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
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
/
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
CES, Homemaker Basic, S5130 - U7, $6.08
CES, Homemaker Enhanced, S5130 - U7 22, $9.12
CES, Personal Care, T1019 - U7, $7.54
CES, Respite, S5150 - U7, $7.27
CES, Respite Overnight, S5151 - U7, $311.25
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
CES, Behavioral Counseling Group, H2019 - U7 TF HQ, $9.47
CES, Behavioral Plan Assessment, T2024 - U7 22, $28.05
DD, HH1 Resident, T2016 - U3 TT, $83.57
DD, HH2 Resident, T2016 - U3 22 TT, $136.26
DD, HH3 Resident, T2016 - U3 TF TT, $168.17
DD, HH4 Resident, T2016 - U3 TF TU, $207.12
DD, HH5 Resident, T2016 - U3 TG TT, $241.12
DD, HH6 Resident, T2016 - U3 TG TU, $307.64
DD, HH7 Resident, T2016 - U3 SC TT, NR
DD, PCA Support, T2016 - U3 PCA, $1.00
DD, PCA1 Resident, T2016 - U3, $90.66
DD, PCA2 Resident, T2016 - U3 22, $147.84
DD, PCA3 Resident, T2016 - U3 TF, $182.54
DD, PCA4 Resident, T2016 - U3 TF 22, $224.83
DD, PCA5 Resident, T2016 - U3 TG, $261.82
DD, PCA6 Resident, T2016 - U3 TG 22, $334.01
DD, PCA7 Resident, T2016 - U3 SC, NR
DD, SCC1 Day Hab, T2021 - U3, $4.65
DD, SCC2 Day Hab, T2021 - U3 22, $4.96
DD, SCC3 Day Hab, T2021 - U3 TF, $5.45
DD, SCC4 Day Hab, T2021 - U3 TF 22, $6.07
DD, SCC5 Day Hab, T2021 - U3 TG, $7.07
DD, SCC6 Day Hab, T2021 - U3 TG 22, $8.93
DD, SCC7 Day Hab, T2021 - U3 SC, $12.61
DD, SCC All Support, S5100 - U3 HB, $7.71
DD, FAC1 Day Hab, T2021 - U3 HQ, $4.02
DD, FAC2 Day Hab, T2021 - U3 22 HQ, $4.31
DD, FAC3 Day Hab, T2021 - U3 TF HQ, $4.67
DD, FAC4 Day Hab, T2021 - U3 TF ST, $5.28
DD, FAC5 Day Hab, T2021 - U3 TG HQ, $6.24
DD, FAC6 Day Hab, T2021 - U3 TG ST, $8.44
DD, FAC7 Day Hab, T2021 - U3 SC HQ, $12.61
DD, FAC All Support, S5100 - U3, $7.71
DD, SE Job Coaching, T2019 - U3 SC, $16.80
DD, SE Job Development 1&2, H2023 - U3, $16.80
DD, SE Job Development 3&4, H2023 - U3 22, $16.80
DD, SE Job Development 5&6, H2023 - U3 TF, $16.80
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
DD, MB2 Transport, T2003 - U3 22, $24.78
DD, MB3 Transport, T2003 - U3 TF, $33.85
DD, OTH Transport, T2004 - U3, $1.00
DD, Disposable Supplies, T2028 - U3, $1.00
SLS, SCC1 Day Hab, T2021 - U8, $4.65
SLS, SCC2 Day Hab, T2021 - U8 22, $4.96
SLS, SCC3 Day Hab, T2021 - U8 TF, $5.45
SLS, SCC4 Day Hab, T2021 - U8 TF 22, $6.07
SLS, SCC5 Day Hab, T2021 - U8 TG, $7.07
SLS, SCC6 Day Hab, T2021 - U8 TG 22, $8.93
SLS, SCC All Support, S5100 - U8 HB, $7.71
SLS, FAC1 Day Hab, T2021 - U8 HQ, $4.02
SLS, FAC2 Day Hab, T2021 - U8 22 HQ, $4.31
SLS, FAC3 Day Hab, T2021 - U8 TF HQ, $4.67
SLS, FAC4 Day Hab, T2021 - U8 TF TU, $5.28
SLS, FAC5 Day Hab, T2021 - U8 TG HQ, $6.24
SLS, FAC6 Day Hab, T2021 - U8 TG TU, $8.44
SLS, FAC All Support, S5100 - U8, $7.71
SLS, Homemaker Basic, S5130 - U8, $6.08
SLS, Homemaker Enhanced, S5130 - U8 22, $9.12
SLS, Mentorship, H2021 - U8, $13.18
SLS, Personal Care, T1019 - U8, $7.54
SLS, Respite, S5150 - U8, $7.27
SLS, Respite Overnight, S5151 - U8, $311.35
SLS, SE Job Coaching, T2019 - U8 SC, $16.80
SLS, SE Job Development 1&2, H2023 - U8, $16.80
SLS, SE Job Development 3&4, H2023 - U8 22, $16.80
SLS, SE Job Development 5&6, H2023 - U8 TF, $16.80
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
SLS, MB2 Transport , T2003 - U8 22, $24.78
SLS, MB3 Transport , T2003 - U8 TF, $33.85
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, $4.88
State, Specialized Habilitation, $4.09
State, Homemaker, HB $4.50, HE $7.32
State, Mentorship, $11.97
State, Personal Care, $5.95
State, Respite, $5.88
State, Respite Overnight, $234.72
State, Supported Employment, $15.60
State, Transport, $15.13
DVR, Supported Employment, PO#, PO Rate
XPS, Private Pay, Individual Rate
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:
