|
EXAMPLE 3
Susan uses licensed care and requires 14 hours of care per day, 3 days per week. The provider charges extra for care over 10 hours per day. To authorize this care correctly, establish two lines of service with a 9 before the appropriate service code.
Compute 'regular' hours care:
14 hours per day X 3 days per week = 210 hours per month (as computed by the SSPS calculator)
Susan needs 22 full-days and 13 half-days. The State maximum rate is $20 per day for full day care and $10 per day for half-day care. Compare the State rate to the provider's rate for this type of care and authorize whichever is lower. The provider's total daily rate for this slot is $25 ($19 for full-day + $6 for half-day to cover care over 10 hours). The State rate is $30 ($20 + $10). You authorize both full-and half-days at the provider's rates.
Authorize:
|