{"text_format":"1","workbook":"xlsx","n_sheets":10,"sheets":[" Demographics","DAP Memory Care Justification","DAP Residential Rate","DAP Behavioral Interventions","Data Source","DAP Narrative","IDAPP Form","Qrtly Totals","Custom Rate Application","Dropdowns"],"not_rendered":{"charts":0,"images":5,"macros":1,"external_links":0,"defined_names":10,"comments":2,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":" Demographics","index":0,"n_rows":13,"n_cols":1,"rows_kept":13,"cut":false,"hidden":false,"merged":[[0,0,4,1],[5,0,5,1]]}
[]
[]
[]
[]
[]
["DAP Patient Demographics "]
[]
["Patient Name"]
["Hosptial"]
["UAI Date"]
["Hosptial Admission Date"]
["Ready For Discharge Date"]
["CSB "]

{"sheet":"DAP Memory Care Justification","index":1,"n_rows":13,"n_cols":10,"rows_kept":13,"cut":false,"hidden":false,"merged":[[12,0,12,3],[12,5,12,11],[9,0,9,3],[9,5,9,11],[10,0,10,3],[10,5,10,11],[11,0,11,3],[11,5,11,11],[6,0,6,3],[6,5,6,11],[7,0,7,3],[7,5,7,11],[8,0,8,3],[8,5,8,11],[1,7,1,11],[2,5,4,5],[2,7,2,11],[3,7,4,11],[5,0,5,3],[5,6,5,8],[5,9,5,11]]}
[]
[null,null,null,null,null,"DAP Memory Care Justification","Individual Name",{"$f":"' Demographics'!B8","v":0}]
[null,null,null,null,null,"Instructions: With the assistance of the hospital social worker, complete to determine the patient's need of secure memory care. ","Date of Assessment"]
[null,null,null,null,null,null,"Name and Role of Assessor"]
[]
[null,null,null,null,null,null,"Approved by:",null,null,"Date:"]
["1. Has this individual been diagnosed with Major Neurocognitive Disorder (dementia)? If the answer is no the individual doesn’t meet criteria."]
["2.What is the individuals diagnosis: "]
["3. What is this individual’s level of mobility? Does this individual require equipment in order to ambulate (walker, wheelchair)? Explain "]
["4. Is this individual currently identified by the state hospital as an elopement risk?  What exit-seeking behaviors has the individual displayed on a consistent basis while hospitalized? Explain "]
["5.  Has this individual had any wandering or unsafe behaviors, 30days prior to hospitalization, due to their cognitive impairment while living in the community? If yes, explain.  "]
["6. Can the individual be supported safely in a less restrictive setting with a monitoring device such as project lifesaver or wander guard? "]
["7. What is the individuals Cognitive Functioning? (Does the individual know where they are and what they are doing, can they recognize danger and get to safety, able to let needs be known, to ask for help, etc)?  "]

{"sheet":"DAP Residential Rate","index":2,"n_rows":62,"n_cols":7,"rows_kept":62,"cut":false,"hidden":false,"merged":[[57,0,57,3],[35,6,36,6],[36,0,37,2],[39,0,39,3],[42,0,45,0],[48,0,48,3],[55,0,55,3],[33,0,33,3],[0,0,0,4],[1,0,1,4],[20,0,22,0],[31,0,31,2],[32,0,32,2]]}
["VA DBHDS DISCHARGE ASSISTANCE PROGRAM"]
["DAP RATE CALCULATION FORM - CALENDAR YEAR 2024"]
[]
["Patient",{"$f":"' Demographics'!B8","v":0}]
["CSB",{"$f":"' Demographics'!B13","v":0}]
["Region"]
["Request/Assessment Date",{"$f":"' Demographics'!B10","v":"00:00:00"}]
[]
["Qualifying Information Source","Assessed Status/Need","Select from the drop down lists","Line total","Section Total"]
["Facility Location/CSB/Region","Region"]
[]
["VIRGINIA UNIFORM ASSESSMENT INSTRUMENT (UAI)","Room and Board, Support Services",null,{"$f":"IFERROR(VLOOKUP(C10,'Data Source'!$D$6:$E$8,2,FALSE),\"Information needed\")","v":"Information needed"}]
["Total Section 1 - Auxiliary Grant",null,null,null,{"$f":"+D12","v":"Information needed"}]
[]
["Potential placement facility type"]
["PATIENT CARE NEEDS - FUNCTIONAL AND MEDICAL"]
["UAI Section 2  - Functional Status","ADLs and Ambulation  ",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C17,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C17,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["UAI Section 2  - Continence ","Continence",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C18,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C18,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["UAI Section 2  - Functional Status ","Eating and Feeding ",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C19,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C19,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["UAI Section 2  - Functional Status ","Bathing, dressing, toileting, and transfers ",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C20,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C20,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile","3 Major, Active Diagnoses - #1",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C21,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C21,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
[null,"3 Major, Active Diagnoses - #2",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C22,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C22,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
[null,"3 Major, Active Diagnoses - #3",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C23,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C23,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["UAI Section 3 Sensory Functions","Vision, Hearing, Speech",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C24,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C24,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["Total Section 2 - Functional status",null,null,null,{"$f":"SUM(D17:D24)","v":0}]
[]
[]
["UAI Section 3 - Behavior pattern","Behavior pattern"]
["DAP Behavioral Assessment Form","Description of behaviors",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C29,'Data Source'!$M:$O,2,FALSE),VLOOKUP($C29,'Data Source'!$M:$O,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["Total Section 3 - Behaviors",null,null,null,{"$f":"+D29","v":"Information needed"}]
[]
["Total Patient Care Needs (sum of Sections 1-3)",null,null,null,{"$f":"IFERROR(+E13+E25+E30,\"Information needed\")","v":"Information needed"}]
["Patient Care Needs Cap",null,null,null,{"$f":"IFERROR(VLOOKUP($C$15,'Data Source'!$A$7:$B$12,2,FALSE),\"Information needed\")","v":"Information needed"}]
["Total authorized patient care rate (Lower of Sections 1-3 or cap)",null,null,null,{"$f":"MIN(E32,E33)","v":0}]
[]
["Extraordinary circumstances payment request - please provide description",null,null,null,null,null,"Customized Rate Approval Date"]
[]
[]
[]
["Total authorized patient care, monthly payment",null,null,null,{"$f":"+E34+E38","v":0}]
[]
["PATIENT CARE  - SOCIAL HISTORY"]
["Hospital Discharge Notes / H&P or Documented Social Work Note","NGRI/pending trial/incompetent to stand the trial",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C43,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C43,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
[null,"Registered Sex Offender",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C44,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C44,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
[null,"Arson",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C45,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C45,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
[null,"Other significant social history impeding hospital discharge",null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C46,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C46,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["Total Social History Section",null,null,null,{"$f":"SUM(D43:D46)","v":0}]
["Social History Section Cap",null,null,null,3000]
["Total authorized  social history one-time add-on payment (Lower of the cap or section total)",null,null,null,{"$f":"MIN(E47,E48)","v":0}]
[]
["FACILITY INFORMATION SECTION"]
["Licensure status",null,null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C52,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C52,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["Training needs",null,null,{"$f":"IFERROR(IF($C$10=\"Northern VA\",VLOOKUP($C53,'Data Source'!$I:$K,2,FALSE),VLOOKUP($C53,'Data Source'!$I:$K,3,FALSE)),\"Information needed\")","v":"Information needed"}]
["Total facility section",null,null,null,{"$f":"SUM(D52:D53)","v":0}]
["Facility Section Cap",null,null,null,1000]
["Total authorized  social history on-time add-on payment (Lower of the cap or section total)",null,null,null,{"$f":"MIN(E54,E55)","v":0}]
[]
["Total authorized one-time add-on payment ",null,null,null,{"$f":"+E49+E56","v":0}]
[]
["Person completing request"]
[]
["Person reviewing/authorizing"]

{"sheet":"DAP Behavioral Interventions","index":3,"n_rows":25,"n_cols":10,"rows_kept":25,"cut":false,"hidden":false,"merged":[[23,0,23,3],[23,4,23,7],[23,8,23,10],[24,0,24,3],[24,4,24,7],[24,8,24,10],[21,0,21,3],[21,4,21,7],[21,8,21,10],[22,0,22,3],[22,4,22,7],[22,8,22,10],[19,0,19,3],[19,4,19,7],[19,8,19,10],[20,0,20,3],[20,4,20,7],[20,8,20,10],[17,0,17,3],[17,4,17,7],[17,8,17,10],[18,0,18,3],[18,4,18,7],[18,8,18,10],[15,0,15,3],[15,4,15,7],[15,8,15,10],[16,0,16,3],[16,4,16,7],[16,8,16,10],[13,0,13,3],[13,4,13,7],[13,8,13,10],[14,0,14,3],[14,4,14,7],[14,8,14,10],[12,8,12,10],[0,4,6,7],[1,9,1,13],[2,9,2,13],[3,9,4,13],[5,8,5,9],[7,0,8,7],[9,0,9,7],[10,0,10,7],[11,0,11,7],[12,0,12,3],[12,4,12,7]]}
[null,null,null,null,"DAP Behavior Intervention Assessment"]
[null,null,null,null,null,null,null,null,"Individual Name",{"$f":"' Demographics'!B8","v":0}]
[null,null,null,null,null,null,null,null,"Date of Assessment"]
[null,null,null,null,null,null,null,null,"Name and Role of Assessor"]
[]
[null,null,null,null,null,null,null,null,"Totals"]
[null,null,null,null,null,null,null,null,"No support needed",{"$f":"COUNTIF(E14:H25,\"No Support Needed\")","v":0}]
["Instructions:  Consider each description then please choose the appropriate box for level of care needed. For individuals in the community consider the last 30 days.  Once completed use the totals to complete the behavioral section of the DAP calculation worksheet.  Definitions for level of care are as follows:",null,null,null,null,null,null,null,"Some Support Needed",{"$f":"COUNTIF(E14:H25, \"Some Support Needed\")","v":0}]
[null,null,null,null,null,null,null,null,"Extensive Support Needed",{"$f":"COUNTIF(E14:H25,\"Extensive Support Needed\")","v":0}]
["No Support Needed:  No support needed because the behavior is not an issue or no support is needed to manage the behavior. ",null,null,null,null,null,null,null,"Total Score",{"$f":"SUM((J7*0)+(J8*1)+(J9*2))","v":0}]
["Some Support Needed:  Some support is needed to address the behavior. Those who provide support must be continuously cognizant of the condition to assure the individuals health and safety. For example: Checking in and observing, monitoring and providing occasional assistance; minimal/physical hands on contribution; support is episodic and or requires minimal support time (less than daily). "]
["Extensive Support Needed:  Extensive support is needed to address the behavior.  For example: Significant physical/hands on contribution or support is intense and requires daily significant support time (daily or more) "]
["Behavior",null,null,null,"Level of Support Required",null,null,null,"Comments"]
["Prevention of assaults or injuries to others"]
["Prevention of property destruction (eg fire setting, breaking furniture)"]
[" Prevention of stealing"]
