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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

Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.