This appendix appears in the following handbooks:

Community Based Alternatives Provider Manual (CBA): Appendix XIV
Case Manager Community Based Alternatives Handbook (CM-CBA-HB): Appendix VII

CBA ISP Cost Limits
8-2010

Community Based Alternatives (CBA) Individual Service Plan (ISP) Cost Limits Based on Resource Utilization Group (RUG)
Effective August 31, 2010

RUG

Annual CBA
Cost Limit (200%)

24-hour Vent

6- to 23-hour Vent

RAD

$142,022

$233,337

$178,551

RAC

$125,998

$217,314

$162,527

RAB

$118,625

$209,941

$155,154

RAA

$104,894

$196,209

$141,423

SE3

$168,696

$260,011

$205,225

SE2

$143,941

$235,257

$180,471

SE1

$125,611

$216,927

$162,140

SSC

$122,786

$214,102

$159,315

SSB

$116,340

$207,656

$152,869

SSA

$116,092

$207,408

$152,621

CC2

$101,163

$192,479

$137,693

CC1

$  96,075

$187,391

$132,605

CB2

$  93,192

$184,508

$129,721

CB1

$  89,199

$180,514

$125,728

CA2

$  84,921

$176,237

$121,450

CA1

$  80,118

$171,433

$116,647

IB2

$  85,045

$176,361

$121,574

IB1

$  79,607

$170,922

$116,136

IA2

$  73,110

$164,425

$109,639

IA1

$  69,584

$160,899

$106,113

BB2

$  83,592

$174,908

$120,122

BB1

$  76,103

$167,418

$112,632

BA2

$  71,825

$163,140

$108,354

BA1

$  65,445

$156,760

$101,974

PE2

$  89,651

$180,967

$126,181

PE1

$  85,016

$176,332

$121,545

PD2

$  86,147

$177,463

$122,677

PD1

$  81,344

$172,660

$117,873

PC2

$  79,315

$170,630

$115,844

PC1

$  76,249

$167,564

$112,778

PB2

$  74,358

$165,674

$110,887

PB1

$  70,985

$162,301

$107,514

PA2

$  66,861

$158,176

$103,390

PA1

$  63,349

$154,665

$  99,879

The higher ventilator cost limit is established by the Medical Necessity and Level of Care (MN/LOC) Assessment. Individuals requiring ventilator use from six to 23 hours daily, as identified with a "6" on the MN/LOC Assessment for Ventilator/Respiratory Care, are eligible for a partial ventilator supplement payment. Other individuals requiring continuous (24-hour) ventilator use, identified with a "7" for Ventilator/Respiratory Care, are eligible for the continuous ventilator supplemental payment. Individuals using ventilators less than six hours per day are not eligible for the increased cost limits.