Service Plans - FT. COLLINS
Service Plans - FT. COLLINS
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Status
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Active
Inactive
Term'd
Medicaid ID
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Client Name
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First
Last
CCB/P
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FGI
Envision
Imagine
XPS
Waiver
CES
CFC
DD
SLS
State
ML
DVR
WDS
XPS
Service
Day Hab - Community
Day Hab - Specialized
Homemaker - Basic
Homemaker - Enhanced
Mentorship
Personal Care
Respite
Behavioral - Counseling
Behavioral - Consultation
Behavioral - Plan
Behavioral - Line Staff
Community Connector (CES)
Respite - Group
PCA Support
Job Coaching (SE)
Job Development (SE)
Workplace Assistance (SE)
Overnight - Respite
Transportation - MB1
Transportation - MB2
Transportation - MB3
Transportation - NDP
Transportation - BUS
Residential - Host Home
Residential - PCA
Disposable Supplies
SIS
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1 SIS
2 SIS
3 SIS
4 SIS
5 SIS
6 SIS
7 SIS
10 State
90 CES
99 XPS
From DOS
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MM
/
DD
YYYY
Thru DOS
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MM
/
DD
YYYY
POS
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12
99
Waiver, Service, Billing Code, Rate
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CES, Community Connector, H2021 - U7, $7.56
CES, Homemaker Basic, S5130 - U7, $6.36
CES, Homemaker Enhanced, S5130 - U7 SC, $8.28
CES, Personal Care, T1019 - U7, $6.82
CES, Respite, S5150 - U7, $7.12
CES, Respite Overnight, S5151 - U7, $305.12
CES, Respite Group, S5151 - U7 HQ, $7.12
CES, Behavioral Line Staff, H2019 - U7, $7.79
CES, Behavioral Consultation, H2019 - U7 22 TG, $27.49
CES, Behavioral Counseling, H2019 - U7 TF TG, $27.49
CFC, Homemaker Basic, S5130 - U2, $6.36
CFC, Personal Care, T1019 - U2, $6.82
DD, HH1 Resident, T2016 - U3 TT, $81.90
DD, HH2 Resident, T2016 - U3 22 TT, $133.53
DD, HH3 Resident, T2016 - U3 TF TT, $164.81
DD, HH4 Resident, T2016 - U3 TF TU, $202.98
DD, HH5 Resident, T2016 - U3 TG TT, $236.30
DD, HH6 Resident, T2016 - U3 TG TU, $301.49
DD, HH7 Resident, T2016 - U3 SC TT, NR
DD, PCA Support, T2016 - U3 PCA, NR
DD, PCA1 Resident, T2016 - U3, $88.85
DD, PCA2 Resident, T2016 - U3 22, $144.88
DD, PCA3 Resident, T2016 - U3 TF, $178.89
DD, PCA4 Resident, T2016 - U3 TF 22, $220.33
DD, PCA5 Resident, T2016 - U3 TG, $256.58
DD, PCA6 Resident, T2016 - U3 TG 22, $327.33
DD, PCA7 Resident, T2016 - U3 SC, NR
DD, SCC1 Day Hab, T2021 - U3, $4.56
DD, SCC2 Day Hab, T2021 - U3 22, $4.86
DD, SCC3 Day Hab, T2021 - U3 TF, $5.34
DD, SCC4 Day Hab, T2021 - U3 TF 22, $5.95
DD, SCC5 Day Hab, T2021 - U3 TG, $6.93
DD, SCC6 Day Hab, T2021 - U3 TG 22, $8.75
DD, SCC7 Day Hab, T2021 - U3 SC, $12.36
DD, SCC All Support, S5100 - U3 HB, $7.56
DD, FAC1 Day Hab, T2021 - U3 HQ, $3.94
DD, FAC2 Day Hab, T2021 - U3 22 HQ, $4.22
DD, FAC3 Day Hab, T2021 - U3 TF HQ, $4.58
DD, FAC4 Day Hab, T2021 - U3 TF ST, $5.17
DD, FAC5 Day Hab, T2021 - U3 TG HQ, $6.12
