DDRS Waiver Manual

FSW CIH
MFP-
CIH
INsite
Code Service Description
Natl.
Code 1 2 3 4 Rate
Unit/
Size
Unit/$
Limit
2
• •
TRN2 Transportation, Level 2 T2002 U7 U5 U2 $20.00 1.00/Trip Trips/Day,$5000/Year
2
• •
TRN3 Transportation, Level 3 T2002 U7 U5 U3 $40.00 1.00/Trip Trips/Day,$7500/Year
• • VMOD Vehicle Modification, Install T2039 U7 U5 Individual 1.00/Unit $15,000 Lifetime
• VMOD Vehicle Modification, Install T2039 U7 U5 Individual 1.00/Unit $7,500 Lifetime
• • • VMOM Vehicle Modification, Maintain T2039 U7 U5 U8 Individual 1.00/Unit $500/Year
• • WEL1 Wellness Coordination Tier 1 T2022 U7 U5 U1 $52.77 1.00/Month 1 Unit/Month
• • WEL2 Wellness Coordination Tier 2 T2022 U7 U5 U2 $111.96 1.00/Month 1 Unit/Month
• • WEL3 Wellness Coordination Tier 3 T2022 U7 U5 U3 $223.92 1.00/Month 1 Unit/Month
• • • WPA Workplace Assistance T1020 U7 U5 $26.37 1.00/Hour
Section 10.3: Adult Day Services
Service Definition
Adult Day Services (ADS) are community-based group programs designed to meet the needs of adults with
impairments through individual plans of care. These structured, comprehensive, non-residential programs
provide health, social, recreational, and therapeutic activities, supervision, support services, and personal
care. Meals and/or nutritious snacks are required. The meals need not constitute the full daily nutritional
regimen. However, each meal must meet one-third of the daily Recommended Dietary Allowance. These
services must be provided in a congregate, protective setting in one of three available levels of service: Basic,
Enhanced, or Intensive.
Individuals attend Adult Day Services on a planned basis. A maximum of 12 hours per day shall be allowable.
The three levels of Adult Day Services are Basic, Enhanced and Intensive.
A half-day unit is defined as one unit of three hours to a maximum of five hours per day. Two units is more
than five hours to a maximum of eight hours per day. A maximum of two half-units per day is allowed.
A quarter-hour unit is defined as 15 minutes. It is billable only if fewer than three hours or more than eight
hours of ADS have been provided on the same day. A maximum of 16 quarter-hour units per day are allowed.
Reimbursable Activities
Adult Day Services may be used in conjunction with Transportation Services.
Basic Adult Day (Level 1) includes:
Monitor and/or supervise all activities of daily living (ADLs) defined as dressing, bathing, grooming,
eating, walking, and toileting with hands-on assistance provided as needed.
Comprehensive, therapeutic activities.
Health assessment and intermittent monitoring of health status.
Monitor medication or medication administration.
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