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Division of Developmental DisabilitiesRATE BOOKEffective DateOctober 1, 2021Revision DateOctober 21, 2021Division of Developmental Disabilities1789 W Jefferson St.Phoenix, AZ 85007
Arizona Department of Economic Security, Division of Developmental DisabilitiesIntroduction to the Rate BookSummary of ChangesSummarized Listing of Rates by ServiceTable of Contents - Effective October 1, 2021RatesCPT/HCPCS Codes & Modifiers for Services78928Home-Based Services32Attendant Care34Habilitation, Community Protection and Treatment, Hourly35Habilitation, Support35Homemaker36Respite, Hourly36Respite, Daily 37Living ServicesHabilitation, Individually Designed Living Arrangement (Client Hour)Habilitation, Individually Designed Living Arrangement, Daily (Client Hour)Habilitation, Individually Designed Living Arrangement (Per Resident Per Day)38404041Day 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)8587888889899090Sign Language or Oral Interpretive Services92Developmental 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, 2021Effective October 1, 2021
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, Clinical Setting, Base RateOccupational Therapy, Clinical Setting, Tier 1Occupational Therapy, Clinical Setting, Tier 2Occupational Therapy, Clinical Setting, Tier 3Page 3102117117117117Revision Date October 21, 2021Effective October 1, 2021
Occupational Therapy, Natural Setting, Base RateOccupational Therapy, Natural Setting, Tier 1Occupational Therapy, Natural Setting, Tier 2Occupational Therapy, Natural Setting, Tier 3Occupational Therapy, Evaluation, Clinical SettingOccupational Therapy, Evaluation, Natural SettingOccupational Therapy, Clinical Setting, Base RateOccupational Therapy, Clinical Setting, Tier 1Occupational Therapy, Clinical Setting, Tier 2Occupational Therapy, Clinical Setting, Tier 3Occupational Therapy, Natural Setting, Base RateOccupational Therapy, Natural Setting, Tier 1Occupational Therapy, Natural Setting, Tier 2Occupational Therapy, Natural Setting, Tier l Therapy, Clinical Setting, Base RatePhysical Therapy, Clinical Setting, Tier 1Physical Therapy, Clinical Setting, Tier 2Physical Therapy, Clinical Setting, Tier 3Physical Therapy, Natural Setting, Base RatePhysical Therapy, Natural Setting, Tier 1Physical Therapy, Natural Setting, Tier 2Physical Therapy, Natural Setting, Tier 3Physical Therapy, Evaluation, Clinical SettingPhysical Therapy, Evaluation, Natural SettingPhysical Therapy, Clinical Setting, Base RatePhysical Therapy, Clinical Setting, Tier 1Physical Therapy, Clinical Setting, Tier 2Physical Therapy, Clinical Setting, Tier 3Physical Therapy, Natural Setting, Base RatePhysical Therapy, Natural Setting, Tier 1Physical Therapy, Natural Setting, Tier 2Physical Therapy, Natural Setting, Tier 26126Speech Therapy, Clinical Setting, Base RateSpeech Therapy, Clinical Setting, Tier 1127127Page 4Revision Date October 21, 2021Effective October 1, 2021
Speech Therapy, Clinical Setting, Tier 2Speech Therapy, Clinical Setting, Tier 3Speech Therapy, Natural Setting, Base RateSpeech Therapy, Natural Setting, Tier 1Speech Therapy, Natural Setting, Tier 2Speech Therapy, Natural Setting, Tier 3Speech Therapy, Evaluation, Clinical SettingSpeech Therapy, Evaluation, Natural SettingSpeech Therapy Clinical Setting, Base RateSpeech Therapy, Clinical Setting, Tier 1Speech Therapy, Clinical Setting, Tier 2Speech Therapy, Clinical Setting, Tier 3Speech Therapy, Natural Setting, Base RateSpeech Therapy, Natural Setting, Tier 1Speech Therapy, Natural Setting, Tier 2Speech Therapy, 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, 2021Effective October 1, 2021
