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Office of Mental Health

Home and Community Based Services
Billing Rules Chart Guide 12-17-09

HCBS Waiver Billing Rules Guide: Effective 4-01-10     Waiver Services       FSS, SBS, RS
Code: X =yes; 0 =no 1 to 4 additional rules ICC IIH - B CRS - B SBS RS FSS Group Work
B=Bundled              
Required service X 0 0 0 0 0 0
Supports child goal X X X X X X X
Document in Service Plans & Progress Notes X X X X X X X
Monthly case payment X1 0 0 0 0 0 0
Bundled 0 X2 X2 0 0 0 0
Fee for service/date of service 0 0 0 X X X X
Billing increments monthly 15 min. 15 min. 15 min. 15 min. 15 min. 15 min.
Frequency requirement 6xMo. 0 0 0 0 0 0
Contact duration minimum requirement 15 min. 30 min.X3 30 min.X3 30 min. 30 min. 30 min. 30 min.
Rounding daily down per 15 min. 0 X X X X X X
Face to face contact billable X X X X X X X
Telephone contact billable 0 0 X4 0 0 0 0
Continuous minimum contact required to bill X X X X X X X
Maximum allowable billable contact hours per day per family 0 0 0 0 6 hrs. 0 0

Please refer to HCBS Waiver Guidance Document on-line for additional details.

Who can receive billable services (must relate to child's goals) ICC IIH-B CS-B SKS RS FSS
Waiver children as indicated in service plan goals and objectives X X X X X 0
Waiver parents/routine caregivers as indicated in service plan objectives X X X X 0 X
Waiver child's siblings who are indicated in the service plan objectives 0 X X X 0 0
Collaterals indicated in the service plan objectives X 0 0 0 0 0

Additional billing rules
ICC:

1 ICC monthly case payment: full & half month, start up, hospitalizations, jail-detention, residential assessment or substance abuse tx programs
Bundled services:

2 Bundled IIH &  Bundled CRS telephone and face to face: reimbursement for an average of 65 IIH and/or CRS contacts per slot included in the monthly case payment
3 Bundled IIH and Bundled CRS face to face: Billed monthly per 15 minute contacts(contacts must be minimum of 30 minutes each to bill)
Bundled CRS:
4 Bundled  CRS telephone calls: billable for up to 48 phone contacts annually per slot of a minimum of 15 min. each contact
Group Work:
See Chapter 600.4 of Waiver Guidance Document for additional billing rules for group work