1096 |
MA CVRD NON-MEDICARE CVRD-DUALS-ART 16-DTC-APG |
Effective 7/1/21 |
Voluntary |
1098 |
MA CVRD NON-COMM INS CVRD-ART 16-DTC-APG |
Effective 7/1/21 |
Voluntary |
|
1546 |
OPWDD APG - Free-Standing Article 16 Clinic |
On-Site - Effective 7/1/11 |
|
|
1900 |
OPWDD CARE COORD ORG/HH LVL 1; VOL; MTHLY |
Effective 7/1/18 |
Voluntary |
1901 |
OPWDD CARE COORD ORG/HH LVL 2; VOL; MTHLY |
Effective 7/1/18 |
Voluntary |
1902 |
OPWDD CARE COORD ORG/HH LVL 3; VOL; MTHLY |
Effective 7/1/18 |
Voluntary |
1903 |
OPWDD CARE COORD ORG/HH LVL 4; VOL; MTHLY |
Effective 7/1/18 |
Voluntary |
1904 |
OPWDD CARE COORD ORG/HH OPT OUT; VOL; MTHLY |
Effective 7/1/18 |
Voluntary |
1905 |
OPWDD CARE COORD ORG/HH TRANS; MTHLY |
Effective 7/1/18 |
Voluntary |
1906 |
OPWDD CARE COORD ORG/HH OPT OUT TRNS; MTHLY |
Effective 7/1/18 |
Voluntary |
|
2438 |
OPWDD FIDA - Age 21-49 Medicare Dual |
Effective 4/1/16 |
Voluntary |
2439 |
OPWDD FIDA - Age 50+ Medicare Dual |
Effective 4/1/16 |
Voluntary |
|
1605 |
OPWDD Specialty Hospital; Vol Operated; Per Diem |
Terrance Cardinal Cooke Specialty Hospital - Effective 1/1/13 |
Voluntary |
|
3822 |
HRF/MR |
VOICF |
Voluntary |
|
4100 |
State Operated OPWDD Development Center |
|
State |
4101 |
OPWDD State Operated ICF/DD |
|
State |
4102 |
OPWDD St. Op ICFDD Small Residential Unit |
|
State |
|
4104 |
ICF; Vol; Day Service; Full Unit |
VOICF Day Service - Effective 1/1/15 |
Voluntary |
4105 |
ICF; Vol; Day Service; Half Unit |
VOICF Day Service - Effective 1/1/15 |
Voluntary |
4106 |
ICF; Vol; Vocational Service; Full Unit |
VOICF Prevoc Service - Effective 1/1/15 |
Voluntary |
4107 |
ICF; Vol; Vocational Service; Half Unit |
VOICF Prevoc Service - Effective 1/1/15 |
Voluntary |
4108 |
ICF; Vol; INHS Day Service; Full Unit |
VOICF In House Day Service effective 1/1/16 |
Voluntary |
4109 |
ICF; Vol;Comm Voc; Group 3 + Ind |
Effective 7/1/15 |
Voluntary |
4110 |
ICF; State; Day Service; Full Unit |
SOICF Day Service - Effective 4/1/16 |
State |
4111 |
ICF; State; Day Service; Half Unit |
SOICF Day Service - Effective 4/1/16 |
State |
4112 |
ICF; State; Vocational Service; Full Unit |
SOICF Prevoc Service - Effective date TBD |
State |
4113 |
ICF; State; Vocational Service; Half Unit |
SOICF Prevoc Service - Effective date TBD |
State |
4114 |
ICF; State; INHS Day Service; Full Unit |
SOICF In House Day Service - effective date TBD |
State |
4115 |
ICF; State; Comm Voc; Group 3 + Ind |
Effective TBD |
State |
4116 |
ICF; Vol; Comm Vocational 1:1 |
Effective 7/1/15 |
Voluntary |
4117 |
ICF; Vol;Comm Voc; Group of 2 |
Effective 7/1/15 |
Voluntary |
4118 |
ICF; State; Comm; Vocational 1:1 |
Effective TBD |
State |
4119 |
ICF; State; Comm Voc; Group of 2 |
Effective TBD |
State |
|
4120 |
ICF TEMPLATE SPECIALIZED; VOL; PER DIEM |
Effective 9/1/18 |
Voluntary |
4121 |
ICF TEMPLATE HIGHLY COMPLEX; VOL;PER DIEM |
Effective 9/1/18 |
Voluntary |
4122 |
ICF AUSPICE CHANGE; VOL; PER DIEM |
Effective 9/1/18 |
Voluntary |
|
4170 |
OPWDD Day Treatment Full Day |
|
Voluntary |
4171 |
OPWDD Day Treatment Half Day |
|
Voluntary |
4172 |
OPWDD Day Treatment Collocated Model |
|
Voluntary |
4173 |
OPWDD Day Treatment Intake |
|
Voluntary |
4174 |
OPWDD Day Treatment Diagnosis & Evaluation |
|
Voluntary |
|
4428 |
Res Hab; State-IRA Supvd; Per Diem |
Effective 7/1/14 |
State |
4429 |
Res Hab; State-IRA Supvd; Med Leave; Per Diem |
Effective 7/1/14 |
State |
4430 |
Res Hab; State-IRA Supvd; Non-Med Leave; Per Diem |
Effective 7/1/14 |
State |
|
4431 |
Res Hab; State-FC; Per Diem |
Effective 7/1/15 |
State |
|
4433 |
Path to Employment; State; Indiv; 1/4 Hr |
Effective 7/1/14 |
State |
4434 |
Path to Employment; State; Group; 1/4 Hr |
Effective 7/1/14 |
State |
|
4436 |
Prevoc; Community; State; 1/4 Hr |
Effective 7/1/15 |
State |
|
4437 |
Res Hab; Vol-IRA Supvd; Per Diem |
Effective 7/1/14 |
Voluntary |
4438 |
Res Hab; Vol-IRA Supvd; Med Leave; Per Diem |
Effective 7/1/14 |
Voluntary |
4439 |
Res Hab; Vol-IRA Supvd; Non-Med Leave; Per Diem |
Effective 7/1/14 |
Voluntary |
|
4440 |
Res Hab; Voluntary-FC; Per Diem |
|
Voluntary |
|
4444 |
Path to Employment; Vol; Indiv; 1/4 Hr |
Effective 7/1/14 |
Voluntary |
4445 |
Path to Employment; Vol; Group; 1/4 Hr |
Effective 7/1/14 |
Voluntary |
|
4446 |
Grp Day Hab-State;Full Unit/OPWDD |
|
State |
4447 |
Grp Day Hab-State;Half Unit/OPWDD |
|
State |
|
4450 |
SEMP; Intensive; State; Ind; 1/4 Hr |
Effective 7/1/15 |
State |
4451 |
SEMP; Intensive; State; Grp; 1/4 Hr |
Effective 7/1/15 |
State |
|
4453 |
Grp Day Hab-Vol;Full Unit/OPWDD |
|
Voluntary |
4454 |
Grp Day Hab-Vol;Half Unit/OPWDD |
|
Voluntary |
4455 |
Supplemental Grp Day Hab-Vol Full Unit/OPWDD |
|
Voluntary |
4456 |
Supplemental Grp Day Hab-Vol Half Unit/OPWDD |
|
Voluntary |
|
4458 |
Prevoc-State;Full Unit/OPWDD |
|
State |
4459 |
Prevoc-State;Half Unit/OPWDD |
|
State |
|
4460 |
SEMP; Extended; State; Ind; 1/4 Hr |
Effective 7/1/15 |
State |
4461 |
SEMP; Extended; State; Grp; 1/4 Hr |
Effective 7/1/15 |
State |
|
4464 |
Prevoc;Voluntary;Full Unit/OPWDD |
|
Voluntary |
4465 |
Prevoc;Voluntary;Half Unit/OPWDD |
|
Voluntary |
|
4476 |
Environ Mods; $1.00 Per Unit Fee; State |
|
State |
4477 |
Environ Mods; $10.00 Per Unit Fee; State |
|
State |
4478 |
Environ Mods; $100.00 Per Unit Fee; State |
|
State |
4479 |
Environ Mods; $1000.00 Per Unit Fee; State |
|
State |
|
4482 |
Adaptive Technology; $1.00 Per Unit Fee; State |
|
State |
4483 |
Adaptive Technology; $10.00 Per Unit Fee; State |
|
State |
4484 |
Adaptive Technology; $100.00 Per Unit Fee; State |
|
State |
4485 |
Adaptive Technology; $1000.00 Per Unit Fee; State |
|
State |
|
4496 |
Individual Family Education &Training Serv-State;Unit |
|
State |
4497 |
Individual Family Education &Training Serv-Voluntary;Unit |
|
Voluntary |
4498 |
Group Family Education &Training Serv-State;Unit |
|
State |
4499 |
Group Family Education &Training Serv-Voluntary;Unit |
|
Voluntary |
|
4703 |
Res Hab;State;IRA-Suprt Monthly |
|
State |
4704 |
Res Hab;State;IRA-Suprt Semi-Monthly 1st half |
