Family Care HCBS Inclusion Logic
SPCs Covered
| 102.00 | Adult Day Care |
| 110.00 | Daily Living Skills Training |
| 706.00 | Day Habilitation Services |
| 202.11 | AFH 1-2 bed (care&supervision) |
| 202.22 | AFH 3-4 bed (care&supervision) |
| 506.71 | CBRF- 5-8 bed (care&supervision) |
| 506.76 | CBRF- greater than 8 beds (care&supervision) |
| 711.02 | RCAC- (care&supervision) daily |
| 103.99 | Respite Care |
| 104.00 | Supportive Homecare – Daily |
| 104.20 | Supportive Homecare |
| 104.30 | Supportive Homecare |
Procedure Codes Not Covered
| S5120 | Chore Services, per 15 min |
| S5121 | Chore Services, per day |
Covered Supported Employment Codes
| 108.10 | Prevocational Services |
| 114.00 | Vocational Futures Planning & Support |
| 615.00 | Supported Employment |
| 615.10 | Supported Employment- Integrated |
Procedure Codes:
| H2025 | Supported employment, ongoing coaching |
| T2014 | Community based prevocational services |
| T2015 | Community based prevocational services |
| T2018 | Integrated: 1-2 Members |
| T2019 | Integrated: 1-2 Members |
| T2038 HJ | Voc Futures Planning |
Family Care Partnership HCBS Inclusion Logic
Procedure Codes Not Covered: A0000 through R9999
Revenue Codes Not Covered: 0550 through 0559
Procedure Codes Covered
| 99509 | RN Supervisory visit for personal care |
| 99600 | Skilled Nursing services |
| H2014 | Daily Living Skills Training |
| S5100 | Day care services, adult; per 15 minutes |
| S5101 | Day care services, adult; per half day |
| S5102 | Day care services, adult; per diem |
| S5105 | Adult day care: SERVICE NOT INCLUDED IN PROGRAM FEE, per diem |
| S5125 | Attendant Care, per 15 mins |
| S5126 | Attendant Care, per day |
| S5130 | SHC-Routine Health Care Service |
| S5136 | Supportive Home Care – per day: Community Supported Living |
| S9125 | Respite care-institutional setting, per diem |
| T1005 | Respite care in the home, per 15 minutes |
| T2012 | Daily Living Skills; per day |
| T2013 | Daily Living Skills per hour |
| T2021 | Day Services; per 15 minutes |
| S5135 | Companion Care; per 15 min |
| T2020 | Community-Based Day Services, per day |
Revenue Codes Covered
| 0220 | AFH bedhold ancillary residential care services only; per day |
| 0229 | CBRF bedhold ancillary residential care services only, day |
| 0240 | AFH- 1-2 bed C/S |
| 0241 | AFH- 3-4 Bed C/S |
| 0242 | CBRF < 8 bed C/S |
| 0243 | CBRF > 8 bed C/S |
| 0670 | RCAC- C/S |
| 0672 | SHC- C/S |
Supported Employment Codes Covered
| H2025 | Supp Employ Coaching, hour |
| T2014 | Prevocational services; per diem |
| T2015 | Prevocational services; per hour |
| T2018 | Supported Employment |
| T2019 | Supported Employment |
| T2038 HJ | Voc Futures Planning |