Emergency Plan - APD

To: The Executive Office of Governor Rick ScottSenator J.D. Alexander, Chair, Senate Budget CommitteeRepresentative Denise Grimsley, Chair, House Appropriation CommitteeAGENCY FOR PERSONS WITH DISABILITIESPLAN PURSUANT TO SECTION 393.0661(7), F.S., FOR ADJUSTMENTSNECESSARY TO COMPLY WITH THE AVAILABLITY OF MONIESPROVIDED TO THE AGENCY FOR PERSONS WITH DISABILITIES INTHE GENERAL APPROPRIATIONS ACTAs mandated by the Florida Legislature in sections 393.0661(7) and ( 8),Florida Statutes, the Agency for Persons with Disabilities (“APD”), inconsultation with the Agency for Health Care Administration, submits thefollowing plan to the Executive Office of the Governor, the chair of the SenateWays and Means Committee, and the chair of the House Fiscal Council. Thisplan addresses the budget deficit for the remainder of FY 2010/2011, and isanticipated to significantly reduce the deficit. A financial analysis is attachedas Attachment 1. The plan has the least impact on clients and insures theirhealth and safety while still significantly addressing the deficit in the mostexpeditious manner.First, for the period April 1, 2011, through June 30, 2011, the plan reduces allprovider rates by 15%. In addition, the rate differential between solo andagency providers is eliminated. A revised rate table is attached asAttachment 2. For providers with negotiated rates, all contracts will beamended to reflect a 1 5% reduction in the current rates. This includesnegotiated contracts for Transportation, Intensive Behavior ResidentialHabilitation, and Special Medical Home Care.Second, no increases to cost plans for additional services through PriorService Authorizations or annual reviews will be m ade without review andapproval by the Director of APD. In the case of an emergency affecting anindividual’s health and safety, APD will review a r equest for additionalservices using the criteria applied to crisis determinations.Third, APD is preparing a budg et amendment to file with the LegislativeBudget Committee to transfer certain monies in the APD’s appropriation towaiver funds.

APD’s Plan Pursuant to Section 393.0661(7)Page 2This temporary plan to reduce provider rates has been designed to have littleor no effect on the level of service to APD clients. It will not affect their healthand safety. Rather, the temporary plan has been designed so that providersabsorb the reductions over the short term of the plan, from April 1, 2011,through June 30, 2011.Signature on FileBryan Vaughan, Acting DirectorAgency for Persons with DisabilitiesSignature on FileElizabeth Dudek, SecretaryAHCADate:Date:

AGENCY FOR PERSONS WITH DISABILITIESState Match OMTF TotalFY 10-11 Available Appropriation $283,489,804 $522,336,814 $805,826,618Deficit Carried Over from FY 09-10 ($15,872,815) ($29,246,044) ($45,118,859)FY10-11 Expenditures Projected ($327,174,000) ($602,826,000) ($930,000,000)Total FY 10-11 Liability Projected ($343,046,815) ($632,072,044) ($975,118,859)Deficit Projected ($59,557,011) ($109,735,230) ($169,292,241)Unallocated Agency Cash $26,845,352 $49,484,907 $76,330,259Other Agency Appropriation Transfer $3,000,000 $5,529,997 $8,529,997Uniform Solo Rates Applied $3,986,648 $7,345,495 $11,332,143Hold Cost Plan Increases Through the PSA $605,616 $1,115,862 $1,721,477Implement Waitlist for each Tier Escalation $0 $0 $0Provider Rate Reduction entered below: $12,269,025 $22,605,975 $34,875,000Surplus / Deficit ($12,841,884) ($23,661,481) ($36,503,364)

Attachment 2

FAMILY AND SUPPORTED LIVING HOME AND COMMUNITY-BASEDSERVICES WAIVERPROCEDURE CODES AND MAXIMUM UNITS OF SERVICEService DescriptionRates are contained in Familyand Supported Living WaiverProvider Rate TableAdult Day Training FacilityBasedAdult Day TrainingOff SiteBehavioral Analysis ServicesAssessmentBehavior AnalysisLevel 1Behavior AnalysisLevel 2Behavior AnalysisLevel 3ProcedureCode Modifier 1Modifier2BillingUnitMaxAllow.Units PerClaimLineS5102 U9 Q 552T2021U9 Q 552H2020 U9 U 1H2019 HP U9 Q 16H2019 U9 HO Q 16H2019 U9 HN Q 16Behavior Assistant Services H2019 U9 HM Q 999Durable Medical Equipment E1399 U9 U 5In - Home Supports (AwakeStaff)In - Home Supports (Live-InStaff) Daily97537 U9 Q 99997537 U9 SC D 31Respite Care - Quarter Hour S5151 U9 Q 2880Respite Care - Day S5151 U9 SC D 30Support Coordination G9012 U9 M 1Supported EmploymentGroupH2023 U9 Q 704April 1, 2011 Page 1

