Standard Rate Schedule: Non‐Medicaid Non‐Clinician Based Rev. 11/01/2022
Service
H0010 ‐ DETOX‐NON‐HSP‐MED H0012HB ‐ Community Residential Tx‐Adult H0013 ‐ SA Med Mon Community Residential Tx H0014 ‐ AMBULATORY DETOX H0015 ‐ SA IOP H0020 ‐ Outpatient Opioid Treatment H0035 ‐ MH PARTIAL HOSP, < 24 HR H0038 ‐ Peer Support Services (PSS) ‐ individual H0038HQ ‐ Peer Support Services (PSS) ‐ group H0040 ‐ ACTT H004022 ‐ ACTT > 4 events per month H2011 ‐ CRISIS SERVICES H2012HA ‐ DAY TREATMENT CHILD H2014U1 ‐ DEVELOPMENTAL TX PARA GROUP H2015HTHF ‐ CST ‐ SA Professional ‐ Community Support Team H2015HTHM ‐ CST ‐ Paraprofessional ‐ Community Support Team H2015HTHN ‐ CST ‐ QP/AP ‐ Community Support Team H2015HTHO ‐ CST ‐ Team Lead ‐ Community Support Team H2015HTU1 ‐ CST ‐ PSS ‐ Community Support Team H2017 ‐ PSYCHOSOCIAL REHAB H2022 ‐ INTENSIVE‐IN‐HOME H2033 ‐ MULTI‐SYSTEMIC‐THER H2034 ‐ SA Half‐way House H2035 ‐ SA Comprehensive Outpatient Trt Prog Q3014GT ‐ TELEHEALTH ORIG SITE FEE S9484 ‐ FAC BASED CRISIS HR T1023 ‐ DIAGNOSTIC‐ASSESSMENT YA125 ‐ Hourly Respite(CMSED) YA213 ‐ Community Respite(CMSED) YA302 ‐ Community Guide‐State YA313 ‐ Crisis Respite YA323 ‐ ASSERTIVE ENGAGEMENT YA331 ‐ Jail Assessment YA332 ‐ Outpatient Commit followup YA334 ‐ Forensic Evaluation YA335 ‐ Jail Coordination YA336 ‐ Hospital dschg plg and tx YA341 ‐ Assertive Engagement YA355 ‐ DD DIVERSION EMERGENCY RESPITE YA368 ‐ ASSERTIVE ENGAGEMENT
Effective Date
7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022
Rate
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
325.58 155.81 241.81 21.25 131.56 16.60 132.32 13.26 2.88 304.18 0.01 90.00 31.41 2.01 25.91 25.91 25.91 25.91 25.91 2.69 239.66 36.57 55.29 45.35 21.25 30.00 231.30 5.00 150.00 150.00 214.38 15.00 175.00 22.65 200.00 12.82 22.65 15.00 200.00 15.00
Standard Rate Schedule: Non‐Medicaid Non‐Clinician Based Rev. 11/01/2022
Service
YA383 ‐ LONG TERM VOCATIONAL SUPPORT(GROUP) YA384 ‐ SAFETY & SUPERVISION PER DIEM YA385 ‐ SAFETY & SUPERVISION‐HOURLY YA389 ‐ LONG‐TERM VOCATIONAL SUPPORT ‐ I/DD YA390 ‐ SUPPORTED EMP IND ‐ I/DD YA393 ‐ Indiv Community Activity and Employment Transition YA394 ‐ Group Community Activity and Employment Transition YA402 ‐ CASE SUPPORT YM120 ‐ Transition Management Services (TMS) YM755 ‐ Family Living High YM812 ‐ MR/MI SUPERVISED LIV 2 RES YM813 ‐ MR/MI SUPERVISED LIV 3 RES YM814 ‐ MR/MI SUPERVISED LIV 4 RES YM815 ‐ MR/MI SUPERVISED LIV 5 RES YM816 ‐ MR/MI SUPERVISED LIV 6 RES YM846 ‐ Residential Supports ‐ IDD and TBI ‐ Level 1 YM847 ‐ Residential Supports ‐ IDD and TBI ‐ Level 2 YM848 ‐ Residential Supports ‐ IDD and TBI ‐ Level 3 YM849 ‐ Residential Rehab TBI ‐ Level 1 YM851 ‐ Community Living and Supports YM852 ‐ Group ‐ Community Living and Supports YM850 ‐ Residential Supports YM853 ‐ Residential Rehab TBI ‐ Level 2 YM854 ‐ Supported Living ‐ Periodic IDD and TBI YP010 ‐ HOURLY RESPITE CARE DD YP011 ‐ RESPITE HOURLY DD GROUP YP020 ‐ INDIVIDUAL HABILITATION YP610 Developmental Day YP620 ‐ MR/MI ADVP YP630 Supported Employment, Individual YP640 ‐ SUPPORTED EMP GROUP ‐ I/DD YP660 Day Activity YP710 ‐ APARTMENT LIVING YP720 ‐ SUPERVISED LIVING MODERATE YP740 ‐ FAMILY LIVING ‐ LOW INTENSITY YP750 ‐ Family Living Moderate YP760 ‐ GROUP LIVING LOW YP770 ‐ GROUP LIV MODERATE NON‐GRANT YP780 ‐ GROUP LIVING HIGH YP790 ‐ Detox ‐ Social Setting
Effective Date
7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 9/1/2022 7/1/2022 7/1/2022 7/1/2022 9/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022
Rate
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
3.00 60.00 15.00 11.21 11.21 9.65 3.75 15.00 17.00 100.00 161.99 116.15 93.17 77.67 68.83 151.77 176.04 200.58 212.97 6.46 4.25 96.25 313.85 8.01 5.00 1.67 4.46 4.74 1.57 14.22 2.53 3.75 28.92 55.11 55.00 77.50 55.29 75.48 141.15 118.42
Standard Rate Schedule: Non‐Medicaid Non‐Clinician Based Rev. 11/01/2022
Service
YP821 ‐ INPATIENT PSYCH YP830 ‐ ALCL &/or DRUG ASSESSMENT ‐ NON LIC YP831 ‐ SA INDIV TX > 30MIN ‐ NON LIC YP832 ‐ ALCOHOL & DRUG GROUP ‐ NON LIC YP833 ‐ BH Family Therapy w/ Client‐ Non Licensed SA YP834 ‐ BH FAMILY THERAPY W/O CLIENT‐ NON LICENSED SA YP835 ‐ ALCL & DRUG GROUP ‐ NON LIC YP836 ‐ MH ASSESSMENT BY NON‐LICENSED YP851 ‐ PSYCHIATRIST ADMIN YP852 ‐ PSYCHIATRIST CONSULT
Effective Date
7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022 7/1/2022
Rate
$ $ $ $ $ $ $ $ $ $
750.00 22.00 22.00 8.11 22.00 22.00 8.11 13.87 25.00 35.00