Supports Specialized Medical Item 384 5 $ 407.12 $ 781,670.40 Equipment Speech Therapy Visit 44 72 $ 78.52 $ 248,751.36 Transitional Assistance Episode 40 2 $ 1,108.42 $ 88,673.60 –RH Transportation One-Way 378 300 $ 37.06 $ 4,202,604.00 Trip $132,221,589.16 GRAND TOTAL: 676 TOTAL ESTIMATED UNDUPLICATED PARTICIPANTS (from Table J-2-a) $195,594.07 FACTOR D (Divide grand total by number of participants) 344 AVERAGE LENGTH OF STAY ON THE WAIVER 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 Residential Habilitation Per Diem 621 347 $ 564.18 $ 121,573,455.66 Supported Employment 15 Minute 117 1,032 $ 10.23 $ 1,235,211.12 Assisted Living Services Per Diem 35 347 $ 116.90 $ 1,419,750.50 Community Based Day 15 Minute 212 3,558 $ 5.77 $ 4,352,287.92 Supports Day Services Per Diem 343 126 $ 115.08 $ 4,973,527.44 Occupational Therapy Visit 104 53 $ 79.64 $ 438,975.68 Physical Therapy Visit 140 56 $ 76.39 $ 598,897.60 Shared Living-24 Hour Per Diem 49 347 $ 236.53 $ 4,021,719.59 Supports Specialized Medical Item 401 5 $ 422.59 $ 847,292.95 Equipment Speech Therapy Visit 46 72 $ 81.50 $ 269,928.00 Transitional Assistance Episode 30 2 $ 1,150.54 $ 69,032.40 –RH Transportation One-Way 394 303 $ 38.47 $ 4,592,625.54 Trip
Supports Specialized Medical Equipment Item 384 5 $ 407.12 $ 781,670.40 Speech Therapy Visit 44 72 $ 78.52 $ 248,751.36 Transitional Assistance –RH Episode 40 2 $ 1,108.42 $ 88,673.60 Transportation One-Way Trip 378 300 $ 37.06 $ 4,202,604.00 GRAND TOTAL: $132,221,589.16 TOTAL ESTIMATED UNDUPLICATED PARTICIPANTS (from Table J-2-a) 676 FACTOR D (Divide grand total by number of participants) $195,594.07 AVERAGE LENGTH OF STAY ON THE WAIVER 344 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 Residential Habilitation Per Diem 621 347 $ 564.18 $ 121,573,455.66 Supported Employment 15 Minute 117 1,032 $ 10.23 $ 1,235,211.12 Assisted Living Services Per Diem 35 347 $ 116.90 $ 1,419,750.50 Community Based Day Supports 15 Minute 212 3,558 $ 5.77 $ 4,352,287.92 Day Services Per Diem 343 126 $ 115.08 $ 4,973,527.44 Occupational Therapy Visit 104 53 $ 79.64 $ 438,975.68 Physical Therapy Visit 140 56 $ 76.39 $ 598,897.60 Shared Living-24 Hour Supports Per Diem 49 347 $ 236.53 $ 4,021,719.59 Specialized Medical Equipment Item 401 5 $ 422.59 $ 847,292.95 Speech Therapy Visit 46 72 $ 81.50 $ 269,928.00 Transitional Assistance –RH Episode 30 2 $ 1,150.54 $ 69,032.40 Transportation One-Way Trip 394 303 $ 38.47 $ 4,592,625.54
ABI-RH%20Renewal%20Application-Clean%20draft-October%202017.docx