Supported Employment -Individual ModelH2023 U9 Q 704Supported Living Coaching 97535 U9 Q 744Transportation (Trip) T2003 U9 T 80Transportation (Month) T2002 U9 M 1Transportation (Mile) A0425 U9 I 200Service DescriptionRates for these services are notcontained in Family andSupported Living WaiverProvider Rate TableConsumable MedicalSuppliesEnvironmental AccessibilityAdaptationsEnvironmental AccessibilityAssessmentPersonal EmergencyResponse - InstallationPersonal EmergencyResponse ServiceProcedureCodeModifier1Modifier2BillingUnitMax. Allow.Units PerClaim LineS5199 U9 D 10S5165 U9 D 5S5165 U9 SC U 1S5160 U9 U 1S5161 U9 M 1April 1, 2011 Page 2

Family and Supported Living WaiverProvider Rate TableEffective April 1, 2011Service DescriptionUnit*Staff Ratioor Level ofCareGeographicalIndependentRatesNon-GeographicalIndependentRatesAdult Day Training - Facility Based Q 1:1 $3.47 $3.45Adult Day Training - Facility Based Q 1:3 $1.97 $1.96Adult Day Training - Facility Based Q 1:5 $1.38 $1.36Adult Day Training - Facility Based Q 1:6-10 $1.08 $1.06Adult Day Training - Off SiteQ 1:1 $3.47 $3.45Adult Day Training - Off SiteQ 1:3 $1.97 $1.96Adult Day Training - Off SiteQ 1:5 $1.38 $1.36Adult Day Training - Off SiteQ 1:6-10 $1.08 $1.06The ADT rate assumes a 6 hour program day for the attendees, with staff present 7 hours.The rate has been adjusted by 12.5% for non-state matching funds. An absence factor of3.85% is included in the rate. A provider may bill up to a total of 240 days per year when theindividual is present. Individuals may attend full time or part-time (less than 6 hours).Attendance is calculated based on the quarter hour for the actual time the attendee receivesBehavior Analysis Level 1Q 1 $13.34 $12.94Behavior Analysis Level 2Q 2 $11.65 $11.30Behavior Analysis Level 3Q 3 $7.24 $7.03Behavior Assistant ServicesQ $3.25 $3.19Behavior Analysis ServicesAssessment Q $262.17 $262.17In - Home Supports (Awake Staff)Qtr. Hour Q 1:1 $2.85 $2.81In - Home Supports (Awake Staff)Qtr. Hour Q 1:2 $1.90 $1.87In - Home Supports (Awake Staff)Qtr. Hour Q 1:3 $1.57 $1.55In - Home Supports (Live-In Staff)Day D 1:1 $88.50 $87.41In - Home Supports (Live-In Staff)Day (per person) D 1:2 $74.33 $73.41

Developmental Disabilities HCBS Waiver Provider Rate Table Effective April 1, 2011Service DescriptionUnit*Staff Ratio or Levelof CareGeographicalIndependent RatesNon-GeographicalIndependent RatesSupported Employment GroupQ 1:1 $2.71 $2.68Supported Employment Group Q 1:2 $1.36 $1.34Supported Employment Group Q 1:3 $0.97 $0.96Supported Employment Group Q 1:4 $0.91 $0.89Supported Employment Group Q 1:5 $0.87 $0.86Supported Employment Group Q 1:6 $0.84 $0.84Supported Employment Group Q 1:7 $0.83 $0.82Supported Employment Group Q 1:8 $0.81 $0.80Supported Employment - IndividualModel Q $6.82 $6.60Supported Living Coaching Q $5.29 $5.18*Units of Service:Geographic rates shall be used for services provided in Areas 9, 10, and11. Monroe County has a separate geographic rate table.D DayM MonthQ Quarter HourU Unit4

