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Long-term services and supports state-established rates

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.

Program key

  • AC = Alternative Care program
  • BI = Brain Injury Waiver
  • CAC = Community Alternative Care Waiver
  • CADI = Community Alternatives for Disability Inclusion Waiver
  • DD = Developmental Disabilities Waiver
  • ECS = Essential Community Supports program
  • EW = Elderly Waiver
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

Manually adjusted rates by program

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 January 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

Respite services using procedure code H0045

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)
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