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
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DD
YYYY
POS
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12
99
02
Waiver, Service, Billing Code, Rate
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CES, Community Connector, H2021 - U7, $12.22, HX $12.56
CES, Homemaker Basic, S5130 - U7, $6.60, HX $6.99
CES, Homemaker Enhanced, S5130 - U7 22, $8.59, HX $8.94
CES, Personal Care, T1019 - U7, $7.07, HX $7.38
CES, Respite, S5150 - U7, $7.39, HX $7.71
CES, Respite Overnight, S5151 - U7, $316.33, HX $339.23
CES, Behavioral Line Staff, H2019 - U7, $8.08
CES, Behavioral Consultation, H2019 - U7 22 TG, $28.50
CES, Behavioral Counseling, H2019 - U7 TF TG, $28.50
CFC, Homemaker Basic, S5130 - U2, $6.60, HX $6.99
CFC, Personal Care, T1019 - U2, $7.07, HX $7.38
DD, HH1 Resident, T2016 - U3 TT, $84.91, HX $91.40
DD, HH2 Resident, T2016 - U3 22 TT, $138.44, HX $149.50
DD, HH3 Resident, T2016 - U3 TF TT, $170.86, HX $185.19
DD, HH4 Resident, T2016 - U3 TF TU, $210.43, HX $229.04
DD, HH5 Resident, T2016 - U3 TG TT, $244.98, HX $267.78
DD, HH6 Resident, T2016 - U3 TG TU, $312.56, HX $343.40
DD, HH7 Resident, T2016 - U3 SC TT, NR
DD, PCA Support, T2016 - U3 PCA, NR
DD, PCA1 Resident, T2016 - U3, $92.11, HX $99.32
DD, PCA2 Resident, T2016 - U3 22, $150.21, HX $162.51
DD, PCA3 Resident, T2016 - U3 TF, $185.46, HX $201.42
DD, PCA4 Resident, T2016 - U3 TF 22, $228.43, HX $249.10
DD, PCA5 Resident, T2016 - U3 TG, $266.01, HX $291.42
DD, PCA6 Resident, T2016 - U3 TG 22, $339.35, HX $373.65
DD, PCA7 Resident, T2016 - U3 SC, NR
DD, SCC1 Day Hab, T2021 - U3, $4.72, HX $5.05
DD, SCC2 Day Hab, T2021 - U3 22, $5.04, HX $5.37
DD, SCC3 Day Hab, T2021 - U3 TF, $5.54, HX $5.87
DD, SCC4 Day Hab, T2021 - U3 TF 22, $6.17, HX $6.50
DD, SCC5 Day Hab, T2021 - U3 TG, $7.18, HX $7.52
DD, SCC6 Day Hab, T2021 - U3 TG 22, $9.07, HX $9.41
DD, SCC7 Day Hab, T2021 - U3 SC, $12.81, HX $13.15
DD, SCC All Support, S5100 - U3 HB, $7.83
DD, FAC1 Day Hab, T2021 - U3 HQ, $4.08, HX $4.42
DD, FAC2 Day Hab, T2021 - U3 22 HQ, $4.38, HX $4.71
DD, FAC3 Day Hab, T2021 - U3 TF HQ, $4.74, HX $5.07
DD, FAC4 Day Hab, T2021 - U3 TF ST, $5.36, HX $5.70
DD, FAC5 Day Hab, T2021 - U3 TG HQ, $6.34, HX $6.66
DD, FAC6 Day Hab, T2021 - U3 TG ST, $8.58, HX $8.91
DD, FAC7 Day Hab, T2021 - U3 SC HQ, $12.81, HX $13.15
DD, FAC All Support, S5100 - U3, $7.83
DD, SE Job Coaching, T2019 - U3 SC, $17.07, HX $17.40