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 HabilitationTransportation ServicesRegular Scheduled Daily Transportation (Day Program)Regular Scheduled Daily Transportation (Employment Program)Single Person Modified, Regularly Scheduled Daily TransportationExtensive Distance, Regularly Scheduled Daily TransportationTransportation, Family and Friend145145145145146147147148149149Habilitation, Community Protection and Treatment, Group Home & Habilitation, Group Home Introduction150Habilitation, Community Protection and Treatment Group Home (Statewide, excludes Flagstaff)152Habilitation, Community Protection and Treatment Group Home (Flagstaff Only)164Habilitation Group Home (Statewide, excludes Flagstaff) TABLE 1176Habilitation Group Home (Flagstaff Only) TABLE 1 180Habilitation Group Home (Statewide, excludes Flagstaff) TABLE 2184Habilitation Group Home (Flagstaff Only) TABLE 2 202Arizona 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, 2021Effective October 1, 2021
Arizona Department of Economic Security, Division of Developmental DisabilitiesSFY 22 Benchmark and Adopted RatesIntroductionPurpose of This ScheduleThis schedule contains the rates for services with dates of service on or after October 1, 2021. The Schedule contains two columns of rates. Thefirst column labeled “Benchmark Rate” contains the rates that the Division calculated through its rate setting process. The second column labeled“Adopted Rate” contains the rates that the Division adopted for the published rate schedule and these are the rates to be used for each servicewhen 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 also not be billed forservices 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 provider may requestadditional 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 SFY 2020 Rate Rebase project recommended various geographic adjustments to some service 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 ratios for thisservice. These new ratios have not been implemented for use.Page 7Revision Date October 21, 2021Effective October 1, 2021
Arizona Department of Economic Security, Division of Developmental DisabilitiesSFY 22 Benchmark and Adopted RatesSummary of ChangesPlease review the attached schedules carefully, the rates for services may have been revised. The following list summarizes the changes whencompared to the set of schedules published May 2020 and provides other important information: Page 8Added Sign Language or Oral Interpretive Services section on page 93.Revision Date October 21, 2021Effective October 1, 2021
Arizona Department of Economic Security, Division of Developmental DisabilitiesSFY 22 Benchmark and Adopted RatesSummarized Listing of Rates by Service10/1/2021Adopted toBenchmarkRatioHCPCService CodeStatewide orFlagstaffHome Based Services DescriptionSFY 2020BenchmarkRateS5125ATCStatewideAttendant Care 23.23 18.92 20.5288.33%T2017HAHStatewideHabilitation, Support 28.54 23.19 24.4985.81%S5130HSKStatewideHomemaker 22.33 16.88 18.1881.42%S5150RSPStatewideRespite, Hourly 23.38 18.48 20.1085.97%S5151RSDStatewideRespite, Daily 454.19 351.80 386.8085.16%1/1/202110/1/2021AdoptedAdopted RateRate10/1/2021Adopted toBenchmarkRatioHCPCService CodeStatewide orFlagstaffHome Based Services DescriptionSFY 2020BenchmarkRateT2017HAIStatewideHabilitation, Individually Designed LivingArrangement, Hourly 31.32 24.65 25.9582.85%T2017HIDStatewideHabilitation, Individually Designed LivingArrangement, Daily 27.87 24.21 25.7192.25%Page 9Revision Date October 21, 20211/1/202110/1/2021AdoptedAdopted RateRateEffective October 1, 2021
