Rick Scott, Governor .... Central Office ... 4030 Esplanade Way Suite 380 TEllahassee, Florida 32389-lJ700 ... (850) 488-4257 Fax.: (85Q) 922-G456 Tofl (866) APC-CARES (866· 2.7322(3) TO: ()pj agency lor persons with disat)ilities State of Florida MEMO TO ALL PROVIDERS OF DEVELOPMENTAL DISABILITIES MEDICAID WAIVER SERVICES March 31, 2011 All APD Providers I FROM: Bryan Director Agency for Persons with Disabilities RE: Changes to Developmental Disabilities Medicaid Waiver Service Rates The Agency has projected a budget deficit of more than $169 million dollars for the 2010-2011 fiscal year. Pursuant to the APD and AHCA's authority in sections 393.0661(7) and (8), Florida Statutes, all provider rates in Rules 59G-13.081, 59G-13.082 and 59G-13.084 for Medicaid Waiver Services provided through the Developmental Disabilities Home and Community Based Waivers will be reduced by 15% for services provided between April 1, 2011, and June 30, 2011. In addition, differentials will be eliminated. After June 30, 2011, these rate reductions may be revised pursuant to legislative action or agency rule. These rates may be found on the Agency's website and will be filed in an emergency rule. If you have a negotiated rate for intensive behavioral residential habilitation, transportation, or special medical home care services, your local area administrator will contact you in the near future with an addendum to your current waiver services agreement. These rate adjustments will be reflected in each client's authorization for services. The rate adjustments do not reduce, modify, or terminate any currently authorized waiver services. APD will provide new service authorizations to all providers within 5 days of this memo. Until such time, this memo will serve as your authorization. In these difficult economic times, the Agency for Persons with Disabilities appreciates your cooperation and thanks you for your service and dedication to individuals with developmental disabilities. http://apdcares.org
Transcript
Rick Scott, Governor
.... Central Office
... 4030 Esplanade Way
Suite 380
TEllahassee,
Florida
32389-lJ700 ... (850) 488-4257
Fax.:
(85Q) 922-G456
Tofl Fr(~e:
(866) APC-CARES
(866· 2.7322(3)
TO:
()pj agency lor persons with disat)ilities
State of Florida
MEMO TO ALL PROVIDERS OF DEVELOPMENTAL DISABILITIES MEDICAID WAIVER SERVICES
March 31, 2011
All APD Providers I FROM: Bryan VaUgha~ting Director
Agency for Persons with Disabilities
RE: Changes to Developmental Disabilities Medicaid Waiver Service Rates
The Agency has projected a budget deficit of more than $169 million dollars for the 2010-2011 fiscal year. Pursuant to the APD and AHCA's authority in sections 393.0661(7) and (8), Florida Statutes, all provider rates in Rules 59G-13.081, 59G-13.082 and 59G-13.084 for Medicaid Waiver Services provided through the Developmental Disabilities Home and Community Based Waivers will be reduced by 15% for services provided between April 1, 2011, and June 30, 2011. In addition, a differentials will be eliminated. After June 30, 2011, these rate reductions may be revised pursuant to legislative action or agency rule.
These rates may be found on the Agency's website and will be filed in an emergency rule. If you have a negotiated rate for intensive behavioral residential habilitation, transportation, or special medical home care services, your local area administrator will contact you in the near future with an addendum to your current waiver services agreement.
These rate adjustments will be reflected in each client's authorization for services. The rate adjustments do not reduce, modify, or terminate any currently authorized waiver services. APD will provide new service authorizations to all providers within 5 days of this memo. Until such time, this memo will serve as your authorization.
In these difficult economic times, the Agency for Persons with Disabilities appreciates your cooperation and thanks you for your service and dedication to individuals with developmental disabilities.
http://apdcares.org
hargerl
Text Box
solo/agency rate differentials will be eliminated. After June 30, 2011,
hargerl
Text Box
these rate reductions may be revised pursuant to legislative action or agency rule
MEDICAID WAIVER SERVICES AGREEMENT
ADDENDUM A
This addendum shall be required as a contract amendment for all Medicaid Waiver Services Agreements between APD and Medicaid Waiver Providers for Intensive Behavioral Residential Habilitation, Transportation, and Special Medical Home Care services pursuant to chapter 393, Florida Statutes.
This addendum shall also be required for all Medicaid Waiver Services Agreements signed by these Providers on or after April 1, 2011. The provider rate modifications stated in this addendum shall remain in effect from April 1 ,2011, through June 30,2011. These modified rates may continue beyond June 30, 2011. The provider acknowledges that the service rates may be further amended by the Florida Legislature or by rule, effective July 1, 2011.
A. The Provider hereby agrees that, pursuant to the Agency's authority in section 393.0661 (7), Florida Statutes, the provider's contracted rate as of March 31, 2011, shall be reduced by 15% for all services provided between April 1, 2011, and June 30, 2011.
B. The Provider acknowledges that violation of this addendum or the Provider's refusal to sign this addendum shall result in the termination or denial of the Provider's enrollment in the Developmental Disabilities Home and Community Based Services Waiver pursuant to Section III of the Medicaid Waiver Services Agreement
C. The Provider acknowledges that this addendum shall be considered a part of the "INTEGRATED AGREEMENT" referred to in Section VII of the Medicaid Waiver Services Agreement
Agency for Persons with Disabilities Developmental Disabilities Home and Community-Sased Services Waiver
Provider Rate Table with Apr'i\ 1, 2011 Rate Reductions Effective April 1, 2011
The ADT rate assume~, 216 hour prograrr. dB'y' fol' tile Bltel',dees. 'Nith staff present 7 hours. The ra\e has been adjusted by 12.5% for non-state matching funds ,A, provider may biil up to a total of 2.40 days pel' ye(lr when the individual is pl"esent individl;a!s miiiY all end lui! time or pall-t!l"ne {less than 6 hours). /l,ttendance is calculat.ed based on the quarter hour for the actuai ljrfle :he altendee receives the service Adult Day Training is part of the services identifiecj for a meanlngfu\ day activity
i!",O"8')IOr Analysis Level 2
Conwanion Services are provided at e. ratio of up to 1 3. When Companion Servit-(~s arf~ provlded ~o someone 'Nho \i"es in a residenFai fr3ci1ity, the services musl be provided solely in the community Companicn Services 3['6 PBHt of the S6rVces
identified for 8 meaningful dt:-lY activity.
I Q I L.
----------" ~-- ----
Provider RBI€' '!"able
Unit" StaffRatiooi Level Geographioal
uf'Ga.:t:e !ndep.e~del\t R:ates
Ef~ectiv0 Apnl'. 2011
NOn-GeOgraPhioall Independent Rates
Otr Hour in-·Home Supports that exceed 8 hrs a day must be bi:\Gd at tlie In-Iiorne Lh.:e·in rate, 1\ total of 365 days per year ma'l" be biiied for Ule Live-In In-h'cr1'1e service when the individuai(s) is pr-esenL
Ilt~e(iICaIi0n Review '.1 I' $.56 ... 76'.' ,I t v _ _ $56.76. i
o $14 1S 1 ~--,
$1419 i [oC2upation8! Therapy
Levels or Personal Carl? Assistance Services are determined based on the type and level of assistance required bY' the Individuai as defined in the Developmental DisabHlties Waiver Services Medicaid Coverage and Limitations Handbook
!Pnvate 'O'J\Y NurS{I')9 . R~.j i... c; I <59- I ~5 87 L, __ "" ______ . ___ ..l--~"'_L. ______ --'-_____ .-:::0::,;.::,;''-' L. ". •
Resic'6111i,a! H~oiii1a't-:dn,-"
!K,os"jer,:lai Habiiilatior:·
f-~es!denli:;?; Habilitation may on~y be bilied by the qtr, hL for S€lo"/ices provided in an individual's own home or farwly horTle, L'icensed facilities must uSe the P'iov'lC.ler Rate: Table for Residential H2,bilitaF,on Se!'v\ces In 8 Licensed f"ac'I\-lty,
2
P"()',;lde( Rate T<\ble Ef1edive Aplii 1,201 j
iRe",tp Care" Quarter Hour
IRe",ifp Care ~ Oay (per person)
Resplle Sen/ices provided at '10 or more hours per day are billed at the daily rate.
