SI PHI01415.008 Administration of State Supplementary Programs — Delaware (RTN 61 — 12/2015)
See SI 01415.010
(DE), Appendix I — Chart 31 (RTN 61 - 01/2015)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2015 -12/2016)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$733.00
|
$733.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$488.67
|
$488.67
|
|
In Parental Hshld.
|
C
|
Z
|
|
$733.00
|
$733.00
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 30.00
|
$ 30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
$733.00
|
$873.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$1100.00
|
$1100.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$ 733.34
|
$ 733.34
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 60.00
|
$ 60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
$1100.00
|
$1,548.00
|
1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the
"O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.
* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes,
Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for
the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION
FORM, completed and signed by the proper authority.
(DE), Appendix I — Chart 30 (RTN 60 - 01/2014)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2014 — 12/2014)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$721.00
|
$721.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$480.67
|
$480.67
|
|
In Parental Hshld.
|
C
|
Z
|
|
$721.00
|
$721.00
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 30.00
|
$ 30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
$721.00
|
$861.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$1082.00
|
$1082.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$ 721.34
|
$ 721.34
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 60.00
|
$ 60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
$1082.00
|
$1,530.00
|
1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the
"O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.
* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes,
Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for
the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION
FORM, completed and signed by the proper authority.
(DE), Appendix I — Chart 29 (RTN 59 - 01/2013)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2013 — 12/2013)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$710.00
|
$710.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$473.34
|
$473.34
|
|
In Parental Hshld.
|
C
|
Z
|
|
$710.00
|
$710.00
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 30.00
|
$ 30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
$710.00
|
$850.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$1066.00
|
$1066.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$ 710.67
|
$ 710.67
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 60.00
|
$ 60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
$1048.00
|
$1,514.00
|
1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the
"O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.
* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes,
Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for
the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION
FORM, completed and signed by the proper authority.
(DE), Appendix I — Chart 29 (RTN 58- 11/2012)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2013 — 12/2013)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$698.00
|
$698.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$465.34
|
$465.34
|
|
In Parental Hshld.
|
C
|
Z
|
|
$698.00
|
$6980.00
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 30.00
|
$ 30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
$698.00
|
$838.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
|
$1048.00
|
$1048.00
|
|
In Another's Hshld.
|
B
|
Z
|
|
$ 698.67
|
$ 698.67
|
|
Medicaid Facility
|
D
|
Z
|
|
$ 60.00
|
$ 60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
$1048.00
|
$1,496.00
|
1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the
"O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.
* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes,
Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for
the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION
FORM, completed and signed by the proper authority.
(DE), Appendix I — Chart 7 (RTN 56 - 12/2008)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2009-12/2009)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$674.00
|
$674.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
449.34
|
449.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
674.00
|
674.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
674.00
|
814.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$1011.00
|
$1011.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
674.00
|
674.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
1011.00
|
1,459.00
|
1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the
"O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.
* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes,
Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for
the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION
FORM, completed and signed by the proper authority.
(DE), Appendix I — Chart 27 (RTN 56 - 12/2007)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2008-12/2008)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$637.00
|
$637.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
424.67
|
424.67
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
637.00
|
637.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
637.00
|
777.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$956.00
|
$956.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
637.34
|
637.34
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
956.00
|
1,404.00
|
(DE), Appendix I — Chart 26 (RTN 52 - 12/2006)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2007-12/2007)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$623.00
|
$623.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
415.34
|
415.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
623.00
|
623.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
623.00
|
763.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$934.00
|
$934.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
622.67
|
622.67
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
934.00
|
1,382.00
|
(DE), Appendix I — Chart 25 (RTN 51 - 1/2006)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2006-12/2006)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$603.00
|
$603.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
402.00
|
402.00
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
603.00
|
603.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
603.00
|
743.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$904.00
|
$904.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
602.67
|
602.67
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
904.00
|
1,352.00
|
(DE), Appendix I — Chart 24 (RTN 49 - 1/2005)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2005-12/2005)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$579.00
|
$579.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
386.00
|
386.00
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
579.00
|
579.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
579.00
|
719.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$869.00
|
$869.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
579.34
|
579.34
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
869.00
|
1,317.00
|
(DE), Appendix I — Chart 23 (RTN 47 - 1/2004)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2004 - 12/2004)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Amount
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$564.00
|
$564.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$376.00
|
$376.00
|
|
In Parental Household
|
C
|
Z
|
—
|
$564.00
|
$564.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$30.00
|
$30.00
|
|
In Certified Residential Care Home*
|
A
|
A
|
$140.00
|
$564.00
|
$704.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$846.00
|
$846.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$564.00
|
$564.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$60.00
