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Ann Marie T. Sullivan, M.D., Commissioner
Governor Andrew M. Cuomo

OMH HCBS Children’s Waiver Rate Codes Effective April 1, 2009

Code Description
4650 ICC Monthly
4651 ICC Half Month
4653 Respite - Individual
4655 Family Support - Individual
4656 Skill Building - Individual
4657 Intensive In–Home Hourly
4658 Intensive In–Home ICC Staff
4659 Crisis Response Hourly
4660 Crisis Response–ICC Staff
4661 ICC Case Mgt. Start–Up Full Month
4662 ICC case Mgt. Start–Up Half Month
4663 ICC/Inpatient–Full Month
4664 ICC/Inpatient–Half Month
4372 Respite – Group of 2
4373 Respite – Group of 3
4374 Family Support – Group of 2
4375 Family Support – Group of 3
4376 Family Support – Group of 4
4377 Family Support – Group of 5-8
4378 Skill Building – Group of 2
4379 Skill Building – Group of 3

Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.