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.

Last Modified: 11/15/2012

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