["Prevention of  self-injury"]
["Prevention of Intrusive Behavior with Peers"]
["Prevention of suicide attempts"]
[" Prevention of sexual aggression"]
["Prevention of non- aggressive but inappropriate behavior"]
["Prevention of tantrums or emotional outbursts"]
[" Prevention of wandering"]
[" Prevention of substance abuse"]
["Maintenance of mental health treatments"]

{"sheet":"Data Source","index":4,"n_rows":63,"n_cols":15,"rows_kept":63,"cut":false,"hidden":true,"merged":[[30,12,30,14]]}
["Inflation - CPI for SSI",3.2000000000000001E-2,2024]
[null,null,2025]
[null,null,2026]
[]
[]
["Facility / Unit Type ","Limit not to exceed ",null,"Region","Region's AG"]
["Assisted Living/ Group Home",6708,null,"Northern VA",2391,"Room and Board, Support Services",null,"Section ","Qualifier","Rate - Northern","Rate- All Others","Data for data validation rules in tab 1"]
["Memory Care ",7740,null,"All Other Regions",2079,null,null,"UAI Section 2  - Functional Status:  ADLs and Ambulation  ","Ambulation - no assistance needed or supervision only ",0,0,null,"N/A"]
["Nursing Facility",8772,null,null,null,null,null,"UAI Section 2  - Functional Status:  ADLs and Ambulation  ","Ambulation - physical assistance needed",627,545]
["Assisted Living/Group Home- Northern",7714,null,null,null,null,null,"UAI Section 2  - Continence ","Continence - no assistance needed or supervision only ",0,0]
["Memory Care- Northern",8901,null,null,null,null,null,"UAI Section 2  - Continence ","Continence - not self care/needs help",627,545]
["Nursing Facility- Northern",10088,null,null,null,null,null,"UAI Section 2  - Functional Status - Eating or ambulation ","Eating/Feeding - no assistance needed, supervision only or minimal assistance",0,0]
[null,null,null,null,null,null,null,"UAI Section 2  - Functional Status - Eating or ambulation ","Eating/Feeding - \"Performed by others\"",1410,1226]
[null,null,null,null,null,null,null,"Bathing, dressing, toileting, transfers ","Bathing, dressing, transfers - no assistance needed, supervision only or minimal assistance"]
[null,null,null,null,null,null,null,"Bathing, dressing, toileting, transfers ","Bathing, dressing, transfers - \"Performed by others\"",1410,1226]
[null,null,null,null,null,null,null,"UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile - 3 Major, Active Diagnoses","Not applicable - no health conditions",0,0,{"$f":"I16","v":"Not applicable - no health conditions"},{"$f":"I16","v":"Not applicable - no health conditions"}]
[null,null,null,null,null,null,null,"UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile - 3 Major, Active Diagnoses","Cancer (03)",627,545,{"$f":"IF('Data Source'!I17<>'DAP Residential Rate'!$C$21,'Data Source'!I17,\"\")","v":"Cancer (03)"},{"$f":"IF(AND('Data Source'!I17<>'DAP Residential Rate'!$C$21,'Data Source'!I17<>'DAP Residential Rate'!$C$22),'Data Source'!I17,\"\")","v":"Cancer (03)"}]
[null,null,null,null,null,null,null,"UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile - 3 Major, Active Diagnoses","Dementia (08,09), Developmental Disabilities (10-17)",470,409,{"$f":"IF('Data Source'!I18<>'DAP Residential Rate'!$C$21,'Data Source'!I18,\"\")","v":"Dementia (08,09), Developmental Disabilities (10-17)"},{"$f":"IF(AND('Data Source'!I18<>'DAP Residential Rate'!$C$21,'Data Source'!I18<>'DAP Residential Rate'!$C$22),'Data Source'!I18,\"\")","v":"Dementia (08,09), Developmental Disabilities (10-17)"}]
[null,null,null,null,null,null,null,"UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile - 3 Major, Active Diagnoses","Diabetes (19) or renal failure (40)",470,409,{"$f":"IF('Data Source'!I19<>'DAP Residential Rate'!$C$21,'Data Source'!I19,\"\")","v":"Diabetes (19) or renal failure (40)"},{"$f":"IF(AND('Data Source'!I19<>'DAP Residential Rate'!$C$21,'Data Source'!I19<>'DAP Residential Rate'!$C$22),'Data Source'!I19,\"\")","v":"Diabetes (19) or renal failure (40)"}]
[null,null,null,null,null,null,null,"UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile - 3 Major, Active Diagnoses","Immune System Disorders / HIV (22)",470,409,{"$f":"IF('Data Source'!I20<>'DAP Residential Rate'!$C$21,'Data Source'!I20,\"\")","v":"Immune System Disorders / HIV (22)"},{"$f":"IF(AND('Data Source'!I20<>'DAP Residential Rate'!$C$21,'Data Source'!I20<>'DAP Residential Rate'!$C$22),'Data Source'!I20,\"\")","v":"Immune System Disorders / HIV (22)"}]
[null,null,null,null,null,null,null,"UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile - 3 Major, Active Diagnoses","Psychiatric Disorders (30-35)",470,409,{"$f":"IF('Data Source'!I21<>'DAP Residential Rate'!$C$21,'Data Source'!I21,\"\")","v":"Psychiatric Disorders (30-35)"},{"$f":"IF(AND('Data Source'!I21<>'DAP Residential Rate'!$C$21,'Data Source'!I21<>'DAP Residential Rate'!$C$22),'Data Source'!I21,\"\")","v":"Psychiatric Disorders (30-35)"}]
[null,null,null,null,null,null,null,"UAI Section 3 - Physical Health Assessment: Diagnoses & Medication Profile - 3 Major, Active Diagnoses","Neurological Problems Brain Trauma/Injury (26-29) ",1521,1521,{"$f":"IF('Data Source'!I22<>'DAP Residential Rate'!$C$21,'Data Source'!I22,\"\")","v":"Neurological Problems Brain Trauma/Injury (26-29) "},{"$f":"IF(AND('Data Source'!I22<>'DAP Residential Rate'!$C$21,'Data Source'!I22<>'DAP Residential Rate'!$C$22),'Data Source'!I22,\"\")","v":"Neurological Problems Brain Trauma/Injury (26-29) "}]
["One Time",null,null,null,null,null,null,"UAI Section 3 Sensory Functions","Sensory functions - No Impairment",0,0]
["Bridge",null,null,null,null,null,null,"UAI Section 3 Sensory Functions","Sensory functions - Impairment",0,0]
["Ongoing",null,null,null,null,null,null,"UAI Section 3 Sensory Functions","Sensory functions - Complete Loss (any one)",940,817]
