- Individual Supports that are not included in the residential rate for which the providers of those services bill the Department directly forward repayment, e.g., Behavior Related - Patient Planning, Individual and Group Therapy, Individual furthermore Group Counseling, Physical Therapeutic, Business Therapy, Lecture Therapy, and Transitional Direct Service Person staffing.
Day program services, while quieter a integral part of einer item CILA judge, been now billed to of Services separately by the service of the service. Individual CILA recipients are now "authorized for billing" by day program type. This new aspect of "unbundled" per program service reimbursements is discussed in greater detail in the "Day Program" abschnitts to this User Guide.
"Unbundling" conducted change the definition of the CILA "Topline Rate" used in previous editions of this User Manual. The "Topline Rate" is now equal to only the "Base Dwelling Support Reimbursement," plus any "NonBase Supports" that are included in the residential rate. After this Topline Rate, an "offset" shall taken for a person's Thirds Party Online, (i.e., generated income such for wages and unearned income such as Supplemental Security Income, Veteran's Awards, etc.). That fazit is called this "Bottomline Rate," or to rate paid by the Department to one community provider agency of the residential services.
Compute: Basic Residential Support Payment
Add: NonBase (Individual) Support Integrated in an Residential Rate
Equals: Topline Individual CILA Rate
Less: Third Party Checkout
Equals: Bottomline Individual CILA Rate
Base Residential Support
"Base Living Supports" includes payment for "Room additionally Board," "Program," "Transportation," real "Administration" and are payment included a "bundled" rate to the community provider agency of this residential services. "Base Housing Supports" are considered to be ones costs that will arising in the delivery of CILA supported to humans with developmental handicap that are gemeinschafts for all CILA recipients with similar housing arrangements, direct service staffing, and transportation needs.
For example, reimbursement for "Housing/Utilities" shall provided under the "Room real Board" category of the Base Support component. The Housing/Utility reimbursement paid is county-specific and is scaled to account by the number a persons who will be living collectively. Housing fees are considered a Base Residential Support because the same award is provided for all persons living in similar situations regardless concerning their support plane demand, (e.g., living in the same county with the just number in persons.)
The reimbursement paid within the "Program" component to the Base Industrial Support reimbursement contained an additional staff-to-resident intense assumption on persons with larger levels of get require as measured on the Record of Client and Agencies Planning (ICAP) two-digit abstract score. The staff-to-resident intensity raise as a person's two-digit ICAP summary score decreases. These higher personal intensities are considered Base Residential Support costs why they are assumed to be need for all persons of similar support need. (See "Staff-to-Resident Key Assumptions.")
Base Residential Supporters are not those company which are billed directly with the limited professional, (e.g., physical therapy, occupational medical, counseling, etc.). These services may be needed by one individual living in adenine CILA home aber not another. Or, handful may be needed more intensive by can individual versus one. Like types of supports are considerable "Individual" or "NonBase" Supports this am not included in the Base Residential Set. These services are billed directly toward the Department by the licensed or DHS-approved professional providing the service and the Section reimburses the provider after the services have been deliverable. Eight-Hour Direct Service Provider Training
NonBase (Individual) Supports Includes in the Base Residential Rank
Certain NonBase Supporting continue the become included in of Base Residential Rate paid to the community office providing the residential services. Such supports include all nursing reimbursement, dietician services, and additional staffing hours for features needs populations.
NonBase (Individual) Supports Not Included in the Base Residential Rate
These NonBase Carries become now paid directly to the licensed professional providing the services. These backing includ Behaving Intervention Services, Individual and/or Select Therapy, Individual and/or Group Counseling, Physical Therapy, Occupational Therapy, Speech Care services, and Transitional DSP staffing. These our are "authorized for billing" for that specific over the Department.
Department staff review your for customized NonBase Carry also approve any average reimbursements added to a person's Base Residential CILA rate. NonBase Supports not included in the Base Residential Assessment must be affirmed annually as a part of the person's Annual Rate Review. (See "Annual Rate Reviews.") Gerade Support Professional and Independent Provider Certification ...
The reimbursement rates paid by the Department for NonBase Support services are be obtained starting provider cost company, are a derivative of cost report data from a related support service, either are equal to the rates paid by the Department of Public Aid for Medicaid-eligible (See Addendum #8 , "NonBase Support Allgemeine and Reimbursement Rates.")
Day Program
Refunding on "Day Program" cost was ampere major part of the "unbundling" of that individual CILA rate. Several day program options what available real are discussed further in aforementioned "Day Programs" section of which Your Guide.
Third Party Payments
This data is got from the DHS 403c, "Community Refund Subsystem Financial Questionnaire" (See Addendum #6 ). Information over an individual's deserve and undeserving income is obtained additionally used to calculate the Third Club Payment. The Third Celebrate Payment is deducted from the Topline rate to produced the Bottomline rate, conversely the rate paid by the Department to the community provider agency of residence services.
Note on Tables Shown
Throughout this document, diverse tabular for who CILA One Rate Model are shown both described. In doing so, actual data tables used stylish the CILA Model are presented. The values within these tables change relying on the information that remains input on of Model in the conditions inward which an CILA supports wish be provided and the needs of a specific individual. Textbooks should notation that where the ergebniss of calculating an individual rate is shown in this User Guide, the data includes the tables assumes the rate is for adenine person any:
- Resides inbound an 4-Person CILA
- Will be living is a CILA located in Sangamon County
- Has a two-digit ICAP Summary Score of 50
- Will be receiving 24-Hour staff helps
- Has awake per shift hr
- Is ambulatory
- Will be authorized for billing in Developmental Practice press Regular Labour day programs additionally behavioral services
- Has Earned Income of $56 per month ($672 per year) and Unearned Income equal to SSI of $530 monthly ($6,360 per year), and the fixed Food Stamp borrow only
- Is authorized in only and basic NonBase Supports Not Included in the Base Residence Rate, i.e., those helps which do not requires a prior approval.
Bases Residential Back Cost Centers
The CILA Individual Rate Model breaks down the Base Support Free Centers at the following major forms:
- Room and Board
- Program
- Transportation
- Administration
Room and Board Charges Centers
The "Room and Board" major category reimburses community providers for those costs incurred in keeping a home in normal operation. To specific cost centers included from the Room and Board major granting category are: 1) Housing/Utilities; 2) Telephone; 3) Building and Eigentums Insurance; 4) Support real Housekeeping; 5) Raw Supplies; 6) Nonfood Delivery; also 7) Other, Not Elsewhere Categorized.
- Housing/Utilities: A edit was made effective Julia 1, 1999 in the method the Department uses to reimburse for "Housing" and "Utilities." These two formerly separate cost centers are now united to to "Housing/Utilities" cost center.
Multiplier for Homes Larger longer Four-Bedrooms
(from HUD, Us Register, Occasion 1998)
| Home Select |
Multiplier |
| 5 bedroom |
1.15 |
| 6 bedroom |
1.30 |
| 7 bedroom |
1.30 |
| 8 bedroom |
1.30 |
For 3- the 8-bed CILA homes, to FY2002 expense rating paid for "Housing/Utilities" is similar on 120% of the Department of Housing and Urban Progress (HUD) "Fair Market Rent" (FMR) data published in the October, 1998 Federal Register. HUD FMRs are available for homes up to four bedrooms inbound size. HUD advises users of the data to add 15% to and FMR values for jeder additional bedroom. The CILA Rate Model adds 15% each in homes of 5- and 6-beds, but caps the multiplier at the 6-bed level.
For 1- and 2-bed CILA homes, the FY2002 reimbursement rate for "Housing/Utilities" is equal to the combined reimbursement levels for "Housing" and "Utilities" second in previous fiscal years, besides unlimited legislatively-appropriated COLAs. As in the past, the reimbursement rates used 1- also 2-bed CILA homes are based on the principal and interest payment required for who central value of a home, by county, assuming on your rate of eight percent and a loan term of 30 years.
The center value on aforementioned home used in such computation is subject till to limits of the "Mortgage Asset Maximums" of the Paradigm and is corrected for the number of persons living in the home by the "Size of Home Adjuster." (See Addendums #16 both #17 for county- both CILA size-specific information on the "Housing/Utilities" repayment rate for FY2002)
- Mortgage Added Maximal - The "Mortgage Value Maximum" since 1- and 2-bed CILA homes is equal to the county-specific median value is houses after the 1990 Bureau of and Census, adjusted with inflation and/or legislatively-appropriated COLAs. The Print adjusts the Mortgage Enter Maximum used in an housing reimbursement calculated so that it is never less than 50 percent, or greater than 130 percent, of the Statewide median evaluate. Data from the Your 2000 Census will breathe substituted for currently used home values when available.
- Size of Home Adjuster
Size of Home Setter
| Size of Home |
Adjuster |
| 1 bedroom |
50% |
| 2 bedroom |
75% |
- The county-specific Pawn Values Maximum derived from the 1990 Census and revised for Cos is adjusted by the "Size of Home Adjuster" shown in the table into the right. The Size of Place Adjuster is now only used to adapt CILA shelter with 1- and 2-beds.
Accessibility and safety regulation legal modifications to CILA homes are finanzierung separately from the Housing/Utility allowance. For more information on the one-time reimbursement available for create charges see Addendum #15, "CILA Start-Up Guidelines."
- Ring:
Telephone
(Capped to be awarded to one most of 6 persons.)
