DADS information letter provides clarification of the requirements for provision of Day Habilitation (DH) services in the host home and for provision of DH services by a Host Home/Companion Care
(HHCC) provider, in accordance with Section 4320 and Section 3710 of the Home and
Community Services (HCS) Program Billing Guidelines. DADS enforcement of Section 3710 as
described in this letter will be effective January 1, 2015. DADS enforcement of Section 4320 will
continue to be cited in accordance with the billing guidelines.
Provision of Day Habilitation Services in the Host Home:
Section 4320, Requirements of Setting, of the HCS Program Billing Guidelines (Guidelines)
provides:
“Day habilitation may be provided to an individual only in a setting that is not the residence of the
individual, unless the provision of day habilitation in a residence is justified because of the
individual’s medical condition or behavioral issues or because the individual is of retirement age,
and such justification is documented in the individual’s record.” Medical or behavioral
justification may include: physician statements, behavior plans, authorization from the service
planning team and/or similar documentation.
A violation of Section 4320 occurs when DH services are provided in the residence of the
individual and there is no medical or behavioral justification for provision of the services in the
home.
When there is justification for the provision of DH services in the individual’s residence, the
HHCC service provider may not be the service provider of DH in that setting. Section 3710, One
Service Provider, of the HCS Program Billing Guidelines states “one service provider may not
provide different service components or subcomponents at the same time to the same individual”.
This provision has been in effect since October 1, 2009 and applies to all services provided in the
HCS Program.
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