[null,null,null,null,null,null,null,"UAI Section 3 - Behavior pattern","Behavior pattern - Appropriate",0,0]
[null,null,null,null,null,null,null,"UAI Section 3 - Behavior pattern","Behavior pattern - Wandering / Passive – Less than weekly",0,0]
[null,null,null,null,null,null,null,"UAI Section 3 - Behavior pattern","Behavior pattern - Wandering / Passive – Weekly or more",0,0]
["Yes",null,null,null,null,null,null,"UAI Section 3 - Behavior pattern","Behavior pattern - Abusive / Aggressive / Disruptive – Less than weekly",0,0]
["No",null,null,null,null,null,null,"UAI Section 3 - Behavior pattern","Behavior pattern - Abusive / Aggressive / Disruptive – Weekly or more",0,0,null,null,"Rate - Northern","Rate- All Others"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Behavior pattern - Abusive / Aggressive / Disruptive "]
[null,null,null,null,null,null,null,null,null,null,null,null,"Disruptive – Behavioral supplement score 1-3",313,272]
[null,null,null,null,null,null,null,null,null,null,null,null,"Disruptive – Behavioral supplement score 4-6",470,409]
["Not waiver eligible",null,null,null,null,null,null,null,null,null,null,null,"Disruptive – Behavioral supplement score 7-9",627,545]
["On waitlist",null,null,null,null,null,null,null,null,null,null,null,"Disruptive – Behavioral supplement score 10-12",1254,1090]
["Will be Referred",null,null,null,null,null,null,null,null,null,null,null,"Disruptive – Behavioral supplement score 13-15",1881,1636]
["Has Waiver",null,null,null,null,null,null,null,null,null,null,null,"Disruptive - Behavioral supplement score 16-20",2508,2181]
[null,null,null,null,null,null,null,null,null,null,null,null,"Disruptive –  Behavioral Supplement Score 21-24 daily staff log required",5642,4906]
[null,null,null,null,null,null,null,null,null,"Rate - Northern","Rate- All Others"]
[null,null,null,null,null,null,null,"NGRI or pending trial/incompetent to stand the trial","NGRI - not applicable",0,0]
[null,null,null,null,null,null,null,"NGRI or pending trial/incompetent to stand the trial","NGRI - non-violent offence",500,{"$f":"+J41","v":500}]
[null,null,null,null,null,null,null,"NGRI or pending trial/incompetent to stand the trial","NGRI - violent offence",1000,{"$f":"+J42","v":1000}]
[null,null,null,null,null,null,null,"Registered Sex Offender","Registered sex offender - not applicable ",0,0]
["NGRI",null,null,null,null,null,null,"Registered Sex Offender","Registered sex offender - non-violent",750,{"$f":"+J44","v":750}]
["CIVIL",null,null,null,null,null,null,"Registered Sex Offender","Registered sex offender - violent",1000,1000]
[null,null,null,null,null,null,null,"Arson","Arson - not applicable",0,0]
[null,null,null,null,null,null,null,"Arson","Arson",1000,1000]
["Adult",null,null,null,null,null,null,"Other significant social history impeding hospital discharge","No legal decision maker currently in place",1000,1000]
["Geri",null,null,null,null,null,null,"Other significant social history impeding hospital discharge","Not applicable",0,0]
[]
[null,null,null,null,null,null,null,"Licensure status","Unlicensed facility",0,0]
[null,null,null,null,null,null,null,null,"Licensed facility",500,{"$f":"+J52","v":500}]
[null,null,null,null,null,null,null,"Training needs","No special training needs beyond those required",0,0]
[null,null,null,null,null,null,null,null,"Special behavioral or medical management needs beyond those required",575,500]
["Residential- Level 11"]
["Assisted Living- Level 12"]
["Memory Care"]
["Nursing Home"]
["Supervised Living Apt or Group Home"]
["ID/DD Residential",null,null,null,null,null,null,"Data"]
[null,null,null,null,null,null,null,"No Support Needed"]
[null,null,null,null,null,null,null,"Some Support Needed"]
[null,null,null,null,null,null,null,"Extensive Support Needed"]

{"sheet":"DAP Narrative","index":5,"n_rows":43,"n_cols":9,"rows_kept":43,"cut":false,"hidden":false,"merged":[[0,0,0,3],[18,0,18,3],[23,0,23,3],[24,0,26,3],[28,0,30,3],[27,0,27,3],[35,0,36,3],[37,1,37,2],[10,1,10,3],[19,1,19,3],[1,0,1,3],[31,0,31,3],[32,0,33,3],[34,0,34,3],[0,6,0,10],[1,7,1,10],[3,7,3,10],[2,8,2,9],[4,7,10,10],[4,6,10,6],[17,7,22,10],[12,6,12,10],[13,7,13,10],[14,8,14,9],[17,6,22,6],[16,7,16,10]]}
["DAP Narrative Justification",null,null,null,null,null,"DAP Plan Update "]
["Patient Demographics",null,null,null,null,null,"Date"]
["Patient Name",{"$f":"' Demographics'!B8","v":0},"Hospital",{"$f":"' Demographics'!B9","v":0},null,null,"Plan Modification",null,"If yes , Amount of Original Plan"]
["Age Group",null,"RFD Date",null,null,null,"Updated Amount"]
["Legal Status",null,null,null,null,null,"Reason for update"]
[]
["Hospital Admission Date",{"$f":"' Demographics'!B11","v":"00:00:00"},"Scheduled Discharge Date"]
[]
["Are benefits active",null,"If No Benefit Application Date"]
[]
["Person Responsible for Benefit Acquisition"]
["Auxiliary Grant Eligible?"]
["ID/DD",null,"Waiver Status",null,null,null,"DAP Plan Update"]
["VA Benefits",null,null,null,null,null,"Date"]
["Medicaid",null,"Medicare",null,null,null,"Plan Modification",null,"If yes , Amount of Original Plan"]
[]
["Income",null,"Other",null,null,null,"Updated Amount"]
[null,null,null,null,null,null,"Reason for update"]
["DAP Justification"]
["Requestor Name"]
["Request Date",null,"CSB",{"$f":"' Demographics'!B13","v":0}]
["Plan Start Date",null,"Type of Funds"]
[]
["Brief Description of Discharge Barriers"]
[]
[]
[]
["What other Public Pay options were tried"]
[]
[]
[]
["Outstanding Clinical needs to consider"]
[]
[]
["What is the plan to step the person off of DAP"]
[]
[]
["Residential Provider"]
["Level Of Care"]
[]
["Is this an Out of Catchment Plan?",null,"OOC Referral been completed?"]