Agency for Persons with DisabilitiesDevelopmental Disabilities Home and Community-Based Services WaiverMonroe CountyProvider Rate Table with April 1, 2011 Rate ReductionsEffective April 1, 2011Service DescriptionUnit*Staff Ratio or Levelof CareGeographicalIndependent RatesAdult Day Training - Facility BasedQ 1:1 $3.30Adult Day Training - Facility BasedAdult Day Training - Facility BasedQ 1:3 $1.89Q 1:5 $1.32Adult Day Training - Facility BasedQ 1:6-10 $1.00Adult Day Training - Off Site* Q 1:1 $3.30Adult Day Training - Off Site Q 1:3 $1.89Adult Day Training - Off Site Q 1:5 $1.32Adult Day Training - Off Site Q 1:6-10 $1.00The ADT rate assumes a 6 hour program day for the attendees, with staff present 7 hours. The ratehas been adjusted by 12.5% for non-state matching funds. A provider may bill up to a total of 240days per year when the individual is present. Individuals may attend full time or part-time (less than 6hours). Attendance is calculated based on the quarter hour for the actual time the attendee receivesthe service. Adult Day Training is part of the services identified for a meaningful day activity.Behavior Analysis Level 1 Q 1 $12.57Behavior Analysis Level 2 Q 2 $10.98Behavior Analysis Level 3 Q 3 $6.83Behavior Assistant Services Q $3.06Companion Q 1:1 $2.66Companion Q 1:2 $1.79Companion Q 1:3 $1.75Companion Services are provided at a ratio of up to 1:3. When Companion Services are provided tosomeone who lives in a residential facility, the services must be provided solely in the community.Companion Services are part of the services identified for a meaningful day activity.Dietician Services Q $9.18

In - Home Supports (Awake Staff)Qtr. Hour Q 1:1 $2.91In - Home Supports (Awake Staff)Qtr. Hour Q 1:2 $1.94In - Home Supports (Awake Staff)Qtr. Hour Q 1:3 $1.61In - Home Supports (Live-In Staff)Day Per Person D 1:1 $96.94In - Home Supports (Live-In Staff)Day Per Person D 1:2 $81.43In - Home Supports (Live-In Staff)Day Per Person D 1:3 $69.79Qtr. Hour In-Home Supports that exceed 8 hrs. a day must be billed at the In-home Live-In rate. Atotal of 365 days per year may be billed for the Live-In In-Home service when the individual(s) ispresent.Medication Review U $56.76Occupational Therapy Q $14.19Personal Care Assistance Q Standard $3.19Personal Care Assistance Q Moderate $3.19Personal Care Assistance Q Intensive $3.19Levels of Personal Care Assistance Services are determined based on the type and level ofassistance required by the individual as defined in the Developmental Disabilities Waiver ServicesMedicaid Coverage and Limitations Handbook.Physical Therapy Q $14.19Private Duty Nursing - LPN Q $4.20Private Duty Nursing - RN Q $6.07Residential Habilitation - QuarterHour Q 1:1 $2.54Residential Habilitation - QuarterHour Q 1:2 $1.70Residential Habilitation - QuarterHour Q 1:3 $1.40Residential Habilitation may only be billed by the qtr. hr. for services provided in an individual's ownhome or family home. Licensed facilities must use the Provider Rate Table for Residential HabilitationServices in a Licensed Facility.Residential Nursing Services -LPN Q $4.20Residential Nursing Services - RNQ $6.07Respiratory Therapy Q $14.19Respite Care - Quarter Hour Q 1:1 $2.71

Respite Care - Quarter Hour Q 1:2 $1.80Respite Care - Quarter Hour Q 1:3 $1.49Respite Care - Day (per person) D 1:1 $108.17Respite Care - Day (per person) D 1:2 $72.17Respite Care - Day (per person) D 1:3 $59.60Respite Services provided at 10 or more hours per day are billed at the daily rate.Skilled Nursing - LPN Q $4.20Skilled Nursing - RN Q $6.43Specialized Mental Health -Therapy Q $9.84Speech Therapy Q $14.19Support Coordination M $111.31Support Coordination-Limited M $55.65Support Coordination -Transitional M $269.36Supported Employment Group Q 1:1 $2.82Supported Employment Group Q 1:2 $1.40Supported Employment Group Q 1:3 $1.02Supported Employment Group Q 1:4 $0.94Supported Employment Group Q 1:5 $0.90Supported Employment Group Q 1:6 $0.88Supported Employment Group Q 1:7 $0.86Supported Employment Group Q 1:8 $0.84Supported Employment -Individual Model Q $6.92Supported Living Coaching Q $5.38*Units of Service:D DayM MonthQ Quarter HourU Unit