r;::-:::'----:-... -----,---.,.-------,----- I L~~!.eE0!ied Living Coaching Q ~ ______ ..;$,,5,,-,,?';:.o_'I ___ ,
Geographic [Cites shaO be used for services provided in ,Il.reas 9, 10, and 11. ~.~onro-e County has a separate geographic fate t8ble
Agency for Persons with Disabilities Deve!opmental OisabHit\es Home and Cornmunity~8a$ed Services Waiver
Providi!r' Rilte Tab!e
Assessments and )ndivldualized Rates with April i, 2011 Rate Reductions
EffectlvB April t 2011
SpAciai2ed Ments! i·ie2!tll Assessr\'.fi"))'r(
, S'p$eGh.otb~~~p:y ·}'.l,sS6ssrr(e!f',1
ilo r-t"1 rr~! ~-~ :r;:';; "..,-(
::r: ~.h1 "':z ,...,~
'0 ;::!,-,., Of.,J'i ",,-:
s2:i ~I"'l
""' "'" ::::;
~ " "'" "" -- r-;jf m r.- 0, Ul J:-
Tile followhg ratl'Js are negoti<lted and identified as part of the provider's Medicald Wniver Services
Geographic rates (or assessments SJ·)2!i bEl used in .A.rear:; 9, 10, and 11 ,nCiudi,ig Monroe County
2
Agency for Persons with Disabilities Developmental Disabtlities Home and Community.Based Services Waiver
Momoe County Provider Rate Table with April 1, 2011 Rate Reductions
Effective April 1, 2011
Unit' ~;~f;~~tib6tL~v"l
. oIB'",e
The pDT rate assumes a 6 hour program day for the attendees, with stafl present 7 I,ours. The rale has been adjusted by 12.5% for non-state matching funds. A provider may bill up to a total ot 240 days per year when the individual is Pl"eS6nt Individuals may aHend full time or pari-time (less than 6 hou's) Attendance:s calCUlated based 011 the quarter I,our for the actual time the attendee receives the service. Adu't Day Training is part of the services identified ior a meaningful day activity .
-------_ ... _------------------_._-Companion Services are provided at a r'-atio of up to i:3 V'Jhen Companion Services are P!'O\j\ded to someone who lives ill a residential facility, the serViCE)$ r"(1,ust be pmvid6d solely in the community, Companion Services are part of the servlces identified for a meaningful day activity
In -HpmeStipP9tts o:trH6li'r
in -
D?'y Per Person In -Horne supports (Civ":ih'st~ff)'·· .C@y~f"..e.LE~!~g.n_ .... _____ .. --;,.+-'-'--c .. _"-__ +-~ __ ~.!.:.:L __ .. __ +.-----"---"-.'!'.'!±::1!~l In - Hom8 Supports (live-In Staff) I Da . Per Person
Qtr, Hour In-Horne Supports that exceed 8 nrs, a day must be billed at the In-home Live-In rate. A total of 365 days per year may be DilierJ for li)e Live-In In-Home service when the individual(s) is present.
I
Personal Care A.ssislance
Levels of Personal Care Assistance Services ate detetmined based on the type and level of assistance required by the individual as defined in ti18 Developnlental Disabilities Waiver Services Medicaid Coverage and Limitations Handbook
Residential Habilitation may only be billed by the qtr. hr. for services provided in an individuai's own horne or family home. Licensed facilities must use the Provider Rate Table for Residential Habilitation Services in a licBnsed Fac\\ity,
Supported Living C08C~'-,--Q--i--'~--'-'-'I""I------- $538]
Q dUMe/HOUr );JWhi!
