When a provider of Adult Day Services must use the fifteen-minute billing unit:
- If the provider delivers less than five hours or more than seven hours of adult day services to the same individual during one calendar day.
- If the individual being served qualifies for, and the provider elects to receive, the behavioral support and/or medical assistance rate modification.
- If the provider delivers adult day services to the individual in multiple modes on the same day. For example, in an integrated community setting when the individual is part of a group of four or fewer individuals, and in another setting.
- If the provider delivers adult day services to the individual through virtual support.
Additionally, the provider must not bill a daily billing unit on the same day they bill fifteen-minute billing units for the same individual. This ensures consistency and prevents double billing for the same services.
If you have questions, please Email Our Service Team.