["Has the Receiving CSB DAP Coordinator been consulted?",null,"IF yes who?"]
["Contact Name and Date",null,"If No why?"]

{"sheet":"IDAPP Form","index":6,"n_rows":73,"n_cols":13,"rows_kept":73,"cut":false,"hidden":false,"merged":[[47,9,48,10],[47,11,48,12],[48,1,48,2],[48,5,48,6],[5,9,5,10],[5,11,5,12],[44,9,44,10],[44,11,44,12],[47,0,48,0],[47,1,47,2],[47,3,48,4],[47,5,47,6],[47,7,48,7],[46,1,46,2],[46,4,46,5],[46,6,46,7],[46,9,46,10],[46,11,46,12],[45,1,45,2],[42,0,42,12],[44,4,44,5],[44,6,44,7],[45,4,45,5],[45,6,45,7],[45,9,45,10],[45,11,45,12],[44,1,44,2],[43,1,43,2],[43,4,43,5],[43,6,43,7],[43,9,43,10],[43,11,43,12],[21,1,21,5],[22,1,22,5],[4,11,4,12],[4,9,4,10],[4,6,4,7],[6,6,6,7],[8,11,9,12],[8,5,8,6],[11,1,11,3],[11,4,11,5],[31,11,31,12],[29,1,29,5],[29,7,29,9],[26,0,26,12],[27,11,27,12],[29,11,29,12],[31,7,31,9],[31,3,31,5],[23,1,23,5],[24,1,24,5],[25,1,25,5],[20,1,20,5],[13,1,13,3],[13,4,13,5],[14,1,14,3],[14,4,14,5],[8,9,9,10],[50,1,50,3],[50,4,50,5],[51,1,51,3],[51,4,51,5],[33,0,33,12],[9,1,9,2],[9,5,9,6],[3,0,3,12],[5,1,5,2],[8,1,8,2],[6,1,6,2],[6,4,6,5],[6,9,6,10],[6,11,6,12],[7,1,7,2],[7,4,7,5],[7,6,7,7],[7,9,7,10],[7,11,7,12],[4,1,4,2],[8,0,9,0],[8,3,9,4],[8,7,9,7],[55,1,55,3],[55,4,55,5],[56,1,56,3],[56,4,56,5],[57,1,57,3],[57,4,57,5],[4,4,4,5],[5,4,5,5],[5,6,5,7],[15,1,15,3],[15,4,15,5],[19,1,19,3],[19,4,19,5],[16,1,16,3],[16,4,16,5],[17,1,17,3],[18,1,18,3],[18,4,18,5],[17,4,17,5],[12,1,12,3],[12,4,12,5],[72,0,72,12],[10,0,10,12],[68,1,68,5],[68,7,68,9],[68,11,68,12],[70,3,70,5],[70,7,70,9],[70,11,70,12],[62,1,62,5],[63,1,63,5],[64,1,64,5],[65,0,65,12],[66,11,66,12],[58,1,58,3],[58,4,58,5],[59,1,59,5],[52,1,52,3],[52,4,52,5],[53,1,53,3],[53,4,53,5],[54,1,54,3],[54,4,54,5],[60,1,60,5],[61,1,61,5]]}
[]
[]
[]
["Discharge Assistance Project- Individual DAP PLAN (IDAPP)"]
["RFD Date",null,null," Plan Type: ",null,null,"Plan Start Date",null,null,"Plan End Date"]
["First Name",null,null,"Last Name",null,null,"Legal Status:",null,null,"ID/DD            "]
["State Hospital",null,null,"Patient ID #",null,null,"State Hospital Admission Date",null,null,"State Hospital Discharge Date"]
["DAP CSB",null,null,"CSB ID#",null,null,"Out of Region:",null,null,"Transfer Due Date",null,{"$f":"IF(OR(I8=\"Region 1\",I8=\"Region 2\",I8=\"Region 3\",I8=\"Region 3.a\",I8=\"Region 3.b\",I8=\"Region 4\",I8=\"Region 5\"),EDATE(L7,6),\"\")","v":""}]
["Insurance Plan",null,null,"Insurance Plan Type",null,null,null,"Income Type",null,"Total Amount Per Month"]
[]
[]
["Code","Core Service Category/Subcategory",null,null,"Notes",null,"Projected Months Needed","Unit Cost","Projected Annual Units","Projected Annual Cost","Projected Other Funds          (medicaid, etc.)","Self Pay ","IDAPP Cost"]
[{"$f":"IF(ISNA(VLOOKUP(B13,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B13,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,{"$f":"I13*H13","v":0},null,null,{"$f":"J13-SUM(K13:L13)","v":0}]
[{"$f":"IF(ISNA(VLOOKUP(B14,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B14,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,{"$f":"J14-SUM(K14:L14)","v":0}]
[{"$f":"IF(ISNA(VLOOKUP(B15,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B15,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B16,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B16,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B17,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B17,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B18,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B18,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B19,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B19,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B20,Dropdowns!A2:B22,2,FALSE)), \"\",VLOOKUP(B20,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER - ",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER  - ",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER -",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"TOTAL",null,null,null,null,null,null,null,{"$f":"SUM(J13:J25)","v":0},{"$f":"SUM(K13:K25)","v":0},{"$f":"SUM(L13:L25)","v":0},{"$f":"J26-SUM(K26:L26)","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,"Regional DAP",{"$f":"M26","v":0}]
[]
["Requested by:",null,null,null,null,null,"Title:",null,null,null,"Date:"]
[]
["Regional Approval:",null,"Name:",null,null,null,"Title:",null,null,null,"Date:"]
[]
["Confidentiality Notice: This document contains confidential health information that is legally privileged and intended only for the use of or by the entity named above.  Redisclosure, copying, distribution or actions taken in reliance on the contents of this document is strictly prohibited.   (version 04-25-2019)"]
[]
[]
[]
[]
[]
[]
[]
[]
["Discharge Assistance Project- Individual DAP PLAN (IDAPP)"]
["RFD Date",null,null," Plan Type: ",null,null,"Plan Start Date",null,null,"Plan End Date"]
["First Name",null,null,"Last Name",null,null,"Legal Status:",null,null,"ID/DD            "]
["State Hospital",null,null,"Patient ID #",null,null,"State Hospital Admission Date",null,null,"State Hospital Discharge Date"]
["DAP CSB",null,null,"CSB ID#",null,null,"Out of Region:",null,null,"Transfer Due Date",null,{"$f":"IF(OR(I47=\"Region 1\",I47=\"Region 2\",I47=\"Region 3\",I47=\"Region 3.a\",I47=\"Region 3.b\",I47 = \"Region 4\",I47=\"Region 5\"),EDATE(L46,6),\"\")","v":""}]
["Insurance Plan",null,null,"Insurance Plan Type",null,null,null,"Income Type",null,"Total Amount Per Month"]
[]
[]
["Code","Core Service Category/Subcategory",null,null,"Notes",null,"Projected Months Needed","Unit Cost","Projected Annual Units","Projected Annual Cost","Projected Other Funds          (medicaid, etc.)","Self Pay ","IDAPP Cost"]
[{"$f":"IF(ISNA(VLOOKUP(B52,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B52,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,{"$f":"I52*H52","v":0},null,null,{"$f":"J52-SUM(K52:L52)","v":0}]
[{"$f":"IF(ISNA(VLOOKUP(B53,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B53,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,{"$f":"J53-SUM(K53:L53)","v":0}]
[{"$f":"IF(ISNA(VLOOKUP(B54,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B54,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B55,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B55,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B56,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B56,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B57,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B57,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B58,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B58,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[{"$f":"IF(ISNA(VLOOKUP(B59,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B59,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER - ",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER  - ",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER -",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"TOTAL",null,null,null,null,null,null,null,{"$f":"SUM(J52:J64)","v":0},{"$f":"SUM(K52:K64)","v":0},{"$f":"SUM(L52:L64)","v":0},{"$f":"J65-SUM(K65:L65)","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,"Regional DAP",{"$f":"M65","v":0}]
[]
["Requested by:",null,null,null,null,null,"Title:",null,null,null,"Date:"]
[]
["Regional Approval:",null,"Name:",null,null,null,"Title:",null,null,null,"Date:"]
[]
["Confidentiality Notice: This document contains confidential health information that is legally privileged and intended only for the use of or by the entity named above.  Redisclosure, copying, distribution or actions taken in reliance on the contents of this document is strictly prohibited.   (version 04-25-2019)"]

{"sheet":"Qrtly Totals","index":7,"n_rows":4,"n_cols":16,"rows_kept":4,"cut":false,"hidden":false,"merged":[[0,12,0,15],[0,0,0,1],[0,2,0,4],[0,5,0,6],[0,7,0,8],[0,9,0,11]]}
["CSB Information",null,"Individual Identifying Information      ",null,null,"State Hospital (S.H.) Information",null,"S.H. Episode Dates",null,"DAP Dates",null,null,"DAP Plan Funding"]
["CSB","CSB Code","First Name","Last Name","CSB ID #","State Hospital","Patient ID #","State Hospital Admission Date","State Hospital Discharge Date","One Time or Ongoing","Plan Start Date","Plan End Date","Projected Annual Cost","Projected Other Funds","Projected Self Pay ","IDAPP Cost"]
[{"$f":"IF('IDAPP Form'!J26,IFERROR('IDAPP Form'!B8,\"\"),\"\")","v":""},{"$f":"_xlfn.IFNA(VLOOKUP(A3,Dropdowns!P2:Q41,2,FALSE),\"\")","v":""},{"$f":"IF('IDAPP Form'!J26,IFERROR('IDAPP Form'!B6,\"\"),\"\")","v":""},{"$f":"IF('IDAPP Form'!J26,IFERROR('IDAPP Form'!E6,\"\"),\"\")","v":""},{"$f":"IF('IDAPP Form'!J26, 'IDAPP Form'!E8:F8,\"\")","v":""},{"$f":"IF('IDAPP Form'!J26, IFERROR('IDAPP Form'!B7,\"\"), \"\")","v":""},{"$f":"IF('IDAPP Form'!J26, IFERROR('IDAPP Form'!E7,0), \"\")","v":""},{"$f":"IF('IDAPP Form'!J26,'IDAPP Form'!I7,\"\")","v":""},{"$f":"IF('IDAPP Form'!J26,'IDAPP Form'!L7,\"\")","v":""},{"$f":"IF(M3='IDAPP Form'!J26,\"Ongoing\",\"\")","v":""},{"$f":"IF('IDAPP Form'!J26,'IDAPP Form'!I5,\"\")","v":""},{"$f":"IF('IDAPP Form'!J26,'IDAPP Form'!L5,\"\")","v":""},{"$f":"IF('IDAPP Form'!J26,'IDAPP Form'!J26,\"\")","v":""},{"$f":"IF('IDAPP Form'!K26,'IDAPP Form'!K26,\"\")","v":""},{"$f":"IF('IDAPP Form'!L26,'IDAPP Form'!L26,\"\")","v":""},{"$f":"IF('IDAPP Form'!M26,'IDAPP Form'!M26,\"\")","v":""}]
[{"$f":"IF('IDAPP Form'!J65,IFERROR('IDAPP Form'!B47,\"\"),\"\")","v":""},{"$f":"_xlfn.IFNA(VLOOKUP(A4,Dropdowns!P2:Q41,2,FALSE),\"\")","v":""},{"$f":"IF('IDAPP Form'!J65,IFERROR('IDAPP Form'!B45,\"\"),\"\")","v":""},{"$f":"IF('IDAPP Form'!J65,IFERROR('IDAPP Form'!E45,\"\"),\"\")","v":""},{"$f":"IF('IDAPP Form'!J65, 'IDAPP Form'!E47:F47,\"\")","v":""},{"$f":"IF('IDAPP Form'!J65, IFERROR('IDAPP Form'!B46,\"\"), \"\")","v":""},{"$f":"IF('IDAPP Form'!J65, IFERROR('IDAPP Form'!E46,0), \"\")","v":""},{"$f":"IF('IDAPP Form'!J65,'IDAPP Form'!I46,\"\")","v":""},{"$f":"IF('IDAPP Form'!J65,'IDAPP Form'!L46,\"\")","v":""},{"$f":"IF(M4='IDAPP Form'!J65,\"One Time\",\"\")","v":""},{"$f":"IF('IDAPP Form'!J65,'IDAPP Form'!I44,\"\")","v":""},{"$f":"IF('IDAPP Form'!J65,'IDAPP Form'!L44,\"\")","v":""},{"$f":"IF('IDAPP Form'!J65,'IDAPP Form'!J65,\"\")","v":""},{"$f":"IF('IDAPP Form'!K65,'IDAPP Form'!K65,\"\")","v":""},{"$f":"IF('IDAPP Form'!L65,'IDAPP Form'!L65,\"\")","v":""},{"$f":"IF('IDAPP Form'!M65,'IDAPP Form'!M65,\"\")","v":""}]