Agency for Persons with Disabilities
Deveiopmentai Disabilities Home and Community-Based Services Waiver Billing Code Matri"
For use with the Deve!opmental Disabilities Horne and Community-Based Services VVaivcr Provider Rate Table April i, Z011
Service Description i l Rates are contained in Developmental Disabilities Home and. Community-Based Services
Waiver Provider Rate Table Procedure Code
Modifier 1
Modifier
2 Billing
Ratio Of ~~~evei Unit Per Date of Service (Claim Line) of Care
Max Allowable Number of Units
Procedure Code Matlx Developmental Dis8bilitJes Hc>rne and Cornmunity-Based Services VValVe[
II-Residential Habilitation - " ---------'--'----- 1---'-- 31 ~avs per Month (Maximum I
__ sta;:yard ____ I ~-I0043 __ ,_U6 _~_ SC I __ ~ __ I __ ~,3:0[)ayspe~year),--__t !----Residential Hab:litatlon -=-t I I ---r r I' Stand aid T2023 I U6 ,M 12 Months per Year l Re"~~::!e~;:~"c .- .. I;O~" 1 U6 i=-=-I Q I=--992 01; ,"",OC",--_ ' ~- 1 1 ==_ I Residential Habllit~tjon - I H0043 t U6 l I 0 i 992 OH per Month =t ~ 2 I (Quarter HOlJlj~ ____ "+ _____ ' , ____ - ---------' -- , \ResIdential Habilitation - i HO;)43 U6 I I 0 992 OH per Month I 1 3 I
1
_, ____ ~taffJ . _" HO I '_ 365 Days per Year) " I-------i I Residential Habilitation - (Live I H0043 I U61 SC 0 31 Days per Month (Maximum I 1,2 '" , I ' In Staff) I 365 Days per Year) Procedure Code Matix
Deve!opn,entai Disabilities Home and Comnltmify-8ased Services VVai'./er 3
Developmental Dlsabi!ilJes Home and Community-Based Services I/VanJer 4 Procedure Code MaUx
'\ lJllIt per Month
Developmental Dlsabl!lties Home and Community-Based Ser;ices 'vYaiv8r 5
I -------'-j
"--,----i --+---"-~ --I
,-------
Procedure Code Matlx
o~~g~:~~g~l~:::, I ---1 Based Services Waiver Provider Modifier Modifier Max Allowable Number of Units Maximum Allowable I
R3te T abie 2 Bulllni",·t9
Rate per lln,·t i Procedure Code 1 Per Date of Service (Claim Line)
Procedure Code Ma!ix
Gcveloprnenid! Disabilities Home- and CO<T)(ounity-Based Services V'Ja!ver 6
Provider Rate Table Residential Habilitation Services in a Licensed Facility
Standard Program Behavior Focus"'" Standard Program Behavior Focus"'*
;;;q~, . "'" lI1'O !:;!,>
r~ r":"":'!f? :x .~ >:, ... ,'> ::x:~ -. -< :;u ..,. -:~ {,Pr;1 w r BasiC
~z ri'l-""~
..". ~ $7999 .. C"\ ,,' ,-,'
..",,:,1'1 ~Ii: Minimal
"0 6<n ,-;:0-1 --> U1 0-; ;p:.,,"'! <ft
Moderate
Extensive 1 $16143
ExtenSive 2
'Geographic diffBrentiai applies to services provided in Areas 9, 1G: and 11. t'/lonroe County I-las a sepal'ate rate
table
~?rovldE!r 8!Jd the recipient must meet the definition of "Behavior Foc\Js" as defined tn the Oeveiopl-nentai Disabilities Horne and Community-Based Servic.es Waiver Coverage and Limitations handbook to q\JBiify for this
rate
Rate Consider<,\tiol1s: Rates are based on 365 days of operation, with 350 possible billing days available per year The monthly rate for this service shall be used by the provider if the recipient is in the home 24 or more days per month, and cannot be used in combinf)tio n with the df)ily rate in a given calendar month, When a reCipient is admitted into, or discharged from a licensed facility during the month, the daily rate shall be used during the month of discharge or admisssion by the admitting or discharging facility for the days the individual is present at tile respective facility. When being admitted or discharged, the facility where the recipient is residing at 1159 PM on the date of admission wili bill for that paliicular day The Daily Rate is limited to no more than 2.3 days in a given month,
P rmddet RatE; T al)ie Res;denti;,31 HabiEtation Services -Licensed FBcility Effective A. phi i I 2011
Residential Ha.bilitation In a Licensed Facility Level of Supports Descriptors
These Descriptors will be used for individuals who have not yet been assessed using the Agency approved assessment and who have experienced a change in circumstance or condition, or who are newly admitted to a licensed residential facility and must have a rate established ·Che level that best describes the individual and their primary area of support needs will be selected to establish or modify the rate. Ail requested changes to the Level of Support Rate shall be determined medically necessary BASK: ---'--------
Functional: Independent in self-care, daily living ;ct\\j\t~es; or requi['e~' supervision, interrnitlant verbal dirf.':-ctlon Dr physical prompts to perforn~ seif~C6re, daiiy living skills:
Behavioral: No formal beliaviora! Ir'lter'v'ention necessary except ;cdirfction; Tay be non-compl!ant 8t times
Physical: Health issues under control through rnedication or diet. Arnbulatory or independent in use of wheeichairi'Naii<cr. May need staff supervision to self-administer medic2iions
Ot~er: This !e\je~ wiEbe used (0 yro .. ,ide r.e~idefltia! hab1litatio(! trainmg f?r indi\~l~\Ja!s re~.i~(n.g in .. a non-APD licensed
l·
faCilIty [hat IS resporlSlble for baSIC SJpervlsion and care, such as an ,A,Ssistecl liVing Facility (ALF),
I ~J!~C~~~;: May ;eqlllre consistent verba! and phYSical he:Pt~c~~~'.!eSB!f~~r~!daiIYII~1n9 \8S~S. in~IU;9·· = j physical assistance and meaitime intervention to eat safely, may require rnealtirne ir,terveniions and/or de.vices, Msy i l{edUI~e SC(1eduied tOfle\lng or use of F',Contlnent bnel's Waiks ino'eDendently m independently' uses a m.S1~ual or !
i power wheelchair hl'tay reqUire assistance to change positions. Needs physical aSSistance of one person to transfe!" LJf' to change positions,
'Behavioral: May exhibit behaviors that require formal3nd infcrn'\ai inl(~rvEmtion; reqUires frequent prompts, instruction or redir-ec(lcn, some 81wiornrnental :"(1odifications 01" restric:ions on mover-nenl f110Y be necessary,
Physical: I{ has seiZIJI-es, no intetierer,ce with functional Bctivities: May require medication for bowe1 elimination. May feq~;ire a special diet. May reqcjre staff supervision to se!f-adn'iinif5tel' rne-dications.
--. -... _-..",.-----~~~:~~;ires substanti;l :prOmp\ing8~drOr Oo,Y8i081 aSslst~r~r~e"':,."':o~p'"e~rft.o":rn":,"s:". e:':J-:'( ."ca"r-:e":"ld~a-:i':'ly~I;'lv'7ln':'·9:"::a'~, \"iv~I"\i-e'-s-'"'i May be totally clepeiident on staff for dressing/bathing, May require mealtime in1erventions and/or devices OR receives all nutrition through a gastrostorny or jejunostomy tube. incontinent of bowei or biadder. May require schea'u!ed wiiering Of" use of incontinent briefs independently uses a powered wheelchair, may' need aSSistance ,,\lith a manuai chair Mey reouire assistance to change positions. Disability prevehis sitting in 81n upriqb1 position, has limited posiiioni!lg options. Nee-ds physicai assis!3nce of one person to tr'ansfer or [0 change pOSition
Behavioral: May exhibit behaviors that require frequent planned, informal and formal interventions. Asssistallce from ()thers may be 'lecessary to redirect th(~ recipient. May require psychotropic medication for control of behaviol Self-Iniury or aggreSSion lOWBi"ds others or prOPerty results in broken Skin, major bruisingfsv,lei!!ng or sigrMlcant tissue damage reqlNing physician/nUl"se attention P,Aay have threatened suicide in pas: 12 months May have :'eqllwec use of re8c!1\18 strategies S or rnore tirnes per rr~or:th iii (ast '12 rnonll"l5. May routinely weal' pro~eCnVEequipment to prevent injur! frcm se!f·,abusi\!(") behaviOl'
Physical: May have seiz.ures that inteliere With func~iona! actiVIties: receives 2 or more medications to centrol IseizUre&. May have experienced a pressure sore I'eqdring medica! attent'lon in the pas,t 6 months" fv1ay requil"e rnedica!ior1 and dail:\i management including enemas, iN iJowel elimination, May be :lLttritionally at risk and teqUlre 2.