Provider Rate Table Effective April 1, 2011Agency for Persons with DisabilitiesDevelopmental Disabilities Home and Community-Based Services WaiverProvider Rate TableAssessments and Individualized Rates with April 1, 2011 Rate ReductionsEffective April , 2011AssessmentsGeographical Independentor AgencyNon-GeographicalIndependent or AgencyBilling for Assessments is basedon the number of quarter hoursrequired to complete theassessment, not to exceed theMaximum Fee Allowable.Units*Usual andCustomaryRateMaximumRateAllowableUsual andCustomaryRateMaximumRateAllowableBehavioral Analysis ServicesAssessmentNursing AssessmentRegistered Nurse (RN) OnlyOccupational TherapyAssessmentPhysical TherapyAssessmentRespiratory Therapy AssessmentSpecialized Mental HealthAssessmentSpeech TherapyAssessmentU $243.26 $486.53 $243.26 $486.53Q8 Qt. Hours atRN rate8 Qt. Hoursat RN rate8 Qt. Hours atRN rate8 Qt. Hours atRN rateU $113.52 $129.74 $113.52 $129.74U $113.52 $162.18 $113.52 $162.18U $162.18 $162.18 $162.18 $162.18U $113.52 $243.26 $113.52 $243.26U $113.52 $129.74 $113.52 $129.741

Provider Rate Table Effective April 1, 2011The following rates are negotiated and identified as part of the provider's Medicaid Waiver ServicesAgreement.Individually Determined and Negotiated RatesResidential Habilitation -Intensive Behavior in aLicensed HomeDRates for this service are individually determined as part of Prior ServiceAuthorization. Rates in efffect prior to July 1, 2008 will be reduced by 3%effective July 1, 2008.Special Medical HomeCare in a Licensed HomeDRates for this service are individually determined as part of Prior ServiceAuthorization. Rates in efffect prior to July 1, 2008 will be reduced by7.21% effective July 1, 2008.Transportation - TripTransportation - MonthTransportation - MileTMIRates for this service are individually determined as part of Prior ServiceAuthorization. Rates in efffect prior to July 1, 2008 will be reduced by7.21% effective July 1, 2008.*Units of Service:D DayM MonthT TripI MileU UnitGeographic rates for assessments shall be used in Areas 9, 10, and 11,including Monroe County.2

Provider Rate TableResidential Habilitation Services in a Licensed FacilityEffective April 1, 2011Residential Habilitation Services Daily - Monthly Rates with April 1, 2011 Rate ReductionsWithout Geographic FactorWith Geographic Factor*Rate for Levelof SupportsStandard ProgramBehavior Focus**Standard ProgramBehavior Focus**DailyRateMonthlyRateDailyRateMonthlyRateDailyRateMonthlyRateDailyRateMonthly RateBasicMinimalModerateExtensive 1Extensive 2Rate for Levelof SupportsBasicMinimalModerateExtensive 1Extensive 2$33.35 $972.83 NA NA $35.85 $1,045.71 NA NA$66.65 $1,943.91 $70.67 $2,061.18 $71.65 $2,089.69 $75.97 ######$100.01 $2,916.99 $105.54 $3,078.13 $107.52 $3,135.90 $113.99 ######$134.53 $3,923.78 $142.62 $4,159.79 $144.62 $4,218.05 $153.31 ######$176.73 $5,154.68 $187.37 $5,464.83 $189.99 $5,541.43 $201.42 ######Monroe County OnlyStandardDaily Monthly Daily Monthly$40.02 $1,167.19Behavior Focus**NotAvailableNotAvailable$79.99 $2,332.90 $84.80 $2,473.22$120.01 $3,500.34 $127.24 $3,711.06$161.43 $4,708.43 $171.15 $4,991.80$212.08 $6,185.52 $224.84 $6,557.89*Geographic differential applies to services provided in Areas 9, 10, and 11. Monroe County has a separaterate table.**Provider and the recipient must meet the definition of "Behavior Focus" as defined in the DevelopmentalDisabilities Home and Community-Based Services Waiver Coverage and Limitations handbook to qualify forthis rate.