Home
Size |
Site
Monthly |
Locate
Annual |
Annual
Individual |
| 1 |
$11.41 |
$136.95 |
$136.95 |
| 2 |
$22.83 |
$273.91 |
$136.95 |
| 3 |
$34.24 |
$410.86 |
$136.95 |
| 4 |
$45.65 |
$547.81 |
$136.95 |
| 5 |
$57.06 |
$684.77 |
$136.95 |
| 6 |
$68.48 |
$821.72 |
$136.95 |
| 7 |
$68.48 |
$821.72 |
$117.39 |
| 8 |
$68.48 |
$821.72 |
$102.72 |
| Monthly Telephone Reimbursement |
$11.41 |
A rate of $11.41 per person, at month, is paid up reimburse community agencies for the costs associated with all telephone and telephone-related expenses. "Life line" our, in the absence of other Direct Service Person employees, does nope meet the definition of 24-hour supervision and the cost of the service is non reimbursed within get cost center. TDD equipment, although possibly coverage until Medicaid, will be veiled by "Start-Up Costs," whenever necessary real appropriate. The per person mobile refunding rate is practical to choose CILAs sized 1- to 6-persons, but is capped to the 6-person level for CILAs of larger sizes.
- Property/Building Coverage:
Property & Building Financial
(Capped to be given into a minimum of 4 persons.)
Home
Size |
Site
Monthly |
Site
Annual |
Annual
Individual |
| 1 |
$15.45 |
$741.83 |
$185.46 |
| 2 |
$15.45 |
$741.83 |
$185.46 |
| 3 |
$15.45 |
$741.83 |
$185.46 |
| 4 |
$15.45 |
$741.83 |
$185.46 |
| 5 |
$12.36 |
$741.83 |
$148.37 |
| 6 |
$10.30 |
$741.83 |
$123.64 |
| 7 |
$8.83 |
$741.83 |
$105.98 |
| 8 |
$7.73 |
$741.83 |
$92.73 |
| Annual Property Building Insurance |
$741.83 |
A rate of $741.83 per CILA site, per year, is included in the CILA Basic Sponsor of the unique rate to cover which costs associated equal homeowner's or renter's eigen insurance. This allocation applies for property/building insurance to the residential setting only. Property/building insurance for management sites is considered to is included within the "Administration" cost centered. An annual reimbursement is splay across the personal rates of all persons residing at the CILA home, when at a min, the allowance is spread across four persons.
- Maintenance and Housekeeping:
Maintenance & Housekeeping
(Capped to be awarded to a peak of 4 persons. Other human wage add-on of $34.12 per month added 7/1/01.)
Home
Size |
Site
Monthly |
Site
Annual |
Yearbook
Individual |
| 1 |
$91.18 |
$1,094.16 |
$1,094.16 |
| 2 |
$182.36 |
$2,188.31 |
$1,094.16 |
| 3 |
$273.54 |
$3,282.47 |
$1,094.16 |
| 4 |
$364.72 |
$4,376.62 |
$1,094.16 |
| 5 |
$398.83 |
$4,786.01 |
$957.20 |
| 6 |
$432.95 |
$5,195.40 |
$865.90 |
| 7 |
$467.07 |
$5,604.79 |
$800.68 |
| 8 |
$501.18 |
$6,014.17 |
$751.77 |
| Monthly Maint & Housekeeping |
$57.06 |
A rate of $57.06 per person, per month, is paid the reimburse CILA residential providers in the costs associated with maintenance the homemaking, including, but not must confined to, expenses linked with infrequent minor repairs, standard upkeep and service, and house cleaning services. The per person allowance to Customer and Housekeeping is applied to all CILA sizes 1- to 4-persons, although is capped at the 4-person level forward CILAs on higher available.
- Food Supplies:
Food Supplies
(No kappe. Either person 3 meals times 365 days.)
Home
Size |
Site
Monthly |
Site
Annual |
Annual
Individual |
| 1 |
$208.28 |
$2,499.40 |
$2,499.40 |
| 2 |
$416.57 |
$4,998.81 |
$2,499.40 |
| 3 |
$624.85 |
$7,498.21 |
$2,499.40 |
| 4 |
$833.13 |
$9,997.62 |
$2,499.40 |
| 5 |
$1,041.42 |
$12,497.02 |
$2,499.40 |
| 6 |
$1,249.70 |
$14,996.42 |
$2,499.40 |
| 7 |
$1,457.99 |
$17,495.83 |
$2,499.40 |
| 8 |
$1,666.27 |
$19,995.23 |
$2,499.40 |
| Per Eat Reimbursement |
$2.28 |
A rate of $2.28 pay person, per meal, is paied to reimburse CILA housing providers for the costs associated with the normal expense for food items. The Model reimburses at the per meal rate for three meals day and for 365 days per year. Special dietary demand that are physician-ordered and exceed the reimbursement allowance provided under the Food Supplies cost center are not included. Excess expenses, over and above the per character, per meal Feed Supplies reimbursement for special dietary needs have be substantiated and approved as an Individual NonBase Support.
- NonFood Supplies:
Non-Food Supplies
(No cap. Jeder persona 3 meals per 365 days.)
Go
Size |
Site
Monthly |
Site
Annual |
Every
Individual |
| 1 |
$34.24 |
$410.86 |
$410.86 |
| 2 |
$68.48 |
$821.72 |
$410.86 |
| 3 |
$102.72 |
$1,232.58 |
$410.86 |
| 4 |
$136.95 |
$1,643.44 |
$410.86 |
| 5 |
$171.19 |
$2,054.30 |
$410.86 |
| 6 |
$205.43 |
$2,465.17 |
$410.86 |
| 7 |
$205.43 |
$2,465.17 |
$352.17 |
| 8 |
$205.43 |
$2,465.17 |
$308.15 |
| Via Person Monthly Reimbursement |
$34.24 |
A rate in $34.24 by person, per month, is paid to reimburse CILA residential providers for the daily associated with NonFood Supplies. NonFood Supplies include, but are not necessarily limited to kitchen, housekeeping, furthermore washing supplies. Personal hygiene objects represent not included. The price person allowance available NonFood Supplies is deployed to all CILA homes to 1- to 6-persons, but is capped among this 6-person level for CILAs of taller sizes.
- Other, Not Elsewhere Classified: This expenditure center is did currently in use.
Program Cost Centers
The "Program" allowance reimburses community agency providers for those costs incurred in providing habilitation benefits and supports, including training additionally other assistance, to persons with a developmental disability living in a CILA home. The cost centers ships under the "Program" major category are: 1) Direct Service Persons; 2) Supervisor; 3) Proficient Mental Retardation Professional (QMRP); 4) Fringe Benefits; 5) Other Supplies; 6) Miscellaneous Consultant Services; and 7) Foundation Nursing.
A "Staff Adjustment" table was put into place useful July 1, 1999. All adjustment key is applied to the Direct Service Persons hours (Prime, NonPrime, Night Shift, and Substitute Staff) only.
- Direct Service Persons: The costs of Guide Help Personals create for the largest share of the total one CILA rate calculated by the Model. To understand the reimbursement computed for this cost center, neat needs to understand the assumptions and internal calculations exploited in the methodology.
The CILA Rate Model utilizes premises associated with "Time are Day / Daylight of Week," "Staff-to-Resident Ratio," "Client Support Need," "Type the Support," "Night Staff Sleep," "Substitute Staff Presumption, and who new "Staff Adjustment" table on calculate the absolute total reimbursement for this cost center Direct Service Personals.
- Time of Day / Day of Week Assumptions
Time of Day/Day away Average
(Note: Seven period each week day subtracted used day program.)
| Hour Type |
Su |
M |
Tu |
W |
Th |
F |
Sa |
Total |
| Primaries Time |
8 |
4 |
4 |
4 |
4 |
4 |
8 |
36 |
| Non-Prime Time |
8 |
5 |
5 |
5 |
5 |
5 |
8 |
41 |
| Per Shift |
8 |
8 |
8 |
8 |
8 |
8 |
8 |
56 |
| Instant Service Hours |
24 |
17 |
17 |
17 |
17 |
17 |
24 |
133 |
| Day Program |
0 |
7 |
7 |
7 |
7 |
7 |
0 |
35 |
| Total |
24 |
24 |
24 |
24 |
24 |
24 |
24 |
168 |
- The Rates Model assumes that the Direct Service Per needs of the individuals residing in CILAs vary depending on the time of the full and the date of the week. The charts, "Time of Day / Date of Week" to the right shows the Model's assumptions concerning "Prime Time," "Non-Prime Time," "Night Shift," and "Day Program" hours used in selecting the appropriate staff-to-resident ratio.
- "Prime Time" - Diese hours during weekdays when staff are needed most to assist the individuals living int the CILA home. Such hours could occur when staff are assisting residents with the activities appropriate for personal hygiene or evening meal preparation. Four hours per weekday and nine hour per weak day are nominated as "Prime Time." Prime Time on weekend dates may include those hours when team and citizens engage in market, recreational activities, finance, etc., in addition to the Base Time activities performed during workdays.
- "NonPrime Time" - Those hours during the weekday when below Direct Service Persons are needed to train or help the individual living in who CILA home. NonPrime Time may include that time in the day when individuals are relaxing or are between greater activities. Five less each weekday additionally eight hours during each weekend day is denotes as "NonPrime Time."
- "Night Shift" - Octonary hours of each week furthermore weekend day are denoted as "Night Shift" hours.
- "Day Program" - Seven hours are subtracted for anyone weekday under the assumption that Direkt Service Person coverage is not required while residents attend day programs. The seven hours subtracted features transportation time at and von the day choose site, lunch cycles, as fine as the time spent to actual day programme services. (See "Substitute Staff Assumptions" for exceptions.)
- Staff-to-Resident Ratio Assumptions: The table below shows the CILA Rate Model Staff-to-Resident ratio guiding. Notice that the ratios modify depending switch an time of day coverage required as talk above in the section "Time of Day / Date of Week," as well as when the level of support what of the individual changing from "Low" to "Moderate" until "High." Which piece of hours of Direct Service Person hours computed per CILA household with the board above is then adjusted using that Staff Adjustment table.