{"sheet":"Custom Rate Application","index":8,"n_rows":46,"n_cols":13,"rows_kept":46,"cut":false,"hidden":false,"merged":[[0,0,3,0],[4,1,4,3],[5,1,5,3],[6,1,6,3],[0,1,3,3],[14,1,14,8],[13,1,13,3],[16,0,16,8],[15,0,15,8],[7,1,7,3],[9,1,9,3],[12,1,12,3],[12,5,12,8],[11,1,11,3],[10,0,10,8],[35,10,35,12],[36,0,47,8],[0,5,0,8],[1,5,1,8],[2,5,2,8],[5,5,5,9],[3,10,3,11],[4,10,12,11],[0,10,1,11],[34,0,34,8],[35,0,35,8],[17,0,28,8],[29,0,29,8],[30,1,30,3],[32,3,32,4],[32,5,33,8]]}
[null,"DAP Custom Rate Application ",null,null,null,"FOR COMMITTEE USE ONLY",null,null,null,null,"Committee Use Only"]
[]
[]
[null,null,null,null,null,"Date",null,null,null,null,"Approval Criteria"]
["Patient Name",{"$f":"' Demographics'!B8","v":0}]
["Application Date",null,null,null,null,"Approved Cost"]
["CSB Contact Information",null,null,null,null,"Hours/Days","Amount per unit","Total","Start date","End date"]
["Provider Contact information",null,null,null,null,null,null,{"$f":"SUM(F8*G8)","v":0}]
[]
["Service Requested","1:1 Support"]
["Eligibility"]
[null,"Choose one"]
["Transitional Service - Must meet both",null,null,null,"AND","Individual has documented history of poor transitions (i.e., evictions or rehospitalizations within 30 days of placement) "]
[null,"Choose one"]
["All Other Services","Individual rate on DAP Rate Tool is $200 or more a month than the designated CAP AND needs one of the avaliable supports in the customized rate plan."]
[]
["Describe the individuals need for the service"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Who will provide the service?","DSP"]
[]
["For 1:1 or 2:1 what hours are requested?","# Per day",4,"Specify times",null,"8am to 12pm"]
[]
[]
["For Programmatic oversight what tasks will be completed? (must choose at least three)",null,null,null,null,null,null,null,null,null," Documentation"]
[null,null,null,null,null,null,null,null,null,null,"Evidence","Explanation","Quantity"]
[null,null,null,null,null,null,null,null,null,null,"Uniformed Assessment Instrument- Required",null,"Within the last 30 days"]
[null,null,null,null,null,null,null,null,null,null,"DAP Rate tool including Behavioral Assessment- Required",null,"Within the last 30 days"]
[null,null,null,null,null,null,null,null,null,null,"Customized rate application- Required"]
[null,null,null,null,null,null,null,null,null,null,"Staffing plan","Required for all except transitional supports"]
[null,null,null,null,null,null,null,null,null,null,"Staff Credentials","Examples: A copy of licensure, college degree, official transcript, resume."]
[null,null,null,null,null,null,null,null,null,null,"Crisis Plan or Behavioral Support Plan","Applicable to all individuals whose primary need for a customized rate is related to challenging behaviors and should detail direct interventions that avert emergency psychiatric hospitalizations or institutional placement and include appropriate admission to crisis response services that are provided in the Commonwealth.","Most recent"]
[null,null,null,null,null,null,null,null,null,null,"Supporting notes","Any notes from professionals with documentation of the needs and interventions provided","Any avaliable"]
[null,null,null,null,null,null,null,null,null,null,"ISP/ Care Plan","Facilities ISP or care plan for individual","Most recent"]
[null,null,null,null,null,null,null,null,null,null,"Additional Information","DBHDS may request additional information at any time to further justify or substantiate the request.","At the time of the request or anytime during the plan year"]

{"sheet":"Dropdowns","index":9,"n_rows":66,"n_cols":17,"rows_kept":66,"cut":false,"hidden":true,"merged":[]}
["Category","Code",null,"CSB",null,"Hospitals",null,"Medicaid","Medicare","Private Insurance ","Other ",null,null,null,null,"CSB","CODE"]
["Outpatient",310,null,"Alexandria",null,"Catawba",null,"QMB","A only",null,null,null,"No",null,null,"Alexandria",1]
["Case Management",320,null,"Alleghany Highlands",null,"CSH ",null,"Spend Down","B only",null,null,null,"Region 1",null,null,"Alleghany Highlands",3]
["Assertive Community Treatment",350,null,"Arlington",null,"ESH",null,"Pending","C only",null,null,null,"Region 2",null,null,"Arlington",5]
["Day Treatment/Partial Hospitilization",410,null,"Blue Ridge",null,"NVMHI",null,"Medicaid","D only",null,null,null,"Region 3.a",null,null,"Blue Ridge",67]
["Rehabilitation/Habilitation",425,null,"Chesapeake",null,"PGH",null,null,"A, B, C, D",null,null,null,"Region 3.b",null,null,"Chesapeake",9]
["Sheltered Employment",430,null,"Chesterfield",null,"SVMHI",null,null,"A, B, C",null,null,null,"Region 3.c",null,null,"Chesterfield",11]
["Ind Supported Emp",460,null,"Colonial",null,"SWVMHI",null,null,"A, B, D",null,null,null,"Region 4",null,null,"Colonial",13]
["Group Supported Emp",465,null,"Crossroads",null,"WSH",null,null,"A, C, D",null,null,null,"Region 5",null,null,"Crossroads",15]
["Highly Intensive Residential\n    • Nursing Home",501,null,"Cumberland Mt.",null,null,null,null,"A, B",null,null,null,null,null,null,"Cumberland Mt.",17]
["Highly Intensive Residential\n    • ICF",501,null,"Danville-Pittsylvania",null,null,null,null,"A, C",null,null,null,null,null,null,"Danville-Pittsylvania",19]
["Highly Intensive Residential    \n  • Substance Use Detox",501,null,"Dickenson County",null,null,null,null,"A, D",null,null,null,null,null,null,"Dickenson County",20]
["Highly Intensive Residential    \n  • Other",501,null,"District 19",null,null,null,null,"B, C, D",null,null,null,null,null,null,"District 19",53]
["Intensive Residential\n    • Group Home",521,null,"Eastern Shore",null,null,null,null,"B, C",null,null,null,null,null,null,"Eastern Shore",21]
["Intensive Residential\n    • Substance Use Rehabilitation",521,null,"Fairfax-Falls Church",null,null,null,null,"B, D",null,null,null,null,null,null,"Encompass",61]
["Supervised Residential\n    • Supervised Apartments",551,null,"Goochland-Powhatan",null,null,null,null,"C, D ",null,null,null,null,null,null,"Fairfax-Falls Church",23]
["Supervised Residential\n    • ALF",551,null,"Hampton-Newport News",null,null,null,null,null,null,null,null,null,null,null,"Goochland-Powhatan",25]
["Supervised Residential\n    • Sponsor Home",551,null,"Hanover",null,null,null,null,null,null,null,null,null,null,null,"Hampton-Newport News",27]
["Supervised Residential\n    • Emergency Shelter",551,null,"Harrisonburg-Rockingham",null,null,null,null,null,null,null,null,null,null,null,"Hanover",29]
["Supportive Residential\n    • PSH",581,null,"Henrico",null,null,null,null,null,null,null,null,null,null,null,"Harrisonburg-Rockingham",31]
["Supportive Residential\n    • In-Home Supports",581,null,"Highlands",null,null,null,null,null,null,null,null,null,null,null,"Henrico",33]
["Assessment & Evaluation",720,null,"Horizon",null,null,null,null,null,null,null,null,null,null,null,"Highlands",35]
[null,null,null,"Loudoun",null,null,null,null,null,null,null,null,null,null,null,"Horizon",7]
[null,null,null,"MPNN",null,null,null,null,null,null,null,null,null,null,null,"Loudoun",37]
[null,null,null,"Mount Rogers",null,null,null,null,null,null,null,null,null,null,null,"Mount Rogers",41]
[null,null,null,"New River Valley",null,null,null,null,null,null,null,null,null,null,null,"MPNN",39]
[null,null,null,"Norfolk",null,null,null,null,null,null,null,null,null,null,null,"New River Valley",43]
[null,null,null,"Northwestern",null,null,null,null,null,null,null,null,null,null,null,"Norfolk",45]
[null,null,null,"Piedmont",null,null,null,null,null,null,null,null,null,null,null,"Northwestern",47]
[null,null,null,"Planning District One",null,null,null,null,null,null,null,null,null,null,null,"Piedmont",51]
[null,null,null,"Portsmouth",null,null,null,null,null,null,null,null,null,null,null,"Planning District One",49]
[null,null,null,"Prince William ",null,null,null,null,null,null,null,null,null,null,null,"Portsmouth",55]
[null,null,null,"Rappahannock Area",null,null,null,null,null,null,null,null,null,null,null,"Prince William ",57]
[null,null,null,"Rappahannock-Rapidan",null,null,null,null,null,null,null,null,null,null,null,"Rappahannock Area",59]
[null,null,null,"Region Ten",null,null,null,null,null,null,null,null,null,null,null,"Region Ten",63]
[null,null,null,"Richmond",null,null,null,null,null,null,null,null,null,null,null,"Richmond",65]
[null,null,null,"Rockbridge Area",null,null,null,null,null,null,null,null,null,null,null,"Rockbridge Area",69]
[null,null,null,"Southside",null,null,null,null,null,null,null,null,null,null,null,"Southside",71]
[null,null,null,"Valley",null,null,null,null,null,null,null,null,null,null,null,"Valley",73]
[null,null,null,"Virginia Beach",null,null,null,null,null,null,null,null,null,null,null,"Virginia Beach",75]
[null,null,null,"Western Tidewater",null,null,null,null,null,null,null,null,null,null,null,"Western Tidewater",77]
[]
[]
[]
[]
[]
["Transitional Support"]
["1:1 Support"]
["2:1 Support"]
["Program Oversight"]
[]
["Individual has been in state facility for 12 months or longer."]
["Individual is hospitalized and has been in more than 3 residential placements in the last 12 months."]
["Individual has been hospitalized more than twice in the past 12 months"]
[]
["Individual scored 20 or higher on DAP Behavioral Assessment AND needs one of the avaliable supports in the customized rate plan"]
["Individual rate on DAP Rate Tool is $200 or more a month than the designated CAP AND needs one of the avaliable supports in the customized rate plan."]
["Individual has documented extraordinary behavioral or medical condition in which one of avaliable supports is needed for community integration.  (Note : Elopement is only considered a behavioral condition for individuals with extreme safety concerns. )"]
[]
["DSP"]
["Peer Support"]
["CNA"]
["LPN "]
["QMHP"]
["RN"]
["LPC/LCSW"]