|
$60.00
|
|
In Certified Residential Care Home*
|
A
|
A
|
$448.00
|
$846.00
|
$1,294.00
|
(DE), Appendix I — Chart 22 (RTN 46 - 1/2003)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2003 - 12/2003)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Amount
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$552.00
|
$552.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$368.00
|
$368.00
|
|
In Parental Household
|
C
|
Z
|
—
|
$552.00
|
$552.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$30.00
|
$30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
$552.00
|
$692.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$829.00
|
$829.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$552.67
|
$552.67
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$60.00
|
$60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
$829.00
|
$1,277.00
|
(DE), Appendix I — Chart 21 (RTN 45 - 1/2002)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2002 - 12/2002)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Amount
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$545.00
|
$545.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$363.34
|
$363.34
|
|
In Parental Household
|
C
|
Z
|
—
|
$545.00
|
$545.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$30.00
|
$30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
$545.00
|
$685.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$817.00
|
$817.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$544.67
|
$544.67
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$60.00
|
$60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
$817.00
|
$1,265.00
|
(DE), Appendix I — Chart 20 (RTN 44 - 1/2001)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2001 - 12/2001)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Amount
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$530.00
|
$530.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$353.34
|
$353.34
|
|
In Parental Household
|
C
|
Z
|
—
|
$530.00
|
$530.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$30.00
|
$30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
$530.00
|
$670.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$796.00
|
$796.00
|
|
In Another's Household
|
B
|
Z
|
—
|
$530.67
|
$530.67
|
|
Medicaid Facility
|
D
|
Z
|
—
|
$60.00
|
$60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
$796.00
|
$1,244.00
|
(DE), Appendix I — Chart 19 (RTN 43 - 1/2000)
SUPPLEMENTATION CODING AND PAYMENT LEVEL (01/2000 - 12/2000)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Amount
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$512.00
|
$512.00
|
|
In Another's Household
|
B
|
Z
|
—
|
314.34
|
341.34
|
|
In Parental Household
|
C
|
Z
|
—
|
512.00
|
512.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
512.00
|
652.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$769.00
|
$769.00
|
|
In Another's Household
|
B
|
Z
|
—
|
512.67
|
512.67
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
769.00
|
1,217.00
|
(DE), Appendix I — Chart 18 (RTN 42 - 01/1999
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1999-12/1999)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$500.00
|
$500.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
333.34
|
333.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
500.00
|
500.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
500.00
|
640.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$751.00
|
$751.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
500.00
|
500.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
751.00
|
1199.00
|
(DE), Appendix I — Chart 17 (RTN 40 - 02/1998)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1998-12/1998)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$494.00
|
$494.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
329.34
|
329.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
494.00
|
494.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
494.00
|
634.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$741.00
|
$741.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
494.00
|
494.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
741.00
|
1189.00
|
(DE), Appendix I — Chart 16
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1997-12/1997)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$484.00
|
$484.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
322.67
|
322.67
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
484.00
|
484.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
484.00
|
624.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$726.00
|
$726.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
484.00
|
484.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
726.00
|
1,174.00
|
(DE), Appendix I — Chart 15
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1996-12/1996)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$470.00
|
$470.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
313.34
|
313.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
470.00
|
470.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
470.00
|
610.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$705.00
|
$705.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
470.00
|
470.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
705.00
|
1,153.00
|
(DE), Appendix I — Chart 14
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1995-12/1995)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$458.00
|
$458.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
305.34
|
305.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
458.00
|
458.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
458.00
|
598.00
|
|
COUPLES 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$687.00
|
$687.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
458.00
|
458.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
687.00
|
1,135.00
|
(DE), Appendix I — Chart 13
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1994-12/1994)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
In Own Household
|
|
|
|
|
|
|
No EP
|
A
|
C
|
$15.00
|
$446.00
|
$461.00
|
|
1 EP
|
A
|
E
|
15.00
|
669.00
|
684.00
|
|
In Certified Adult
|
A
|
A
|
147.20
|
446.00
|
593.20
|
|
Foster Care Home
|
A
|
B
|
257.20
|
446.00
|
703.20
|
|
In Another's Hshld.
|
|
|
|
|
|
|
No EP
|
B
|
D
|
15.00
|
297.34
|
312.34
|
|
1 EP
|
B
|
F
|
15.00
|
446.00
|
461.00
|
|
In Parental Hshld.
|
C
|
C
|
15.00
|
446.00
|
461.00
|
|
Medicaid Facility
|
D
|
G
|
40.00
|
30.00
|
70.00
|
|
COUPLES 1/
In Own Household
|
|
|
|
|
|
|
No EP
|
A
|
C
|
$ 30.00
|
$669.00
|
$699.00
|
|
1 EP
|
A
|
E
|
30.00
|
892.00
|
922.00
|
|
In Certified Adult
|
A
|
A
|
517.40
|
669.00
|
1,186.40
|
|
Foster Care Home
|
A
|
B
|
737.40
|
669.00
|
1,406.40
|
|
In Another's Hshld.
|
|
|
|
|
|
|
No EP
|
B
|
D
|
30.00
|
446.00
|
476.00
|
|
1 EP
|
B
|
F
|
30.00
|
594.67
|
624.67
|
|
Medicaid Facility
|
D
|
G
|
80.00
|
60.00
|
140.00
|
(DE), Appendix I — Chart 12
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1993-12/1993)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$434.00
|
$434.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
289.34
|
289.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
434.00
|
434.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
434.00
|
574.00
|
|
COUPLES 2/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$652.00
|
$652.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
434.67
|
434.67
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
652.00
|
1,100.00
|
(DE), Appendix I — Chart 11
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1992 - 12/1992)
|
Living Arrangement
|
L/A Code
|
O/S Code
|
O/S Amount
|
Federal Payment Amount
|
Total Payment Level
|
|
INDIVIDUALS 1/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$422.00
|
$422.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
281.34
|
281.34
|
|
In Parental Hshld.
|
C
|
Z
|
—
|
422.00
|
422.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
30.00
|
30.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$140.00
|
422.00
|
562.00
|
|
COUPLES 2/
|
|
|
|
|
|
|
In Own Household
|
A
|
Z
|
—
|
$633.00
|
$633.00
|
|
In Another's Hshld.
|
B
|
Z
|
—
|
422.00
|
422.00
|
|
Medicaid Facility
|
D
|
Z
|
—
|
60.00
|
60.00
|
|
In Certified Residential Care Home
|
A
|
A
|
$448.00
|
633.00
|
1,081.00
|