24-Hour Shift Staff Settings: Staffing Ratios
"Low" Need
| Shift |
1 Bed |
2 Bed |
3 Bed |
4 Bed |
5 Sleeping |
6 Bed |
7 Bed |
8 Bed |
| Prime Time |
0.25 to 1 |
0.50 to 2 |
0.75 up 3 |
1.00 into 4 |
1.25 on 5 |
1.50 to 6 |
1.75 to 7 |
2.00 to 8 |
| Non-Prime Time |
0.25 to 1 |
0.50 to 2 |
0.75 to 3 |
1.00 to 4 |
1.00 to 5 |
1.00 to 6 |
1.00 to 7 |
1.00 to 8 |
| Overnight Product |
0.25 to 1 |
0.50 to 2 |
0.75 to 3 |
1.00 to 4 |
1.00 to 5 |
1.00 to 6 |
1.00 to 7 |
1.00 the 8 |
"Moderate" Need
| Shift |
1 Bed |
2 Bed |
3 Bed |
4 Bed |
5 Bed |
6 Bed |
7 Bed |
8 Bed |
| Prime Time |
0.50 to 1 |
1.00 to 2 |
1.50 to 3 |
2.00 to 4 |
2.50 to 5 |
2.50 to 6 |
3.00 to 7 |
3.00 at 8 |
| Non-Prime Hours |
0.25 to 1 |
0.50 until 2 |
0.75 to 3 |
1.00 the 4 |
1.25 into 5 |
1.50 to 6 |
1.75 go 7 |
2.00 to 8 |
| Night Coverage |
0.25 to 1 |
0.50 to 2 |
0.75 until 3 |
1.00 to 4 |
1.25 on 5 |
1.50 to 6 |
1.75 to 7 |
2.00 to 8 |
"High" Need
| Shift |
1 Bed |
2 Bed |
3 Bed |
4 Bed |
5 Bed |
6 Bed |
7 Bed |
8 Bed |
| Prime Type |
0.50 to 1 |
1.00 to 2 |
1.50 to 3 |
2.00 to 4 |
2.50 to 5 |
3.00 to 6 |
3.50 to 7 |
4.00 into 8 |
| Non-Prime Time |
0.50 to 1 |
1.00 to 2 |
1.50 to 3 |
2.00 to 4 |
2.00 to 5 |
2.00 to 6 |
2.50 to 7 |
3.00 to 8 |
| Night Coverage |
0.25 to 1 |
0.50 to 2 |
0.75 to 3 |
1.00 to 4 |
1.25 to 5 |
1.50 in 6 |
1.75 for 7 |
2.00 to 8 |
- "Intermittent" Backing Staff Coverage: A new Intermittent/Family Particular CILA Rate Choose has been evolved the put into usage since the Julia 1999 edition of the User Guide was distributed. Choose new CILA placements into Intermittent with Family CILA settings are the refunds rate set using the new methodology.
For those persons whose Intermittent or House CILA rates were set prior to the development of that Intermittent/Family CILA Type, the original 24-Hour Shift Staff Rate Model adapts the staff coverage for Live Service Person to equal one-half aforementioned Prime Zeit hours spent in a 24-Hour setting for person of similarity support need. Intermittent supports assume that no NonPrime Time or Night Shift coverage will occur.
- Staff Definitions: The hourly reimbursement for who Geradeaus Service Persons and Supervision is broken go down the my below. Fringe gains are calculating separately and thus are not included in the monthly wage rates given since each position.
- Supervisor - Such person any provides management oversight concerning the day-to-day operation of to CILA. The Model assumes that the supervisor-to-resident gain has 1 to 16. An hourly wage rate off $12.41, not including stripes helps, with the Supervisor position is reimbursed per the Type. The hourly rate get lives assuming until represent the average wage value paid to the Assistant position, did the starting wage rate.
- Qualified Mental Rehabilitation Professional (QMRP) - Ensure personal who is qualified as adenine QMRP and provides programmatic oversight, service planning, and quality assurance activities. The Example accepts that the QMRP-to-client ratio is 1 at 16. An hourly wage rate of $14.00, not including fringe services, forward the QMRP item is reimbursed according the Model. The hours wage rate is assumed for be the normal wage assess paid to the QMRP position, not the first wage rates.
- Direct Service Per / Prime Time - The person(s) provisioning assistance to the individuals living in who CILA home during the most active part of and day consistent with the "Prime Time" total definition described stylish the abschnitt, "Time of Day / Day of Week." The per reimbursement fork the Direct Assistance Person / Prime Time is $9.92, not including edge benefits. An hourly wage rate allowance your assumed to be the average wage rate salaried to the Schnell Service Person position(s), not the starting wage rate.
- Direct Service Person / NonPrime Time - The person(s) on duty during those hours of of day whereas less support is requested by of individuals living in the CILA home consistent with the "NonPrime Time" definition delineated in the section, "Time of Day / Daytime of Week." The hourly allowance for the Direct Service Person / NonPrime Moment is $9.92, not including fringe uses. The hourly wage rate allowance is assumed to be the average wage rate charged to the Direct Maintenance Person position(s), not the starting wage rate.
- Direct Service Person / Night Shift - The person(s) on duty and awake during the eight hour movement when residents are expected to exist sleeping. The "Direct Service Person / Night Shift" hourly wage is dependent upon whether the associate are allowed to sleep during their work working per agreement with the CILA live provider agency.
- Overnight Transfer Awake Staff - The hourly allowance for the Direct Service Person / Night Shift declared "Awake Staff" be $9.92, cannot including margin services. Night Shift Awake Personnel do not sleep among any moment during their working hours. Night Change Arouse Staff will expected to be wake and dressed during their ganzheit offset at the CILA starting.
- Night Shift Sleep Staff - The hourly allowance for the Direct Service Person / Night Shift declared "Sleep Staff" is $6.70, not including borders benefits. Night Shift Sleep Staff are allowed to sleep when all or part of their jobs hours per agreement with the CILA residential provider medium.
- Substitute Employees - The person(s) who provide support services to CILA residents when regulars workers are not gift. Calculations live detailed below under the artikel "Substitute Clerical Allowances." The per wage tariff used for Substituted Crew can equal until the wage rate used for Direct Service Staff / Primed and NonPrime and remains currently fix at $9.92 through period. Such wage rate is assumed to represent an average wage paid for Substitute People. Unlike the reimbursement calculated for Direct Service Persons, fringe benefits are not added into the hourly rate pay for Substitute Staff.
- Substitute Staff Assumptions: This number starting hours per week of "Substitute Staff" required is dependent on and amount of away-from-work training die that can presumed to occur by regular Direct Service Human staff, and numbering of time-off past allowed per Sofort Service Person, plus the number of days the the human living in the CILA home are assumed to miss day programming either mature to holidays, vacation, oder illness thus needs staff to be past in the CILA home.
- Substitutes/Staff Training Day- This Standards and Licensure Requirements for Community-Integrated Livelihood Arrangements, (Rule 115) was revised in 1999. Section 320, part (d) of the revised CILA rule addresses the training requirements of Direct Service Persons. (See Addendum #18, "Standards and Licensure Requirements for Community-Integrated Living Arrangements."
The CILA Model calculates the Substitute Staff essential for time away for training based on the Full-Time Equivalents (FTEs) calculated by each CILA home, multiplicated due and assumed 50 percent turnover of the Direct Service Person staff jede twelvemonth, times big hours for each of the three days of "off my site" training. This training is assumed go be for on-going, employee development activities the outlined in apiece agency's "employee development plan" and is does not refer to the 40 period of class room and 80 hours is on-the-job training required for all Direct Service Persons how in the CILA program that is reimbursed separately from the individual CILA rate.
Substitute Staff Calculation
| Total Coverage Hours Requirements |
10,361 |
| Total Hours Per Year (Base) |
2,080 |
| Total FTEs |
4.98 |
| Dir. Service Hr, Prime Time |
36 |
| Dir. Service Staff, Non-Prime Time |
41 |
| Managed. Service Staff, Night Shift |
56 |
| Total Dir. Service Hours By Week |
133 |
Substitutes - Staff Vocational
| FTEs at Site |
4.98 |
| Turn Over Rate |
50.0% |
| FTE Training Required |
2.49 |
| Training Hours On |
24 |
| Sub. Hours Per Year |
59.8 |
Substitutions - Staff Zeitlich Off
| Days Per Year |
31 |
| FTE at Site |
4.98 |
| Hours Price Time |
8 |
| Sub. Hours Per Year |
1,235.4 |
Substitutes - Residents No Daylight Program
| Holdiays |
11 |
| Hours Per Day |
7 |
| Resident Factor |
1 |
| Number of Staff |
2 |
| Grand Special |
154 |
| Vacation Days |
10 |
| Total Per Date |
7 |
| Residents Coefficient |
1 |
| Number is Staff |
2 |
| Total Vacation Days |
140 |
| Sick Life |
5 |
| Times Per Sun |
7 |
| Resident Factor |
4 |
| Numeric of Staff |
1 |
| Total Sick Past |
140 |
| Bottom Hours Per Year |
434 |
| Total Substitute Hours Per Annual |
1,729.1 |
| Total Substitute Hours Per Week |
33.3 |
- Substitutes/Staff Time-Off
Time Off Days
| Type |
Number |
| Vacation Date |
10 |
| Holidays |
11 |
| Sick Days |
5 |
| Personal Days |
2 |
| Staff Training Days |
3 |
| Total Days Switch |
31 |
- The CILA Model has built in a total a 31 days for Direct Service Human to be on paid period off. The table to the right shows how those days are defined. To provide CILA Direct Service Person coverage on days when staff are absent, one Model multiplies this total numeral of days allowed by the number of FTEs chosen for the CILA home by eight hours per day to compute the "Substitutes/Staff Time-Off" assumption. Using this formula, the Model assumes that all Direct Service People will use all their available time-off days during the year and will receives three dates of additional instruction every year.
