Date: April 4, 2019
To: Medically Complex for the Developmentally Disabled (MC/DD) Facilities
Re: Reimbursement and Billing for Services Effective April 1, 2019
Pursuant to Public Act 100-0646 and effective for dates of service beginning April 1, 2019, the Department of Healthcare and Family Services (HFS) is responsible for reimbursement calculations and direct payment for services provided by Medically Complex for the Developmentally Disabled (MC/DD) facilities.
Exceptional Care Reimbursement Changes
In addition, Public Act 100-0646 establishes a tiered reimbursement structure for exceptional care services provided by MC/DD facilities. The conditions and services provided shall have the same meaning as ascribed to those conditions and services under the federal Resident Assessment Instrument (RAI) and as specified in the most recent federal manual. MC/DD providers will be responsible for maintaining documentation within each resident’s medical record that documents qualification for exceptional care reimbursement. Documentation shall be signed, dated and shall consistently support the condition and/or services provided. The three tiers of exceptional care reimbursement are structured as follows:
· Tier 1 rate of $326 per day for residents receiving at least 51% of their caloric intake via a feeding tube
· Tier 2 rate of $546 per day for residents receiving tracheostomy care without a ventilator
· Tier 3 rate of $735 per day for residents receiving tracheostomy care with ventilator care
Claim Submittal Coding Changes
For dates of service prior to April 1, 2019, Revenue Code 0190 should continue to be used for billing of exceptional care services. For services on or after April 1, 2019, the following revenue codes should be used by MC/DD facilities submitting claims for residents receiving one of the three exceptional care tiered services.
· Revenue Code 0191 for days of care that residents received Tier 1 services
· Revenue Code 0192 for days of care that residents received Tier 2 services
· Revenue Code 0193 for days of care that residents received Tier 3 services
Revenue Code 0190 will not be an allowable code for exceptional care services provided after April 1, 2019. There are no changes to the revenue codes required to bill for non-exceptional care services or developmental training services.
All claims from MC/DD providers, including developmental training claims, must be submitted using Taxonomy Code 3140N1450X. Claims with other taxonomy codes will be rejected.
The systems coding to implement these changes is being tested. All claims submitted prior to the implementation of the new coding will be held for processing. HFS anticipates the coding will be implemented by May 1, 2019, allowing providers to submit their April monthly bills.
Appropriations and Payments
All claims for services beginning April 1, 2019 will be paid from HFS appropriations. Historically, MC/DD provider claims have been paid from the same Department of Human Services (DHS) appropriations as the Intermediate Care for Individuals with Intellectual Disabilities (ICF/IID) provider claims. Provider claims being paid from HFS appropriations are not subject to the same Comptroller payment timeframes as DHS ICF/IID provider claims. To receive consistent, expedited payments from the Comptroller, MC/DD providers should apply for Expedited Payment status through HFS. To apply, please call the HFS Bureau of Long Term Care (BLTC) at 217-782-0545 and ask for Expedited Payment Status instructions and a Cash Position Statement that must be returned.
Effective for services beginning April 1, 2019, bed reserve payments for both hospital and therapeutic leaves of absence will be calculated using the MC/DD facility’s Medicaid per diem rate rather than the rate paid for the provision of exceptional care services.
Requests for staff training reimbursement will need to be submitted to HFS BLTC. Additional information on this process will be provided in a future notice.
HFS has scheduled a webinar for Tuesday April 9, 2019, to present information and discuss issues associated with the changes detailed in this provider notice. HFS will specifically address the new billing requirements, the expedited payment process, and documentation requirements to support the provision of exceptional care services. Time will also be allotted for providers to ask questions and discuss these changes. Registration for the webinar can be accessed from the following link:
Questions regarding this notice may be directed to the Bureau of Long Term Care at