|
State |
4705 |
Res Hab;State;IRA-Suprt Semi-Monthly 2nd half |
|
State |
|
4709 |
Res Hab;Vol;IRA/CR-Suprt Monthly |
|
Voluntary |
4710 |
Res Hab;Vol;IRA/CR-Suprt Semi-Monthly 1st half |
|
Voluntary |
4711 |
Res Hab;Vol;IRA/CR-Suprt Semi-Monthly 2nd half |
|
Voluntary |
|
4720 |
IBS; Vol; IBP/FBA Plan Development; Flat Fee |
Effective 10/1/13 |
Voluntary |
4721 |
IBS; Vol; Plan Implementation; ¼ Hr |
Effective 10/1/13 |
Voluntary |
|
4722 |
Comm/Res Hab; Vol; Indiv; ¼ Hr |
Effective 11/1/10 |
Voluntary |
4723 |
Comm/Res Hab; Vol; Group – 2 Individuals; ¼ Hr |
Effective 11/1/10 |
Voluntary |
4724 |
Comm/Res Hab; Vol; Group – 3 Individuals; ¼ Hr |
Effective 11/1/10 |
Voluntary |
|
4741 |
Comm/Res Hab; State; Group-1 Individual; 1/4 Hr |
Effective 10/1/13 |
State |
4742 |
Comm/Res Hab; State; Group-2 Individuals; 1/4 Hr |
Effective 10/1/13 |
State |
4743 |
Comm/Res Hab; State; Group-3 Individuals; 1/4 Hr |
Effective 10/1/13 |
State |
|
4749 |
Respite-Hourly;1/4 Hour Unit; State |
VO OPTS and SO Effective 2/1/10 |
State |
|
4755 |
Com Hab; Agy Sup; Vol; Ind; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4756 |
Com Hab; Agy Sup; Vol; Grp; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4757 |
Com Hab; Cert Fac Resid; Agy Sup; Vol; Ind; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4758 |
Com Hab; Cert Fac Resid; Agy Sup; Vol; Grp; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
|
4759 |
SEMP; Agy Sup; Phase 1; Vol; Ind; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4760 |
SEMP; Agy Sup; Phase 1; Vol; Grp; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4761 |
SEMP; Agy Sup; Phase 2; Vol; Ind; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4762 |
SEMP; Agy Sup; Phase 2; Vol; Grp; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
|
4764 |
Respite; Via FI Fee; Vol; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4765 |
Com Hab; Via FI; Vol; Ind; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4766 |
Com Hab; Via FI; Vol; Grp; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4767 |
Com Hab; Cert Fac Resid; Via FI; Vol; Ind; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4768 |
Com Hab; Cert Fac Resid; Via FI; Vol; Grp; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
|
4769 |
SEMP; Via FI; Phase 1; Vol; Ind; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4770 |
SEMP; Via FI; Phase 1; Vol; Grp; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4771 |
SEMP; Via FI; Phase 2; Vol; Ind; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4772 |
SEMP; Via FI; Phase 2; Vol; Grp; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
|
4777 |
Live-In Caregiver; Via FI; Vol; Month |
Effective 10/1/14 |
Voluntary |
4778 |
Support Broker; Via FI; Vol; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
|
4781 |
Prevoc; Comm; Ind; Vol; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4782 |
Prevoc; Comm; Group of 2; Vol; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4783 |
