Professional Medication Monitoring - $9,005.04 RN Per Episode 11 108 $7.58 Professional Medication Monitoring - $2,279.40 LPN Per Episode 5 87 $5.24 Specialized Medical $663.20 Equipment/Supplies/Assistive Technology - Purchase Per Episode 1 1 $663.20 Specialized Medical $437.85 Equipment/Supplies/Assistive Technology - Monthly Fee Monthly 3 7 $20.85 $1,311,374.26 Supported Living 15 Minute 94 2807 $4.97 Non-Medical Transportation - Daily $79,945.59 (Flat rate for all trips needed) Daily 47 177 $9.61 Non-Medical Transportation - UTA $13,065.36 Bus Pass Purchase Per Episode 14 11 $84.84 Non-Medical Transportation - $733.50 Mileage Per Mile 1 1630 $0.45 Non-Medical Transportation - Per $5,666.05 Trip (UTA) Per Episode 5 299 $3.79 $500.00 Service Animal Per Episode 1 10 $50.00 GRAND TOTAL: $4,058,546.59 TOTAL ESTIMATED UNDUPLICATED PARTICIPANTS (from Table J-2-a) 130 FACTOR D (Divide grand total by number of participants) $31,219.59 AVERAGE LENGTH OF STAY ON THE WAIVER $337.00 Waiver Year: Year 2 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 $52,705.44 Day Supports - 15 minute 15 Minute 4 2153 $6.12 $493,843.20 Day Supports - daily (6 hr avg) Daily 40 178 $69.36 $2,355.08 Homemaker Services 15 Minute 1 647 $3.64 Residential Habilitation - Facility $1,302,192.00 Based Daily 25 288 $180.86 Residential Habilitation - Facility $213,023.70 Based - DCFS Daily 15 82 $173.19 Residential Habilitation - Host $123,298.56 Home/Professional Parent Daily 4 224 $137.61
Professional Medication Monitoring - RN Per Episode 11 108 $7.58 $9,005.04 Professional Medication Monitoring - LPN Per Episode 5 87 $5.24 $2,279.40 Specialized Medical Equipment/Supplies/Assistive Technology - Purchase Per Episode 1 1 $663.20 $663.20 Specialized Medical Equipment/Supplies/Assistive Technology - Monthly Fee Monthly 3 7 $20.85 $437.85 Supported Living 15 Minute 94 2807 $4.97 $1,311,374.26 Non-Medical Transportation - Daily (Flat rate for all trips needed) Daily 47 177 $9.61 $79,945.59 Non-Medical Transportation - UTA Bus Pass Purchase Per Episode 14 11 $84.84 $13,065.36 Non-Medical Transportation - Mileage Per Mile 1 1630 $0.45 $733.50 Non-Medical Transportation - Per Trip (UTA) Per Episode 5 299 $3.79 $5,666.05 Service Animal Per Episode 1 10 $50.00 $500.00 GRAND TOTAL: $4,058,546.59 TOTAL ESTIMATED UNDUPLICATED PARTICIPANTS (from Table J-2-a) 130 FACTOR D (Divide grand total by number of participants) $31,219.59 AVERAGE LENGTH OF STAY ON THE WAIVER $337.00 Waiver Year: Year 2 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 $6.12 $52,705.44 Day Supports - daily (6 hr avg) Daily 40 178 $69.36 $493,843.20 Homemaker Services 15 Minute 1 647 $3.64 $2,355.08 Residential Habilitation - Facility Based Daily 25 288 $180.86 $1,302,192.00 Residential Habilitation - Facility Based - DCFS Daily 15 82 $173.19 $213,023.70 Residential Habilitation - Host Home/Professional Parent Daily 4 224 $137.61 $123,298.56
ABI_Amendment_11.3.17.docx