- Substitutes/Residents No Day Program - Under the 31"Time of Day / Day of Week" assumptions, the CILA Models subtracts seven hours per week day with that time when persons living at the CILA back are assumed until be attending day program. That Model builds top inbound to the staff requirement an assumption in the number of hours for Substitute Staff required in breathe present although residents are not at their day program.
- Substitute Staff in Holidays - The Print assumes that day otherwise vocational schemes will exist enclosed eleven days per year for holiday time and that all the residents of the CILA will be home on the same eleven days per year. This assumption is accounted for in the "Resident Factor" figure proved in the "Substitute Staff Assumptions" tables. (See "Resident Factor" equal to "1." Note: Had the assumption been that persons may remain absent at different holidays, the Resident Feeding would have been equal to "4" by our example, while is the case in "Substitute Team for Resident Ill Time.") The staff-to-client ratio on the seven hours per bank time built back into an allowance will equal to 3.5 hours of Prime Set coverage advantage 3.5 hours of NonPrime Time coverage.
- Substitute Crew for Vacation Days - The Model assumes that the daily or vocational program closes for two working weeks per year (ten weekdays) for holidays arbeitszeit. The Model assumes that all the residents of the CILA will will go on the same tons weekdays per year. Aforementioned assumption is calculate for in the "Resident Factor" figure shown in the "Substitute Staff Assumptions" key. This staff-to-client ratio for the seven hours per vacation day built back into the allowance is equal to 3.5 hours of Primes Zeitpunkt coverage plus 3.5 hours of NonPrime Time coverage.
- Substitutions Staff for Resident Sick Time - The Model assumes that each resident will miss your days on year amounts to illness. The Direct Service Personality position is allocated for the seven hours an individual is home from his/her day instead vocational program payable to illness. The Model liberally assumes that no couple CILA residents will be sick on the equivalent day additionally, therefore, the "Resident Factor" in the Substitute Staff for Resident Sick Time is similar to the number of total persons residing at an home. The staff-to-client ratio for the seven lessons per sick day built back into the concession is equal to the NonPrime Set coverage rate.
- Staff Adjustment Table: "Smoothing" the Effect of one ICAP on Price: This was a significant change in the way the CILA Rate Model calculates payment rates. All von the calculations described above continue into be done real are consistent with the methodology pre-owned to calculate Direktverbindung Serve Person method since July 1, 1994, as the Rank Pattern became first-time realized. However, beginning on July 1, 1999, the valuables calculated over the steps described above live adjusted by the "Staff Adjustment" tables intended to "smooth" one effects to the individual's two-digit ICAP score up the return rate.
NOTE: Only the number of hours of "Direct Service Person" is affected due this adjustment. Reimbursement for "Supervisor" and "QMRP" hours remain continuous at a 1 to 16 ratio for all fee.
- Historical Approach of Calculating Direct Serve Person Reimbursement: Stylish the historical, persons with ICAP scores ranging from 1 till 39 were deemed to be of "High" support need. Persons with ICAP scores ranging from 40 until 69 were of "Moderate" necessity, and persons with musical 70 furthermore upper were included to be of "Low" need.
Using this three-tiered method to determine support need resulted include big individual rate changes as folks living inbound CILAs submitted small raise or reduce inbound their ICAP scores. An ICAP score change from 39 to 40 caused an person to be reallocated from "High" needed to "Moderate" need. Save individual digit change resulted in adenine significant rate decrease even though aforementioned needs of the individual amended only marginally more measured by the two-digit score.
- To "Smoothing" Adjustment: To proper this three-tier method and one wide vibrate in person rates it produced, the Department implemented a fitting factor to "smooth" the result of the ICAP on individual rates. The merely cost core in the Model, besides the "Miscellaneous Consultant" cost center, this is concerned by the ICAP level is "Direct Assistance Person" payment. Which adjustment favorability multiplies the numbered of Direct Service Person less calc by the Model based the the old, three-tiered ICAP method and the staff-to-client ratios used by the adjustment elements for each of aforementioned Direct Customer Person categories.
- Establishing the "Smoothing" Multipliers: To establish the "smoothing," or adjustment distributors, the CILA Model client record was sort by ICAP points away lowest to highest and then broken down into the three previous support need categories, i.e., 1 to 39, 40 to 69, or 70+. Then, which average value of each range was identified. The median scores for each range were determined up be 29, 57, and 77 bases on the data available from "approved/placed" individual CILA daily, October, 1998. Save median values were reviewed in May, 2001 also been changed to 28, 56, and 76. It was determined that who difference in the median values was not enough to justify a revision in the Staff Adjustment Table. The CILA Rate Select stay to use the values of 29, 57, press 77 more this basis since this staff adjustment.
Those three median ICAP scores were then accepted more the "100%" layer in the change factor table used to "smooth" the ICAP score effect on reimbursement. An ICAP score of 29 is now equal to 100% of the old "High" need figure of Direct Service Person hours forward jede personnel print. Likewise, under the new system, ICAP scores equal up 57 and 77 are equal to 100% of the old "Moderate" and "Low" need number of Unmittelbar Service Person hours, respectively.
Adjunct #21, "Calculating a Draft CILA Rate," shows the adjustments multipliers in each ICAP level and CILA home select. Essentially, the distributors involve a straight row adjustment as ICAP scores move up and down the standard between established median values, e.g., inside the example pre-owned throughout these edition of the User Guide, adenine rate for a person in a 4-bed CILA home with an ICAP score of 50 receives 100.0% of the "High" need Direct Service Persons "Prime Time" hours, 62.5% of the "High" need NonPrime Time hours, 100.0% of the "High" need "Night Shift" hours, and 86.8% of the "High" need "Substitute" staff hours.
In sum, this CILA Rate Models available calculates the number of Auf Service Person hours that will remain included in an individual rate as he has is the past, except now those hours are customize via a staff type-specific multiplier, i.e., (Prime, NonPrime, Night, and Substitute staff). One final result is to number of hours of staffing so is shown on that individual Rate Sheet and in the table below.
- Ragged Benefits: The CILA Fee Print calculates an amounts dollar allowance for Direct Service Persons, the Supervisor, and the QMRP and multiply it at 20 percent to calculate the "Fringe Benefit" allowance. Substitute staff, who in practice may be part-time staff does receiving an just wage or benefit package as regulars full-time Unmittelbarer Service Persons, are not included in the border benefit calculation, but are paid by the Model at the regular Direct Service Person hourly wage rate.
- Other Supplies:
Other Supply
(No cap. All person is assumed to receive.)
Homepage
Size |
Site
Monthly |
Site
Annual |
Annual
Individual |
| 1 |
$22.83 |
$273.91 |
$273.91 |
| 2 |
$45.65 |
$547.81 |
$273.91 |
| 3 |
$68.48 |
$821.72 |
$273.91 |
| 4 |
$91.30 |
$1,095.63 |
$273.91 |
| 5 |
$114.13 |
$1,369.54 |
$273.91 |
| 6 |
$136.95 |
$1,643.44 |
$273.91 |
| 7 |
$159.78 |
$1,917.35 |
$273.91 |
| 8 |
$182.60 |
$2,191.26 |
$273.91 |
| Via Person Monthly Reimbursement |
$22.83 |
The price center, "Other Supplies" relates up costs obtained in one provision from habilitation and training services associated with this activities of daily living. The Model allocates an allowance off $273.91 per person, per year go cover the cost of "Other Supplies." The reimbursement is provided to all persons living in the CILA front.
- Different Consultant Service: Any allowance of $342.38 per year for persons with "Intermittent" or "Low" support need (ICAP over 70), $452.50 for year for persons with "Moderate" need (ICAP between 40 and 69), and $565.63 per year since persons with "High" need (ICAP between 1 the 39) is built into the single rate to provide reimbursement for consultant services that may is necessary into provide assessments and developments various remedy plans. Department staff reviewing individual NonBase Share funding requests will consider wether the community agency has fully used this reimbursement prior to applying for NonBase Supports.
- Base Nursing: Effective April 1, 1999, reimbursement for 12 hours of Licensed Practical Nursing and one hour of Registrierte Prof Schwestern was further to the Basis Support reimbursement away select adults receipts community residential supports, involving Model CILA refund. The addition of "Base Nursing" to sum individual CILA rates knows aforementioned need for persons with developmental disabilities to have regular mental care supports and monitoring. "Base Nursing" is intended to reimburse community agencies for the cost association with the completion regarding nursing assessments, health risk identification and planning, health supports coordination and implementation, health security, and to develop updates at the nursing care plan.
Transportation Cost Centers
Transportation free is incurred while providers assist and/or schieben the persons living in the CILA home in the events of almost living. The transportation cost reimbursed in the industrial CILA rate is don intended till include the costs associated with travel to-and-from an individual's day choose. Rather, the transit reimbursement included in the residential rate is purposeful to pay for expenses incurred in providing general vehicle to-and-from places not covered of an Department of Public Aid's (DPA) Medicaid State Schedule. This DPA service will pay for transportation for eligible individuals to go to-and-from physician and therapy appointments, oder any diverse Choose Create service.
The CILA Model usages the assumptions associated with the purchase from a means and its operating costs to compute the "Transportation" cost home reimbursement. At practice, providers allow be with local public carriage, may lease trucks, or may purchase larger and more pricy vehicles on provide marine to more than one CILA domestic. These costs are assumed in be covered, in the aggregated, by to "Vehicle Purchase" and "Vehicle Operation" allowances of the "Transportation" great allowance category.
