Developmental Disabilities Waiver Services & Rates

Service Name / National Code / BI / FI / CL / Modifier / Units / Location / Rate /
Employment and Day Options
Individual Supported Employment / H2023
/ √ / √ / √ / N/A / Hour / NOVA / DARS
ROS / DARS
Group Supported Employment 2 or fewer members per staff / H2024 / √ / √ / √ / UA / Hour / NOVA / $20.99
ROS / $19.25
Group Supported Employment More than 2, up to 4 members per staff / H2024 / √ / √ / √ / U2 / Hour / NOVA / $14.70
ROS / $13.52
Group Supported Employment More than 4 members per staff / H2024 / √ / √ / √ / U3 / Hour / NOVA / $12.18
ROS / $11.21
Workplace Assistance Services / H2025 / √ / √ / N/A / Hour / NOVA / $33.53
ROS / $29.24
Community Engagement
Tier 1 / T2021 / √ / √ / √ / N/A / Hour / NOVA / $16.19
ROS / $14.29
Community Engagement
Tier 2 / T2021 / √ / √ / √ / N/A / Hour / NOVA / $18.21
ROS / $16.01
Community Engagement
Tier 3 / T2021 / √ / √ / √ / N/A / Hour / NOVA / $21.01
ROS / $18.38
Community Engagement
Tier 4 / T2021 / √ / √ / √ / N/A / Hour / NOVA / $25.98
ROS / $22.61
Community Coaching / 97532 / √ / √ / √ / N/A / Hour / NOVA / $33.53
ROS / $29.24
Group Day Support
Tier 1 / 97150 / √ / √ / √ / N/A / Hour / NOVA / $10.01
ROS / $8.60
Group Day Support
Tier 2 / 97150 / √ / √ / √ / N/A / Hour / NOVA / $13.12
ROS / $11.25
Group Day Support
Tier 3 / 97150 / √ / √ / √ / N/A / Hour / NOVA / $15.55
ROS / $13.31
Group Day Support
Tier 4 / 97150 / √ / √ / √ / N/A / Hour / NOVA / $20.29
ROS / $17.34
Peer Mentoring
(Rate Effective 7/1/17) / H0038 / √ / √ / √ / N/A / Hour / NOVA / $28.49
ROS / $24.47
Community Guide
(Rate Effective 7/1/17) / H2015 / √ / √ / √ / N/A / Hour / NOVA / $49.62
ROS / $39.19
Personal Care and Related Services
Personal Assistance / T1019 / √ / √ / N/A / Hour / NOVA / $15.81
ROS / $13.43
Respite Care / T1005 / √ / √ / N/A / Hour / NOVA / $15.81
ROS / $13.43
Companion Care / S5135 / √ / √ / N/A / Hour / NOVA / $15.81
ROS / $13.43
CD Personal Assistance / S5126 / √ / √ / N/A / Hour / NOVA / $11.93
ROS / $9.22
CD Respite Care / S5150 / √ / √ / N/A / Hour / NOVA / $11.93
ROS / $9.22
CD Companion Care / S5136 / √ / √ / N/A / Hour / NOVA / $11.93
ROS / $9.22
CD Routine Visit / 99509 / √ / √ / N/A / Hour / NOVA / $72.41
ROS / $55.69
CD Initial Comprehensive Visit / H2000 / √ / √ / N/A / Hour / NOVA / $232.78
ROS / $179.33
CD Employee Management Training / Consumer Training / S5109 / √ / √ / N/A / Hour / NOVA / $231.67
ROS / $178.21
Individual & Family Caregiver Training / S5111 / √ / N/A / Hour / NOVA / $53.35
ROS / $46.39
CD Management Training / S5116 / √ / √ / N/A / Hour / NOVA / $28.96
ROS / $22.28
CD Reassessment Visit / T1028 / √ / √ / N/A / Hour / NOVA / $116.96
ROS / $89.11
Residential Options
Independent Living Supports
Tier 1 / T2032 / √ / N/A / Month / NOVA / $1,366.21
ROS / $1,168.44
Independent Living Supports
Tier 2-4 / T2032 / √ / N/A / Month / NOVA / $2,271.36
ROS / $1,945.28
Independent Living Supports- Partial Month Tier 1 / T2032 / √ / U1 / Partial Month / NOVA / $683.11
ROS / $584.22
Independent Living Supports-
Partial Month Tier 2-4 / T2032 / √ / U1 / Partial Month / NOVA / $1,135.68