Rate Considerations: Rates are based on 365 days of operation, with 350 possiblebilling days available per year. The monthly rate for this service shall be used by theprovider if the recipient is in the home 24 or more days per month, and cannot be used incombination with the daily rate in a given calendar month. When a recipient is admittedinto, or discharged from a licensed facility during the month, the daily rate shall be usedduring the month of discharge or admisssion by the admitting or discharging facility forthe days the individual is present at the respective facility. When being admitted ordischarged, the facility where the recipient is residing at 11:59 PM on the date ofadmission will bill for that particular day. The Daily Rate is limited to no more than 23days in a given month.

Provider Rate Table Residential Habilitation Services -Licensed Facility Effective April 1, 2011Residential Habilitation in a Licensed FacilityLevel of Supports DescriptorsThese Descriptors will be used for individuals who have not yet been assessed using the Agencyapproved assessment and who have experienced a change in circumstance or condition, or whoare newly admitted to a licensed residential facility and must have a rate established. The levelthat best describes the individual and their primary area of support needs will be selected toestablish or modify the rate. All requested changes to the Level of Support Rate shall bedetermined medically necessary.BASICFunctional: Independent in self-care, daily living activities; or requires supervision, intermittant verbal direction orphysical prompts to perform self-care, daily living skills;Behavioral: No formal behavioral intervention necessary except redirection; may be non-compliant at times,Physical: Health issues under control through medication or diet. Ambulatory or independent in use ofwheelchair/walker. May need staff supervision to self-administer medications.Other: This level will be used to provide residential habilitation training for individuals residing in a non-APDlicensed facility that is responsible for basic supervision and care, such as an Assisted Living Facility (ALF).MINIMALFunctional: May require consistent verbal and physical help to complete self care/daily living tasks, includingphysical assistance and mealtime intervention to eat safely, may require mealtime interventions and/or devices. Mayrequire scheduled toileting or use of incontinent briefs. Walks independently or independently uses a manual orpower wheelchair. May require assistance to change positions. Needs physical assistance of one person to transferor to change positions.Behavioral: May exhibit behaviors that require formal and informal intervention; requires frequent prompts,instruction or redirection, some enviornmental modifications or restrictions on movement may be necessary.Physical: If has seizures, no interference with functional activities; May require medication for bowel elimination.May require a special diet. May require staff supervision to self-administer medications.MODERATEFunctional: Requires substantial prompting and/or physical assistance to perform self-care/daily living activities.May be totally dependent on staff for dressing/bathing. May require mealtime interventions and/or devices ORreceives all nutrition through a gastrostomy or jejunostomy tube. Incontinent of bowel or bladder. May requirescheduled toileting or use of incontinent briefs. Independently uses a powered wheelchair, may need assistancewith a manual chair. May require assistance to change positions. Disability prevents sitting in an upright position,has limited positioning options. Needs physical assistance of one person to transfer or to change position.Behavioral: May exhibit behaviors that require frequent planned, informal and formal interventions. Asssistancefrom others may be necessary to redirect the recipient. May require psychotropic medication for control of behavior.Self-injury or aggression towards others or property results in broken skin, major bruising/swelling or significanttissue damage requiring physician/nurse attention. May have threatened suicide in past 12 months. May haverequired use of reactive strategies 5 or more times per month in last 12 months. May routinely wear protectiveequipment to prevent injury from self-abusive behavior.Physical: May have seizures that interfere with functional activities; receives 2 or more medications to controlseizures. May have experienced a pressure sore requiring medical attention in the past 6 months. May requiremedication and daily management, including enemas, for bowel elimination. May be nutritionally at risk and requirea physician/dietitian prescribed special diet.

Provider Rate Table Residential Habilitation Services -Licensed Facility Effective April 1, 2011EXTENSIVE 1Functional: Totally dependent on staff for self-care/daily living activities; Disability prevents sitting in an uprightposition, has limited positioning options. Requires two person lift or lifting equipment to transfer. Independentlyuses a powered wheelchair, needs assistance with a manual chair. Requires daily monitoring and frequent handsonassistance to stay healthy. Health issues result in inability to attend outside programs 5-10 days a month; healthcondition is unstable or becoming progressively worse.Behavioral: Frequent planned, informal or formal interventions necessary. Assistance from others may benecessary to redirect the recipient. Requires psychotropic medication for control of behavior. Use ofphysical/mechanical restraint. Self-injury or aggression towards others or property results in significant tissuedamage, scarring, damage to bones that requiring physician attention. May have attempted suicide in past 12months. May have required the use of reactive strategies 5 or more times per month in last 12 months . Mayroutinely wear protective equipment to prevent injury from self abusive behavior at least 12 hours per day. Hasreceived emergency medication to control behavior in last 12 months. May meet criteria of Intensive BehavioralResidential Habilitation.Physical: May have uncontrolled seizures that have required hospital or emergency room intervention during past12 months; receives medications to control seizures. May have been hospitalized for medication toxicity in past 12months. May have experienced a pressure sore requiring recurrent medical attention or hospitalization in the past 6months. May require medication and daily management, including enemas, for bowel elimination. May have beenhospitalized for impaction in last 12 months. May be at high nutritional risk and requires intensive nutritionalintervention. Has a condition that requires physician prescribed procedures. (Cannot be delegated to a nonlicensedstaff.)Other: If the recipient’s primary need is to receive visual supervision based on a documented history ofinappropriate sexual behavior or sexually provocative behavior, assignment to this level is appropriate.EXTENSIVE 2Functional: Requires total physical assistance in self-care, daily living activities. May require mealtimeinterventions and/or devices OR receives all nutrition through a gastrostomy or jejunostomy tube. Incontinent ofbowel or bladder. May require scheduled toileting or use of incontinent briefs. May have indwelling catheter orcolostomy managed by staff. Disability prevents sitting in an upright position, has limited positioning options.Requires two person lift or lifting equipment to transfer. Totally dependent on others to stay healthy. Health issuesresult in inability to consistently attend outside programs; health condition is unstable or becoming progressivelyworse.Behavioral: Frequent planned, formal interventions necessary. Assistance from others necessary to redirectrecipient . Receives multiple psychotropic medications for control of behavior, possibly frequent medicationchanges. Use of physical/mechanical restraint. Meets the criteria of Intensive Behavioral Residential Habilitation.Physical: Self-injury or aggression towards others or property results in significant tissue damage, scarring,damage to bones requiring physician attention. May have attempted suicide in past 12 months. May have engagedin sexual predatory behavior in the past 12 months. May have been restrained 5 or more times per month in last 12months . May routinely wear protective equipment to control self abuse at least 12 hours per day. Receives 2 ormore medications to control behaviors that have been changed in the last year; is still unstable or showing sideeffects of the medications. Has received emergency medication to control behavior 4 or more times in last 12months. May have uncontrolled seizures that have required hospital or emergency room intervention during past 12months; receives 2 medications to control seizures that have been changed in the past 12 months. May have beenhospitalized for medication toxicity in past 12 months. May have experienced a pressure sore requiring recurrentmedical attention or hospitalization in the past 6 months. May require medication and daily management, includingenemas, for bowel elimination.May have been hospitalized for impaction in last 12 months. May be at high nutritional risk and requires intensivenutritional intervention. Has a condition that requires physician prescribed procedures. (Cannot be delegated to anon-licensed staff.) Requires 4 or more physician visits per month; may have been admitted to the hospital throughemergency room visit; may have been admitted to ICU.

Provider Rate Table Residential Habilitation Services -Licensed Facility Effective April 1, 2011Other: If the recipient’s primary support need is to receive visual supervision due to a history of engagement insexual predatory behavior or sexual aggression and the recipient is currently identified as having active predatorytendencies by the Area Certified Behavior Analyst, this support level is appropriate.

Provider Rate TableResidential Habilitation Services in a Licensed FacilityEffective April 1, 2011Residential Habilitation Services Live-In Rate with April 1, 2011 Rate ReductionsServiceDescriptionUnitStaff Ratio orLevel of CareGeographicIndependentRatesNon-GeographicIndependent RatesMonroe CountyIndependentRatesResidentialHabilitation - LiveIn StaffDay 1:1 $92.81 $91.66 $94.63ResidentialHabilitation - LiveIn Staff (PerPerson)Day 1:2 $77.95 $77.00 $79.48ResidentialHabilitation - LiveIn Staff (PerPerson)Day 1:3 $66.83 $66.00 $68.13The Residential Habilitation "Live-In" rate may be used only for licensed residentialfacilities that are licensed for 3 or fewer persons. Staff do not have to "live-in" the home forthis rate model to be used. A total of 365 days per year may be billed for this service whenthe individual(s) is present. The Geographic Agency Rate applies to services provided inAreas 9, 10 and 11.

Agency for Persons with DisabilitiesDevelopmental Disabilities Home and Community-Based Services Waiver Billing Code MatrixFor use with the Developmental Disabilities Home and Community-Based Services Waiver Provider Rate Table April 1, 2011Service DescriptionRates are contained inDevelopmental Disabilities Homeand Community-Based ServicesWaiver Provider Rate TableProcedureCodeModifier1Modifier2Developmental Disabilities Home and Community-Based Services Waiver 1BillingUnitMax Allowable Number of UnitsPer Date of Service (Claim Line)Ratio orof CareAdult Day Training - FacilityBasedS5102 U6 Q 552 QH per Month 1:1Adult Day Training - FacilityBasedS5102 U6 Q 552 QH per Month 1:3Adult Day Training - FacilityBasedS5102 U6 Q 552 QH per Month 1:5Adult Day Training - FacilityBasedS5102 U6 Q 552 QH per Month 1:6-10Adult Day TrainingOff SiteT2021U6 Q 552 QH per Month 1:1Adult Day TrainingOff SiteT2021U6 Q 552 QH per Month 1:3Adult Day TrainingOff SiteT2021U6 Q 552 QH per Month 1:5Adult Day TrainingOff SiteT2021U6 Q 552 QH per Month 1:6-10Behavioral Analysis ServicesAssessmentH2020 U6 U 1 Unit in 365 DaysBehavior Analysis Level 1 H2019 HP U6 Q 16 QH per Day 1Behavior Analysis Level 2 H2019 U6 HO Q 16 QH per Day 2Behavior Analysis Level 3 H2019 U6 HN Q 16 QH per Day 3Procedure Code MatixLevel

Behavior Assistant Services H2019 U6 HM Q 1984 QH per MonthCompanion S5135 U6 Q 24 QH per Day 1:1Companion S5135 U6 Q 24 QH per Day 1:2Companion S5135 U6 Q 24 QH per Day 1:3Dietitian Services 97802 U6 Q 12 QH per DayIn - Home Supports (AwakeStaff)In - Home Supports (AwakeStaff)In - Home Supports (AwakeStaff)In - Home Supports (Live-InStaff) Quarter HourIn - Home Supports (Live-InStaff) Quarter HourIn - Home Supports (Live-InStaff) Quarter Hour97537 U6 Q 992 QH per Month 1:197537 U6 Q 992 QH per Month 1:297537 U6 Q 992 QH per Month 1:397537 U6 SC D 31 Days per Month 1:197537 U6 SC D 31 Days per Month 1:297537 U6 SC D 31 Days per Month 1:3Medication Review 99499 U6 U 2 Units per 365 DaysOccupational TherapyAssessment97003 U6 U 1 Unit per 365 DaysOccupational Therapy 97530 U6 Q 8 QH per DayPersonal Care Assistance T1019 U6 Q 720 QH per Month StandardPersonal Care Assistance T1019 U6 Q 720 QH per Month ModeratePersonal Care Assistance T1019 U6 Q 1200 QH per Month IntensivePhysical Therapy -Assessment97001 U6 U 1 Unit per 365 DaysDevelopmental Disabilities Home and Community-Based Services Waiver 2Procedure Code Matix

Physical Therapy 97110 U6 Q 8 QH per DayPrivate Duty Nursing - LPN T1000 U6 Q 96 QH per DayPrivate Duty Nursing - RN T1000 U6 HN Q 96 QH per DayResidential Habilitation -Intensive BehaviorDayResidential Habilitation -Intensive BehaviorMonthlyResidential Habilitation -Behavior FocusedDayResidential Habilitation -Behavior FocusedMonthlyResidential Habilitation -StandardDayResidential Habilitation -StandardMonthlyResidential Habilitation -(Quarter Hour)Residential Habilitation -(Quarter Hour)Residential Habilitation -(Quarter Hour)Residential Habilitation - (LiveIn Staff)Residential Habilitation - (LiveIn Staff)Residential Habilitation - (LiveIn Staff)T2016 U6 D31 Days per Month (Maximum365 Days per Year)IntensiveT2023 U6 HI M 12 Months per Year IntensiveT2020 U6 D31 Days per Month (Maximum350 Days per Year)T2023 U6 SC M 12 Months per YearH0043 U6 SC D31 Days per Month (Maximum350 Days per Year)T2023 U6 M 12 Months per YearH0043 U6 Q 992 QH per Month 1:1H0043 U6 Q 992 QH per Month 1:2H0043 U6 Q 992 QH per Month 1:3H0043 U6 SC DH0043 U6 SC DH0043 U6 SC D31 Days per Month (Maximum365 Days per Year)31 Days per Month (Maximum365 Days per Year)31 Days per Month (Maximum365 Days per Year)1:11:21:3Developmental Disabilities Home and Community-Based Services Waiver 3Procedure Code Matix

