APPENDIX I MAXIMUM PROCEDURE SERVICE ALLOWANCE CODE Effective 7/1/18 T2017 Home Support-Quarter Hour $7.75 per ¼ hour T2017 QC Home Support-Remote Support-Monitor Only $1.63 per ¼ hour T2017 GT Home Support-Remote Support-Interactive Support $7.75 per ¼ hour Shared Living (Foster Care, adult)-Shared Living Model-One member $156.00 per diem served Shared Living (Foster Care, adult)-Shared Living Model-Two members S5140 UN $78.02 per diem served T2021 Community Support (Day Habilitation) $6.53 per ¼ hour T2021 SC Community Support (Day Habilitation)- with Medical Add On $8.05 per ¼ hour Employment Specialist Services (Habilitation, Supported Employment T2019 $9.09 per ¼ hour waiver)
APPENDIX I PROCEDURE CODE SERVICE MAXIMUM ALLOWANCE Effective 7/1/18 T2017 Home Support-Quarter Hour $7.75 per ¼ hour T2017 QC Home Support-Remote Support-Monitor Only $1.63 per ¼ hour T2017 GT Home Support-Remote Support-Interactive Support $7.75 per ¼ hour Shared Living (Foster Care, adult)-Shared Living Model-One member served $156.00 per diem S5140 UN Shared Living (Foster Care, adult)-Shared Living Model-Two members served $78.02 per diem T2021 Community Support (Day Habilitation) $6.53 per ¼ hour T2021 SC Community Support (Day Habilitation)- with Medical Add On $8.05 per ¼ hour T2019 Employment Specialist Services (Habilitation, Supported Employment waiver) $9.09 per ¼ hour
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