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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	SELF SUFFICIENT FOR SUCCESSFUL LIVING LLC
Address:	816 DEKALB ST FL 1 BRIDGEPORT, PA 19405-1212
Phone:	(215) 390-0065
E-mail:	larissa.mcclain@ss4sl.com
Web Site:	N/A

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	SELF SUFFICIENT FOR SUCCESSFUL LIVING LLC
Address:	816 DEKALB ST FL 1 BRIDGEPORT, PA 19405-1212
Phone:	(215) 390-0065

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Allegheny
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Beaver
\|Service Name / Level	\|Rate

Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day

County : Berks
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Bucks
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Chester
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Clarion
\|Service Name / Level	\|Rate

CPS Community 2:1	$26.59 / 15 min.
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day

County : Dauphin
\|Service Name / Level	\|Rate

Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.

County : Delaware
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Needs Excptn Allowance (NEA)-Adult Res (6400)-521	Not Set
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Erie
\|Service Name / Level	\|Rate

Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day

County : Fayette
\|Service Name / Level	\|Rate

Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Lancaster
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Lawrence
\|Service Name / Level	\|Rate

Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.

County : Lehigh
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Montgomery
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
In-Home & Commnty Supprts (Lvl 3 Enh)	$25.64 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$21.42 / 15 min.
Needs Exception Allowance (NEA)-Adult Res (6400)	Not Set
Needs Excptn Allowance (NEA)-Adult Res (6400)-521	Not Set
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Northampton
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Northumberland
\|Service Name / Level	\|Rate

Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day

County : Philadelphia
\|Service Name / Level	\|Rate

CPS Community 1:1	$13.83 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$15.31 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
In-Home & Commnty Supprts (Lvl 3 Enh)	$25.64 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$21.42 / 15 min.
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Potter
\|Service Name / Level	\|Rate

Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set

County : Schuylkill
\|Service Name / Level	\|Rate

Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

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