Appendix I PROCEDURE MAXIMUM ALLOWANCE DESCRIPTION CODE Effective 7/1/18 HOME SUPPORT: AGENCY See Appendix II and IIB Per T2016 AGENCY HOME SUPPORT (Habilitation, residential, waiver) diem** AGENCY HOME SUPPORT (Habilitation, residential, waiver) with See Appendix II and IIB Per T2016 SC Medical Add On diem** HOME SUPPORT: QUARTER HOUR T2017 HOME SUPPORT (Habilitation, residential, waiver) $7.75 ¼ hr HOME SUPPORT (Habilitation, residential, waiver) with Medical Add T2017 SC $9.27 ¼ hr On HOME SUPPORT: REMOTE SUPPORT HOME SUPPORT (Habilitation, residential, waiver)-REMOTE T2017 QC $2.00 ¼ hr SUPPORT-Monitor Only HOME SUPPORT (Habilitation, residential, waiver)-REMOTE T2017 GT $7.75 ¼ hr SUPPORT-Interactive Support HOME SUPPORT: FAMILY CENTERED SUPPORT HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered T2016 U5 $128.78 Per diem Support -One member served HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered T2016 TG U5 $268.22 Per diem Support -One member served- increased level of support HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered T2016 UN U5 $106.06 Per diem Support-Two members served HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered UN TG U5 $243.27 Per diem Support-Two members served- increased level of support HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered T2016 UP U5 $90.44 Per diem Support-Three members served HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered UP TG U5 $220.54 Per diem Support-Three members served- increased level of support
Appendix I PROCEDURE CODE DESCRIPTION MAXIMUM ALLOWANCE Effective 7/1/18 HOME SUPPORT: AGENCY T2016 AGENCY HOME SUPPORT (Habilitation, residential, waiver) See Appendix II and IIB Per diem** T2016 SC AGENCY HOME SUPPORT (Habilitation, residential, waiver) with Medical Add On See Appendix II and IIB Per diem** HOME SUPPORT: QUARTER HOUR T2017 HOME SUPPORT (Habilitation, residential, waiver) $7.75 ¼ hr T2017 SC HOME SUPPORT (Habilitation, residential, waiver) with Medical Add On $9.27 ¼ hr HOME SUPPORT: REMOTE SUPPORT T2017 QC HOME SUPPORT (Habilitation, residential, waiver)-REMOTE SUPPORT-Monitor Only $2.00 ¼ hr T2017 GT HOME SUPPORT (Habilitation, residential, waiver)-REMOTE SUPPORT-Interactive Support $7.75 ¼ hr HOME SUPPORT: FAMILY CENTERED SUPPORT T2016 U5 HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support -One member served $128.78 Per diem T2016 TG U5 HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support -One member served- increased level of support $268.22 Per diem T2016 UN U5 HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Two members served $106.06 Per diem UN TG U5 HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Two members served- increased level of support $243.27 Per diem T2016 UP U5 HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Three members served $90.44 Per diem UP TG U5 HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Three members served- increased level of support $220.54 Per diem
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