Prevoc; Comm; Group of 3+; Vol; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
|
4785 |
Ind Goods & Svcs; Via FI; Vol; $10 Unit |
Effective 10/1/14 |
Voluntary |
|
4786 |
Com Trans Svcs; Via FI; Vol; $10 Unit |
Effective 12/1/14 |
Voluntary |
|
4787 |
Fiscal Intermediary; Vol; Level 1; Mth |
Effective 10/1/14 |
Voluntary |
4788 |
Fiscal Intermediary; Vol; Level 2; Mth |
Effective 10/1/14 |
Voluntary |
4789 |
Fiscal Intermediary; Vol; Level 3; Mth |
Effective 10/1/14 |
Voluntary |
|
4790 |
SEMP; Intensive; Vol; Ind; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4791 |
SEMP; Intensive; Vol; Grp; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4792 |
SEMP; Extended; Vol; Ind; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
4793 |
SEMP; Extended; Vol; Grp; 1/4 Hr |
Effective 7/1/15 |
Voluntary |
|
4796 |
Com Hab; Cert Fac Resid; Vol; Ind; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4797 |
Com Hab; Cert Fac Resid; Vol; Grp; 1/4 Hr |
Effective 10/1/14 |
Voluntary |
4798 |
Com Hab; Cert Fac Resid; State; Ind; 1/4 Hr |
Effective 11/1/17 |
State |
4799 |
Com Hab; Cert Fac Resid; State; Grp; 1/4 Hr |
Effective 11/1/17 |
State |
|
7400 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 1 |
Effective 7/1/17 |
Voluntary |
7401 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 1;MED LEAVE |
Effective 7/1/17 |
Voluntary |
7402 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 1;NONMED LEAVE |
Effective 7/1/17 |
Voluntary |
7403 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 2 |
Effective 7/1/17 |
Voluntary |
7404 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 2;MED LEAVE |
Effective 7/1/17 |
Voluntary |
7405 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 2;NONMED LEAVE |
Effective 7/1/17 |
Voluntary |
7406 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 3 |
Effective 7/1/17 |
Voluntary |
7407 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 3;MED LEAVE |
Effective 7/1/17 |
Voluntary |
7408 |
RES HAB;VOL;IRA SPVD;HIGH NEEDS TIER 3;NONMED LEAVE |
Effective 7/1/17 |
Voluntary |
|
7409 |
RES HAB; VOL; IRA SPT MTH; HIGH NEEDS TIER 1 |
Effective 7/1/17 |
Voluntary |
7410 |
RES HAB; VOL; IRA SPT 1ST; HIGH NEEDS TIER 1 |
Effective 7/1/17 |
Voluntary |
7411 |
RES HAB; VOL; IRA SPT 2ND; HIGH NEEDS TIER 1 |
Effective 7/1/17 |
Voluntary |
7412 |
RES HAB; VOL; IRA SPT MTH; HIGH NEEDS TIER 2 |
Effective 7/1/17 |
Voluntary |
7413 |
RES HAB; VOL; IRA SPT 1ST; HIGH NEEDS TIER 2 |
Effective 7/1/17 |
Voluntary |
7414 |
RES HAB; VOL; IRA SPT 2ND; HIGH NEEDS TIER 2 |
Effective 7/1/17 |
Voluntary |
|
7421 |
Respite; In Home; Vol; 1/4 Hr |
Effective 7/1/17 |
Voluntary |
7422 |
Respite; Site Based; Vol; 1/4 Hr |
Effective 7/1/17 |
Voluntary |
7423 |
Respite; Recreation; Vol; 1/4 Hr |
Effective 7/1/17 |
Voluntary |
7424 |
Respite; Camp; Vol; 1/4 Hr |
Effective 7/1/17 |
Voluntary |
7425 |
Respite; Intensive; Vol; 1/4 Hr |
Effective 7/1/17 |
Voluntary |
7426 |
Respite; Agy Sup; In Home; Vol; 1/4 Hr |
Effective 7/1/17 |
Voluntary |
7427 |