Residential Nursing Services -LPNResidential Nursing Services -RNRespiratory TherapyAssessmentT1001 U6 Q 96 QH per DayT1002 U6 Q 96 QH per DayS5180 U6 U 2 Units per 365 DaysRespiratory Therapy S5181 U6 Q 8 QH per DayRespite Care - Quarter Hour S5151 U6 QRespite Care - Quarter Hour S5151 U6 QRespite Care - Quarter Hour S5151 U6 Q96 QH per Day 2880 QH perYear96 QH per Day 2880 QH perYear96 QH per Day 2880 QH perYearRespite Care - Day S5151 U6 SC D 30 Days per Year 1:1Respite Care - Day S5151 U6 SC D 30 Days per Year 1:2Respite Care - Day S5151 U6 SC D 30 Days per Year 1:3Skilled Nursing - LPN T1001 U6 HM Q 32 QH per daySkilled Nursing - RN T1001 U6 HN Q 32 QH per daySpecial Medical Home Care S9122 U6 DSpecialized Mental Health -AssessmentSpecialized Mental Health -TherapySpeech Therapy -Assessment31 Days per Month (Maximum of365 Days per Year)H0031 U6 U 1 Unit per 365 DaysH0046 U6 Q 8 QH per Day92506 U6 U 1 Unit per 365 DaysSpeech Therapy 92507 U6 Q 8 QH per DaySupport Coordination G9012 U6 M 1 Unit per Month1:11:21:3Developmental Disabilities Home and Community-Based Services Waiver 4Procedure Code Matix

Support CoordinationLimitedSupport Coordination -TransitionalSupported EmploymentGroupSupported EmploymentGroupSupported EmploymentGroupSupported EmploymentGroupSupported EmploymentGroupSupported EmploymentGroupSupported EmploymentGroupSupported EmploymentGroupSupported Employment -Individual ModelT2022 U6 M 1 Unit per MonthG9012 U6 SC M1 Unit per Month(Maximum number of units is 6. 3months prior to move and 3 months aftermove.)H2023 U6 Q 704 QH per Month 1:1H2023 U6 Q 704 QH per Month 1:2H2023 U6 Q 704 QH per Month 1:3H2023 U6 Q 704 QH per Month 1:4H2023 U6 Q 704 QH per Month 1:5H2023 U6 Q 704 QH per Month 1:6H2023 U6 Q 704 QH per Month 1:7H2023 U6 Q 704 QH per Month 1:8H2023 U6 Q 704 QH per MonthSupported Living Coaching 97535 U6 Q40 QH per Day (Limited to 80 QHper Month when received in conjunctionwith In-Home Support Services.)Transportaion - Trip T2003 U6 T 80 Trips per MonthTransportaion - Month T2002 U6 M 1 Unit per MonthTransportaion - Mile A0425 U6 I 200 Miles per DayDevelopmental Disabilities Home and Community-Based Services Waiver 5Procedure Code Matix

Service DescriptionRates for these services are notcontained in the DevelopmentalDisabilities Home and Community-Based Services Waiver ProviderRate TableProcedure CodeModifier1Modifier2BillingUnitMax Allowable Number of UnitsPer Date of Service (Claim Line)Maximum AllowableRate per unitAdult Dental Services D0160 U6 U 10 Units per Day$436.94Durable Medical Equipment E1399 U6 U 5 Units per Day $4,369.43Environmental AccessabilityAdaptationsHome AccessabilityAssessmentPersonal EmergencyResponse - InstallationPersonal EmergencyResponse - ServiceS5165 U6 U 5 Units per Day $655.42S5165 U6 SC U 1 Unit per 365 Days $699.11S5160 U6 U 1 Unit per 365 Days $218.48S5161 U6 M 1 Unit per Month $34.95Developmental Disabilities Home and Community-Based Services Waiver 6Procedure Code Matix