~~~~~--~~------.~-------'--------~-----------'--~~ ,EXtENSIVE 1 Functional: ~y dependent on staff fer self~care/dad);'living activities; Disability prevents s'tting in a~ UPright position, Ms !i!Y)I[ed positioning options, Requires two ~efson lift or lifirng equipment to transfer Independently uses a powered wheelchair, needs assistance ~\Ali a manual chair, Requires daily rnonitoring and frequent hards-on 85sistanceto S!8Y heai1hy, Health issues re~~uit in inabilily \0 ate.no outside progmr,'\$ 5-·\0 days a 'l\ol\th; heaith condition IS unstable or beGorn;ng progressively vvorse.
Behavioral: Frequent planned, :nfOrniBi or ionna! inlervenUons necessary, Assistance from other's i"llay be necessary to redirect the reopicroL Requires psychotropic medication for control of behavior. Use of physical/mechanical restraint. SB!f~injury or aggression towards otbers 01· propeliy results i:l significanl tissue damage, scarring, da-rllage to bones that requ'lring physician attenlior1. May have attempted s~lcide in past 12 months May i)aVe required thE USe of re3ctive strategies 5 or more times pel· month in last 12 mon(hs May routinely WBar protective equipme.nt to prevent mjurj from self abusive behavior at least '12 hours pet" day Has rece:ved err'lergency rne(iication to control behavior in last 12 rnonths May (nest criieria of intensive BehaviOl"at ReSidenti8i HabH'ltation
Physical: r,,~ay fl<3'J2 uncontro)\ed s.eizures th8t 118V8 required hospital or emergency room intervenHon durin'] past 12 months; receives medications to conlrol seiZUres. May have been nospitailzed for medication to>::icity in past 12 months. il,.1ay have experienced 8 pressure sore I·equ"iring recurrent medica! attention or hospitali7..alion in the D8St 6 rnon1hs. May require medicat!on and daily !T1snagen-lent, including enemas, 'fol' bowel eiimination, May haVe been rospilalized for imp8ction in last '12 months. May be at high nutritional risk and requiret=i intensive r.utr:h~Jn81 intecver\t\on. Has a condition tl~,at requires physidBn prescribed ?focedures, (Can00t be delegated to a non~licensBd staff;
Other: If the recipient's primal'Y need is to receiVe visual supervision o8sed on a documented 'listorj of ina.ppwpriBte sexual behaviOi ·:'r sexuaHy pi·ovocative beh.avior, assig0nl ent to th;s level IS appropriate.
~~--,~"--~.~----~ E'ktENSIVE25> ,f;;;' _'.,.,' ,:,--....."...-...j Functional: F';eauires total physical 8ssist8rce in self-carE, daily living activit'ies, May require Ill.ea\titYI0 tnterventions an(i/or devices OR ree-eives alilLilritiOli through a gastrostomy Of jejunostomy tube. Incontinent of bowel Or bladder May require schecW!ed tOlleting or use of inconjment briefs, May have indwefiing catheter or colostomy t1ianaged by staff. Disability prevents sitting in an upright position, h8S i\mited positioning options. Requires two person li-:,< or lifting equipment. to trar,sfer Totally dependent on others to stay heallhy. He-alth issues result in w,abi!ity- to consistently attend oJts!de programs; 1'"",e8ith condition is unstable or becoming pl"Ogressive\i worse,
Behavioral,> Frequent planned, Tormal interv'e-nlions necess3ry, AssistEnce from others necessary to redirect recipient Receives multiple psychotropIc medication5 for cO'ilIO! of behavior, possibly frequ8r:t medication c~""ii)nges Use of physlca!imechar:lcal restr8int. Meets lile criteria of intensive Behovioral Hesidentiai Habiiltation.