ROS / $972.64
Shared Living / T1020 / √ / √ / √ / N/A / Month / NOVA / IC
ROS / IC
Shared Living / T1020 / √ / √ / √ / N/A / Partial Month / NOVA / IC
ROS / IC
Supported Living Residential
Tier 1 / H0043 / √ / √ / N/A / 344 billing days Per Diem / NOVA / $160.03
ROS / $136.76
Supported Living Residential
Tier 2 / H0043 / √ / √ / N/A / 344 billing days Per Diem / NOVA / $208.22
ROS / $177.12
Supported Living Residential
Tier 3 / H0043 / √ / √ / N/A / 344 billing days Per Diem / NOVA / $242.67
ROS / $205.98
Supported Living Residential
Tier 4 / H0043 / √ / √ / N/A / 344 billing days Per Diem / NOVA / $306.26
ROS / $259.25
In-Home Support Services
Size 1 / H2014 / √ / √ / UA / Hour / NOVA / $29.84
ROS / $25.61
In-Home Support Services
Size 2 / H2014 / √ / √ / U2 / Hour / NOVA / $16.41
ROS / $14.09
In-Home Support Services
Size 3 / H2014 / √ / √ / U3 / Hour / NOVA / $11.94
ROS / $10.24
Sponsored Residential
Tier 1 (Rate Effective (1/1/17) / T2033 / √ / N/A / 344 billing days Per Diem / NOVA / $161.80
ROS / $131.98
Sponsored Residential
Tier 2 (Rate Effective (1/1/17) / T2033 / √ / N/A / 344 billing days Per Diem / NOVA / $222.80
ROS / $180.98
Sponsored Residential
Tier 3 (Rate Effective (1/1/17) / T2033 / √ / N/A / 344 billing days Per Diem / NOVA / $287.16
ROS / $232.60
Sponsored Residential
Tier 4 (Rate Effective (1/1/17) / T2033 / √ / N/A / 344 billing days Per Diem / NOVA / $372.57
ROS / $301.19
Sponsored Residential
(Rate Effective 07/01/2016 thru 12/31/2016) / T2033 / √ / N/A / Hour / NOVA / $17.36
ROS / $15.10
Sponsored Residential- Exceptional Supports
(Rate Effective 07/01/2016 thru 12/31/2016) / T2033 / √ / U1 / Hour / NOVA / $21.70
ROS / $18.88
Group Home Residential- Tier 1
4 or fewer person homes / H2022 / √ / UA / 344 billing days Per Diem / NOVA / $237.62
ROS / $201.76
Group Home Residential- Tier 2
4 or fewer person homes / H2022 / √ / UA / 344 billing days Per Diem / NOVA / $283.29
ROS / $240.00
Group Home Residential- Tier 3
4 or fewer person homes / H2022 / √ / UA / 344 billing days Per Diem / NOVA / $312.26
ROS / $264.26
Group Home Residential- Tier 4
4 or fewer person homes / H2022 / √ / UA / 344 billing days Per Diem / NOVA / $373.27
ROS / $315.36
Group Home Residential- Tier 1
5 person homes / H2022 / √ / U2 / 344 billing days Per Diem / NOVA / $221.80
ROS / $188.09
Group Home Residential- Tier 2
5 person homes / H2022 / √ / U2 / 344 billing days Per Diem / NOVA / $249.07
ROS / $210.93
Group Home Residential- Tier 3
5 person homes / H2022 / √ / U2 / 344 billing days Per Diem / NOVA / $276.33
ROS / $233.76
Group Home Residential- Tier 4
5 person homes / H2022 / √ / U2 / 344 billing days Per Diem / NOVA / $325.40
ROS / $274.86
Group Home Residential- Tier 1
6 person homes / H2022 / √ / U3 / 344 billing days Per Diem / NOVA / $214.99
ROS / $182.38
Group Home Residential- Tier 2
6 person homes / H2022 / √ / U3 / 344 billing days Per Diem / NOVA / $238.84
ROS / $202.36
Group Home Residential- Tier 3
6 person homes / H2022 / √ / U3 / 344 billing days Per Diem / NOVA / $266.10
ROS / $225.20
Group Home Residential- Tier 4
