PAA7 REQUEST FOR PASSPORT AGREEMENT RENEWAL/EXPANSION Please check current and new services SERVICE COUNTIES RATE CURRENT PAA use only you wish to provide. RATE Current New Adult Day Care $49.39/day $49.39/day Enhanced $24.70/ ½ day $24.70/ ½ day $1.55/ 15 min. unit $1.55/ 15 min. unit Adult Day Care $64.84/day $64.84/day INTENSIVE $32.41/ ½ day $32.41/ ½ day $2.03/ 15 min. unit $2.03/ 15 min. unit ADS Transportation UP TO $1.54/MILE UP TO $1.54/MILE $1.16 2ND PERSON $1.16 2ND PERSON $15.76/ONE WAY $15.76/ONE WAY $11.82 2ND PERSON $11.82 2ND PERSON $20.28/ROUND TRIP $20.28/ROUND TRIP $15.21 2ND PERSON $15.21 2ND PERSON chore cOMMUNITY TRANSITION EMERGENCY RESPONSE SYSTEM ENHANCED COMMUNITY lIVING home care attendant /unit /unit Home Delivered Meals Hot /meal /meal Frozen /meal /meal Therapeutic /meal /meal Kosher /meal /meal HOME MEDICAL EQUIPMENT & SUPPLIES Homemaker /unit /unit ILA IN-PERSON ACTIVITIES /unit /unit TELEPHONE SUPPORT /call /call TRAVEL ATTENDANT /unit /unit Minor Home Modifications Nutrition Consultation /unit /unit out-of-home respite /unit /unit Personal Care /unit /unit /unit /unit Personal Care 2nd Pest control Social Work Counseling /unit /unit TRANSPORTATION NON-MEDICAL TRANSPORTATION NON-EMERGENCY waiver nursing /unit /unit DESIGNATED SERVICES MUST HAVE MEDICARE CERTIFCATION – Occupational Therapy $70/day $70/day $4.50/ 15 min unit $4.50/ 15 min unit Physical Therapy $70/day $70/day $4.50/ 15 min unit $4.50/ 15 min unit Registered Nurse $55/day $55/day $4.50/ 15 min unit $4.50/ 15 min unit Speech Therapy $70/day $70/day $4.50/ 15 min unit $4.50/ 15 min unit
PAA7 REQUEST FOR PASSPORT AGREEMENT RENEWAL/EXPANSION Please check current and new services you wish to provide. SERVICE COUNTIES RATE CURRENT RATE PAA use only Current New Adult Day Care Enhanced $49.39/day $49.39/day $24.70/ ½ day $24.70/ ½ day $1.55/ 15 min. unit $1.55/ 15 min. unit Adult Day Care INTENSIVE $64.84/day $64.84/day $32.41/ ½ day $32.41/ ½ day $2.03/ 15 min. unit $2.03/ 15 min. unit ADS Transportation UP TO $1.54/MILE $1.16 2ND PERSON UP TO $1.54/MILE $1.16 2ND PERSON $15.76/ONE WAY $11.82 2ND PERSON $15.76/ONE WAY $11.82 2ND PERSON $20.28/ROUND TRIP $15.21 2ND PERSON $20.28/ROUND TRIP $15.21 2ND PERSON chore cOMMUNITY TRANSITION EMERGENCY RESPONSE SYSTEM ENHANCED COMMUNITY lIVING home care attendant /unit /unit Home Delivered Meals Hot Frozen Therapeutic Kosher /meal /meal /meal /meal /meal /meal /meal /meal HOME MEDICAL EQUIPMENT & SUPPLIES Homemaker /unit /unit ILA IN-PERSON ACTIVITIES TELEPHONE SUPPORT TRAVEL ATTENDANT /unit /call /unit /unit /call /unit Minor Home Modifications Nutrition Consultation /unit /unit out-of-home respite /unit /unit Personal Care Personal Care 2nd /unit /unit /unit /unit Pest control Social Work Counseling /unit /unit TRANSPORTATION NON-MEDICAL TRANSPORTATION NON-EMERGENCY waiver nursing /unit /unit DESIGNATED SERVICES – MUST HAVE MEDICARE CERTIFCATION Occupational Therapy $70/day $4.50/ 15 min unit $70/day $4.50/ 15 min unit Physical Therapy $70/day $4.50/ 15 min unit $70/day $4.50/ 15 min unit Registered Nurse $55/day $4.50/ 15 min unit $55/day $4.50/ 15 min unit Speech Therapy $70/day $4.50/ 15 min unit $70/day $4.50/ 15 min unit
PAA7%20REQUEST%20FOR%20PASSPORT%20AGREEMENT%20RENEWAL%20EXPANSION%202014.docx