HCPCServiceCodeStatewide orFlagstaffHome Based Services DescriptionT2021DTAStatewideDay Treatment and Training, Adult (1:3.5) 11.59 11.01 11.3898.19%T2021DTAStatewideDay Treatment and Training, Adult (1:5.5) 8.92 8.47 8.7197.65%T2021DTAStatewideDay Treatment and Training, Adult (1:7.5) 7.71 7.32 7.4997.15%T2021DTTStatewideDay Treatment and Training, Children(After-School) (1:3.5) 13.09 12.40 12.7797.56%T2021DTTStatewideDay Treatment and Training, Children(After-School) (1:5.5) 10.63 10.07 10.3196.99%T2021DTTStatewideDay Treatment and Training, Children(After-School) (1:7.5) 9.60 9.09 9.2696.46%T2021DTSStatewideDay Treatment and Training, Children(Summer) (1:3.5) 13.09 12.40 12.7797.56%T2021DTSStatewideDay Treatment and Training, Children(Summer) (1:5.5) 10.63 10.07 10.3196.99%T2021DTSStatewideDay Treatment and Training, Children(Summer) (1:7.5) 9.60 9.09 9.2696.46%T2021DTAStatewideDay Treatment and Training, Adult - Rural(1:3.5) 12.10 12.10 12.47103.06%T2021DTAStatewideDay Treatment and Training, Adult - Rural(1:5.5) 9.13 9.25 9.49103.94%T2021DTAStatewideDay Treatment and Training, Adult - Rural(1:7.5) 7.78 7.90 8.07103.73%Page 10SFY 20201/1/202110/1/202110/1/2021 AdoptedBenchmark Rate Adopted Rate Adopted Rate to Benchmark RatioRevision Date October 21, 2021Effective October 1, 2021
HCPCServiceCodeStatewide 1DTSStatewideT2021DTXStatewideHCPCServiceCodeHome Based Services DescriptionDay Treatment and Training, Children (AfterSchool)-Rural (1:3.5)Day Treatment and Training, Children (AfterSchool)-Rural (1:5.5)Day Treatment and Training, Children (AfterSchool)-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)SFY 20201/1/2021Benchmark Rate Adopted Rate10/1/2021Adopted Rate10/1/2021Adopted toBenchmark Ratio 14.61 13.84 14.2197.26% 12.40 11.74 11.9896.61% 11.52 10.91 11.0896.18% 14.61 13.84 14.2197.26% 12.40 11.74 11.9896.61% 11.52 10.91 11.0896.18%Day Treatment and Training, Intense 26.96 24.32 25.6295.03%Statewide orFlagstaffSign Language or Oral Interpretive ServiceDescriptionAdopted RateT1013StatewideSign Language or Oral Interpretive Services 22.50A9270StatewideNon-covered services due to member absencefor Sign Language or Oral Interpretive Services 180.00Developmental Home Services Description10/1/2021Adopted Rate10/1/2021Adopted toBenchmark RatioHCPCServiceCodeStatewide RBDStatewidePage 11Habilitation, Vendor Supported DevelopmentalHome (Adult)Habilitation, Vendor Supported DevelopmentalHome (Child)Room and Board, Vendor SupportedDevelopmental HomeSFY 20201/1/2021Benchmark Rate Adopted Rate 143.19 112.56 137.5696.07% 169.39 112.56 137.5681.21% 22.00 14.58 14.5866.27%Revision Date October 21, 2021Effective October 1, 2021
HCPCService StatewideCode or FlagstaffDevelopmental Home Services DescriptionSFY 2020Benchmark Rate1/1/202110/1/2021AdoptedAdopted RateRate10/1/2021Adopted toBenchmarkRatioT2016HPDStatewideHabilitation, Community Protection and TreatmentGroup Home 32.44 32.44 33.66103.76%T2016HABStatewideHabilitation, Group Home, Residents: 1 29.60 20.93 22.0674.53%T2016HABStatewideHabilitation, Group Home, Residents: 2 29.60 21.13 22.3075.34%T2016HABStatewideHabilitation, Group Home, Residents: 3 29.60 22.05 23.4279.12%T2016HANStatewide Habilitation, Nursing Supported Group Home, Level I 439.18 413.79 439.18100.00%T2016HANStatewide Habilitation, Nursing Supported Group Home, Level II 519.74 484.73 519.74100.00%T2016HANStatewide Habilitation, Nursing Supported Group Home, Level III 579.06 544.19 579.06100.00%DD030RRBStatewide 34.72 23.58 23.5867.91%DD030RRB 32.37 21.01 21.0164.91%DD030RRBStatewide Room and Board, All Group Homes (Pima/Urban) 3BR 32.22 21.73 21.7367.44%DD030RRBStatewide Room and Board, All Group Homes (Pima/Urban) 4BR 30.46 19.45 19.4563.85%DD030RRBStatewide Room and Board, All Group Homes (Yuma/Rural) 3BR 30.17 21.02 21.0269.67%DD030RRBStatewide Room and Board, All Group Homes (Yuma/Rural) 4BR 28.18 18.38 18.3865.22%Page 12Room and Board, All Group Homes (Maricopa/Urban)3BRRoom and Board, All Group Homes (Maricopa/Urban)Statewide4BRRevision Date October 21, 2021Effective October 1, 2021
HCPCService StatewideCode or FlagstaffProfessional Services DescriptionSFY 2020BenchmarkRate3/1/2021Adopted Rate10/1/2021Adopted Rate10/1/2021Adopted toBenchmark RatioT1021HHAStatewideHome Health Aide 27.21 22.28 22.2881.88%G0299G0300/G0299StatewideNursing Visit (RN) 99.59 71.61 82.5782.91%G0300G0300StatewideNursing Visit (LPN) 74.51 53.57 62.0783.30%G0299G0300/G0299StatewideNursing, Intermittent (RN) 82.57 71.61 82.57100.00%G0300G0300StatewideNursing, Intermittent (LPN) 62.07 53.57 62.07100.00%S9123S9123/S9124StatewideNursing, Continuous(RN) 66.49 51.80 59.8490.00%S9124S9124StatewideNursing, Continuous (LPN) 50.14 39.06 45.1289.99%S9123HNRStatewideNursing, Respite (RN) 66.49 51.80 59.8490.00%S9123HNRStatewideNursing, Respite (LPN) 50.14 39.06 45.1289.99%Professional Services DescriptionSFY 2020BenchmarkRate1/1/2020Adopted Rate10/1/2020Adopted Rate10/1/2020Adopted toBenchmark RatioHCPCService StatewideCode or Flagstaff97535OTAStatewideOccupational Therapy (Clinic, Base Rate) 101.88 74.86 85.4083.82%97535OTAStatewideOccupational Therapy (Natural, Base Rate) 132.55 99.54 113.2685.45%97004OEAStatewideOccupational Therapy Evaluation (Clinic) 305.64 162.52 162.5253.17%97004OEAStatewideOccupational Therapy Evaluation (Natural) 397.64 181.70 181.7045.69%97535OTAStatewide 87.06 63.97 72.9883.83%97535OTAStatewide 121.95 91.58 104.2085.44%Page 13Occupational Therapy Assistant(Clinic, Base Rate)Occupational Therapy Assistant(Natural, Base Rate)Revision Date October 21, 2021Effective October 1, 2021
10/1/2020Adopted toBenchmark RatioHCPCServiceCodeStatewide orFlagstaffProfessional Services Description97530PTAStatewidePhysical Therapy (Clinic, Base Rate) 101.88 74.86 85.4083.82%97530PTAStatewidePhysical Therapy (Natural, Base Rate) 132.55 99.54 113.2685.45%97161PEAStatewidePhysical Therapy Evaluation (Clinic) 305.64 162.52 162.5253.17%97161PEAStatewidePhysical Therapy Evaluation (Natural) 397.64 181.70 181.7045.69%97530PTAStatewide 87.06 63.97 72.9883.83%97530PTAStatewide 121.95 91.58 104.2085.44%92507STAStatewideSpeech Therapy (Clinic, Base Rate) 101.88 74.86 85.4083.82%92507STAStatewideSpeech Therapy (Natural, Base Rate) 132.55 99.54 113.2685.45%92523SEAStatewideSpeech Therapy Evaluation (Clinic) 305.64 162.52 162.5253.17%92523SEAStatewideSpeech Therapy Evaluation (Natural) 397.64 181.70 181.7045.69%92507STAStatewide 87.06 63.97 72.9883.83%92507STAStatewide 121.95 91.58 104.2085.44%S5181RP1StatewideRespiratory Therapy (Clinic) 52.45 37.67 37.6771.82%S5181RP1StatewideRespiratory Therapy (Natural) 67.41 48.50 48.5071.95%Page 14Physical Therapy Assistant(Clinic, Base Rate)Physical Therapy Assistant(Natural, Base Rate)Speech Language Pathology Assistant(Clinic)Speech Language Pathology Assistant(Natural)SFY 20201/1/202010/1/2020Benchmark Rate Adopted Rate Adopted RateRevision Date October 21, 2021Effective October 1, 2021