Physica~: Se:f-:Iljury or aggression tovvsros othe's or property results in significant tissue dam,~ge, scarrir:g, ri8.rnage to bones requiring physician atlention, May hBve attenlpted suicide in pas! 12 months. May have engaged iii sexual predatory b(:::i18vior in the past 12 months, May have beer restrained 5 or rnore times per month in las\ 12 rnonths May rOIAineiy wear protective equiprnent to control self Sb;,jS8 a~ leas·t 12 hours pel" de!"y. ReCelves 2 or more ill.edic2.tio!1S to control behaviors that have been changed in the \:Ist year: is still unstable or showing side effects cf the medicatio/1s, Has feceiv81j emergency rr,edication to control behavior 4 01" rno:e times in iast 12 months, May t'18ve u!1controi!ed seizures that have required hospital or emergency room intervention during past 12 months; receives 2 medications to control sBlzllres th:J.~ have been changed in the- past 12 !Y"lonths, May have been hospltaiized for medicatiol"' toxicity in past 12 months May h,9ve experienced 8 pressure sore requiring recurrent 111edicai aHen:ion or hospitalization in the past 6 months, ~'v1ay require Inedication and daily management, including enemas. for bows! ehmination May' havf; i)een hospitalized for impaction in last 12 months. 1'.18)1 be at l)igh nutritional rtsk and requires iniensive nutt'iiiona\ H"ltervention. Has ZI condition that requires physiCian prescribed procedlln;:?s (Cannot be delegated to a non-licensed staff.) Requires 4 or more physician ViSits per montl1: may ha'fe been admitted to tile ho:~pitai through,
emergency roonl vlsit, rnay have been aCll1ittd to leu.
Residential Habilii8rion Services ~Licensed Facility Effective April 1 2011
Other: if [he recipient's prim81Y support need is to t<eceive visual soper,t\sion due to a hislorj of engagement in J sex~a( ~reda(Ory behavi;f o:,.sexual, ag~ression a,rld t.he recipie~t is ,c,urrently identmed as having active predatory tenoe-nCt8S by the Area l,.,ert!1"fea Benav!or Analyst. this support level is appropna(e. --- . ' '-
Provider Rate Table
Residentia! Habilitation Services in a Licensed Facility
Effective April 1 , 2011 ,-...;.,----------"~~
Resid,mtial Habilitation Services Live-In Rate with April 1 ,201 i Rate Reductions
'S'erV·ice Pescription
Unit' IIWlepel1tl~nt
Rates
i I I Residerttial !; '1'::.
M\irj foe C(} I!l n ty Independent
Rates
$94,63 H8bllltaiion- Live Day I 1:.1 [' '$92,81 $8166 I InStaft ±' i', I - --T--'---,-+--------+------,.,( --, --.......,[ Residentia' I I II, H8sbi!itf~\lOpn - Live I Day 1,2 I S77.95 $77.00 $7948 in 'tar( er I' 'I I'
Pwson) i --:'l, """,'"-",, " :,It"""" ""1 Residential "'Ill I Hab'H\(att.oh*tiv.e' 1 """".,: " .-! In Staff (PAr Day )1' I ' ,$6o!QQ $65 13 " 'I
The Resider,\ial Habilitatton "Live-In" rale may be lIsed only for licensed residential facilities that are licensed for 3 or fewer persons Staff do not have to "live-in" the home for this rate model to be used. A total of 365 days per year may be billed for this service when the individual(s) is present. The Geographic Agency Rate applies to services provided in Areas g,10an01'1,
Family and Supported Living Waiver Provider Rate Table
Effective Aprti 1, 2011
Adult D~yTrainll1g.· Fa6iHty BaSed. . 10 i .1j $.347' $345
