2005/06/20 Council Agenda Packet

4 Exhibit A Rate Table d: $ ' 10 ..izv:" \j'ate 4.0.4 Out-of home in a licensed $8.93 hr facility: Not to exceed 8 hours 7306— Hourly • Daycare/Childcare Daily = $71.44 in a 24 hour period 7311- Daily • Child foster home, [8 hrs x $8.93 7809, 7812 • Child group home • AFH 8178, 8278, 8378 • ARC Staffed residential home $14.93 hr Not to exceed 8 hours 7315 licensed by Children's in a 24 hour period Administration 8177, 8277, 8377 _ Home care agency: $14.93 hr Pay for each hour 7315 in client's home 7854, 7855 8177, 8277, 8377 Camp and other $14.93 hr Number of Hours = 7306, 7311, 7315, community settings Cost of service providing respite 14.93. 8177, 8277, 8377 Round up or down as makes sense. Camp and other EA (each) 7340 community settings For FS services only. Not applicable 7856 providing respite Do NOT use for Waiver 8176 clients once the respite assessment is completed. Notes: • Use of hourly codes for out-of-home respite care and community activities is only required for Waiver clients with a completed respite assessment. • Respite and personal care cannot be paid at the same time for the same service. Respite services include any personal care and supervision that is needed. • Respite in SOLA is not authorized or paid through SSPS. • Waiver respite assessment results in maximum number of hours per year so authorizations must be hourly. • Community Settings will be reimbursed at the Contractor's published fee for services provided. A copy of the Contractor's Published Service and Fee Schedule can be located at the following web site www.everettwa.org/parks. A printed copy of the Contractor's Published Service and Fee Schedule shall be maintained in the Contractor's Contract file for each year services are provided by this Contract. • A custom contract must be developed and approved at HQ to pay more than the rates listed above. DSHS Central Contract Services 1735LP Agency Respite Care Interlocal(6-09-05) Page 12 2 4