DD, SE Job Development 1&2, H2023 - U3, $17.07, HX $17.40
DD, SE Job Development 3&4, H2023 - U3 22, $17.07, HX $17.40
DD, SE Job Development 5&6, H2023 - U3 TF, $17.07, HX $17.40
DD, Behavioral Line Staff, H2019 - U3, $8.08
DD, Behavioral Consultation, H2019 - U3 22 TG, $28.50
DD, Behavioral Counseling, H2019 - U3 TF TG, $28.50
DD, Behavioral Counseling Group, H2019 - U3 TF HQ, $9.62
DD, Behavioral Plan Assessment, T2024 - U3 22, $28.50
DD, MB1 Transport, T2003 - U3, $13.62, HX $14.26
DD, MB2 Transport, T2003 - U3 22, $25.18, HX $26.34
DD, MB3 Transport, T2003 - U3 TF, $34.39, HX $35.90
DD, OTH Transport, T2004 - U3, $1.00
DD, Disposable Supplies, T2028 - U3, $1.00
SLS, SCC1 Day Hab, T2021 - U8, $4.72, HX $5.05
SLS, SCC2 Day Hab, T2021 - U8 22, $5.04, HX $5.37
SLS, SCC3 Day Hab, T2021 - U8 TF, $5.54, HX $5.87
SLS, SCC4 Day Hab, T2021 - U8 TF 22, $6.17, HX $6.50
SLS, SCC5 Day Hab, T2021 - U8 TG, $7.18, HX $7.52
SLS, SCC6 Day Hab, T2021 - U8 TG 22, $9.07, HX $9.41
SLS, SCC All Support, S5100 - U8 HB, $7.83
SLS, FAC1 Day Hab, T2021 - U8 HQ, $4.08, HX $4.42
SLS, FAC2 Day Hab, T2021 - U8 22 HQ, $4.38, HX $4.71
SLS, FAC3 Day Hab, T2021 - U8 TF HQ, $4.74, HX $5.07
SLS, FAC4 Day Hab, T2021 - U8 TF TU, $5.36, HX $5.70
SLS, FAC5 Day Hab, T2021 - U8 TG HQ, $6.34, HX $6.66
SLS, FAC6 Day Hab, T2021 - U8 TG TU, $8.58, HX $8.91
SLS, FAC All Support, S5100 - U8, $7.83
SLS, Homemaker Basic, S5130 - U8, $6.60, HX $6.99
SLS, Homemaker Enhanced, S5130 - U8 22, $8.59, HX $8.94
SLS, Mentorship, H2021 - U8, $13.39, HX $13.73
SLS, Personal Care, T1019 - U8, $7.07, HX $7.38
SLS, Respite, S5150 - U8, $7.39, HX $7.71
SLS, Respite Overnight, S5151 - U8, $316.33, HX $339.23
SLS, SE Job Coaching, T2019 - U8 SC, $17.07, HX $17.40
SLS, SE Job Development 1&2, H2023 - U8, $17.07, HX $17.40
SLS, SE Job Development 3&4, H2023 - U8 22, $17.07, HX $17.40
SLS, SE Job Development 5&6, H2023 - U8 TF, $17.07, HX $17.40
SLS, Behavioral Line Staff, H2019 - U8, $8.08
SLS, Behavioral Consultation, H2019 - U8 22 TG, $28.50
SLS, Behavioral Counseling, H2019 - U8 TF TG, $28.50
SLS, Behavioral Counseling Group, H2019 - U8 TF HQ, $9.62
SLS, Behavioral Plan Assessment, T2024 - U8 22, $28.50
SLS, MB1 Transport , T2003 - U8, $13.62, HX $14.26
SLS, MB2 Transport , T2003 - U8 22, $25.18, HX $26.34
SLS, MB3 Transport , T2003 - U8 TF, $34.39, HX $35.90
SLS, OTH Transport, T2004 - U8, $1.00
SLS, NDP Transport, T2003 - U8 SC, $14.90
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:
