COMMUNITY CHOICES WAIVER Waiver Eligibility Segment Code

Transcription

1 08 Transition Service Community Transition, Waiver T2038 Lifetime cap $1, Transition Intensive Support Coordination Community Choices High Risk Case Management Z0178 $ Support Coordination Community Choices Case Management Z0195 $ Basic Assessment and Approval Basic Assessment and Approval Z0640 $ Complex Assessment and Approval Complex Assessment and Approval Z0642 $ Ramp Ramp Z0060 Lift Lift Z0061 Bathroom Bathroom Z0062 Other Adaptations Services Services Shared by 2 Participants Other Adaptations per 15 minutes per 15 minutes, 2 participants served Z0063 S Minutes $2.83 S5125 UN 15 Minutes $2.31 Page 1of 5

2 Services Shared by 3 Participants Services-a.m./p.m., provided in the morning Services-a.m./p.m., provided in the evening 85 Adult Day Health Care Service Therapy Evaluation, Therapy Re-Evaluation, Therapy, in the home Therapy-Home Care Training, Family, per 15 minutes, 3 participants served provided in the morning provided in the evening Medical Rehabilitation Day Program Physical Therapy Evaluation, Physical Therapy Reevaluation, Physical Therapy, in the home Physical Therapy Home Care Training, Family, per session, S5125 UP 15 Minutes $2.02 S5126 UF S5126 UH HR Minutes $2. + provider specific transportation rate Max of 40 units/day or 200 units/week GP GP S9131 S5111 GP Page 2of 5

3 Therapy-Home Care Training, Non-Family, Therapy Evaluation, Therapy Re-Evaluation, Therapy, in the home Therapy- Home Care Training, Family, Therapy- Home Care Training, Non-Family, Therapy-Speech, Language, Hearing Evaluation, Therapy- Speech/Language- Swallowing Function Evaluation, Physical Therapy Home Care Training, Non- Occupational Therapy Evaluation, Occupational Therapy Re- Evaluation, Occupational Therapy, in the home Occupational Therapy- Home Care Training, Occupational Therapy- Home care training, Non- Speech, Language, Hearing Evaluation, Swallowing Function Evaluation, S5116 GP GO GO S9129 S5111 GO S5116 GO GN GN Page 3of 5

4 Therapy-Speech, Language, Hearing Therapy, Therapy- Speech/Language-Oral Function Therapy, Speech, Language, Hearing Therapy, Oral Function Therapy, GN GN 78 Nurse Practitioner 78 Nursing Practitioner Visit in home R.N. L.P.N. Nurse Practitioner Nurse Practitioner Visit in home R.N. L.P.N. Nursing Care by R.N. Nursing Care, in the home by R.N. Nursing Care by L.P.N. Nursing Care, in the home by L.P.N. 16 Personal Emergency Response (PERS) (Assistive Devices & Medical Supplies) Installation Personal Emergency Response (PERS), Installation T1001 S0274 $.22 $.22 T1001 TD $.22 T1001 TE $58.00 T1030 T1031 Z0058 $.22 $58.00 Initial Installation 16 Personal Emergency Response (PERS) (Assistive Devices & Medical Supplies) Personal Emergency Response (PERS), Z0059 Maintenance $27.00 Page 4of 5

5 17 TeleCare - Activity & Sensor Monitoring- Equipment Installation & Removal (by home health agency) Emergency Response System, Installation & Testing S5160 One Time at Installation $ TeleCare Activity & Sensor Monitoring- Monitoring, Routine Maintenance & Rental (by home health agency) Emergency Response system, Per Month (Excludes installation & testing) S5161 $ AM Home Delivered Meals Home Delivered Meals S5170 /Meal Max of $7.00 per service/meal & Max of 2 meals per day Support Service, in home Based, Not Overnight (by ADHC) (by assisted living facility) (by nursing facility) Respite Care Services T Minutes $2.83 group setting not in the home not in the home, group setting T1005 HQ 15 Minutes $2.66 Max of 40 units per day H0045 Daily with $95.00 H0045 HQ Daily with $ (by respite care center) not in the home, group setting, services provided at night H0045 HQ, UJ Daily with $ Page 5of 5