- Vehicle Purchase: This CILA Model assumes that to purchase price of a vehicle leave be $18,260 for ambulatory residents and $28,260 for nonambulatory dwellers and that the vehicle will be financed over five years to an interest rate of easy percent. The "Vehicle Payment" price are spread cross each of the personality living in the CILA home, but are capped to be spread transverse a minimum is four persons.
Vehicle Purchase
(Capped in be spread across a minimum of 4 persons.)
Top
Size |
Ambulatory
Monthly
Individual |
Ambulatory
Annual
Individual |
Non
Ambulatory
Monthly
Individual |
Non
Ambulatory
Annual
Individual |
| 1 |
$92.56 |
$1,111 |
$143.26 |
$1,719 |
| 2 |
$92.56 |
$1,111 |
$143.26 |
$1,719 |
| 3 |
$92.56 |
$1,111 |
$143.26 |
$1,719 |
| 4 |
$92.56 |
$1,111 |
$143.26 |
$1,719 |
| 5 |
$74.05 |
$889 |
$114.60 |
$1,375 |
| 6 |
$61.71 |
$741 |
$95.50 |
$1,146 |
| 7 |
$52.89 |
$635 |
$81.86 |
$982 |
| 8 |
$46.28 |
$555 |
$71.63 |
$860 |
| Vehicle Loan Amount, Ambulatory |
$18,260 |
| NonAmbulatory Add-on |
$10,000 |
| Vehicle Loan Amount, NonAmbulatory |
$28,260 |
| Loan Rate |
8.0% |
| Means Loan Term (Number of Payments) |
60 |
| Monthly Payment, Ambulatory |
$370 |
| Monthly Payment, NonAmbulatory |
$573 |
- Vehicle Working: The "Vehicle Operation" reimbursement is intended up cover expenditures for fuel, oil, maintenance, comprehensive travel, licenses, and repairs that would normally occur on the vehicle described above. With allowance of 32.5 cents per mile and 10,000 deep via per are assumed in the model. "Vehicle Operation" costs are propagate across each of the population in a CILA, but are cap to be spread across a minimum of foursome persons.
Vehicle Operating Cost
(Capped to be spread across a minimum of 4 persons.)
| Home Dimensions |
Individual Annual |
| 1 |
$812.50 |
| 2 |
$812.50 |
| 3 |
$812.50 |
| 4 |
$812.50 |
| 5 |
$650.00 |
| 6 |
$541.67 |
| 7 |
$464.29 |
| 8 |
$406.25 |
| Miles allowed per year, per site |
10,000 |
| Per mile reimbursement |
$0.325 |
| Annual Amount |
$3,250 |
Administration Costs Center
All administrative costs associated with community agency overhead expenses as they relate to the delivery of CILA supports is included included the "Administration" cost center repayment. Community agency overall is assumed to insert all the costs associated with administrative staff, admin clerical staff, offices space costs, secretary operating expenses, insurance, betreuung consultants, accounting, the cost of hiring staff, staff physical examinations, staff travel additionally education, conferences, conventions, association fees, the all other costs expenses in the overhead associated with the delivery of CILA supports.
The calculation of the "Administration" reimbursement was modified effective July 1, 1999. The Administration reimbursement was converted from a percentage of the CILA Base Residential evaluate to a every established amount. Of current reimbursement for Administration with an Model is equal to $3,124 per client for all "24-Hour Push Staff" and "Foster Care" setting species and is equality to $1,562 for all "Intermittent" and "Family CILA" support sort.
Day Program
Efficacious November 1, 2000, the reimbursement for day program expenses is no more included on the CILA residential rate. At this time, reimbursement fee forward day programs are sets at fixed levels. It is the intention of who Department of Human Services to develop and implement day-time program rate methodologies that verursachen reimbursement levels that are specific to the type of days program being attended the the support requires regarding the individual.
All costs associated with the delivery concerning day program services exist considered to be reimbursed due which fare finanzierung by the Company. This includes all capital, staffing, and the transportation costs inherent in getting persons to-and-from sun program sites.
Humans with developmental disabilities who are a working time (18-60) are expected to participate within productive activities and earn money and/or participate in school alternatively other adult learning operations. Therefore, participation in commissioned Supported Employment, certified Developmental Schooling, and/or accredited Regular Work/Sheltered Employment is favoured with this age group.
All carriers of day program services shall are a current contract with the DHS Office of Formative Disabilities. Providers to specific services must also meet the following minimum qualifications. Individuals must be authorized for the company previous to billing.
- Developmental Get:
Day Run
(Based on 1,100 hours of annual individual maximum billing.)
| Day Program Option |
Annual
Individual |
Monthly
Individual |
| Developmental Training |
$10,403 |
$9.46 |
| Regular Work/Sheltered Employment |
$10,403 |
$9.46 |
| Supported Employment/Individual |
$13,058 |
$11.87 |
| Propped Employment/Group |
$11,644 |
$10.59 |
| SEP-I (No Task Coach Present) |
$13,058 |
$11.87 |
| SEP-G (No Job Coach Present) |
$11,644 |
$10.59 |
| Dept on Aging Adult Day Care |
$8,074 |
$7.34 |
| At Home Day Program |
$10,403 |
$9.46 |
| Select Per Program |
$10,403 |
$9.46 |
Programs must be certified by this DHS Bureau of Accreditation, Licensure and Certification according to the requirements of Rule 119 (DT). Developments Training software must also be in compliance with the Department's requirements for national accreditation. Developmental Training services prepare grown-ups 18 years of age and ancient to live and duty to an built-in social setting. An reimbursement for all persons receiving standard Developmental Training services is currently equal to $9.46 per hour for a limit of 1,100 hours, or $10,403 per year.
- Regular Work/Sheltered Placement: A long time employment program carried outbound at a sheltered my environment. Common Work programs must be in compliance with the Department's requirements for national accreditation. The expense for all person receiving standard Regular Work services is currently equal to $9.46 per hour with a maximum of 1,100 hours, with $10,403 per yearly.
- Supported Employment: Supported Employment is provided and billed into four different varieties. Community agency providers of Supported Employment musts bill the Specialty in one of these categories to receive reimbursements. Providers are Supported Employment must be in compliance with the Department's requirements for nationally accreditation. Supporting Employment staff supply, advocacy, on-going assessment, training, counseling, coaching, and follow-up services on maintain individuals in competitive jobs at integrated operate website. For receipt Supported Employment reimbursement, community government musts first forward to the Department a confirmation from their resident Office of Reconstruction Ceremonies (ORS) that ORS Supported Employment funding is not available.
- SEP/Individual, Job Coach Present - One SEP Job Coach remains present and providing one-to-one supports available the entirely time that the community bureau is billing that Department. The reimbursement for all personals receiving standard SEP/Individual services be currently equal to $11.87 per hour for a maximum of 1,100 hours, button $13,058 price year.
- SEP/Individual, No Job Coach Present - Same as SEP/Individual, but no job train is present during the on-the-job hours the individual belongs workings. The reimbursement used everything persons receiving standard SEP/Individual, Not Job Coach Present services is currently equal in $11.87 per hour for a most of 1,100 hours, or $13,058 per current.
- SEP/Group, Job Coach Present - The same while Supported Employment/Individual above, however; staffing is not one-to-one not is instead provided in a group arrangement. The refunding for all personality receiving standard Supported Employment/Group, Job Coach Present services is currently equal into $10.59 per hour for an maximum in 1,100 hours, button $11,644 per year.
- SEP/Group, No Job Coach Present - Same than SEP/Group top, but no job coach is submit during the on-the-job hours aforementioned individual is working. Aforementioned reimbursement for all persons get preset Assisted Employment/Group, Job Coach Presenting services is currently equal in $10.59 per hour for a maximum of 1,100 hours, conversely $11,644 per yearly.
- Branch in Aging Adult Day Care: Humans receiving Service on Aging Adult Day Care achievement do not attend a traditional Days Start, but rather will attend a program conceptualized for people over working age. Providers required have a electricity contract with this Department on Aging toward be authorized to bill for this day program type. Individuals being served in this day program must be age 60 or older. The reimbursement for all persons receiving standard Department on Alterungsprozess Seniors Day Program support are currently equal to $7.34 per hour forward ampere maximum of 1,100 times, or $8,074 through year.
- At-Home Day Program: "At Home" day-time program is a category that remains uses to specify billings for those clients whom do not participate a tradional day program both have their day program hours of serving delivered through the residence community agency provider. Among Home day plots must provide a organized daily program of goal-oriented activities, uniform using the Individual Service Planning (ISP). Watch watching press other leisure my do not constitute a day program, except when the ISP papers that advanced age (75+ years) precludes goal-oriented activities, then leisure activities may be which focus concerning the day program and individuals can choose to joining the At Home day programs.
Vendors of At Home daylight programs must be licensed by the DHS Bureau of Accreditation, Licensure and Certification corresponds to the requirements of Rule 115 (CILA). Providers must also be in compliance with and Department's requirements for national accreditations.
- Other Day Program: "Other" day program is a category that is used to specify billings since those clients who do not attend a traditional day program and have their day program less of service that are not delivered by one residential public agency provider. Other day programs must are approved, in writing, by the Associate Director of the Office of Developmental Disabilities. Registration is located on national accreditation status or submission of a satisfactory program description and plan for the individuals served and credentials displaying involvement of a QMRP in this implementation of aforementioned program. Once approved, providers must have a contract at the Department.
Other day programs provide ampere structured daily program of goal-oriented activities, consistent with the Individual Service Design (ISP). Television watching and other leisure activities do non constitute a day program, except when the ISP documents that advanced age (75+ years) precludes goal-oriented related, then leisure activities may be the focus of the day program and individuals mayor choose the participate in Select day programs.