I,-A:.::d:-=u.:.:lt-=D-=ay~T r:.:a,i,n"ln",g'--',--F-=a:::..ci:l~tyJ3_"~~ __ L 0 13 $ t .97 . $ i .86 AdultDayTraining·FaoilityE3ased 10 15 $138 $1.36 Ad ult Day Trall1lng - Facility Based '\0'. 1.0·10 $108 I $1.06
Aduit Day Training· Off Site 10 i 1J I $3.47 $~A5 I Adult Day Training· Off Site I t-~-". ; : 1
1-:-:-7Cc::---::::--:-c--.--:::c::--;:,,,----FI Qc..._.: ~13 L-, $1 97. $1 .96 , Adult Day Training.· Off Site l' ~.... I Adult Day Training _ Off Site', q . ·'fc1 ,$,·i ' ", ,: ...;1.38 c. . $.1 .. 3.13
10 I '16·10 , ......... ,$108 $1 06J
The ADT rate asslimes a 6 flour program day for the attendees, With staff present 7 hours. TI1e rate has been adjusted by 12.5% for non·state matching funds. An absence factor of 3.85% is included in the rate A provider may bill up to a total of 240 days per year when the individual is present. Individuals Inay attend fUil time or part-tillle (less than 6 hours) Attendance is calculated based on the uarter hoUl" for the actual time the attendee receives
In . Home Supports (Awake Staff) I '--r---' Oir. HO~1f II Q I13 $1.57 li;"='H;;;T;e SUPI)orts (Live·ln Staff) I Day 10. ..-11J.----_----L
1. _$S8 .. 5.J4-. I ~
In· Home Supports (l.ive-If) Staff) I 1 &..,., " I Day (per person)ID ...J1~ .... __ 1 ___ . Ej,,3:U $73.41 I ~.---'-*~~""~~---... ----.---.----
$1.55
In - Horne Supports (LiCe-In St~ff~ ] --,j I ,I --l Day (per person) _ D n i ,,', "'$():):72J ,_$6293/ Otr Hour In-Home Supports that exceed 8 hrs a day must be billed at the In-home Live-In rate A total of 365 days per year may be billed for the Live-In In-Home service wilen the
Res,oite Care - Ouar-ter Hour ! 1- -1-1--~ ____ ,~ ________ ,_J9'1'11 $2651 $262 i
Respite Care - Quarter Hour 1',','0', ',1 ','2 $' 7- I ,1 I , $1,15
Respite is pmvided in the ind1vidual's/family/licensed home, Services provided at 10 or more hours of respite per day are billed at the daily rate,
Su pport Coordi nation -1M ~ . ~~---,
SupporiCoordi nation-Limited "li S Llpport CoordmaV;)n "T!i:nsitiof~ r~ - I $277..'70 i $277,10 ' -L-~~~~-'-~ ___ ~
$$73$ $57.38 $114.75 $114,75
$29,2\'-~ ,$14,6 $11§j
------~~--"~~~~ 'Units of Serv,ice :0 Day
Geographical rates shall be utilized by Areas 9, 10,
8nd1·1. !vi Mo,ri.fh 0. Quar-ter Hour U Unit
,
FAMilY AND SUPPORTED LIVING HOl\~1E 1\.1'II1l COMMUI'IIITY·BASED
SERVICES WAiVER
f'ROCEIHJRE CODES AND MAXIMUM UNiTS Of SERVICE
-Max
Service Descri.ption Allow. Rates are contained in Family Units Per and Supported Living Waiver Procedure Modifier Bilting Claim
Provider Rate Table Code Modifier 1 2 Unit Une
Aduit Day Training Facility 55102 I Q 552 U9
Based . i Adult Day II'aining
,
I i I
U9 Q I 552 Off Site T202 ", !
~ ... ~'",";""' Ae""," S'NiW'i H2020 I I --j . Assessment 'I \ U9 J
1
_._ I U I __ ...• ~_._~ BehaVior Analysis I H2019 HP U9 1 0 16~'
Levell ~_,._~_-+I ___ +I. _n_--Tl _ Behavior A~alysis I H201~ I I Q 1
-.. B~"~~;:i'~;; ... 1-. H-2-019 I·:: 1 :: . QL::J .. BehaviorAsSis.t .. antSerVlces I, H2019 II U9 1 14M. I Q I 7 8 =:1.
, ..... I . -_ .• -----r- I fe:; !l "1l I,' Durable Medical Equipment I E 1399 'U9 I U . i#l:F.? w 1-.' ....
I .. ~z - r In· Hom-e'~-l;-~~r ll---.-±tQ
•• ~~9~. I .. g; "'~ " ,
In· HomeSuppor SC D ~i;;!;b1~ I.
Staff) Dai I . __ : ~.--.--.. I,;
I ResPlt_8_C_are ~_~_ ~~, ___ i _:. I 28~~ I C . sc I D II ,30 I
