Revision 17-1; Effective March 15, 2017

 

 

Service Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, Score Form 2101, Authorization for Community Care Services, Item 16 Service Code
Adult Foster Care 18 18
Consumer Managed Personal Assistant Services Not required 27
Community Attendant Services (CAS) 24 17D (CAS)
17DS (CAS/SRO)
17DV (CAS/CDS)
Individual Directed Services (CDS) – Financial Management Services Not applicable 63V
63VY (ICM)
CDS – Support Consultation Not applicable 57V (for PHC and CAS)
57CV (for FC)
57V4 (For PHC in ICM)
Day Activity and Health Services Not required 29
29Y (ICM)
Residential Care (RC) 18 19I (RC Bed Hold, Non-Apt., Title XX)
19J (RC, Apt., Title XX)
19L (RC, Non Apt., Title XX)
19M (RC Emergency Care)
19N (grandfathered RC, R&B, Non-Apt.)
19O (grandfathered RC, R&B, Apt.)
Emergency Response Service 20 20
Family Care (FC) 24 17C (FC)
17CS (FC/SRO)
17CV (FC/CDS)
Home-Delivered Meals 20 25
Primary Home Care (PHC)

 

 

24 17 (PHC)
17S (PHC/SRO)
17V (PHC/CDS)
17Y (PHC/ICM)
17SY (PHC/SRO/ICM)
17VY (PHC/CDS/ICM)
Special Services to Persons with Disabilities 9 28