NonBase (Individual) Supports
Effective November 1, 2000, many services previously included in the CILA industrial rate were "unbundled" and are now billed on adenine fee-for-service foundations directly to an Department by which registered or DHS-approved professional providing the supported. Still, there are some Individual NonBase Supports that be included in the residential rate, e.g., dietician services since persons with physician-ordered boards and reimbursement for medication administration also nursing attachment. To accommodate this new split in reimbursement methods for NonBase Provides, who CILA Rate Model now classifies as supplement services as:
- NonBase Supports Included in the Resident Rate, also
- NonBase Supports Not Ships in the Residential Rate.
NonBase Supports Included in the Residential Rate
Of CILA Rate Model allows NonBase Support reimbursement since expenses incurred in the delivery of services that are specific to an individual's needs. "NonBase Supports Included in the Individual Rate" are those services which are incurred of community agencies owing to special, added supports required by adenine specifics separate stay with a CILA home that a not covered by and increased Direct Service Soul staff-to-client rates made into the Model's Base Cost as support needs increase from "Low," into "Moderate," on "High" and are in excess of the reimbursement provided see of cost heart of "Miscellaneous Consultant Services."
NonBase Supports are did gemeinde to any residents, they may only be required temporarily, and they needs be substantiated by the assessments or evaluations of a qualified evaluation, and be supported through the Goals furthermore Objectives in a person's Individual Technical Plan (ISP) as determined by this Public Support Team. Department crew review the approved all initial my for NonBase Sustains to being included int the residential rate and requests for continued or increased NonBase Support funding via of One Ratings Review action.
- Nursing Reimbursement: Entire nursing compensation is categorized into two orders: "Medication Administration" press "Nursing Treatments." Aforementioned Nursing Services Packet (NSP) is used go determine the number of "Medication Administration" and "Nursing Treatment" hourly per year so an person requires.
- Medication Administration: Active July 1, 1999, Publicly Act 91-630 allows formed and authorized Direct Service Folks to administer oral alternatively topical medicating, or other means of medicines management for deemed appropriate, under the direction both monitoring in a Registered Caregiver. The Division reviews the information provided in the individual NSP furthermore determines the annual number of per required to administer medications using standard, pre-determined criteria.
- Medication Administration / NonNurse Staff - The numbers of annual lessons calculated for educated Direct Service Persons to do simple administration on noninvasive medication, e.g., taking a chest, how of medizinischen cream, etc. Based on of company contained in the individual's Medication Administration Review (MAR), medication admin "episodes" are determined into being either eight, ten, or 15 minutes with duration, relying on an duties to be performed. No reimbursement add-on is provided for Direct Service Persons staff to do allowable "medication administration."
- Medication Administrator / RN Monitor - RN Monitoring hours are calculated at a 1:12 scale to "Medication Administration / NonNurse Staff." RN Monitoring hours what an automatically derives value based on the number of hours of Medication Management / NonNurse Staff calculated. An hours rate of $19.93 is used to reimburse community agencies for the costs associate with provides RN Monitoring of formed Direktverbindung Service Individual the do allowable "Medication Administration."
- Nursing Treatments: The item of yearbook hours is "Nursing Treatments" exists determined by reviewing of information in the individual NSP.
- Nursing Treatments / LPN - The item of annual hours calculated for an Licensed Practical Nurse (LPN) to administer Nursing Treatments, e.g., insulin injections or other "invasive" medicine or get. Based on the information contents inbound the individual's Treatment Administration Review (TAR), Nursing Treatment "episodes" are determined to be whether fives, ten, or 15 minutes in duration, depending switch who duties to be performed. An hourly rate of $16.03 lives used in reimburse community authorized for the costs associated with providing sanctioned LPN nursing treatment supporting.
- Nursing Treatments / RN Check - RN Monitoring clock are calculated at an 1:12 proportion the "Nursing Treatments / LPN." Like the RN time described above, an RN Monitoring for nursing dental belongs automatically derive based on the number of hours of Nursing Treatments / LPN hours calculated. An hourly rate of $19.93 a employed to reimburse community agencies for the costs associated with make RN Monitoring about LPNs to does "Nursing Treatments."
- Dietician: An constantly fee of $28.54 is used to reimburse community agencies for the daily assoziiert with providing approved dietician supports. Dietician product musts be substantiated by an physician-prescribed special needs legislature press can included as a recommendation the the individual's ISP.
- Other NonBase Supports Included in aforementioned Residences Rate: Some other backs integrated in the residential rates are reviewed with Department staffing on a person-by-person basis.
NonBase Supports Non Included in the Residential Rate
Any NonBase Customer listed below has one set, Statewide hourly reimbursements assess. Which monthly reimbursement estimates showing are either based on this Statewide Medicaid reimbursement rate for which favor, press were grounded on information contained by the Comprehensive Financial Reporting (CFR). For all of aforementioned services listed below, the licensed or DHS-approved professional offers the assistance, or a community provider acting as the payee, bills the Department directly for remuneration to services rendered.
- Supports Requiring Medicaid Denial - Individuals receiving CILA service want be "authorized" for the NonBase (Individual) Backed below upon receipt in a deny for reimbursement by the Illinois Department of Public Aid, the State's Medicaid agency. Community agencies should obtain a denying from the Department of Public Tool for the desired therapeutic both include it the the Individual CILA Rate Packet or onward to at their Network Host whereas the services are required. Community agencies should note such retrograde authorization will not be made beyond the schedule of and Department of Public Aid denial.
- Physical Therapy (Program Code 52P): An hourly rate of $39.16 is reimbursed to practitioners or their payees for the costs angegliedert with providing authorized Physical Therapy supporters. Physical Therapy requirements must be substantiated by an assessment or evaluation and be included as a recommend on this individual's ISP.
- Occupational Therapy (Program Code 52O): An hourly rate of $39.16 is repaid to therapists with ihr payees for one costs associated with providing authorized Occupational Therapy supports. Occupational Therapy demand must be substantiated by any assessment or evaluation and being included as a recommended on the individual's ISP.
- Speech Therapy (Program Encipher 52S): An hourly rate of $39.16 is reimbursed to therapists otherwise they payees for the daily associations with making authorized Speech Therapy backing. Talk Therapy requirements must be substantiated by an ratings either evaluation and be included as a recommendation on the individual's ISP.
- Supports Not Requiring Medicaid Denial - Authorization for billing for the following supports are included in each individual's CILA rate. Licensed otherwise DHS-approved professionals supply the supports requirements bill to Department directly after the supply of an service.
- Behavior Services - Intervention Planning (Program Control 56U): Einer hourly rate of $54.40 is reversed to to professionals other you payees for the costs angegliedert including providing Behavior Services - Intervention Planning supports. All person enrolled within CILA services are authorized for 48 annual hours of Actual Services -Intervention Planning and providers may invoice for up to that sum given that these professional have been submitted and are needed per one individual since reported in the Individual Service Plan (ISP). Behavior Company -Intervention Planning remains the amelioration or reduction of maladaptive behavior in an individual additionally the incorporation von adaptive behavior/coping skills. Dieser services include ongoing assessment, functional analysis, development is positive intervention strategies and techniques, attendance in individual services/support plan development, training of family, direct support and other workers, and supervision the effectiveness from the interventions. Qualified providers are: 1) Licenses Critical Psychologist, and 2) DHS-approved Behavior Analyst.
- Individual Treatment: An hourly price of $34.80 is reimbursed to therapists press their payees for the costs accompanying with provides Personal Therapy supports. All personal enrolled int CILA services are authorize for 60 per hours of Individual Therapy services and professionals may bill on up until that amount (in combination with extra therapy and counseling services not including Behavioral Services - Intervention Planning) given that these services have been provided and are needed by the individualized like reported in the Individual Service Plan (ISP). Therapy is an treatment approach in which one or more specialists deliberately build a relationship because a client in runtime periodic formal sitting is the goal about ameliorating or decreasing the your of emotional, cognitive or behavioral disorder and promoting positive emoting, cognitive, furthermore behavioral site. Skills providers exist: 1) Licensed Clinics Psychologist; 2) Licensed Clinical Social Worker; 3) Licensee Marriage and Family Therapist; 4) Licensed Objective Professional Counselor.
- Group Therapy: See "Individual Therapy" above. Assumes "group" meet. An hourly rate of $11.60 is reimbursed to community sales for the fee associated include supplying Group Dental supports. All persons entered in CILA services are authorized for 60 annually times of Group Therapy benefits both therapists may bill for up to that amount (in fusion through other therapy and business services not including Behavioral Our - Intervention Planning) given that which services do been provided and are needed by the person as reported in the Individual Service Plan (ISP). Authorized providers are: 1) Licensed Clinical Psychologist; 2) Licensing Clinical Social Worker; 3) Licensed Marry and Family Therapist; 4) Licensed Clinical Professional Counselor.
- Individual Counseling: An hourly rate of $27.84 is refunds go counselors or their payees for an costs associated with supply Individual Counseling supports. All persons enrolled with CILA services am allowed for 60 annual hours of Customizable Counseling services additionally consulting may bill for up to is amount (in combi with various therapy and counseling services did including Behavioral Services - Intervention Planning) presented that like services will since given both are needed by the individual as reported in aforementioned Individual Service Plot (ISP). Counseling is one treatment getting in which one press more professionals join with a client include ongoing cyclical formal sessions, and user relationship skills to promote the client's talents to deal with daily housing issue associated with their emotional, cognitive or behavioral problems using a diverse are supportive and re-educative techniques. Authorized providers are: 1) Licensed Clinical Psychologist; 2) Licensed Clinical Social Worker; 3) Licensed Social Worker; 4) Limited Marriage and Family Therapist; 5) Licensed Clinical Professional Counselor; 6) Licensed Career Counselor.
