Transcription of OLTL Home and Community Based Waiver Services Rates …
1 ServiceACT150 OBRAP rocedure CodeRate Region 1 Rate Region 2 Rate Region 3 Rate Region 4 UnitFee Schedule RateVendorAdult Daily $ $ $ $ 1 DayXAdult Daily Living- Half DayN/AXS5102 $ $ $ $ 1/2 DayXAdult Daily Living EnhancedN/AXS5102 $ $ $ $ 1 DayXAdult Daily Living Enhanced Half Day N/AXS5102 $ $ $ $ 1/2 DayXCommunity $ $ $ $ 15 MinutesXEmployment- Benefits $ $ $ $ 15 MinutesXEmployment- Career $ $ $ $ 15 MinutesXEmployment- Employment Skills Development (1:1) $ $ $ $ 15 MinutesXEmployment- Employment Skills Development (1:2 to 1:3) $ $ $ $ 15 MinutesXEmployment- Employment Skills Development (1:15) $ $ $ $ 15 MinutesXEmployment- Job Coaching 1:1 (Follow Along)N/AXW1733 $ $ $ $ 15 MinutesXEmployment- Job Coaching 1:2 to 1:4 (Follow Along)N/AXW1734 $ $ $ $ 15 MinutesXEmployment- Job Coaching 1.
2 1 (Intensive)N/AXW1733 $ $ $ $ 15 MinutesXEmployment- Job Coaching 1:2 to 1:4 (Intensive)N/AXW1734 $ $ $ $ 15 MinutesXEmployment- Job $ $ $ $ 15 MinutesXHome Health- Nursing (LPN)NAXT1003 $ $ $ $ 15 MinutesXHome Health- Nursing (RN)N/AXT1002 $ $ $ $ 15 MinutesXHome Health- Occupational TherapyN/AXT2025 $ $ $ $ 15 MinutesXHome Health- Occupational Therapy AssistantN/AXT2025 GO $ $ $ $ 15 MinutesXHome Health- Physical TherapyN/AXT2025 $ $ $ $ 15 MinutesXHome Health- Physical Therapy AssistantN/AXT2025 GP $ $ $ $ 15 MinutesXHome Health- Speech & Language TherapyN/AXT2025 $ $ $ $ 15 MinutesxPAS (Agency)
3 $ $ $ $ 15 MinutesXPAS (Consumer) $ $ $ $ 15 MinutesXPAS (Consumer Overtime)XXW1792 $ $ $ $ 15 MinutesXPAS (CSLA)N/AXW1793 $ $ $ $ 15 MinutesXResidential Habilitation 1-3 $ $ $ $ 1 DayX Residential Habilitation 1-3 Support 1:1N/AXW101 $ $ $ $ 1 HourX Residential Habilitation1-3 Support 2:1N/AXW101 $ $ $ $ 1 HourXResidential Habilitation 4-8 $ $ $ $ 1 DayX Residential Habilitation 4-8 Support 1:1N/AXW0103 $ $ $ $ 1 HourX Residential Habilitation 4-8 Support 2.
4 1N/AXW0103 $ $ $ $ 1 HourXRespite (Agency)* $ $ $ $ 15 MinutesXRespite (Consumer) $ $ $ $ 15 MinutesXRespite (Consumer Overtime)N/AXS5150 $ $ $ $ 15 MinutesXService $ $ $ $ 15 MinutesXStructured Day Habilitation $ $ $ $ 1 HourX Structured Day Habilitation 1:1N/AXW0105 $ $ $ $ 1 HourX Structured Day Habilitation 2:1N/AXW0105 $ $ $ $ 1 HourXTherapeutic & Counseling Services - Behavior $ $ $ $ 15 MinutesXTherapeutic & Counseling Services - Cognitive RehabilitationN/AX97127 $ $ $ $ 15 MinutesXTherapeutic & Counseling Services - Counseling $ $ $ $ 15 MinutesXTherapeutic & Counseling Services - Nutritional CounselingN/AXS9470 AE $ $ $ $ 15 MinutesXTransition Service $ $ $ $ 15 MinutesXAssistive TechnologyN/AXW0138N/AN/AN/AN/APer PurchaseXCommunity
5 Transition Services - Health SafetyN/AXW7336N/AN/AN/AN/AOne TimeXCommunity Transition Services - Household SuppliesN/AXW7332N/AN/AN/AN/AOne TimeXCommunity Transition Services - Moving ExpensesN/AXW7333N/AN/AN/AN/AOne TimeXCommunity Transition Services - Security DepositN/AXW7334N/AN/AN/AN/AOne TimeXCommunity Transition Services - Set-Up FeesN/AXW7335N/AN/AN/AN/AOne TimeXFinancial Management ServicesXXW7341N/AN/AN/AN/A1 MonthXFinancial Management Services - Start UpXXW7341 U4N/AN/AN/AN/A1 TimeXHome Adaptations < $6,000N/AXW0140N/AN/AN/AN/APer PurchaseXHome Adaptations > $6,000N/AXW0141N/AN/AN/AN/APer PurchaseXNon-Medical TransportationN/AXW6110N/AN/AN/AN/APer One-Way Trip/Per ItemXPersonal Emergency Response System- InstallationXXW1894N/AN/AN/AN/APer PurchaseXPersonal Emergency Response System- Monthly MaintenanceXXW1895N/AN/AN/AN/APer PurchaseXSpecialized Medical Equipment & SuppliesN/AXW0137N/AN/AN/AN/APer PurchaseXVehicle ModificationsN/AXW0139N/AN/AN/AN/APer PurchaseX*In facility respite will be reimbursed at the nursing facility's case-mix per diem home and Community Based Waiver Services RatesRates Effective January 01, 2020
