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• <br /> 2 <br /> Exhibit A Rate Table <br /> } <br /> 3 . 5�,t ' E x� +sg�c5ys �y'i1 i .17 r e y, <br /> ra� ,#a�y Provider fi x +, =33 *' at�s�i°"` ° €ii to a fT�ent+ iFP fTlellt 'O1S°A'F <br /> C-i, , 4: w1 t i ' ' meati b e4hti ti 4 h r C Icu�a.i.�n5 liti y ^ 14i{ ^1 <br /> Out-of home in a licensed facility: $10.03 hr Not to exceed 8 7362—Agency <br /> ■ Daycare/Childcare hours in a 24 respite (IFS) <br /> ■ Child foster home, Daily = $80.24 hour period. <br /> ■ AFH [8 hrs x $10.03] 7811 (VPS state- <br /> ■ ARC Prior approval only) <br /> required to <br /> authorize more 8178, 8278, 8378, <br /> than 8 hours 8377 <br /> Child group home $17.54 hr Not to exceed 8 7362—Agency <br /> hours in a 24 respite (IFS) <br /> Staffed residential home Daily= $140.32 hour period <br /> [8hrs x$17.54] 8177, 8277, 8377 <br /> Prior approval 8777 <br /> required to <br /> authorize more <br /> • <br /> than 8 hours <br /> Home care agency: $17.54 hr Pay for each 7362—Agency <br /> in client's home hour respite (IFS) <br /> 8177, 8277, <br /> 8377,8777 <br /> Camp and other community $17.54 hr Number of Hours 8177, 8277,8377, <br /> settings providing respite = Cost of service 8777 <br /> $17.54. <br /> Round up to the <br /> nearest hour. <br /> Hours authorized <br /> will never exceed <br /> number of <br /> service hours <br /> provided. <br /> Notes: <br /> ■ Respite and personal care cannot be paidat the same time for the same service. <br /> Respite services include any personal care and supervision that is needed. <br /> ■ SSPS authorizations will be authorized at an hourly rate. <br /> • Community Settings will be reimbursed at the Contractor's published fee for services <br /> provided and not to exceed that rate noted above in the table. A copy of the <br /> Contractor's Published Service and Fee Schedule can be located at the following web <br /> site . A printed copy of the Contractor's Published Service and Fee Schedule <br /> shall be maintained in the Contractor's Contract file for each year services are provided <br /> by this Contract. . <br /> ■ Respite services must be tracked separately from personal care services. <br /> DSHS Central Contract Services <br /> 1735LP Agency Respite Care Interlocal(9-23-10) Page 14 <br /> 31 <br />