Service Plans - DENVER METRO
Service Plans - DENVER METRO
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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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DDRC
DPI
NMCS
RMHS
TRE
XPS
Waiver
CES
CFC
DD
SLS
State
WDS
ML
DVR
XPS
Service
Community Connector (CES)
Behavioral - Counseling
Behavioral - Consultation
Behavioral - Plan
Behavioral - Line Staff
PCA Support
Day Hab - Community
Homemaker - Basic
Homemaker - Enhanced
Mentorship
Personal Care
Respite
Job Coaching (SE)
Job Development (SE)
Overnight - Respite
Day Hab - Specialized
Medical Appointments
Transportation Services
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
02
Waiver, Service, Billing Code, Rate
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CES, Community Connector, H2021 - U7, $12.03, HX $12.36
CES, Homemaker Basic, S5130 - U7, $6.49, HX $6.88
CES, Homemaker Enhanced, S5130 - U7 22, $8.45, HX $8.80
CES, Personal Care, T1019 - U7, $6.96, HX $7.26
CES, Respite, S5150 - U7, $7.27, HX $7.59
CES, Respite Overnight, S5151 - U7, $311.25, HX $333.89
CES, Behavioral Line Staff, H2019 - U7, $7.95
CES, Behavioral Consultation, H2019 - U7 22 TG, $28.05
CES, Behavioral Counseling, H2019 - U7 TF TG, $28.05
CFC, Homemaker Basic, S5130 - U2, $6.49, HX $6.88
CFC, Personal Care, T1019 - U2, $6.96, HX $7.26
DD, HH1 Resident, T2016 - U3 TT, $83.57, HX $89.96
DD, HH2 Resident, T2016 - U3 22 TT, $136.26, HX $147.15
DD, HH3 Resident, T2016 - U3 TF TT, $168.17, HX $182.27
DD, HH4 Resident, T2016 - U3 TF TU, $207.12, HX $225.43
DD, HH5 Resident, T2016 - U3 TG TT, $241.12, HX $263.56
DD, HH6 Resident, T2016 - U3 TG TU, $307.64, HX $337.99
DD, HH7 Resident, T2016 - U3 SC TT, NR
DD, PCA Support, T2016 - U3 PCA, NR
DD, PCA1 Resident, T2016 - U3, $90.66, HX $97.76
DD, PCA2 Resident, T2016 - U3 22, $147.84, HX $159.95
DD, PCA3 Resident, T2016 - U3 TF, $182.54, HX $198.25
DD, PCA4 Resident, T2016 - U3 TF 22, $224.83, HX $245.18
DD, PCA5 Resident, T2016 - U3 TG, $261.82, HX $286.83
DD, PCA6 Resident, T2016 - U3 TG 22, $334.01, HX $367.77
DD, PCA7 Resident, T2016 - U3 SC, NR
DD, SCC1 Day Hab, T2021 - U3, $4.65, HX $4.97
DD, SCC2 Day Hab, T2021 - U3 22, $4.96, HX $5.29
DD, SCC3 Day Hab, T2021 - U3 TF, $5.45, HX $5.78
DD, SCC4 Day Hab, T2021 - U3 TF 22, $6.07, HX $6.40
DD, SCC5 Day Hab, T2021 - U3 TG, $7.07, HX $7.40
DD, SCC6 Day Hab, T2021 - U3 TG 22, $8.93, HX $9.26
DD, SCC7 Day Hab, T2021 - U3 SC, $12.61, HX $12.94
DD, SCC All Support, S5100 - U3 HB, $7.71
DD, FAC1 Day Hab, T2021 - U3 HQ, $4.02, HX $4.35
DD, FAC2 Day Hab, T2021 - U3 22 HQ, $4.31, HX $4.64
DD, FAC3 Day Hab, T2021 - U3 TF HQ, $4.67, HX $4.99
DD, FAC4 Day Hab, T2021 - U3 TF ST, $5.28, HX $5.61
DD, FAC5 Day Hab, T2021 - U3 TG HQ, $6.24, HX $6.56
DD, FAC6 Day Hab, T2021 - U3 TG ST, $8.44, HX $8.77
DD, FAC7 Day Hab, T2021 - U3 SC HQ, $12.61, HX $12.94