6 person homes / H2022 / √ / U3 / 344 billing days Per Diem / NOVA / $316.88
ROS / $267.72
Group Home Residential- Tier 1
7 person homes / H2022 / √ / U4 / 344 billing days Per Diem / NOVA / $208.17
ROS / $176.67
Group Home Residential- Tier 2
7 person homes / H2022 / √ / U4 / 344 billing days Per Diem / NOVA / $228.61
ROS / $193.80
Group Home Residential- Tier 3
7 person homes / H2022 / √ / U4 / 344 billing days Per Diem / NOVA / $255.88
ROS / $216.63
Group Home Residential- Tier 4
7 person homes / H2022 / √ / U4 / 344 billing days Per Diem / NOVA / $308.36
ROS / $260.59
Group Home Residential- Tier 1
8 person homes / H2022 / √ / U5 / 344 billing days Per Diem / NOVA / $201.35
ROS / $170.97
Group Home Residential- Tier 2
8 person homes / H2022 / √ / U5 / 344 billing days Per Diem / NOVA / $218.40
ROS / $185.24
Group Home Residential- Tier 3
8 person homes / H2022 / √ / U5 / 344 billing days Per Diem / NOVA / $245.65
ROS / $208.07
Group Home Residential- Tier 4
8 person homes / H2022 / √ / U5 / 344 billing days Per Diem / NOVA / $299.84
ROS / $253.45
Group Home Residential- Tier 1
9 person homes / H2022 / √ / U6 / 344 billing days Per Diem / NOVA / $194.54
ROS / $165.25
Group Home Residential- Tier 2
9 person homes / H2022 / √ / U6 / 344 billing days Per Diem / NOVA / $208.17
ROS / $176.67
Group Home Residential- Tier 3
9 person homes / H2022 / √ / U6 / 344 billing days Per Diem / NOVA / $235.44
ROS / $199.51
Group Home Residential- Tier 4
9 person homes / H2022 / √ / U6 / 344 billing days Per Diem / NOVA / $291.32
ROS / $246.32
Group Home Residential- Tier 1
10 person homes / H2022 / √ / U7 / 344 billing days Per Diem / NOVA / $187.72
ROS / $159.54
Group Home Residential- Tier 2
10 person homes / H2022 / √ / U7 / 344 billing days Per Diem / NOVA / $197.95
ROS / $168.10
Group Home Residential- Tier 3
10 person homes / H2022 / √ / U7 / 344 billing days Per Diem / NOVA / $225.21
ROS / $190.95
Group Home Residential- Tier 4
10 person homes / H2022 / √ / U7 / 344 billing days Per Diem / NOVA / $282.80
ROS / $239.18
Group Home Residential- Tier 1
11 person homes / H2022 / √ / U8 / 344 billing days Per Diem / NOVA / $180.91
ROS / $153.83
Group Home Residential- Tier 2
11 person homes / H2022 / √ / U8 / 344 billing days Per Diem / NOVA / $187.72
ROS / $159.54
Group Home Residential- Tier 3
11 person homes / H2022 / √ / U8 / 344 billing days Per Diem / NOVA / $214.99
ROS / $182.38
Group Home Residential- Tier 4
11 person homes / H2022 / √ / U8 / 344 billing days Per Diem / NOVA / $274.28
ROS / $232.05
Group Home Residential- Tier 1
12 person homes / H2022 / √ / U9 / 344 billing days Per Diem / NOVA / $174.09
ROS / $148.12
Group Home Residential- Tier 2
12 person homes / H2022 / √ / U9 / 344 billing days Per Diem / NOVA / $177.50
ROS / $150.98
Group Home Residential- Tier 3
12 person homes / H2022 / √ / U9 / 344 billing days Per Diem / NOVA / $204.76
ROS / $173.82
Group Home Residential- Tier 4
12 person homes / H2022 / √ / U9 / 344 billing days Per Diem / NOVA / $265.76
ROS / $224.91
Crisis Support Options
Community-Based Crisis Supports
(professional) / H0040 / √ / √ / √ / U1 / Hour / NOVA / $101.67
ROS / $88.41
Community-Based Crisis Supports
(non-professional) / H0040 / √ / √ / √ / N/A / Hour / NOVA / $27.61
ROS / $24.02
Center-Based Crisis Supports
(professional) / H2011 / √ / √ / √ / U1 / Hour / NOVA / $101.67
ROS / $88.41
Center-Based Crisis Supports
(non-professional) / H2011 / √ / √ / √ / UA / Hour / NOVA / $27.61
ROS / $24.02
Crisis Support Services
(professional) / T2034 / √ / √ / √ / U1 / Hour / NOVA / $101.67
ROS / $88.41
Crisis Support Services
(non-professional) / T2034 / √ / √ / √ / N/A / Hour / NOVA / $27.61
ROS / $24.02
Medical and Behavioral Support Options
Skilled Nursing , RN / S9123 / √ / √ / N/A / 15 minutes / NOVA / $11.28
ROS / $9.29
Skilled Nursing, LPN / S9124 / √ / √ / N/A / 15 minutes / NOVA / $9.78
ROS / $8.05
Private Duty Nursing, RN / T1002 / √ / √ / N/A / 15 minutes / NOVA / $9.22
ROS / $7.59
Private Duty Nursing, LPN / T1003 / √ / √ / N/A / 15 minutes / NOVA / $7.99
ROS / $6.59
Therapeutic Consultation, Therapist/Behavior Analysts/Rehab. Engineers / 97139 / √ / √ / N/A / Hour / NOVA / $92.85
ROS / $87.75
Therapeutic Consultation,
Psychologist/Psychiatrist / H2017 / √ / √ / N/A / Hour / NOVA / $83.71
ROS / $72.75
Therapeutic Consultation,
Other Professionals / 97530 / √ / √ / N/A / Hour / NOVA / $70.69
ROS / $63.12
RN/ Personal Emergency Response System (PERS) / H2021 / √ / √ / √ / TD / 30 minutes / NOVA / $14.85
ROS / $12.13
LPN/ Personal Emergency Response System (PERS) / H2021 / √ / √ / √ / TE / 30 minutes / NOVA / $12.87
ROS / $10.15
PERS Installation / S5160 / √ / √ / √ / N/A / One-time Purchase / NOVA / $58.41
ROS / $49.50
PERS Installation and Medication Monitoring / S5160 / √ / √ / √ / U1 / One-time Purchase / NOVA / $87.62
ROS / $74.25
PERS Monitoring / S5161 / √ / √ / √ / N/A / Month / NOVA / $35.05
ROS / $29.70
PERS Medication Monitoring / S5185 / √ / √ / √ / N/A / Month / NOVA / $58.41
ROS / $49.50
Additional Options
Assistive Technology Only / T1999 / √ / √ / √ / N/A / *Per Item / NOVA / IC
ROS / IC
Assistive Technology Maintenance Cost Only / T1999 / √ / √ / √ / U5 / *Per Item / NOVA / IC
ROS / IC
Electronic-Based Home Supports / A9279 / √ / √ / √ / N/A / *Per Item / NOVA / IC
ROS / IC
Environmental Modifications Only / S5165 / √ / √ / √ / N/A / *Per Item / NOVA / IC
ROS / IC
Environmental Modifications, Maintenance Costs Only / 99199 / √ / √ / √ / U4 / *Per Item / NOVA / IC
ROS / IC
Transition Services / T2038 / √ / √ / √ / N/A / **Per Item / NOVA / IC
ROS / IC
Benefits Planning
(Rate Effective 7/1/17) / T1023 / √ / √ / √ / N/A / Hour / NOVA / $39.46
ROS / $30.69

*Individual Consideration (IC) will be based on approved cost up to $5,000 per year consistent with the service authorization. The total authorized amount can be used on one single item or multiple items during the year.

** Individual Consideration (IC) will be based on approved cost up to $5,000 consistent with the service authorization and is considered a lifetime limit.

Rates Effective 09/01/2016

BI= Building Independence Waiver; FI= Family & Individual Waiver; CL= Community Living Waiver