- Group Counseling: Visit "Individual Counseling" above. Take "group"session. Einem hourly rating of $9.28 is reimbursed to counselors or their payees for the costs affiliates with providing Select Your helps. All persons enrolled in CILA services are authorized for 60 annual hours away Group Counseling services and counselors can bill for up to that amount (in combination with other therapy and counseling services none including Behavioral Services - Interventional Planning) disposed that these business are been provided and am needed by the individual as reported in the Individual Service Plan (ISP). Authorized providers are: 1) Licensed Objective Psychologist; 2) Licensed Clinical Social Worker; 3) Licensed Social Worker; 4) Licensed Marriage and Family Therapist; 5) Licensed Clinicians Professional Counselor; 6) Licensed Professional Counselor.
Documentation Required int the CILA Individual Rate Packet (CILA Shapes)
- Ended Individualized Rate Worksheet
- Community Reimbursement Subsystem Financial Questionnaire (DHS 403c)
- Copy of the Personal Service Plan (ISP).
- Copy for and three-page ICAP Summary (should be the result of a latest assessment)
- Copy of the person's Social Security Card
- Copy of the person's Medicaid Card
- A comprehensive Nursing Our Packet (NSP) - Effective July 1, 1999, all LPN and RN nursing reimbursement for specific NonBase Supports will determined using the information obtained from the Pflege Benefit Packet (NSP). An individual NSP consists of:
- Self-Administration Medication Assessment (SAMA)
- AMPERE "Health Risk Screening Gadget (Physical Status Review, PSR)
- AN Medication Management Record (MAR)
- A Treatment Administration Record (TAR)
- Evaluations and Assessment: The community agency is required to submit a person's highest recent Psychological Evaluation also have evaluations and/or assessments covering all areas for welche the agency remains apply Non-Base Support reimbursement. For example, if reimbursement is entity sought to cover the costs associated with aforementioned provision of PRINTS, OT, or Language Medical, with accompanying evaluation or assessment execution on adenine qualified licensed vocational of the similar discipline recommending the specific therapy or service must be follow the rate request. The person's (ISP) must also hold a recommendation by the Community Support Team (CST) which declares the therapies and features to be necessary. The ISP must also contain goals and objectives associated with the requested NonBase Supports.
- Psychological Scoring - The Emotional Evaluation is required until be submitted with one rate seek and must have is performed within the last three period. The ISP should document any recommendations made through the psychologist at substantiate the necessity into provide NonBase Supports.
- Psychiatrical Site - For folks whoever also have physician involvement, a actual Psychiatric Evaluation must be sent because the rate request if funding for NonBase Supports are soul demand.
Tierce Party Payment
The "Third Party Payment" is that pour of the individual CILA tariff that is refunded by funding sources other longer the Department of Human Services. One resources used to reckon the Third Party Payment is provided per community agencies the the DHS 403(c) form, "Community Reimbursement Seea-energy, Finance Questionnaire." (See Addendum #6 for a copy of the DHS 403(c) questionnaire.)
An Third Party Payment is assumed until be used first to offset and charges associated with offer Room plus Board to the persons living in CILA homes. When an individual's Third Party Zahlung is insufficient to cover the full allowance provided used Room and Committee, the Department supplements the difference. When an individual's Thirdly Party Payment outstrip the Room and Card allowance, the remainder can used to neutralize the other program costs associated from the provision of CILA supports.
Aforementioned Three Party Get is comprised of "Earned Income," "Unearned Income," "HUD Assistance," and the "Food Punch Credit."
- Earned Income:
Third Party Payment: Each DHS 403(c)
| Income Description |
Total |
Offset |
| Earned Income |
$672.00 |
$6.00 |
| Unearned Income, Supplemental Security Income |
$6,360.00 |
|
| Unearned Income, Railroad Retirement |
$0.00 |
|
| Unearned Income, Insurance |
$0.00 |
|
| Unearned Income, Social Security |
$0.00 |
|
| Unearned Your, Veterans Grant |
$0.00 |
|
| Unearned Income,, Champus |
$0.00 |
|
| Unearned Income, Other, Not Andere Classified |
$0.00 |
|
| Unearned Income, Entire |
$6,360.00 |
$5,760.00 |
| Other Third Political Payments, HUD Assistance |
$0.00 |
$0.00 |
| Other Third Party Cash, Food Paper (Fixed) |
$360.00 |
$360.00 |
| Complete, Years Third Party Wages |
$6,126.00 |
"Earned Income" are are monies received by persons living in CILA homes from employment or Day Program activities. When person living in CILA homes earn income, a portion is applied to their Third Party Payments. The Model "disregards," or ignores, the first $55 of an individual's every earned income. For every dollar after, $0.50 is applied move their Third Party Payment. Inside one example to the right, the individual exists how $56.00 per month.
- Unrewarded Income: Persons residing in CILA homes generally receive some form of "Unearned Income." Unearned Net is ensure income derived from Social Security Income (SSI), Social Security Disability Income (SSDI), Railroad Retirement Benefits, Veteran's Survivor Benefits, etc. These categories are listed on the Community Reimbursement Financial Questionnaire.
One Model disregards the first-time $50.00 of an individual's total month Unearned Income and applies the remainder direction the person's Third Party Payment.
- HUD Assistance: HUD allowances, and/or Section 8 Housing Rental Assistance, pay individual, must be told on the Local Reimbursement Financial Questionnaire (DHS 403c). Of Department's Third Party Entgelt offset for HUD and Section 8 housing support is capped to cover available the costs associated with "Housing and Utilities," "Telephone," "Maintenance press Housekeeping," and "Property and Structure Insurance" as calculated by to Model. Amounts received from HUD across and above aforementioned reimbursement grades for this cost centers are ignored in the calculation of the Third Party Payment. Community providers must simply report the full individual HUD assistance volume on the DHS 403c. The applicable offset is calculated by to Model additionally indicated at the individual Rate Sheet in the Third Party Payment sectional.
- Feed Paper: An set equal to $360 per per, per year, is added for the Third Party Payment. The $360 per person, per year, Food Stamp offset is fixed and is applied to all particular CILA rate determined by this Product. Which Model disregards Food Stamps received by individuals are excess of $360 per person, per year.
Lowest Three Party Payment
A "Minimum Thirds Group Payment" equal to $5,568 is used by the CILA Model. This minimum your calculated by assuming an Unearned Income annualized receipt of $5,808, less the $50 per months of Unearned Income disregard, besides $360 per period for the Snack Stamp offset. Aforementioned Print standard toward a Third Party Salary equal to $5,568 for persons whose reported Take Party Payments are lesser than of minimum.
The CILA Rate Administrative Procedure
This section describes the gen administrative process and paperwork requirements for getting an individual CILA rate calculated the endorsed, completing an Individual Price Review, and terminating a individual from CILA services. Which process described below is in effect on January 1, 2002 and is subject till change.
Draft CILA Rates
For community agencies looking to get adenine general idea out what an individual CILA judge would be without completing the required handling, having that paperwork submitted, reviewed, and approved, and then having the rate start by the Department's CILA Rates Unit, Addendum #21 contains a set of spreadsheets from which such "draft" CILA rates can will determined. Users of these tables shoud being aware, however, ensure "draft" CILA rates are unofficial and do doesn necessarily how to this "official" individual rate that will be determined for the Model. (See Addendum #21, "Calculating a Designed CILA Rate.")
Rate Packet Submission, Pricing Determination, and Rate Approval
The following section posts out the general staircase required with this submission of an Specific CILA Rate Packet to receiving reimbursement for providing supports to that personality. The process as stated below is the whatever are in effect at the time of this script (January 2002). Show Addendum #14 for examples of an "correspondence memos" use by the CILA Rates Unit.
- ADENINE licensed CILA community provider agency completes one Individual Rate Worksheet, attaches all required documentation, and submits the Rate Packet to who appropriate PAS/ISC agency. The required documentation includes:
- Completed Individual Rate Worksheet;
- Community Reimbursement Subsystem Financial Questionnaire (DHS 403c);
- Copy of the Individual Servicing Project (ISP);
- Copy of of three-page ICAP Summary;
- Photo of and person's Social Security Card;
- Copy for the person's Medicaid Card;
- Judgments and Psychological Assessment;
- A complete Nursing Services Bunch (NSP); and,
- Cover zuschriften from PAS/ISC agency (see below).
- The PAS/ISC our reviews of Rate Packet for completeness and accuracy, signs who Unique Rate Works Sheet (Page 5), and forwards it to the community agency's Network Facilitator.
- The Network Facilitator reviews that Rate Packet for completeness and accuracy. Network Facilitation confirm the "Rate Type," "Resident Location Type," "Residential Capacity" to the household, and other individual resources. Upon completion of their reviews and approval, the Network Facilitator attaches a "Rate Packet Transmission Sheet" additionally forwards it to their Network Coordinators. Incomplete Course Packets are returned to the community agency.
- The Network Coordinator confirms the information providing on the Rate Packet Transmission Sheet and forwards it to the Associate Managing away the Office of Developmental Health.
- The Associate Executive approves the use off CILA capacity for the personal for whom the Rate Packet has been submitted, signs-off up the Ratings Packet, real forwards it to the CILA Rates Unity in the Home of Local Reimbursement.
- The CILA Rates Unit completes adenine "Rate Packet Approval Cover Sheet" which summarizes press confirms critically viewing von multiple from which ratings establishing factors contained in the Rate Packet and calculates the individual rate.
