$1,563,695.49 Supported Living 15 Minute 93 2807 $5.99 Non-Medical Transportation - Daily $86,793.72 (Flat rate for all trips needed) Daily 46 177 $10.66 Non-Medical Transportation - UTA $13,196.26 Bus Pass Purchase Per Episode 14 11 $85.69 Non-Medical Transportation - $733.50 Mileage Per Mile 1 1630 $0.45 Non-Medical Transportation - Per $5,725.85 Trip (UTA) Per Episode 5 299 $3.83 $510.10 Service Animal Per Episode 1 10 $50.50 GRAND TOTAL: $4,759,141.47 TOTAL ESTIMATED UNDUPLICATED PARTICIPANTS (from Table J-2-a) 128 FACTOR D (Divide grand total by number of participants) $37,180.79 AVERAGE LENGTH OF STAY ON THE WAIVER 337 Waiver Year: Year 4 (only appears if applicable based on Item 1-C) Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Waiver Service / Component Avg. Units Avg. Cost/ Unit # Users Total Cost Per User Unit $327,678.00 ABI Waiver Support Coordination Monthly 130 12 $210.05 $58,647.72 Day Supports - 15 minute 15 Minute 4 2153 $6.81 $549,379.20 Day Supports - daily (6 hr avg) Daily 40 178 $77.16 $2,620.35 Homemaker Services 15 Minute 1 647 $4.05 Residential Habilitation - Facility $1,448,568.00 Based Daily 25 288 $201.19 Residential Habilitation - Facility $236,971.80 Based - DCFS Daily 15 82 $192.66 Residential Habilitation - Host $137,159.68 Home/Professional Parent Daily 4 224 $153.08 Residential Habilitation - Host $37,617.00 Home/Professional Parent - DCFS Daily 3 100 $125.39 Respite - Room and Board Included - $11,632.80 Daily (6 hrs +) Daily 6 20 $96.94 $25,249.86 Respite Care - Unskilled 15 Minute 15 Minute 6 1311 $3.21
Supported Living 15 Minute 93 2807 $5.99 $1,563,695.49 Non-Medical Transportation - Daily (Flat rate for all trips needed) Daily 46 177 $10.66 $86,793.72 Non-Medical Transportation - UTA Bus Pass Purchase Per Episode 14 11 $85.69 $13,196.26 Non-Medical Transportation - Mileage Per Mile 1 1630 $0.45 $733.50 Non-Medical Transportation - Per Trip (UTA) Per Episode 5 299 $3.83 $5,725.85 Service Animal Per Episode 1 10 $50.50 $510.10 GRAND TOTAL: $4,759,141.47 TOTAL ESTIMATED UNDUPLICATED PARTICIPANTS (from Table J-2-a) 128 FACTOR D (Divide grand total by number of participants) $37,180.79 AVERAGE LENGTH OF STAY ON THE WAIVER 337 Waiver Year: Year 4 (only appears if applicable based on Item 1-C) Waiver Service / Component Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Unit # Users Avg. Units Per User Avg. Cost/ Unit Total Cost ABI Waiver Support Coordination Monthly 130 12 $210.05 $327,678.00 Day Supports - 15 minute 15 Minute 4 2153 $6.81 $58,647.72 Day Supports - daily (6 hr avg) Daily 40 178 $77.16 $549,379.20 Homemaker Services 15 Minute 1 647 $4.05 $2,620.35 Residential Habilitation - Facility Based Daily 25 288 $201.19 $1,448,568.00 Residential Habilitation - Facility Based - DCFS Daily 15 82 $192.66 $236,971.80 Residential Habilitation - Host Home/Professional Parent Daily 4 224 $153.08 $137,159.68 Residential Habilitation - Host Home/Professional Parent - DCFS Daily 3 100 $125.39 $37,617.00 Respite - Room and Board Included - Daily (6 hrs +) Daily 6 20 $96.94 $11,632.80 Respite Care - Unskilled 15 Minute 15 Minute 6 1311 $3.21 $25,249.86