Respite; Agy Sup Intensive; In Home; Vol; 1/4 Hr |
Effective 7/1/17 |
Voluntary |
7428 |
Respite; In Home; Vol; Per Diem |
Effective 7/1/17 |
Voluntary |
7429 |
Respite; Site Based; Vol; Per Diem |
Effective 7/1/17 |
Voluntary |
7430 |
Respite; In Home; State; 1/4 Hr |
Effective 7/1/17 |
State |
|
7435 |
Group Day Hab; Vol; Full Unit; High Needs Tier 1 |
Effective 7/1/17 |
Voluntary |
7436 |
Group Day Hab; Vol; Half Unit; High Needs Tier 1 |
Effective 7/1/17 |
Voluntary |
7437 |
Group Day Hab; Vol; Full Unit; High Needs Tier 2 |
Effective 7/1/17 |
Voluntary |
7438 |
Group Day Hab; Vol; Half Unit; High Needs Tier 2 |
Effective 7/1/17 |
Voluntary |
7439 |
Group Day Hab; Vol; Full Unit; High Needs Tier 3 |
Effective 7/1/17 |
Voluntary |
7440 |
Group Day Hab; Vol; Half Unit; High Needs Tier 3 |
Effective 7/1/17 |
Voluntary |
|
7441 |
Supplemental Grp Day Hab;Vol;Full Unit;High Needs Tier 1 |
Effective 7/1/17 |
Voluntary |
7442 |
Supplemental Grp Day Hab;Vol;Half Unit;High Needs Tier 1 |
Effective 7/1/17 |
Voluntary |
7443 |
Supplemental Grp Day Hab;Vol;Full Unit;High Needs Tier 2 |
Effective 7/1/17 |
Voluntary |
7444 |
Supplemental Grp Day Hab;Vol;Half Unit;High Needs Tier 2 |
Effective 7/1/17 |
Voluntary |
7445 |
Supplemental Grp Day Hab;Vol;Full Unit;High Needs Tier 3 |
Effective 7/1/17 |
Voluntary |
7446 |
Supplemental Grp Day Hab;Vol;Half Unit;High Needs Tier 3 |
Effective 7/1/17 |
Voluntary |
|
7447 |
RESPITE; INTENSIVE CSIDD RESOURCE CTR; VOL; 1/4 HR |
Effective 1/1/24 |
Voluntary |
|
7450 |
CSIDD-Stable;Vol;Monthly |
Effective 5/1/22 |
Voluntary |
7451 |
CSIDD-Mild;Vol;Monthly |
Effective 5/1/22 |
Voluntary |
7452 |
CSIDD-Moderate;Vol;Monthly |
Effective 5/1/22 |
Voluntary |
7453 |
CSIDD-Intensive;Vol;Monthly |
Effective 5/1/22 |
Voluntary |
7454 |
CSIDD-Stable;State;Monthly |
Effective 5/1/22 |
State |
7455 |
CSIDD-Mild;State;Monthly |
Effective 5/1/22 |
State |
7456 |
CSIDD-Moderate;State;Monthly |
Effective 5/1/22 |
State |
7457 |
CSIDD-Intensive;State;Monthly |
Effective 5/1/22 |
State |
|
8032 |
ENVIR MODS - $1.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8034 |
ENVIR MODS - $10.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8035 |
ENVIR MODS - $100.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8036 |
ENVIR MODS - $1000.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8037 |
ADAP & ASSIST EQUIP - $1.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8038 |
ADAP & ASSIST EQUIP - $10.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8039 |
ADAP & ASSIST EQUIP - $100.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8040 |
ADAPT & ASSIST EQUIP - $1000.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8041 |
VEHICLE MODS - $1.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8042 |
VEHICLE MODS - $10.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8043 |
VEHICLE MODS - $100.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
8044 |
VEHICLE MODS - $1000.00 UNIT (CHILDREN'S WAIVER) |
Effective 4/1/19 |
State |
|