HCPCService Statewide orCodeFlagstaffEmployment Support Services DescriptionSFY 20201/1/202110/1/2021Benchmark Rate Adopted Rate Adopted Rate10/1/2021Adopted toBenchmark RatioT2019CBEStatewideCenter-Based Employment (High Density) (1:6) 8.45 6.13 6.3575.15%T2019CBEStatewideCenter-Based Employment (Low Density) (1:6) 10.91 6.63 6.8562.79%T2019CBEStatewideCenter-Based Employment (High Density) (1:4) 12.68 9.20 9.5275.11%T2019CBEStatewideCenter-Based Employment (Low Density) (1:4) 16.37 9.95 10.2762.76%T2019CBEStatewideCenter-Based Employment (High Density) (1:3) 16.90 12.27 12.7075.15%T2019CBEStatewideCenter-Based Employment (Low Density) (1:3) 21.82 13.27 13.7062.79%T2019CBEStatewideCenter-Based Employment (High Density) (1:2) 25.35 18.40 19.0575.15%T2019CBEStatewideCenter-Based Employment (Low Density) (1:2) 32.73 19.90 20.5562.79%T2019CBEStatewideCenter-Based Employment (High Density) (1:1) 50.70 36.80 38.1075.15%T2019CBEStatewideCenter-Based Employment (Low Density) (1:1) 65.46 39.80 41.1062.79%T2019GSEStatewideGroup Supported Employment (Urban) (1:2) 27.69 22.35 23.0083.06%T2019GSEStatewideGroup Supported Employment (Rural) (1:2) 29.53 23.82 24.4782.86%T2019GSEStatewideGroup Supported Employment (Urban) (1:3) 19.63 15.84 16.2782.88%T2019GSEStatewideGroup Supported Employment (Rural) (1:3) 21.59 17.42 17.8582.68%T2019GSEStatewideGroup Supported Employment (Urban) (1:4) 15.59 12.58 12.9082.75%Page 15Revision Date October 21, 2021Effective October 1, 2021
HCPCService Statewide orCodeFlagstaffEmployment Support Services DescriptionSFY 20201/1/202110/1/2021Benchmark Rate Adopted Rate Adopted Rate10/1/2021Adopted toBenchmark RatioT2019GSEStatewideGroup Supported Employment (Rural) (1:4) 17.63 14.23 14.5582.53%T2019GSEStatewideGroup Supported Employment (Urban) (1:5) 13.17 10.63 10.8982.69%T2019GSEStatewideGroup Supported Employment (Rural) (1:5) 15.25 12.31 12.5782.43%T2019GSEStatewideGroup Supported Employment (Urban) (1:6) 11.56 9.33 9.5482.53%T2019GSEStatewideGroup Supported Employment (Rural) (1:6) 13.66 11.02 11.2382.21%T2019ISEStatewide 52.97 42.80 44.1083.25%T2019ISEStatewide 63.51 50.78 52.0882.00%T2019ISEStatewide 51.03 41.23 42.5383.34%T2019ISEStatewide 48.95 39.55 40.8583.45%T2019TTEStatewideTransition to Employment (1:1), Urban 53.00 42.84 44.1483.28%T2019TTEStatewideTransition to Employment (1:1), Rural 56.84 45.92 47.2283.08%T2019TTEStatewideTransition to Employment (1:2), Urban 26.50 21.42 22.0783.28%T2019TTEStatewideTransition to Employment (1:2), Rural 28.42 22.96 23.6183.08%T2019TTEStatewideTransition to Employment (1:4), Urban 13.25 10.71 11.0483.28%T2019TTEStatewideTransition to Employment (1:4), Rural 14.21 11.48 11.8183.08%Page 16Individual Supported Employment, Job Coaching(Urban)Individual Supported Employment, Job Coaching(Rural)Individual Supported Employment, JobDevelopment (Urban)Individual Supported Employment, JobDevelopment (Rural)Revision Date October 21, 2021Effective October 1, 2021