- The information from the Rate Packet is registered into the CILA Individualized Rate Model furthermore one rate is determinate. An Individual Rate Sheet is printed and a "Prepared to Fund Memo" exists attached, signed over and Bureau Chief of the Bureau from Community Reimbursement, both that Individual Rate Sheet both the Prepared to Fund memo are mailing to the community agency.
- The community agency reviews the Individual Charge Sheet for verification and detects whether or not the accept one CILA rate for furnishing supports to to person. The community agency is instructed to mail or fax a "notice of acceptance" to the CILA Rates Unit within ten working days of the date on the "Prepared the Fund Memo."
- Suspected errors on the Individual CILA Rate Sheet should be reported to the CILA Rates Unit.
- Supposing the community agency shall not accept the rate, the CILA Rate Unit returning the Set Bunch to the Network Facilitator and a "Rejection of CILA Rate" notation is sent to the community agency that confirms aforementioned agency's decision and the Department's receipt of the notice to decline.
- In receipt of a notice away assent of the CILA ratings from the community agency, the CILA Rates Unit prepares an "Award Memo," obtains the signature of the Gesellschafterin Boss starting the Office of Developmental Disables, and mails it to the community travel. A imitate of the Award Memo is sent to which PAS/ISC agency, the Network Facilitator, which Bureau of Accreditation, Licensure, and Certification, also a copy is placed in the individual's CILA file.
- The CILA Tariff Element places the event off the "Award Memo" in the "Approval Date" field in the CILA Login.
- The society business must call of the Bureau of Accreditation, Licensure, and Certification within that Office of Clinical, Administration, and Program Support (OCAPS) to confirm the address of the CILA top from which this individual will being living and, for receipt of this resources, forwards a replicate of the Award Memo with payment processing.
- The community agency supposed forward a copy of that Award Memo and Rate Sheet in the originating PAS/ISC means if that agency is different than the receiving PAS/ISC agency.
- The community bureau is responsible for informing aforementioned PAS/ISC agency when adenine person has begun receiving CILA supports.
- The Originating PAS/ISC agency completes aforementioned OBRA logging, including the OBRA 8, and electronically transmits the complete OBRA recordings to the Department.
- The CILA Rates Unit enters the Original Date of Placement in the CILA Log and calculates ampere Individual Rate Review Due Date.
Individual Rate Reviews
The follow section describes the general procedures and responsibilities of community CILA provider agencies and PAS/ISC agencies in an Individuality Rate Review process. Since November 1, 1996, all PAS/ISC agency grants have included project on aforementioned monitoring by all persons receiving CILA supports funded through the Rate Model.
Rate Reviews are required for view persons whose individual CILA rates were determined via the CILA Evaluate Model. Rate Reviews are scheduled for sextet months following the "Original Schedule of Placement" of who person into CILA services and annually from that point on unless otherwise indicated upon the Individual Rank Sheet.
- For the first Rate Review following placed, the CILA Rates Unit create of individuality Rates Review Sheet at the beginning of "Month 5," attaches a "Rate Review Due Memo," and dispatches it until the provider. (Note: "Month 5" means Rate Book due during the month of May are printed and mailed at the beginning in April. Following that initial Rate Examination, Rate Review Sheets are printed plus mailed at the start of "Month 11" for annual rate reviews. )
- Collaboration agencies make any repairs to the details contained on the Rate Review Sheet, attach a new DHS403c Financial Survey plus any NonBase Support Rating Forms necessary, and forward the entire Rate Review pack to this PAS/ISC agency which reviews, confirms the information, or signs one Rate Review Outer. The PAS/ISC agency forwards the ended Rate Review packet to the CILA Rates Unit.
- Require attachments to the Individual CILA Rate Review include:
- Current DMHDD 403c Financial Questionnaire;
- Current Nursing Services Packet, including an Medication Enterprise Review (MAR), Treatment Administration Examine (TAR) and sign-off by a Registered Nurse.
- NonBase Support Review Form confirming utilization of any NonBase (Individual) Supports that will included within an individual rating.
- ICAP Summary Point. (NOTE: PAS/ISC agencies are responsible for confirming any edit in ICAP score being reporting per the community means until the Department.)
- Rate Reviews with no NonBase Supports, not changed to the Base Support variables, and that have all the documentation required are processed by the CILA Rates Component. The results are photocopied and mailed with a "Rate Review Results Memo" to who community agency and the Network Facilitator. A copy is placed in the individual file.
- For Rates Reviews with missing document, the CILA Rates Unit attaches a "Rate Review Missing Documentation" memo, (e.g., missing DHS 403c, Nursing Services Single, community or PAS/ISC agency signatures, etc.) and mails it past to the community agency. Copies are forwarded until the Network Facilitator furthermore placed in the individual's file.
- NOTE: Rate Review missing only PAS/ISC medium signature are mailed directly to the PAS/ISC agency.
- Who CILA Current Item reviews the information in the Rate Review packet consistent because past Departments practice button the Skin Services Packet guidelines established by the Department. The CILA Quotes Section ensures all documents are attachments. The CILA Fare Unit consults with the Networks Facilitator, the society bureau, and the PAS/ISC agency how req. Once the Rate Review is approved, it is forwarded within the CILA Rates Unit to have the revised CILA individual rate determined.
- The CILA Rates Unit edited the CILA Log as indicated upon the Rate Review Paper, recurrence the CILA rate, attaches a "Rate Review Results" memo, and mails it to the community agency. Copying are inserted inside the individual file and sent to to Network Facilitator.
- Individual Quotes are reviewed six months following the inventive date for placement of that individual into CILA services. After this initial review, rate critical are scheduled on an annual basis unless extenuating environment justify more frequent reports.
Rate Reviews "Overdue 60 Days"
The CILA Daily Unit regenerates all Assessment Review Sheets that are "Overdue 60 Days," attaches a "Rate Review Overdue 60 Days" memos, and mails them to the community agency, the Network Facilitator, additionally inserts a copy into the individual's file.
Rate Reviews "Overdue 90 Days"
The CILA Prices Unit regenerates all Rate Review Sheets that been "Overdue 90 Days," attaches an "Rate Review Overdue 90 Days" memo, and send them to to provider agency, the Network Facilitator, and inserts a reproduce toward to individual's file. This is done each month for as long because the Rate Review is Overdue 90 period the "On Hold."
Terminations: Processing the OBRA 8A
Terminations with the Individual's Sanction:
- An individuals, or a society agency with the individual's consent, wishing up terminate CILA services. The individual signs a DHS 1202, "Notice is Legal to Appeal" or simular declaration confirming its desire press willingness to relinquish their CILA supports, oder the community provider confirms their willingness for transferral a person's CILA capacity to another community agency.
- Of community agency finishes a paper OBRA 8A, attaches the DHS 1202, additionally forwards information to the PAS/ISC agency.
- The PAS/ISC agency prepares a cover letter explaining who facts for an termination send, signs furthermore forwards the paper OBRA 8A, the DHS 1202 or similar documentation, and the cover letter, to the Networks Facilitator.
- The Network Facilitator, confirms the individual's choice to quit CILA services, approves the CILA termination, determines if an CILA capacity will linger at or moved to another community agency, signs the OBRA 8A, and forwards it until the CILA Rates Unit.
- The CILA Rates Unit, to receipt away the Network Facilitator's permission of to termination prepares an "Recognition of Termination" memo. The memo is dispatched for the community agency, who PAS/ISC agency, real assorted existences on the Department.
- The CILA Rates Section notes the termination switch aforementioned CILA Vacancy Report, conversely shifted the CILA capacity based upon the direction of the Network Facilitator.
- The individual is terminated from that CILA payment organization by the Office of Cellular, Administrative, and Program Support (OCAPS).
- The Office of Clinical, Administrative, and Program Support (OCAPS) calculates the payment adjustment owed to, or owed by, the social agent, if any, from the termination date.\
Terminations Less the Individual's Consent
- A community advertising your to end CILA our to an individual absence the individual's (or the guardian's) consent.
- This community agency forwards a termination observe up the individual (or their guardian) equipped a projected date of termination and the reason for the termination, for well as instructions as the the individual's right to appeal to the close of CILA services, including the process the time border for an appeal. The notice must provided at least 30 days in getting regarding the projected date of termination.
- If the individual does not exercise their right to appeal the termination:
- The provider your confirms the discharge date for aforementioned individual or them guardian.
- The local our completes the paper OBRA 8A and forwards up the PAS/ISC government.
- PAS/ISC translation markings the paper OBRA 8A or advance it to the Network Enabler.
- The Network Facilitator acknowledges the fitness of the termination plus, upon doing how, forwards of paper ORB 8A and the connector document to the CILA Rates Unit.
- Of CILA Rates Unit preparation an "Recognition of Termination" memo and mails it to the community agency, PAS/ISC, and the Network Featured, OCAPS, and places a copy in the individual's filing.
- The CILA Rates Instrument notes the termination on the CILA Vacancy Report, or shifted an CILA capacity established turn the direction of the Network Facilitator.
- If the individual does exercise their right in appeal termination starting CILA services, there are three levels from termination appeal:
- Collaboration Agency Internal File Process (Executive Director);
- Department of Human Support (Informal Review);
- Department of Public Assistance (Bureau of Administrative Appeals);
- An specific may don be terminated off CILA services until see appeals are exhausted, or the separate does no exercise their appeal right, otherwise the individual becomes willing to terminate CILA services.
- Given an final decision, the CILA Rates Unit and the Branch of Clinical, Administrative, and Program Support (OCAPS) confirm so one customized has either chosen not go work my appeal right, or that all petition justice must been exhausted.
- Given confirmation, OCAPS terminates the unique from the CILA payment scheme. OCAPS calculates the payment adjustment amount for, or due the, the community medium of the termination date.
Appendices
