Transcription
Division of Developmental DisabilitiesRATE BOOKEffective DateOctober 1, 2019Revision DateOctober 21, 2019Division of Developmental Disabilities1789 W Jefferson St.Phoenix, AZ 85007
Arizona Department of Economic Security, Division of Developmental DisabilitiesTable of Contents - Effective October 1, 2019Introduction to the Rate BookSummary of ChangesSummarized Listing of Rates by Service7810RatesCPT/HCPCS Codes & Modifiers for Services29Home-Based ServicesAttendant CareHabilitation, Community Protection and Treatment, HourlyHabilitation, SupportHomemakerRespite, HourlyRespite, Daily33353636373738Living ServicesHabilitation, Individually Designed Living Arrangement (Client Hour)Habilitation, Individually Designed Living Arrangement, Daily (Client Hour)Habilitation, Individually Designed Living Arrangement (Per Resident Per Day)39414142Day Treatment and Training ServicesDay Treatment and Training, AdultDay Treatment and Training, Children (After School)Day Treatment and Training, Children (Summer)Day Treatment and Training, Adult RuralDay Treatment and Training, Children Rural (After School & Summer)Behaviorally or Medically Intense Day Treatment and Training, AdultBehaviorally or Medically Intense Day Treatment and Training, Children (After School & Summer)8688898990909191Developmental Home ServicesHabilitation, Vendor Supported Developmental Home (Adult)Habilitation, Vendor Supported Developmental Home (Child)Room and Board, Vendor Supported Developmental Home (Child and Adult)93939393Page 2Revision Date October, 21, 2019Effective October, 1, 2019
Group Home ServicesHabilitation, Community Protection and Treatment Group HomeHabilitation, Group HomeHabilitation, Nursing Supported Group Home Level IHabilitation, Nursing Supported Group Home Level IIHabilitation, Nursing Supported Group Home Level IIIRoom and Board, All Group Homes (Maricopa County)Room and Board, All Group Homes (Pima County)Room and Board, All Group Homes (Apache, Coconino, Navajo & Yavapai Counties)Room and Board, All Group Homes(Cochise, Gila, Graham, Greenlee, La Paz, Mojave, Pinal, Santa Cruz & Yuma Counties)9495959595959698100Professional ServicesHome Health AideNursing Visit, RN Base RateNursing Visit, RN Service Delivery Requiring Travel of 50 to 100 MilesNursing Visit, RN Service Delivery Requiring Travel of More Than 100 MilesNursing Visit, LPN Base RateNursing Visit, LPN Service Delivery Requiring Travel of 50 to 100 MilesNursing Visit, LPN Service Delivery Requiring Travel of More Than 100 MilesNursing, Intermittent, RN Base RateNursing, Intermittent, RN Service Delivery Requiring Travel of 50 to 100 MilesNursing, Intermittent, RN Service Delivery Requiring Travel of More Than 100 MilesNursing, Intermittent, LPN Base RateNursing, Intermittent, LPN Service Delivery Requiring Travel of 50 to 100 MilesNursing, Intermittent, LPN Service Delivery Requiring Travel of More Than 100 MilesNursing, Continuous/Respite, RN Base RateNursing, Continuous/Respite, RN Service Delivery Requiring Travel of 50 to 100 MilesNursing, Continuous/Respite, RN Service Delivery Requiring Travel of More Than 100 MilesNursing, Continuous/Respite, LPN Base RateNursing, Continuous/Respite, LPN Service Delivery Requiring Travel of 50 to 100 MilesNursing, Continuous/Respite, LPN Service Delivery Requiring Travel of More Than 100 112113114115116Occupational Therapy/Early Intervention, Clinical Setting, Base RateOccupational Therapy/Early Intervention, Clinical Setting, Tier 1Occupational Therapy/Early Intervention, Clinical Setting, Tier 2Occupational Therapy/Early Intervention, Clinical Setting, Tier 3Page 3Revision Date October, 21, 2019102117117117117Effective October, 1, 2019
Occupational Therapy/Early Intervention, Natural Setting, Base RateOccupational Therapy/Early Intervention, Natural Setting, Tier 1Occupational Therapy/Early Intervention, Natural Setting, Tier 2Occupational Therapy/Early Intervention, Natural Setting, Tier 3Occupational Therapy/Early Intervention, Evaluation, Clinical SettingOccupational Therapy/Early Intervention, Evaluation, Natural SettingOccupational Therapy/Early Intervention Assistant, Clinical Setting, Base RateOccupational Therapy/Early Intervention Assistant, Clinical Setting, Tier 1Occupational Therapy/Early Intervention Assistant, Clinical Setting, Tier 2Occupational Therapy/Early Intervention Assistant, Clinical Setting, Tier 3Occupational Therapy/Early Intervention Assistant, Natural Setting, Base RateOccupational Therapy/Early Intervention Assistant, Natural Setting, Tier 1Occupational Therapy/Early Intervention Assistant, Natural Setting, Tier 2Occupational Therapy/Early Intervention Assistant, Natural Setting, Tier l Therapy/Early Intervention, Clinical Setting, Base RatePhysical Therapy/Early Intervention, Clinical Setting, Tier 1Physical Therapy/Early Intervention, Clinical Setting, Tier 2Physical Therapy/Early Intervention, Clinical Setting, Tier 3Physical Therapy/Early Intervention, Natural Setting, Base RatePhysical Therapy/Early Intervention, Natural Setting, Tier 1Physical Therapy/Early Intervention, Natural Setting, Tier 2Physical Therapy/Early Intervention, Natural Setting, Tier 3Physical Therapy/Early Intervention, Evaluation, Clinical SettingPhysical Therapy/Early Intervention, Evaluation, Natural SettingPhysical Therapy/Early Intervention Assistant, Clinical Setting, Base RatePhysical Therapy/Early Intervention Assistant, Clinical Setting, Tier 1Physical Therapy/Early Intervention Assistant, Clinical Setting, Tier 2Physical Therapy/Early Intervention Assistant, Clinical Setting, Tier 3Physical Therapy/Early Intervention Assistant, Natural Setting, Base RatePhysical Therapy/Early Intervention Assistant, Natural Setting, Tier 1Physical Therapy/Early Intervention Assistant, Natural Setting, Tier 2Physical Therapy/Early Intervention Assistant, Natural Setting, Tier 26126Speech Therapy/Early Intervention, Clinical Setting, Base RateSpeech Therapy/Early Intervention, Clinical Setting, Tier 1127127Page 4Revision Date October, 21, 2019Effective October, 1, 2019
Speech Therapy/Early Intervention, Clinical Setting, Tier 2Speech Therapy/Early Intervention, Clinical Setting, Tier 3Speech Therapy/Early Intervention, Natural Setting, Base RateSpeech Therapy/Early Intervention, Natural Setting, Tier 1Speech Therapy/Early Intervention, Natural Setting, Tier 2Speech Therapy/Early Intervention, Natural Setting, Tier 3Speech Therapy/Early Intervention, Evaluation, Clinical SettingSpeech Therapy/Early Intervention, Evaluation, Natural SettingSpeech Therapy/Early Intervention Assistant, Clinical Setting, Base RateSpeech Therapy/Early Intervention Assistant, Clinical Setting, Tier 1Speech Therapy/Early Intervention Assistant, Clinical Setting, Tier 2Speech Therapy/Early Intervention Assistant, Clinical Setting, Tier 3Speech Therapy/Early Intervention Assistant, Natural Setting, Base RateSpeech Therapy/Early Intervention Assistant, Natural Setting, Tier 1Speech Therapy/Early Intervention Assistant, Natural Setting, Tier 2Speech Therapy/Early Intervention Assistant, Natural Setting, Tier espiratory Therapy, Clinical SettingRespiratory Therapy, Natural Setting131131Employment Support ServicesCenter Based EmploymentGroup Supported EmploymentIndividual Supported Employment, Job CoachingIndividual Supported Employment, Job DevelopmentTransition to EmploymentEmployment Supported AideCareer Preparation & Readiness132135136138138138139139Specialized Habilitation ServicesHabilitation with Music TherapyHabilitation, Consultation Assessment & PlanningHabilitation, Consultation Licensed PsychologistHabilitation, Consultation Licensed Behavior Analyst/BCBAHabilitation, Consultation Board Certified Assistant Behavior AnalystHabilitation, Early Childhood Autism Specialized BCBA-D140142142143143144145Page 5Revision Date October, 21, 2019Effective October, 1, 2019
Habilitation, Early Childhood Autism Specialized Licensed Behavior AnalystHabilitation, Early Childhood Autism Specialized Masters LevelHabilitation, Early Childhood Autism Specialized Bachelors LevelHabilitation, Early Childhood Autism Specialized Hourly Habilitation145145145145Transportation ServicesRegular Scheduled Daily Transportation (Day Program)Regular Scheduled Daily Transportation (Employment Program)Single Person Modified, Regularly Scheduled Daily TransportationExtensive Distance, Regulary Scheduled Daily TransportationTransportation, Family and Friend146147147148149149Habilitation, Community Protection and Treatment, Group Home & Habilitation, Group Home IntroductionHabilitation, Community Protection and Treatment Group Home (Statewide, excludes Flagstaff)Habilitation, Community Protection and Treatment Group Home (Flagstaff Only)Habilitation Group Home (Statewide, excludes Flagstaff) TABLE 1Habilitation Group Home (Flagstaff Only) TABLE 1Habilitation Group Home (Statewide, excludes Flagstaff) TABLE 2Habilitation Group Home (Flagstaff Only) TABLE 2150152164176180184202Arizona Independent Provider Rate Schedule220Appendix 1 - Employment Related Services, List of High/Low Density Cities & Zip Codes238Appendix 2 - Listing of Tier Assignment by Zip Code243Appendix 3 - Listing of Urban-Rural Assignments by County252Page 6Revision Date October, 21, 2019Effective October, 1, 2019
Arizona Department of Economic Security, Division of Developmental DisabilitiesSFY 20 Benchmark and Adopted RatesIntroductionPurpose of This ScheduleThis schedule contains the rates for services with dates of service on or after October 1, 2019 The Schedule contains two columns ofrates. The first column labeled “Benchmark Rate” contains the rates that the Division calculated through its rate setting process. Thesecond column labeled “Adopted Rate” contains the rates that the Division adopted for the published rate schedule and these are therates to be used for each service when billing the Division.In accordance with Arizona Administrative Codes R9-22-702, R9-27-702, R9-28-702, R9-30-702 and R9-31-702, Division ALTCSmembers cannot be billed by the Qualified Vendor for AHCCCS covered services, including co-payments. ALTCS members may alsonot be billed for services that are not paid due to the failure of the Qualified Vendor to comply with Division notification or billingrequirements.Qualified Vendors cannot request additional payments from the member or family for Medicaid covered services. However, a providermay request additional payments for items or services that are not covered by Medicaid.All Qualified Vendors must register with AHCCCS to obtain an AHCCCS Provider Identification number before providing services.Decisions Not Included in this Publication Geographic Adjustments to Rates: The SFY2020 Rate Rebase project recommended various geographic adjustments to someservice rates. Applicable services include: Day Treatment and Training, Room and Board, All Group Homes, Therapy and Therapy Assistant Services, Employment Support Services Developmental Home: The SFY 2020 Rate Rebase project recommended the ‘un-bundling’ of the Home-Based supports (e.g.Respite) provided by Qualified Vendors. These services would be separately authorized and billed to the Division. Center Based Employment: The SFY 2020 Rate Rebase project developed additional rates for 1:3 and 1:9 staff to member ratiosfor this service. These new ratios have not been implemented for use.Page 7Revision Date October, 21, 2019Effective October, 1, 2019
Arizona Department of Economic Security, Division of Developmental DisabilitiesSFY 20 Benchmark and Adopted RatesSummary of ChangesChanges to Rate Schedules Released on September 25, 2019Please review the attached schedules carefully, the rates for services may have been revised. The following list summarizes thechanges when compared to the set of schedules published September 25, 2019 and provides other important information:Adjustments to Adopted Rates and Adopted-to-Benchmark Ratios The Adopted rates and the associated Adopted-to-Benchmark ratios for selected services have been revised as a result of increases to funding for DDD services. These changes continue to address the increased labor costs for direct care staff for theseservices, resulting from the Arizona minimum wage increase and Sick leave policy mandated by Proposition 206. For details onthe individual services, please refer to either the information contained on the “Summary Comparison by Service” page or theappropriate rate schedule within this document.Selected services continue to include separate rate calculations for services performed in the Flagstaff area (see note below).These changes include an additional increase to address the increased labor costs for direct care staff, for these services, resulting from the City of Flagstaff minimum wage increase locally mandated by Proposition 414. For details on the individual services,please refer to either the information contained on the “Summary Comparison by Service” page or the appropriate rate schedulewithin this document. Services performed within the following ZIP codes are the “Flagstaff” rate: 86001, 86004, and 86005. All services performedwithin ZIP codes not listed above (all other) are eligible for the “Statewide, Excluding Flagstaff” rate.In order to adhere to CMS regulations, the basis of tracking time for the Specialized Habilitation services has been updated. Thethree services HCA, HCB, and HCM are now calculated on a quarter-hour basis and the rates reflect that update.There have been corrections made to the HCPCs and descriptions for Nursing Services: For clarity, the description for HN1 was changed to “Nursing, Continuous” and the description for HNR was changed to“Nursing, Respite”. The HCPC for HN1 and HNR LPNs was updated to “S9124”. The HCPCs for HNV and HN9 have been adjusted based on whether the visit was by an RN or LPN. The RN HCPC is“G0299” and the LPN HCPC is “G0300”.Page 8Revision Date October, 21, 2019Effective October, 1, 2019
Arizona Department of Economic Security, Division of Developmental DisabilitiesSFY 20 Benchmark and Adopted RatesSummary of ChangesUpdate to Flagstaff Rates:Services performed in Flagstaff are not subject to two different rates based on the density of the location (urban vs. rural). As a result,rural rates have been removed from services performed in Flagstaff in the following sections: Summary Listing of Rates by ServiceEmployment Support Services Individual Supported Employment, Job Coaching Individual Supported Employment, Job Development Transition to EmploymentSpecialized Habilitation Services Habilitation, Consultation Assessment & Planning Habilitation, Consultation Licensed Psychologist Habilitation, Consultation Licensed Behavior Analyst/BCBA Habilitation, Consultation Board Certified Assistant Behavior AnalystTransportation Services Regular Scheduled Daily Transportation (Day Program) Regular Scheduled Daily Transportation (Employment Program)This change was applied by removing the lower of the two rates for each service and designating the higher rate as the “urban” rate forFlagstaff.Benchmark Rates for Therapy Services:The benchmark rates for Tier 2 & 3 natural therapy services (OTA, PTA, STA) were posted incorrectly. That error has now beencorrected.Adopted Rate for Transportation, Family and FriendThe previous version of the rate book did not show an adopted rate for Transportation, Family and Friend. In addition, the benchmarkrate was incorrect. Both of these errors have now been corrected.Page 9Revision Date October, 21, 2019Effective October, 1, 2019
HCPCStatewideor FlagstaffHome BasedServices DescriptionSFY wideStatewideStatewideStatewideStatewideAttendant CareHabilitation, SupportHomemakerRespite, HourlyRespite, Daily 23.23 28.54 22.33 23.38 454.19 17.09 21.81 15.74 16.75 226.34 18.19 22.80 16.34 17.55 280.65Independent LivingServices DescriptionSFY dRate7/1/2019Adopted toBenchmarkRatio 31.32 22.03 24.0176.66% 27.87 21.07 24.0186.15%HCPCPage 107/1/2019Adopted iceCodeServiceCodeStatewideor ation, IndividuallyDesigned Living Arrangement,HourlyHabilitation, IndividuallyDesigned Living Arrangement,DailyRevision Date October, 21, 2019Effective October, 1, 2019
Page 11HCPCServiceCodeStatewideor 1DTAStatewideDay Treatment and TrainingServices DescriptionDay Treatment and Training,Adult (1:3.5)Day Treatment and Training,Adult (1:5.5)Day Treatment and Training,Adult (1:7.5)Day Treatment and Training,Children (After-School) (1:3.5)Day Treatment and Training,Children (After-School) (1:5.5)Day Treatment and Training,Children (After-School) (1:7.5)Day Treatment and Training,Children (Summer) (1:3.5)Day Treatment and Training,Children (Summer) (1:5.5)Day Treatment and Training,Children (Summer) (1:7.5)Day Treatment and Training,Adult - Rural (1:3.5)Day Treatment and Training,Adult - Rural (1:5.5)Day Treatment and Training,Adult - Rural (1:7.5)SFY dRate7/1/2019Adopted toBenchmarkRatio 11.59 10.40 10.6191.54% 8.92 7.82 7.9689.24% 7.71 6.65 6.7587.55% 13.09 10.77 10.9883.88% 10.63 8.31 8.4579.49% 9.60 7.15 7.2575.52% 13.09 10.77 10.9883.88% 10.63 8.31 8.4579.49% 9.60 7.15 7.2575.52% 12.10 11.83 12.0499.50% 9.13 9.25 9.25101.31% 7.78 7.90 7.90101.54%Revision Date October, 21, 2019Effective October, 1, 2019
HCPCPage 12ServiceCodeStatewideor deor DStatewideDay Treatment and TrainingServices DescriptionDay Treatment and Training,Children (After-School)-Rural(1:3.5)Day Treatment and Training,Children (After-School)-Rural(1:5.5)Day Treatment and Training,Children (After-School)-Rural(1:7.5)Day Treatment and Training,Children (Summer)-Rural(1:3.5)Day Treatment and Training,Children (Summer)-Rural(1:5.5)Day Treatment and Training,Children (Summer)-Rural(1:7.5)Day Treatment and Training,IntenseDevelopmental HomeServices DescriptionHabilitation, Vendor SupportedDevelopmental Home (Adult)Habilitation, Vendor SupportedDevelopmental Home (Child)Room and Board, VendorSupported DevelopmentalHomeSFY dRate7/1/2019Adopted toBenchmarkRatio 14.61 11.64 11.8581.11% 12.40 9.81 9.8179.11% 11.52 9.07 9.0778.73% 14.61 11.64 11.8581.11% 12.40 9.81 9.8179.11% 11.52 9.07 9.0778.73% 26.96 21.58 24.3290.21%SFY dRate7/1/2019Adopted toBenchmarkRatio 143.19 102.33 108.5675.82% 169.39 104.38 108.5664.09% 22.00 14.58 14.5866.27%Revision Date October, 21, 2019Effective October, 1, 2019
HCPCServiceCodeStatewideor 0RRBStatewideDD030RRBStatewidePage 13Group HomeServices DescriptionHabilitation, CommunityProtection and TreatmentGroup HomeHabilitation, Group Home,Residents: 1Habilitation, Group Home,Residents: 2Habilitation, Group Home,Residents: 3 Habilitation, Nursing SupportedGroup Home, Level IHabilitation, Nursing SupportedGroup Home, Level IIHabilitation, Nursing SupportedGroup Home, Level IIIRoom and Board, All GroupHomes (Maricopa/Urban) 3BRRoom and Board, All GroupHomes (Maricopa/Urban) 4BRRoom and Board, All GroupHomes (Pima/Urban) 3BRRoom and Board, All GroupHomes (Pima/Urban) 4BRRoom and Board, All GroupHomes (Yuma/Rural) 3BRRoom and Board, All GroupHomes (Yuma/Rural) 4BRSFY dRate7/1/2019Adopted toBenchmarkRatio 32.44 20.37 32.44100.00% 29.60 20.37 20.6769.83% 29.60 20.37 20.8770.51% 26.60 20.37 21.6981.54% 439.18 392.10 413.7994.22% 519.74 459.96 484.7393.26% 579.06 517.12 544.1993.98% 34.72 23.58 23.5867.91% 32.37 21.01 21.0164.91% 34.41 21.73 21.7363.15% 32.55 19.45 19.4559.75% 30.17 21.02 21.0269.67% 28.18 18.38 18.3865.22%Revision Date October, 21, 2019Effective October, 1, 2019
HCPCServiceCodeStatewideor FlagstaffProfessional ServicesDescriptionSFY dRateT1021HHAStatewideHome Health Aide 27.21 22.08 22.087/1/2019Adopted toBenchmarkRatio81.15%G0299HNVStatewideNursing Visit (RN) 99.59 54.92 71.6171.90%G0300HNVStatewideNursing Visit (LPN) 74.51 43.09 53.5771.90%G0299HN9StatewideNursing, Intermittent (RN) 82.57 57.09 64.3277.90%G0300HN9StatewideNursing, Intermittent (LPN) 62.07 44.61 48.3577.90%S9123HN1StatewideNursing, Continuous (RN) 66.49 43.34 51.8077.91%S9124HN1StatewideNursing, Continuous (LPN) 50.14 37.82 39.0677.90%S9123HNRStatewideNursing, Respite (RN) 66.49 43.34 51.8077.91%S9124HNRStatewideNursing, Respite (LPN) 50.14 37.82 39.0677.90%97535OTAStatewide 101.88 59.38 74.8673.48%97535OTAStatewide 132.55 78.82 99.5475.10%97004OEAStatewide 305.64 162.52 162.5253.17%97004OEAStatewide 397.64 181.70 181.7045.69%97535OTAStatewide 87.06 53.24 63.9773.48%97535OTAStatewide 121.95 70.99 91.5875.10%Page 14Occupational Therapy(Clinic, Base Rate)Occupational Therapy(Natural, Base Rate)Occupational TherapyEvaluation (Clinic)Occupational TherapyEvaluation (Natural)Occupational TherapyAssistant (Clinic, Base Rate)Occupational TherapyAssistant (Natural, Base Rate)Revision Date October, 21, 2019Effective October, 1, 2019
Page 15HCPCServiceCodeStatewideor 7STAStatewideS5181RP1StatewideS5181RP1StatewideSFY dRate7/1/2019Adopted toBenchmarkRatio 101.88 59.38 74.8673.48% 132.55 78.82 99.5475.10% 305.64 162.52 162.5253.17% 397.64 181.70 181.7045.69% 87.06 53.24 63.9773.48% 121.95 70.99 91.5875.10% 101.88 59.38 74.8673.48% 132.55 78.82 99.5475.10% 305.64 162.52 162.5253.17% 397.64 181.70 181.7045.69% 87.06 53.24 63.9773.48% 121.95 70.99 91.5875.10%Respiratory Therapy (Clinic) 52.45 34.85 37.6771.82%Respiratory Therapy (Natural) 67.41 44.86 48.5071.95%Professional ServicesDescriptionPhysical Therapy(Clinic, Base Rate)Physical Therapy(Natural, Base Rate)Physical TherapyEvaluation (Clinic)Physical TherapyEvaluation (Natural)Physical Therapy Assistant(Clinic, Base Rate)Physical Therapy Assistant(Natural, Base Rate)Speech Therapy(Clinic, Base Rate)Speech Therapy(Natural, Base Rate)Speech TherapyEvaluation (Clinic)Speech TherapyEvaluation (Natural)Speech Language PathologyAssistant (Clinic)Speech Language PathologyAssistant (Natural)Revision Date October, 21, 2019Effective October, 1, 2019
Page 16HCPCServiceCodeStatewideor loyment SupportServices DescriptionCenter-Based Employment(High Density) (1:6)Center-Based Employment(Low Density) (1:6)Group Supported Employment(Urban) (1:2)Group Supported Employment(Rural) (1:2)Group Supported Employment(Urban) (1:3)Group Supported Employment(Rural) (1:3)Group Supported Employment(Urban) (1:4)Group Supported Employment(Rural) (1:4)Group Supported Employment(Urban) (1:5)Group Supported Employment(Rural) (1:5)Group Supported Employment(Urban) (1:6)Group Supported Employment(Rural) (1:6)Individual SupportedEmployment, Job Coaching(Urban)Individual SupportedEmployment, Job Coaching(Rural)SFY dRate7/1/2019Adopted toBenchmarkRatio 8.45 5.85 6.1072.19% 10.91 6.36 6.4759.30% 27.69 17.98 18.6467.32% 29.53 19.99 20.7270.17% 19.63 12.81 13.2967.70% 21.59 14.71 15.2570.63% 15.59 9.39 9.7462.48% 17.63 10.83 11.2463.75% 13.17 7.76 8.0661.20% 15.25 9.45 9.8164.33% 11.56 7.00 7.2762.89% 13.66 8.72 9.0566.25% 52.97 35.85 36.8669.59% 63.51 49.37 50.7879.96%Revision Date October, 21, 2019Effective October, 1, 2019
Page 17HCPCServiceCodeStatewideor yment SupportServices DescriptionIndividual SupportedEmployment, JobDevelopment (Urban)Individual SupportedEmployment, JobDevelopment (Rural)Transition to Employment(1:4), UrbanTransition to Employment(1:4), RuralEmployment Support Aide GSE/ISE (Urban)Employment Support Aide GSE/ISE (Rural)Career Preparation &Readiness (Urban)Career Preparation &Readiness (Rural)SFY dRate7/1/2019Adopted toBenchmarkRatio 51.03 34.88 35.8670.27% 54.10 37.12 38.1770.55% 13.25 10.30 10.5579.62% 14.21 11.13 11.4180.30% 40.00 19.37 20.0950.23% 47.05 21.10 21.8746.48% 40.01 15.04 15.4338.57% 42.53 16.30 16.7339.34%Revision Date October, 21, 2019Effective October, 1, 2019
HCPCServiceCodeStatewideor HCBStatewidePage 18Specialized HabilitationServices DescriptionHabilitation with MusicTherapyHabilitation, ConsultationLicensed PsychologistBCBA-D (Urban)Habilitation, ConsultationLicensed PsychologistBCBA-D (Rural)Habilitation, ConsultationLicensed Behavior Analyst(Urban)Habilitation, ConsultationLicensed Behavior Analyst(Rural)Habilitation, Consultation BoardCertified BehaviorAnalyst (Urban)Habilitation, Consultation BoardCertified BehaviorAnalyst (Rural)Habilitation, ConsultationBachelors Level (Urban)Habilitation, ConsultationBachelors Level (Rural)SFY dRate7/1/2019Adopted toBenchmarkRatio 52.78 32.05 42.6680.83% 47.99 33.87 33.8770.58% 58.54 40.67 40.6769.48% 23.06 20.36 20.3688.27% 28.50 24.73 24.7386.79% 23.06 20.36 20.3688.27% 28.50 24.73 24.7386.79% 16.65 11.47 11.4768.89% 20.27 14.14 14.1469.76%Revision Date October, 21, 2019Effective October, 1, 2019
SFY dRate7/1/2019Adopted toBenchmarkRatio 20.40 20.35 20.3599.75% 24.47 24.73 24.73101.06% 158.17 124.77 124.7778.88% 185.83 144.23 144.2377.61% 90.42 59.45 81.7990.46%Habilitation, Early ChildhoodAutism Specialized (Masters) 99.34 54.85 75.4675.96%StatewideHabilitation, Early ChildhoodAutism Specialized (Bachelors) 67.67 37.29 45.8367.73%StatewideHabilitation, Early ChildhoodAutism Specialized HourlyHabilitation 39.21 24.08 24.9463.61%HCPCServiceCodeStatewideor wideT2017ECMStatewideT2017ECBT2017Page 19ECHSpecialized HabilitationServices DescriptionHabilitation, ConsultationAssessment & Planning(Urban)Habilitation, ConsultationAssessment & Planning (Rural)Habilitation, Early ChildhoodAutism Specialized (BCBA-D)(Urban)Habilitation, Early ChildhoodAutism Specialized (BCBA-D)(Rural)Habilitation, Early ChildhoodAutism Specialized(Lic. Beh. Analyst)Revision Date October, 21, 2019Effective October, 1, 2019
HCPCServiceCodeStatewideor 0TREStatewidePage 20SFY dRate7/1/2019Adopted toBenchmarkRatio 12.59 11.74 12.59100.00% 13.45 11.74 12.5993.61% 23.19 18.16 23.19100.00% 23.19 18.16 23.19100.00% 28.44 18.65 28.44100.00%Single PersonModified Rate, Rural 40.83 28.38 40.83100.00%Extensive DistanceModified Rate, Urban 48.28 33.77 48.28100.00% 53.99 33.77 48.2889.42% 28.44 18.65 28.44100.00% 40.83 28.38 40.83100.00% 48.28 33.77 48.28100.00% 53.99 33.77 48.2889.42%Transportation ServicesDescriptionRegular Scheduled DailyTransportation (Day Program)Regular ScheduledDaily Transportation(Employment Program)Regular Scheduled DailyTransportation, Rural(Employment Program)Regular ScheduledDaily Transportation,Rural (Day Program)Single PersonModified Rate, UrbanExtensive DistanceModified Rate, RuralSingle PersonModified Rate, UrbanSingle PersonModified Rate, RuralExtensive DistanceModified Rate, UrbanExtensive DistanceModified Rate, RuralRevision Date October, 21, 2019Effective October, 1, 2019
HCPCStatewideor FlagstaffHome BasedServices DescriptionSFY taffFlagstaffFlagstaffFlagstaffFlagstaffAttendant CareHabilitation, SupportHomemakerRespite, HourlyRespite, Daily 25.03 30.72 24.08 25.19 490.13 17.57 22.43 16.17 17.22 232.72 19.63 24.55 17.65 18.92 303.69Independent LivingServices DescriptionSFY dRate7/1/2019Adopted toBenchmarkRatio 32.79 22.64 25.1676.73% 29.16 21.63 22.7177.88%HCPCPage 217/1/2019Adopted iceCodeServiceCodeStatewideor ation, IndividuallyDesigned Living Arrangement,HourlyHabilitation, IndividuallyDesigned Living Arrangement,DailyRevision Date October, 21, 2019Effective October, 1, 2019
Page 22HCPCServiceCodeStatewideor FlagstaffT20
RATE BOOK Effective Date October 1, 2019 Revision Date October 21, 2019 Division of Developmental Disabilities 1789 W Jefferson St. Phoenix, AZ 85007. . Physical Therapy/Early Intervention, Clinical Setting, Base Rate 122 Physical Therapy