HCPCService Statewide orCodeFlagstaffEmployment Support Services DescriptionSFY 2020BenchmarkRate10/1/20211/1/202110/1/2021 Adopted toAdoptedAdopted Rate BenchmarkRateRatioT2019ESAStatewideEmployment Support Aide - GSE/ISE (Urban) 40.00 32.32 33.6284.05%T2019ESAStatewideEmployment Support Aide - GSE/ISE (Rural) 47.05 38.02 39.3283.57%T2019CPRStatewideCareer Preparation & Readiness (Urban) 40.01 32.33 33.6384.05%T2019CPRStatewideCareer Preparation & Readiness (Rural) 42.53 34.36 35.6683.85%Specialized Habilitation Services DescriptionSFY 2020BenchmarkRateHabilitation with Music Therapy 52.78 42.66 43.9683.29% 47.99 33.87 33.8770.58% 58.54 40.67 40.6769.47%HCPCService Statewide orCodeFlagstaff10/1/20211/1/202110/1/2021 Adopted toAdoptedAdopted Rate de97153HCMStatewide97153HCMStatewide Habilitation, Consultation Licensed Behavior Analyst (Urban) 23.06 20.36 20.3688.29%97153HCMStatewide 28.50 24.73 24.7386.77%97153HCMStatewide 23.06 20.36 20.3688.29%97153HCMStatewide 28.50 24.73 24.7386.77%97156HCBStatewideHabilitation, Consultation Bachelors Level (Urban) 16.65 11.47 11.4768.89%97156HCBStatewideHabilitation, Consultation Bachelors Level (Rural) 20.27 14.14 14.1469.76%Page 17Habilitation, Consultation Licensed Psychologist BCBA-D(Urban)Habilitation, Consultation Licensed Psychologist BCBA-D(Rural)Habilitation, Consultation Licensed Behavior Analyst (Rural)Habilitation, Consultation Board Certified Behavior Analyst(Urban)Habilitation, Consultation Board Certified Behavior Analyst(Rural)Revision Date October 21, 2021Effective October 1, 2021
HCPC97151971529715197152Service Statewide orSFY 20201/1/202110/1/2021Specialized Habilitation Services DescriptionCodeFlagstaffBenchmark Rate Adopted Rate Adopted 7ECBStatewideT2017ECHStatewidePage 18Habilitation, Consultation Assessment &Planning (Urban)Habilitation, Consultation Assessment &Planning (Rural)Habilitation, Early Childhood AutismSpecialized (BCBA-D) (Urban)Habilitation, Early Childhood AutismSpecialized (BCBA-D) (Rural)Habilitation, Early Childhood AutismSpecialized (Lic. Beh. Analyst)Habilitation, Early Childhood AutismSpecialized (Masters)Habilitation, Early Childhood AutismSpecialized (Bachelors)Habilitation, Early Childhood AutismSpecialized Hourly Habilitation10/1/2021Adopted toBenchmark Ratio 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 81.79 81.7990.46% 99.34 75.46 75.4675.96% 67.67 45.83 45.8367.73% 39.21 25.65 26.9568.73%Revision Date October 21, 2021Effective October 1, 2021
HCPCService Statewide A0120TRAA0120Transportation Services DescriptionRegular Scheduled Daily Transportation (DayProgram)Regular Scheduled Daily Transportation(Employment Program)Regular Scheduled Daily Transportation, Rural(Employment Program)Regular Scheduled Daily Transportation, Rural(Day Program)SFY 20201/1/202110/1/2021Benchmark Rate Adopted Rate Adopted Rate10/1/2021Adopted toBenchmark Ratio 12.59 12.59 12.90102.46% 13.45 12.59 12.9095.91% 23.19 23.19 23.50101.34% 23.19 23.19 23.50101.34%Single Person Modified Rate, Urban 28.44 28.44 29.66104.29%StatewideSingle Person Modified Rate, Rural 40.83 40.83 42.05102.99%TRAStatewideExtensive Distance Modified Rate, Urban 48.28 48.28 48.59100.64%A0120TRAStatewideExtensive Distance Modified Rate, Rural 53.99 48.28 48.5990.00%A0120TREStatewideSingle Person Modified Rate, Urban 28.44 28.44 29.66104.29%A0120TREStatewideSingle Person Modified Rate, Rural 40.83 40.83 42.05102.99%A0120TREStatewideExtensive Distance Modified Rate, Urban 48.28 48.28 48.59100.64%A0120TREStatewideExtensive Distance Modified Rate, Rural 53.99 48.28 48.5990.00%Page 19Revision Date October 21, 2021Effective October 1, 2021
HCPCServiceCodeStatewideor FlagstaffHome Based Services DescriptionSFY 2020BenchmarkRateS5125ATCFlagstaffAttendant Care 25.03 22.52 24.1296.36%T2017HAHFlagstaffHabilitation, Support 30.72 27.08 28.3892.38%S5130HSKFlagstaffHomemaker 24.08 20.34 21.6489.87%S5150RSPFlagstaffRespite, Hourly 25.19 22.03 23.6593.89%S5151RSDFlagstaffRespite, Daily 490.13 422.76 457.7693.40%T1021HHAFlagstaffHome Health Aide 29.17 26.10 26.1089.48%T2019CBEFlagstaffCenter-Based Employment (High Density) (1:6) 9.01 7.17 7.3881.91%T2017ECHFlagstaffHabilitation, Early Childhood Autism Spec HourlyHabilitation 42.30 26.95 26.9563.71%HCPCServiceCodeStatewideor FlagstaffIndependent Living Services DescriptionSFY fT2016HABFlagstaffT2016HABT2016HABPage 20Habilitation, Individually Designed LivingArrangement, HourlyHabilitation, Individually Designed LivingArrangement, Daily1/1/202110/1/202110/1/2021AdoptedAdopted toAdopted RateRateBenchmark Ratio1/1/202110/1/202110/1/2021AdoptedAdopted toAdopted RateRateBenchmark Ratio 32.79 27.60 28.9088.14% 29.16 25.52 27.0292.66%Habilitation, Group Home, Residents: 1 30.89 24.00 25.1281.32%FlagstaffHabilitation, Group Home, Residents: 2 30.89 24.21 25.3882.16%FlagstaffHabilitation, Group Home, Residents: 3 30.89 25.17 26.5485.92%Revision Date October 21, 2021Effective October 1, 2021
10/1/2021Adopted toBenchmarkRatioHCPCServiceCodeStatewideor FlagstaffDay Treatment and Training Services DescriptionSFY 2020BenchmarkRateT2021DTAFlagstaffDay Treatment and Training, Adult (1:3.5) 12.21 12.03 12.40101.56%T2021DTAFlagstaffDay Treatment and Training, Adult (1:5.5) 9.32 9.12 9.36100.43%T2021DTAFlagstaffDay Treatment and Training, Adult (1:7.5) 8.01 7.81 7.9899.63%T2021DTTFlagstaff 13.71 13.43 13.80100.66%T2021DTTFlagstaff 11.04 10.73 10.9799.37%T2021DTTFlagstaff 9.91 9.59 9.7698.49%T2021DTSFlagstaff Day Treatment and Training, Children (Summer) (1:3.5) 13.71 13.43 13.80100.66%T2021DTSFlagstaff Day Treatment and Training, Children (Summer) (1:5.5) 11.04 10.73 10.9799.37%T2021DTSFlagstaff Day Treatment and Training, Children (Summer) (1:7.5) 9.91 9.59 9.7698.49%T2021DTXFlagstaffDay Treatment and Training, Intense 28.94 27.54 28.8499.65%Developmental Home Services DescriptionSFY 2020BenchmarkRateHCPCServiceCodeStatewideor DFlagstaffPage 21Day 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)Habilitation, Vendor Supported Developmental Home(Adult)Habilitation, Vendor Supported Developmental Home(Child)Room and Board, Vendor Supported DevelopmentalHomeRevision Date October 21, 20211/1/202110/1/2021AdoptedAdopted RateRate1/1/202110/1/2021AdoptedAdopted RateRate10/1/2021Adopted toBenchmarkRatio 143.19 112.56 137.5696.07% 169.39 112.56 137.5681.21% 22.00 14.58 14.5866.27%Effective October 1, 2021
DD030RRBFlagstaffPage 22SFY ed Rate10/1/2021Adopted toBenchmark Ratio 32.53 32.44 33.66103.47% 448.10 437.92 448.10100.00% 531.63 516.03 531.63100.00% 590.95 579.67 590.95100.00%Room and Board, All Group Homes 3BR 32.22 24.08 24.0874.74%Room and Board, All Group Homes 4BR 30.46 21.45 21.4570.42%StatewideDay Treatment and Training Services Descriptionor FlagstaffHabilitation, Community Protection andTreatment Group HomeHabilitation, Nursing Supported Group Home,Level IHabilitation, Nursing Supported Group Home,Level IIHabilitation, Nursing Supported Group Home,Level IIIRevision Date October 21, 2021Effective October 1, 2021
HCPCServiceCodeStatewideor FlagstaffProfessional Services DescriptionSFY 2020BenchmarkR
RATE BOOK Effective Date October 1, 2021 Revision Date October 21, 2021 Division of Developmental Disabilities 1789 W Jefferson St. . Nursing, Continuous/Respite, RN Service Delivery Requiring Travel of More Than 100 Miles 113 Nursing, Continuous/Respite, LPN Base Rate 114 Nursing, Continuous/Respite, LPN Service Delivery Requiring Travel of .