DD, FAC All Support, S5100 - U3, $7.71
DD, SE Job Coaching, T2019 - U3 SC, $16.80, HX $17.13
DD, SE Job Development 1&2, H2023 - U3, $16.80, HX $17.13
DD, SE Job Development 3&4, H2023 - U3 22, $16.80, HX $17.13
DD, SE Job Development 5&6, H2023 - U3 TF, $16.80, HX $17.13
DD, Behavioral Line Staff, H2019 - U3, $7.95
DD, Behavioral Consultation, H2019 - U3 22 TG, $28.05
DD, Behavioral Counseling, H2019 - U3 TF TG, $28.05
DD, Behavioral Counseling Group, H2019 - U3 TF HQ, $9.47
DD, Behavioral Plan Assessment, T2024 - U3 22, $28.05
DD, MB1 Transport, T2003 - U3, $13.41, HX $14.04
DD, MB2 Transport, T2003 - U3 22, $24.78, HX $25.93
DD, MB3 Transport, T2003 - U3 TF, $33.85, HX $35.33
DD, OTH Transport, T2004 - U3, $1.00
DD, Disposable Supplies, T2028 - U3, $1.00
SLS, SCC1 Day Hab, T2021 - U8, $4.65, HX $4.97
SLS, SCC2 Day Hab, T2021 - U8 22, $4.96, HX $5.29
SLS, SCC3 Day Hab, T2021 - U8 TF, $5.45, HX $5.78
SLS, SCC4 Day Hab, T2021 - U8 TF 22, $6.07, HX $6.40
SLS, SCC5 Day Hab, T2021 - U8 TG, $7.07, HX $7.40
SLS, SCC6 Day Hab, T2021 - U8 TG 22, $8.93, HX $9.26
SLS, SCC All Support, S5100 - U8 HB, $7.71
SLS, FAC1 Day Hab, T2021 - U8 HQ, $4.02, HX $4.35
SLS, FAC2 Day Hab, T2021 - U8 22 HQ, $4.31, HX $4.64
SLS, FAC3 Day Hab, T2021 - U8 TF HQ, $4.67, HX $4.99
SLS, FAC4 Day Hab, T2021 - U8 TF TU, $5.28, HX $5.61
SLS, FAC5 Day Hab, T2021 - U8 TG HQ, $6.24, HX $6.56
SLS, FAC6 Day Hab, T2021 - U8 TG TU, $8.44, HX $8.77
SLS, FAC All Support, S5100 - U8, $7.71
SLS, Homemaker Basic, S5130 - U8, $6.49, HX $6.88
SLS, Homemaker Enhanced, S5130 - U8 22, $8.45, HX $8.80
SLS, Mentorship, H2021 - U8, $13.18, HX $13.51
SLS, Personal Care, T1019 - U8, $6.96, HX $7.26
SLS, Respite, S5150 - U8, $7.27, HX $7.59
SLS, Respite Overnight, S5151 - U8, $311.35, HX $333.89
SLS, SE Job Coaching, T2019 - U8 SC, $16.80, HX $17.13
SLS, SE Job Development 1&2, H2023 - U8, $16.80, HX $17.13
SLS, SE Job Development 3&4, H2023 - U8 22, $16.80, HX $17.13
SLS, SE Job Development 5&6, H2023 - U8 TF, $16.80, HX $17.13
SLS, Behavioral Line Staff, H2019 - U8, $7.95
SLS, Behavioral Consultation, H2019 - U8 22 TG, $28.05
SLS, Behavioral Counseling, H2019 - U8 TF TG, $28.05
SLS, Behavioral Counseling Group, H2019 - U8 TF HQ, $9.47
SLS, Behavioral Plan Assessment, T2024 - U8 22, $28.05
SLS, MB1 Transport , T2003 - U8, $13.41, HX $14.04
SLS, MB2 Transport , T2003 - U8 22, $24.78, HX $25.93
SLS, MB3 Transport , T2003 - U8 TF, $33.85, HX $35.33
SLS, OTH Transport, T2004 - U8, $1.00
SLS, NDP Transport, T2003 - U8 SC, $14.67
SLS, Disposable Supplies, T2028 - U8, $1.00
State, Community Connections, $6.07
State, Specialized Habilitation, $5.28
State, Homemaker, HB $6.08, HE $9.12
State, Mentorship, $13.18
State, Personal Care, $7.54
State, Respite, $7.27
State, Respite Overnight, $311.35
State, Supported Employment, $16.80
State, Transport, $24.78
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:
