The following table identifies those services and programs in which the line item REQ RATE field (requested rate) must match the service statewide maximum rate shown in the APP RATE field for services effective July 1, 2016, and later. The individual community living supports services use the statewide service rate effective July 1, 2017, and later.
| Service name | Service unit | Procedure code | Program |
|---|---|---|---|
| Adult day service | 15 minute | S5100 | AC, EW, ECS |
| Adult day service or Family adult day services | 15 minute | S5100 U7 | AC, EW |
| Adult day service bath | 15 minute | S5100 TF | AC, EW |
| Companion services | 15 minute | S5135 | AC, EW |
| Chore service | 15 minute | S5120 | AC, EW, BI, CADI, DD, ECS |
| Family caregiver coaching and counseling (including assessment) | 15 minute | S5115 TF | AC, EW, ECS |
| Family caregiver/family memory care | 15 minute | S5115 TG | AC, EW |
| Home-delivered meals | Per meal | S5170 | AC, EW, BI, CAC, CADI, DD, ECS |
| Homemaker – assistance with personal care | 15 minute | S5130 TG | AC, EW, BI, CAC, CADI, DD, ECS |
| Homemaker – home management | 15 minute | S5130 TF | AC, EW, BI, CAC, CADI, DD, ECS |
| Individual community living supports – in person | 15 minute | H2015 U3 | AC, EW |
| Individual community living supports – remote | 15 minute | H2015 U3, U4 | AC, EW |
| Nutrition services | Visit | S9470 | AC |
| Respite care services, in home | 15 minute | S5150 | AC, EW |
| Respite care services, in home | Daily | S5151 | AC, EW |
| Respite care services, out of home | 15 minute | S5150 UB | AC, EW |
Beginning July 1, 2016, manually adjust all existing authorized rates in MMIS for the services below. Refer to the long-term services and supports (LTSS) rate limits by program found in Long-Term Services and Supports Service Rate Limits Effective July 1, 2019, DHS-3945-ENG (PDF), for the new state-established rates for county-provided case management.
Continue to authorize contracted case management rates at the county-determined rate, up to the service limit. Contracted case management must be billed at the rate in the contract.
| Service name | Service unit | Procedure code | Applicable service/program |
|---|---|---|---|
| Case management | 15 minutes | T1016 UC | AC, EW, BI, CAC, CADI, DD, ECS |
| Case management conversion | 15 minutes | T1016 | AC |
| Case management aide (paraprofessional) | 15 minutes | T1016 TF UC | AC, EW, BI, CAC, CADI, ECS |
| CDCS mandatory case management | 15 minutes | T2041 | AC, EW |
Authorize respite services using the H0045 procedure code in the Elderly Waiver and Alternative Care programs to the state-established rate for services provided in an out-of-home setting that was not an institution or for services provided in a hospital. Use the person’s case mix level as the maximum up-to rate for services provided in a non-certified nursing facility. Refer to the Long-term service and supports (LTSS) rate limits (PDF) by program.
| Service name | Service unit | Procedure code | Applicable service/program |
|---|---|---|---|
| Respite hospital, 24 hours | Daily | H0045 | AC, EW |
| Respite care services, out of home | Daily | H0045 | AC, EW |
| Respite certified facility | Daily | H0045 | AC (NFs per diem for the client’s case mix)
EW (NFs per diem for the client’s case mix) |