DD, FAC6 Day Hab, T2021 - U3 TG ST, $8.27
DD, FAC7 Day Hab, T2021 - U3 SC HQ, $12.36
DD, FAC All Support, S5100 - U3, $7.56
DD, SE Job Coaching, T2019 - U3 SC, $16.46
DD, SE Job Development 1&2, H2023 - U3, $16.46
DD, SE Job Development 3&4, H2023 - U3 22, $16.46
DD, SE Job Development 5&6, H2023 - U3 TF, $16.46
DD, SE Workplace Assistance, T2019 - U3 HB, $14.65
DD, Behavioral Line Staff, H2019 - U3, $7.79
DD, Behavioral Consultation, H2019 - U3 22 TG, $27.49
DD, Behavioral Counseling, H2019 - U3 TF TG, $27.49
DD, Behavioral Counseling Group, H2019 - U3 TF HQ, $9.28
DD, Behavioral Plan Assessment, T2024 - U3 22, $27.49
DD, MB1 Transport , T2003 - U3, $13.14
DD, MB2 Transport , T2003 - U3 22, $24.28
DD, MB3 Transport , T2003 - U3 TF, $33.17
DD, OTH Transport, T2004 - U3, $1.00
DD, Disposable Supplies, T2028 - U3, $1.00
SLS, SCC1 Day Hab, T2021 - U8, $4.56
SLS, SCC2 Day Hab, T2021 - U8 22, $4.86
SLS, SCC3 Day Hab, T2021 - U8 TF, $5.34
SLS, SCC4 Day Hab, T2021 - U8 TF 22, $5.95
SLS, SCC5 Day Hab, T2021 - U8 TG, $6.93
SLS, SCC6 Day Hab, T2021 - U8 TG 22, $8.75
SLS, SCC All Support, S5100 - U8 HB, $7.56
SLS, FAC1 Day Hab, T2021 - U8 HQ, $3.94
SLS, FAC2 Day Hab, T2021 - U8 22 HQ, $4.22
SLS, FAC3 Day Hab, T2021 - U8 TF HQ, $4.58
SLS, FAC4 Day Hab, T2021 - U8 TF TU, $5.17
SLS, FAC5 Day Hab, T2021 - U8 TG HQ, $6.12
SLS, FAC6 Day Hab, T2021 - U8 TG TU, $8.27
SLS, FAC All Support,, S5100 - U8, $7.56
SLS, Homemaker Basic, S5130 - U8, $6.36
SLS, Homemaker Enhanced, S5130 - U8 SC, $8.28
SLS, Mentorship, H2021 - U8, $12.92
SLS, Personal Care, T1019 - U8, $6.82
SLS, Respite, S5150 - U8, $7.12
SLS, Respite Overnight, S5151 - U8, $305.12
SLS, SE Job Coaching, T2019 - U8 SC, $16.46
SLS, SE Job Development 1&2, H2023 - U8, $16.46
SLS, SE Job Development 3&4, H2023 - U8 22, $16.46
SLS, SE Job Development 5&6, H2023 - U8 TF, $16.46
SLS, SE Workplace Assistance, T2019 - U8 HB, $14.65
SLS, Behavioral Line Staff, H2019 - U8, $7.79
SLS, Behavioral Consultation, H2019 - U8 22 TG, $27.49
SLS, Behavioral Counseling, H2019 - U8 TF TG, $27.49
SLS, Behavioral Counseling Group, H2019 - U8 TF HQ, $9.28
SLS, Behavioral Plan Assessment, T2024 - U8 22, $27.49
SLS, MB1 Transport , T2003 - U8, $13.14
SLS, MB2 Transport , T2003 - U8 22, $24.28
SLS, MB3 Transport , T2003 - U8 TF, $33.17
SLS, OTH Transport, T2004 - U8, $1.00
SLS, NDP Transport, T2003 - U8 SC, $14.38
SLS, Disposable Supplies, T2028 - U8, $1.00
State, Community Connections, $5.95
State, Specialized Habilitation, $5.17
State, Homemaker, HB $6.36, HE $8.28
State, Mentorship, $12.92
State, Personal Care, $6.82
State, Respite, $7.12
State, Respite Overnight, $305.12
State, Supported Employment, $16.46
State, Transport, $24.28
DVR, Supported Employment, PO#, PO Rate
XPS, Private Pay, NR
Medicaid Billing Code
Proc Code
Mod1
Mod2
Mod3
Mod4
Medicaid Billing Rate
$
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Dollars
Cents
Annual Units
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Monthly Units
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Notes:
