Certified Hospice Program

Medicaid Rate Sheet

Effective: 04/02/2020 - 09/30/2020

  • Rates also available in Excel Format (XLSX)
Table of Contents
Albany-Schenectady-Troy
Binghamton
Buffalo
Elmira
Glens Falls
Nassau Suffolk
New York City
Niagara Falls
Orange County
Poughkeepsie
Rochester
Syracuse
Utica-Rome
Rural

SMSA: Albany-Schenectady-Troy

Hospice Rate Sheets for the Counties of: ALBANY, GREENE, MONTGOMERY, RENSSELAER, SARATOGA, SCHENECTADY

Rate
Code
Description Base Rate WRR
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $171.19 $3.85 $9.92 $184.96
3946 Inpatient Respite $428.63 $9.64 $9.92 $448.19
3947 General Inpatient Care $906.13 $20.39 $9.92 $936.44
3948 Continuous Home Care - Min 8 Hours $409.08 $9.20 $9.92 $428.20
3949 Continuous Home Care - Min 9 Hours $460.22 $10.35 $9.92 $480.49
3950 Continuous Home Care - Min 10 Hours $511.35 $11.51 $9.92 $532.78
3951 Continuous Home Care - Min 11 Hours $562.49 $12.66 $9.92 $585.07
3952 Continuous Home Care - Min 12 Hours $613.62 $13.81 $9.92 $637.35
3953 Continuous Home Care - Min 13 Hours $664.76 $14.96 $9.92 $689.64
3954 Continuous Home Care - Min 14 Hours $715.89 $16.11 $9.92 $741.92
3955 Continuous Home Care - Min 15 Hours $767.03 $17.26 $9.92 $794.21
3956 Continuous Home Care - Min 16 Hours $818.16 $18.41 $9.92 $846.49
3957 Continuous Home Care - Min 17 Hours $869.30 $19.56 $9.92 $898.78
3958 Continuous Home Care - Min 18 Hours $920.43 $20.71 $9.92 $951.06
3959 Continuous Home Care - Min 19 Hours $971.57 $21.86 $9.92 $1,003.35
3960 Continuous Home Care - Min 20 Hours $1,022.70 $23.01 $9.92 $1,055.63
3961 Continuous Home Care - Min 21 Hours $1,073.84 $24.16 $9.92 $1,107.92
3962 Continuous Home Care - Min 22 Hours $1,124.97 $25.31 $9.92 $1,160.20
3963 Continuous Home Care - Min 23 Hours $1,176.11 $26.46 $9.92 $1,212.49
3964 Continuous Home Care - Min 24 Hours $1,227.24 $27.61 $9.92 $1,264.77
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.43 $0.48 $0.50 $22.41
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $279.80 $6.30 $9.92 $296.02
3970 Routine Home Care w/Escort $189.72 $4.27 $9.92 $203.91
3971 Continuous Home Care w/AIDS Min 8 Hours $418.44 $9.41 $9.92 $437.77
3972 Continuous Home Care w/AIDS Min 9 Hours $470.75 $10.59 $9.92 $491.26
3973 Continuous Home Care w/AIDS Min 10 Hours $523.05 $11.77 $9.92 $544.74
3974 Continuous Home Care w/AIDS Min 11 Hours $575.36 $12.95 $9.92 $598.23
3975 Continuous Home Care w/AIDS Min 12 Hours $627.67 $14.12 $9.92 $651.71
3976 Continuous Home Care w/AIDS Min 13 Hours $679.97 $15.30 $9.92 $705.19
3977 Continuous Home Care w/AIDS Min 14 Hours $732.28 $16.48 $9.92 $758.68
3978 Continuous Home Care w/AIDS Min 15 Hours $784.58 $17.65 $9.92 $812.15
3979 Continuous Home Care w/AIDS Min 16 Hours $836.89 $18.83 $9.92 $865.64
3980 Continuous Home Care w/AIDS Min 17 Hours $889.19 $20.01 $9.92 $919.12
3981 Continuous Home Care w/AIDS Min 18 Hours $941.50 $21.18 $9.92 $972.60
3982 Continuous Home Care w/AIDS Min 19 Hours $993.80 $22.36 $9.92 $1,026.08
3983 Continuous Home Care w/AIDS Min 20 Hours $1,046.11 $23.54 $9.92 $1,079.57
3984 Continuous Home Care w/AIDS Min 21 Hours $1,098.41 $24.71 $9.92 $1,133.04
3985 Continuous Home Care w/AIDS Min 22 Hours $1,150.72 $25.89 $9.92 $1,186.53
3986 Continuous Home Care w/AIDS Min 23 Hours $1,203.02 $27.07 $9.92 $1,240.01
3987 Continuous Home Care w/AIDS Min 24 Hours $1,255.33 $28.24 $9.92 $1,293.49
3988 General Inpatient w/ AIDS $1,007.07 $22.66 $9.92 $1,039.65
3989 Routine Home Care w/ AIDS Escort $298.33 $6.71 $9.92 $314.96
3991 Service Intensity Add-on $51.13 $1.15 $0.00 $52.28

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Binghamton

Hospice Rate Sheets for the Counties of: BROOME, TIOGA

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $173.46 $3.90 $9.92 $187.28
3946 Inpatient Respite $432.99 $9.74 $9.92 $452.65
3947 General Inpatient Care $917.25 $20.64 $9.92 $947.81
3948 Continuous Home Care - Min 8 Hours $414.51 $9.33 $9.92 $433.76
3949 Continuous Home Care - Min 9 Hours $466.33 $10.49 $9.92 $486.74
3950 Continuous Home Care - Min 10 Hours $518.14 $11.66 $9.92 $539.72
3951 Continuous Home Care - Min 11 Hours $569.96 $12.82 $9.92 $592.70
3952 Continuous Home Care - Min 12 Hours $621.77 $13.99 $9.92 $645.68
3953 Continuous Home Care - Min 13 Hours $673.58 $15.16 $9.92 $698.66
3954 Continuous Home Care - Min 14 Hours $725.40 $16.32 $9.92 $751.64
3955 Continuous Home Care - Min 15 Hours $777.21 $17.49 $9.92 $804.62
3956 Continuous Home Care - Min 16 Hours $829.03 $18.65 $9.92 $857.60
3957 Continuous Home Care - Min 17 Hours $880.84 $19.82 $9.92 $910.58
3958 Continuous Home Care - Min 18 Hours $932.66 $20.98 $9.92 $963.56
3959 Continuous Home Care - Min 19 Hours $984.47 $22.15 $9.92 $1,016.54
3960 Continuous Home Care - Min 20 Hours $1,036.28 $23.32 $9.92 $1,069.52
3961 Continuous Home Care - Min 21 Hours $1,088.10 $24.48 $9.92 $1,122.50
3962 Continuous Home Care - Min 22 Hours $1,139.91 $25.65 $9.92 $1,175.48
3963 Continuous Home Care - Min 23 Hours $1,191.73 $26.81 $9.92 $1,228.46
3964 Continuous Home Care - Min 24 Hours $1,243.54 $27.98 $9.92 $1,281.44
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.65 $0.49 $0.50 $22.64
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $283.52 $6.38 $9.92 $299.82
3970 Routine Home Care w/Escort $191.99 $4.32 $9.92 $206.23
3971 Continuous Home Care w/AIDS Min 8 Hours $426.28 $9.59 $9.92 $445.79
3972 Continuous Home Care w/AIDS Min 9 Hours $479.56 $10.79 $9.92 $500.27
3973 Continuous Home Care w/AIDS Min 10 Hours $532.85 $11.99 $9.92 $554.76
3974 Continuous Home Care w/AIDS Min 11 Hours $586.13 $13.19 $9.92 $609.24
3975 Continuous Home Care w/AIDS Min 12 Hours $639.42 $14.39 $9.92 $663.73
3976 Continuous Home Care w/AIDS Min 13 Hours $692.70 $15.59 $9.92 $718.21
3977 Continuous Home Care w/AIDS Min 14 Hours $745.98 $16.78 $9.92 $772.68
3978 Continuous Home Care w/AIDS Min 15 Hours $799.27 $17.98 $9.92 $827.17
3979 Continuous Home Care w/AIDS Min 16 Hours $852.55 $19.18 $9.92 $881.65
3980 Continuous Home Care w/AIDS Min 17 Hours $905.84 $20.38 $9.92 $936.14
3981 Continuous Home Care w/AIDS Min 18 Hours $959.12 $21.58 $9.92 $990.62
3982 Continuous Home Care w/AIDS Min 19 Hours $1,012.41 $22.78 $9.92 $1,045.11
3983 Continuous Home Care w/AIDS Min 20 Hours $1,065.69 $23.98 $9.92 $1,099.59
3984 Continuous Home Care w/AIDS Min 21 Hours $1,118.98 $25.18 $9.92 $1,154.08
3985 Continuous Home Care w/AIDS Min 22 Hours $1,172.26 $26.38 $9.92 $1,208.56
3986 Continuous Home Care w/AIDS Min 23 Hours $1,225.55 $27.57 $9.92 $1,263.04
3987 Continuous Home Care w/AIDS Min 24 Hours $1,278.83 $28.77 $9.92 $1,317.52
3988 General Inpatient w/ AIDS $1,019.43 $22.94 $9.92 $1,052.29
3989 Routine Home Care w/ AIDS Escort $302.05 $6.80 $9.92 $318.77
3991 Service Intensity Add-on $51.81 $1.17 $0.00 $52.98

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Buffalo

Hospice Rate Sheets for the Counties of: ERIE

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $201.27 $4.53 $9.92 $215.72
3946 Inpatient Respite $486.28 $10.94 $9.92 $507.14
3947 General Inpatient Care $1,053.09 $23.69 $9.92 $1,086.70
3948 Continuous Home Care - Min 8 Hours $480.96 $10.82 $9.92 $501.70
3949 Continuous Home Care - Min 9 Hours $541.08 $12.17 $9.92 $563.17
3950 Continuous Home Care - Min 10 Hours $601.20 $13.53 $9.92 $624.65
3951 Continuous Home Care - Min 11 Hours $661.32 $14.88 $9.92 $686.12
3952 Continuous Home Care - Min 12 Hours $721.45 $16.23 $9.92 $747.60
3953 Continuous Home Care - Min 13 Hours $781.57 $17.59 $9.92 $809.08
3954 Continuous Home Care - Min 14 Hours $841.69 $18.94 $9.92 $870.55
3955 Continuous Home Care - Min 15 Hours $901.81 $20.29 $9.92 $932.02
3956 Continuous Home Care - Min 16 Hours $961.93 $21.64 $9.92 $993.49
3957 Continuous Home Care - Min 17 Hours $1,022.05 $23.00 $9.92 $1,054.97
3958 Continuous Home Care - Min 18 Hours $1,082.17 $24.35 $9.92 $1,116.44
3959 Continuous Home Care - Min 19 Hours $1,142.29 $25.70 $9.92 $1,177.91
3960 Continuous Home Care - Min 20 Hours $1,202.41 $27.05 $9.92 $1,239.38
3961 Continuous Home Care - Min 21 Hours $1,262.53 $28.41 $9.92 $1,300.86
3962 Continuous Home Care - Min 22 Hours $1,322.65 $29.76 $9.92 $1,362.33
3963 Continuous Home Care - Min 23 Hours $1,382.77 $31.11 $9.92 $1,423.80
3964 Continuous Home Care - Min 24 Hours $1,442.89 $32.47 $9.92 $1,485.28
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $24.31 $0.55 $0.50 $25.36
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $328.97 $7.40 $9.92 $346.29
3970 Routine Home Care w/Escort $219.80 $4.95 $9.92 $234.67
3971 Continuous Home Care w/AIDS Min 8 Hours $522.04 $11.75 $9.92 $543.71
3972 Continuous Home Care w/AIDS Min 9 Hours $587.29 $13.21 $9.92 $610.42
3973 Continuous Home Care w/AIDS Min 10 Hours $652.55 $14.68 $9.92 $677.15
3974 Continuous Home Care w/AIDS Min 11 Hours $717.80 $16.15 $9.92 $743.87
3975 Continuous Home Care w/AIDS Min 12 Hours $783.06 $17.62 $9.92 $810.60
3976 Continuous Home Care w/AIDS Min 13 Hours $848.31 $19.09 $9.92 $877.32
3977 Continuous Home Care w/AIDS Min 14 Hours $913.56 $20.56 $9.92 $944.04
3978 Continuous Home Care w/AIDS Min 15 Hours $978.82 $22.02 $9.92 $1,010.76
3979 Continuous Home Care w/AIDS Min 16 Hours $1,044.07 $23.49 $9.92 $1,077.48
3980 Continuous Home Care w/AIDS Min 17 Hours $1,109.33 $24.96 $9.92 $1,144.21
3981 Continuous Home Care w/AIDS Min 18 Hours $1,174.58 $26.43 $9.92 $1,210.93
3982 Continuous Home Care w/AIDS Min 19 Hours $1,239.84 $27.90 $9.92 $1,277.66
3983 Continuous Home Care w/AIDS Min 20 Hours $1,305.09 $29.36 $9.92 $1,344.37
3984 Continuous Home Care w/AIDS Min 21 Hours $1,370.35 $30.83 $9.92 $1,411.10
3985 Continuous Home Care w/AIDS Min 22 Hours $1,435.60 $32.30 $9.92 $1,477.82
3986 Continuous Home Care w/AIDS Min 23 Hours $1,500.86 $33.77 $9.92 $1,544.55
3987 Continuous Home Care w/AIDS Min 24 Hours $1,566.11 $35.24 $9.92 $1,611.27
3988 General Inpatient w/ AIDS $1,170.40 $26.33 $9.92 $1,206.65
3989 Routine Home Care w/ AIDS Escort $347.50 $7.82 $9.92 $365.24
3991 Service Intensity Add-on $60.12 $1.35 $0.00 $61.47

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Elmira

Hospice Rate Sheets for the Counties of: CHEMUNG

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $175.64 $3.95 $9.92 $189.51
3946 Inpatient Respite $437.17 $9.84 $9.92 $456.93
3947 General Inpatient Care $927.90 $20.88 $9.92 $958.70
3948 Continuous Home Care - Min 8 Hours $419.73 $9.44 $9.92 $439.09
3949 Continuous Home Care - Min 9 Hours $472.19 $10.62 $9.92 $492.73
3950 Continuous Home Care - Min 10 Hours $524.66 $11.80 $9.92 $546.38
3951 Continuous Home Care - Min 11 Hours $577.12 $12.99 $9.92 $600.03
3952 Continuous Home Care - Min 12 Hours $629.59 $14.17 $9.92 $653.68
3953 Continuous Home Care - Min 13 Hours $682.06 $15.35 $9.92 $707.33
3954 Continuous Home Care - Min 14 Hours $734.52 $16.53 $9.92 $760.97
3955 Continuous Home Care - Min 15 Hours $786.99 $17.71 $9.92 $814.62
3956 Continuous Home Care - Min 16 Hours $839.45 $18.89 $9.92 $868.26
3957 Continuous Home Care - Min 17 Hours $891.92 $20.07 $9.92 $921.91
3958 Continuous Home Care - Min 18 Hours $944.39 $21.25 $9.92 $975.56
3959 Continuous Home Care - Min 19 Hours $996.85 $22.43 $9.92 $1,029.20
3960 Continuous Home Care - Min 20 Hours $1,049.32 $23.61 $9.92 $1,082.85
3961 Continuous Home Care - Min 21 Hours $1,101.78 $24.79 $9.92 $1,136.49
3962 Continuous Home Care - Min 22 Hours $1,154.25 $25.97 $9.92 $1,190.14
3963 Continuous Home Care - Min 23 Hours $1,206.71 $27.15 $9.92 $1,243.78
3964 Continuous Home Care - Min 24 Hours $1,259.18 $28.33 $9.92 $1,297.43
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.86 $0.49 $0.50 $22.85
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $287.09 $6.46 $9.92 $303.47
3970 Routine Home Care w/Escort $194.17 $4.37 $9.92 $208.46
3971 Continuous Home Care w/AIDS Min 8 Hours $433.79 $9.76 $9.92 $453.47
3972 Continuous Home Care w/AIDS Min 9 Hours $488.01 $10.98 $9.92 $508.91
3973 Continuous Home Care w/AIDS Min 10 Hours $542.23 $12.20 $9.92 $564.35
3974 Continuous Home Care w/AIDS Min 11 Hours $596.46 $13.42 $9.92 $619.80
3975 Continuous Home Care w/AIDS Min 12 Hours $650.68 $14.64 $9.92 $675.24
3976 Continuous Home Care w/AIDS Min 13 Hours $704.90 $15.86 $9.92 $730.68
3977 Continuous Home Care w/AIDS Min 14 Hours $759.13 $17.08 $9.92 $786.13
3978 Continuous Home Care w/AIDS Min 15 Hours $813.35 $18.30 $9.92 $841.57
3979 Continuous Home Care w/AIDS Min 16 Hours $867.57 $19.52 $9.92 $897.01
3980 Continuous Home Care w/AIDS Min 17 Hours $921.80 $20.74 $9.92 $952.46
3981 Continuous Home Care w/AIDS Min 18 Hours $976.02 $21.96 $9.92 $1,007.90
3982 Continuous Home Care w/AIDS Min 19 Hours $1,030.24 $23.18 $9.92 $1,063.34
3983 Continuous Home Care w/AIDS Min 20 Hours $1,084.47 $24.40 $9.92 $1,118.79
3984 Continuous Home Care w/AIDS Min 21 Hours $1,138.69 $25.62 $9.92 $1,174.23
3985 Continuous Home Care w/AIDS Min 22 Hours $1,192.91 $26.84 $9.92 $1,229.67
3986 Continuous Home Care w/AIDS Min 23 Hours $1,247.14 $28.06 $9.92 $1,285.12
3987 Continuous Home Care w/AIDS Min 24 Hours $1,301.36 $29.28 $9.92 $1,340.56
3988 General Inpatient w/ AIDS $1,031.27 $23.20 $9.92 $1,064.39
3989 Routine Home Care w/ AIDS Escort $305.62 $6.88 $9.92 $322.42
3991 Service Intensity Add-on $52.46 $1.18 $0.00 $53.64

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Glens Falls

Hospice Rate Sheets for the Counties of:WARREN, WASHINGTON

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $168.47 $3.79 $9.92 $182.18
3946 Inpatient Respite $423.42 $9.53 $9.92 $442.87
3947 General Inpatient Care $892.86 $20.09 $9.92 $922.87
3948 Continuous Home Care - Min 8 Hours $402.59 $9.06 $9.92 $421.57
3949 Continuous Home Care - Min 9 Hours $452.91 $10.19 $9.92 $473.02
3950 Continuous Home Care - Min 10 Hours $503.23 $11.32 $9.92 $524.47
3951 Continuous Home Care - Min 11 Hours $553.56 $12.46 $9.92 $575.94
3952 Continuous Home Care - Min 12 Hours $603.88 $13.59 $9.92 $627.39
3953 Continuous Home Care - Min 13 Hours $654.20 $14.72 $9.92 $678.84
3954 Continuous Home Care - Min 14 Hours $704.53 $15.85 $9.92 $730.30
3955 Continuous Home Care - Min 15 Hours $754.85 $16.98 $9.92 $781.75
3956 Continuous Home Care - Min 16 Hours $805.17 $18.12 $9.92 $833.21
3957 Continuous Home Care - Min 17 Hours $855.50 $19.25 $9.92 $884.67
3958 Continuous Home Care - Min 18 Hours $905.82 $20.38 $9.92 $936.12
3959 Continuous Home Care - Min 19 Hours $956.14 $21.51 $9.92 $987.57
3960 Continuous Home Care - Min 20 Hours $1,006.47 $22.65 $9.92 $1,039.04
3961 Continuous Home Care - Min 21 Hours $1,056.79 $23.78 $9.92 $1,090.49
3962 Continuous Home Care - Min 22 Hours $1,107.11 $24.91 $9.92 $1,141.94
3963 Continuous Home Care - Min 23 Hours $1,157.44 $26.04 $9.92 $1,193.40
3964 Continuous Home Care - Min 24 Hours $1,207.76 $27.17 $9.92 $1,244.85
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.17 $0.48 $0.50 $22.15
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $275.36 $6.20 $9.92 $291.48
3970 Routine Home Care w/Escort $187.00 $4.21 $9.92 $201.13
3971 Continuous Home Care w/AIDS Min 8 Hours $409.09 $9.20 $9.92 $428.21
3972 Continuous Home Care w/AIDS Min 9 Hours $460.22 $10.35 $9.92 $480.49
3973 Continuous Home Care w/AIDS Min 10 Hours $511.36 $11.51 $9.92 $532.79
3974 Continuous Home Care w/AIDS Min 11 Hours $562.49 $12.66 $9.92 $585.07
3975 Continuous Home Care w/AIDS Min 12 Hours $613.63 $13.81 $9.92 $637.36
3976 Continuous Home Care w/AIDS Min 13 Hours $664.77 $14.96 $9.92 $689.65
3977 Continuous Home Care w/AIDS Min 14 Hours $715.90 $16.11 $9.92 $741.93
3978 Continuous Home Care w/AIDS Min 15 Hours $767.04 $17.26 $9.92 $794.22
3979 Continuous Home Care w/AIDS Min 16 Hours $818.17 $18.41 $9.92 $846.50
3980 Continuous Home Care w/AIDS Min 17 Hours $869.31 $19.56 $9.92 $898.79
3981 Continuous Home Care w/AIDS Min 18 Hours $920.45 $20.71 $9.92 $951.08
3982 Continuous Home Care w/AIDS Min 19 Hours $971.58 $21.86 $9.92 $1,003.36
3983 Continuous Home Care w/AIDS Min 20 Hours $1,022.72 $23.01 $9.92 $1,055.65
3984 Continuous Home Care w/AIDS Min 21 Hours $1,073.85 $24.16 $9.92 $1,107.93
3985 Continuous Home Care w/AIDS Min 22 Hours $1,124.99 $25.31 $9.92 $1,160.22
3986 Continuous Home Care w/AIDS Min 23 Hours $1,176.12 $26.46 $9.92 $1,212.50
3987 Continuous Home Care w/AIDS Min 24 Hours $1,227.26 $27.61 $9.92 $1,264.79
3988 General Inpatient w/ AIDS $992.32 $22.33 $9.92 $1,024.57
3989 Routine Home Care w/ AIDS Escort $293.89 $6.61 $9.92 $310.42
3991 Service Intensity Add-on $50.32 $1.13 $0.00 $51.45

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Nassau Suffolk

Hospice Rate Sheets for the Counties of: NASSAU, SUFFOLK

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $233.21 $5.25 $9.92 $248.38
3946 Inpatient Respite $547.50 $12.32 $9.92 $569.74
3947 General Inpatient Care $1,209.12 $27.21 $9.92 $1,246.25
3948 Continuous Home Care - Min 8 Hours $557.29 $12.54 $9.92 $579.75
3949 Continuous Home Care - Min 9 Hours $626.96 $14.11 $9.92 $650.99
3950 Continuous Home Care - Min 10 Hours $696.62 $15.67 $9.92 $722.21
3951 Continuous Home Care - Min 11 Hours $766.28 $17.24 $9.92 $793.44
3952 Continuous Home Care - Min 12 Hours $835.94 $18.81 $9.92 $864.67
3953 Continuous Home Care - Min 13 Hours $905.60 $20.38 $9.92 $935.90
3954 Continuous Home Care - Min 14 Hours $975.26 $21.94 $9.92 $1,007.12
3955 Continuous Home Care - Min 15 Hours $1,044.93 $23.51 $9.92 $1,078.36
3956 Continuous Home Care - Min 16 Hours $1,114.59 $25.08 $9.92 $1,149.59
3957 Continuous Home Care - Min 17 Hours $1,184.25 $26.65 $9.92 $1,220.82
3958 Continuous Home Care - Min 18 Hours $1,253.91 $28.21 $9.92 $1,292.04
3959 Continuous Home Care - Min 19 Hours $1,323.57 $29.78 $9.92 $1,363.27
3960 Continuous Home Care - Min 20 Hours $1,393.23 $31.35 $9.92 $1,434.50
3961 Continuous Home Care - Min 21 Hours $1,462.90 $32.92 $9.92 $1,505.74
3962 Continuous Home Care - Min 22 Hours $1,532.56 $34.48 $9.92 $1,576.96
3963 Continuous Home Care - Min 23 Hours $1,602.22 $36.05 $9.92 $1,648.19
3964 Continuous Home Care - Min 24 Hours $1,671.88 $37.62 $9.92 $1,719.42
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $27.38 $0.62 $0.50 $28.50
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $381.18 $8.58 $9.92 $399.68
3970 Routine Home Care w/Escort $251.74 $5.66 $9.92 $267.32
3971 Continuous Home Care w/AIDS Min 8 Hours $632.03 $14.22 $9.92 $656.17
3972 Continuous Home Care w/AIDS Min 9 Hours $711.04 $16.00 $9.92 $736.96
3973 Continuous Home Care w/AIDS Min 10 Hours $790.04 $17.78 $9.92 $817.74
3974 Continuous Home Care w/AIDS Min 11 Hours $869.05 $19.55 $9.92 $898.52
3975 Continuous Home Care w/AIDS Min 12 Hours $948.05 $21.33 $9.92 $979.30
3976 Continuous Home Care w/AIDS Min 13 Hours $1,027.05 $23.11 $9.92 $1,060.08
3977 Continuous Home Care w/AIDS Min 14 Hours $1,106.06 $24.89 $9.92 $1,140.87
3978 Continuous Home Care w/AIDS Min 15 Hours $1,185.06 $26.66 $9.92 $1,221.64
3979 Continuous Home Care w/AIDS Min 16 Hours $1,264.07 $28.44 $9.92 $1,302.43
3980 Continuous Home Care w/AIDS Min 17 Hours $1,343.07 $30.22 $9.92 $1,383.21
3981 Continuous Home Care w/AIDS Min 18 Hours $1,422.08 $32.00 $9.92 $1,464.00
3982 Continuous Home Care w/AIDS Min 19 Hours $1,501.08 $33.77 $9.92 $1,544.77
3983 Continuous Home Care w/AIDS Min 20 Hours $1,580.08 $35.55 $9.92 $1,625.55
3984 Continuous Home Care w/AIDS Min 21 Hours $1,659.09 $37.33 $9.92 $1,706.34
3985 Continuous Home Care w/AIDS Min 22 Hours $1,738.09 $39.11 $9.92 $1,787.12
3986 Continuous Home Care w/AIDS Min 23 Hours $1,817.10 $40.88 $9.92 $1,867.90
3987 Continuous Home Care w/AIDS Min 24 Hours $1,896.10 $42.66 $9.92 $1,948.68
3988 General Inpatient w/ AIDS $1,343.82 $30.24 $9.92 $1,383.98
3989 Routine Home Care w/ AIDS Escort $399.71 $8.99 $9.92 $418.62
3991 Service Intensity Add-on $69.66 $1.57 $0.00 $71.23

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: New York City

Hospice Rate Sheets for the Counties of: BRONX, KINGS, NEW YORK, PUTNAM, QUEENS, RICHMOND, ROCKLAND, WESTCHESTER

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $231.48 $5.21 $9.92 $246.61
3946 Inpatient Respite $544.19 $12.24 $9.92 $566.35
3947 General Inpatient Care $1,200.69 $27.02 $9.92 $1,237.63
3948 Continuous Home Care - Min 8 Hours $553.17 $12.45 $9.92 $575.54
3949 Continuous Home Care - Min 9 Hours $622.31 $14.00 $9.92 $646.23
3950 Continuous Home Care - Min 10 Hours $691.46 $15.56 $9.92 $716.94
3951 Continuous Home Care - Min 11 Hours $760.60 $17.11 $9.92 $787.63
3952 Continuous Home Care - Min 12 Hours $829.75 $18.67 $9.92 $858.34
3953 Continuous Home Care - Min 13 Hours $898.90 $20.23 $9.92 $929.05
3954 Continuous Home Care - Min 14 Hours $968.04 $21.78 $9.92 $999.74
3955 Continuous Home Care - Min 15 Hours $1,037.19 $23.34 $9.92 $1,070.45
3956 Continuous Home Care - Min 16 Hours $1,106.33 $24.89 $9.92 $1,141.14
3957 Continuous Home Care - Min 17 Hours $1,175.48 $26.45 $9.92 $1,211.85
3958 Continuous Home Care - Min 18 Hours $1,244.63 $28.00 $9.92 $1,282.55
3959 Continuous Home Care - Min 19 Hours $1,313.77 $29.56 $9.92 $1,353.25
3960 Continuous Home Care - Min 20 Hours $1,382.92 $31.12 $9.92 $1,423.96
3961 Continuous Home Care - Min 21 Hours $1,452.06 $32.67 $9.92 $1,494.65
3962 Continuous Home Care - Min 22 Hours $1,521.21 $34.23 $9.92 $1,565.36
3963 Continuous Home Care - Min 23 Hours $1,590.35 $35.78 $9.92 $1,636.05
3964 Continuous Home Care - Min 24 Hours $1,659.50 $37.34 $9.92 $1,706.76
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $27.21 $0.61 $0.50 $28.32
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $378.36 $8.51 $9.92 $396.79
3970 Routine Home Care w/Escort $250.01 $5.63 $9.92 $265.56
3971 Continuous Home Care w/AIDS Min 8 Hours $626.09 $14.09 $9.92 $650.10
3972 Continuous Home Care w/AIDS Min 9 Hours $704.35 $15.85 $9.92 $730.12
3973 Continuous Home Care w/AIDS Min 10 Hours $782.61 $17.61 $9.92 $810.14
3974 Continuous Home Care w/AIDS Min 11 Hours $860.87 $19.37 $9.92 $890.16
3975 Continuous Home Care w/AIDS Min 12 Hours $939.14 $21.13 $9.92 $970.19
3976 Continuous Home Care w/AIDS Min 13 Hours $1,017.40 $22.89 $9.92 $1,050.21
3977 Continuous Home Care w/AIDS Min 14 Hours $1,095.66 $24.65 $9.92 $1,130.23
3978 Continuous Home Care w/AIDS Min 15 Hours $1,173.92 $26.41 $9.92 $1,210.25
3979 Continuous Home Care w/AIDS Min 16 Hours $1,252.18 $28.17 $9.92 $1,290.27
3980 Continuous Home Care w/AIDS Min 17 Hours $1,330.44 $29.93 $9.92 $1,370.29
3981 Continuous Home Care w/AIDS Min 18 Hours $1,408.70 $31.70 $9.92 $1,450.32
3982 Continuous Home Care w/AIDS Min 19 Hours $1,486.96 $33.46 $9.92 $1,530.34
3983 Continuous Home Care w/AIDS Min 20 Hours $1,565.23 $35.22 $9.92 $1,610.37
3984 Continuous Home Care w/AIDS Min 21 Hours $1,643.49 $36.98 $9.92 $1,690.39
3985 Continuous Home Care w/AIDS Min 22 Hours $1,721.75 $38.74 $9.92 $1,770.41
3986 Continuous Home Care w/AIDS Min 23 Hours $1,800.01 $40.50 $9.92 $1,850.43
3987 Continuous Home Care w/AIDS Min 24 Hours $1,878.27 $42.26 $9.92 $1,930.45
3988 General Inpatient w/ AIDS $1,334.45 $30.03 $9.92 $1,374.40
3989 Routine Home Care w/ AIDS Escort $396.89 $8.93 $9.92 $415.74
3991 Service Intensity Add-on $69.14 $1.56 $0.00 $70.70

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Niagara Falls

Hospice Rate Sheets for the Counties of: NIAGARA

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $201.27 $4.53 $9.92 $215.72
3946 Inpatient Respite $486.28 $10.94 $9.92 $507.14
3947 General Inpatient Care $1,053.09 $23.69 $9.92 $1,086.70
3948 Continuous Home Care - Min 8 Hours $480.96 $10.82 $9.92 $501.70
3949 Continuous Home Care - Min 9 Hours $541.08 $12.17 $9.92 $563.17
3950 Continuous Home Care - Min 10 Hours $601.20 $13.53 $9.92 $624.65
3951 Continuous Home Care - Min 11 Hours $661.32 $14.88 $9.92 $686.12
3952 Continuous Home Care - Min 12 Hours $721.45 $16.23 $9.92 $747.60
3953 Continuous Home Care - Min 13 Hours $781.57 $17.59 $9.92 $809.08
3954 Continuous Home Care - Min 14 Hours $841.69 $18.94 $9.92 $870.55
3955 Continuous Home Care - Min 15 Hours $901.81 $20.29 $9.92 $932.02
3956 Continuous Home Care - Min 16 Hours $961.93 $21.64 $9.92 $993.49
3957 Continuous Home Care - Min 17 Hours $1,022.05 $23.00 $9.92 $1,054.97
3958 Continuous Home Care - Min 18 Hours $1,082.17 $24.35 $9.92 $1,116.44
3959 Continuous Home Care - Min 19 Hours $1,142.29 $25.70 $9.92 $1,177.91
3960 Continuous Home Care - Min 20 Hours $1,202.41 $27.05 $9.92 $1,239.38
3961 Continuous Home Care - Min 21 Hours $1,262.53 $28.41 $9.92 $1,300.86
3962 Continuous Home Care - Min 22 Hours $1,322.65 $29.76 $9.92 $1,362.33
3963 Continuous Home Care - Min 23 Hours $1,382.77 $31.11 $9.92 $1,423.80
3964 Continuous Home Care - Min 24 Hours $1,442.89 $32.47 $9.92 $1,485.28
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $24.31 $0.55 $0.50 $25.36
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $328.97 $7.40 $9.92 $346.29
3970 Routine Home Care w/Escort $219.80 $4.95 $9.92 $234.67
3971 Continuous Home Care w/AIDS Min 8 Hours $522.04 $11.75 $9.92 $543.71
3972 Continuous Home Care w/AIDS Min 9 Hours $587.29 $13.21 $9.92 $610.42
3973 Continuous Home Care w/AIDS Min 10 Hours $652.55 $14.68 $9.92 $677.15
3974 Continuous Home Care w/AIDS Min 11 Hours $717.80 $16.15 $9.92 $743.87
3975 Continuous Home Care w/AIDS Min 12 Hours $783.06 $17.62 $9.92 $810.60
3976 Continuous Home Care w/AIDS Min 13 Hours $848.31 $19.09 $9.92 $877.32
3977 Continuous Home Care w/AIDS Min 14 Hours $913.56 $20.56 $9.92 $944.04
3978 Continuous Home Care w/AIDS Min 15 Hours $978.82 $22.02 $9.92 $1,010.76
3979 Continuous Home Care w/AIDS Min 16 Hours $1,044.07 $23.49 $9.92 $1,077.48
3980 Continuous Home Care w/AIDS Min 17 Hours $1,109.33 $24.96 $9.92 $1,144.21
3981 Continuous Home Care w/AIDS Min 18 Hours $1,174.58 $26.43 $9.92 $1,210.93
3982 Continuous Home Care w/AIDS Min 19 Hours $1,239.84 $27.90 $9.92 $1,277.66
3983 Continuous Home Care w/AIDS Min 20 Hours $1,305.09 $29.36 $9.92 $1,344.37
3984 Continuous Home Care w/AIDS Min 21 Hours $1,370.35 $30.83 $9.92 $1,411.10
3985 Continuous Home Care w/AIDS Min 22 Hours $1,435.60 $32.30 $9.92 $1,477.82
3986 Continuous Home Care w/AIDS Min 23 Hours $1,500.86 $33.77 $9.92 $1,544.55
3987 Continuous Home Care w/AIDS Min 24 Hours $1,566.11 $35.24 $9.92 $1,611.27
3988 General Inpatient w/ AIDS $1,170.40 $26.33 $9.92 $1,206.65
3989 Routine Home Care w/ AIDS Escort $347.50 $7.82 $9.92 $365.24
3991 Service Intensity Add-on $60.12 $1.35 $0.00 $61.47

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Orange

Hospice Rate Sheets for the Counties of: ORANGE

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $231.48 $5.21 $9.92 $246.61
3946 Inpatient Respite $544.19 $12.24 $9.92 $566.35
3947 General Inpatient Care $1,200.69 $27.02 $9.92 $1,237.63
3948 Continuous Home Care - Min 8 Hours $553.17 $12.45 $9.92 $575.54
3949 Continuous Home Care - Min 9 Hours $622.31 $14.00 $9.92 $646.23
3950 Continuous Home Care - Min 10 Hours $691.46 $15.56 $9.92 $716.94
3951 Continuous Home Care - Min 11 Hours $760.60 $17.11 $9.92 $787.63
3952 Continuous Home Care - Min 12 Hours $829.75 $18.67 $9.92 $858.34
3953 Continuous Home Care - Min 13 Hours $898.90 $20.23 $9.92 $929.05
3954 Continuous Home Care - Min 14 Hours $968.04 $21.78 $9.92 $999.74
3955 Continuous Home Care - Min 15 Hours $1,037.19 $23.34 $9.92 $1,070.45
3956 Continuous Home Care - Min 16 Hours $1,106.33 $24.89 $9.92 $1,141.14
3957 Continuous Home Care - Min 17 Hours $1,175.48 $26.45 $9.92 $1,211.85
3958 Continuous Home Care - Min 18 Hours $1,244.63 $28.00 $9.92 $1,282.55
3959 Continuous Home Care - Min 19 Hours $1,313.77 $29.56 $9.92 $1,353.25
3960 Continuous Home Care - Min 20 Hours $1,382.92 $31.12 $9.92 $1,423.96
3961 Continuous Home Care - Min 21 Hours $1,452.06 $32.67 $9.92 $1,494.65
3962 Continuous Home Care - Min 22 Hours $1,521.21 $34.23 $9.92 $1,565.36
3963 Continuous Home Care - Min 23 Hours $1,590.35 $35.78 $9.92 $1,636.05
3964 Continuous Home Care - Min 24 Hours $1,659.50 $37.34 $9.92 $1,706.76
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $27.21 $0.61 $0.50 $28.32
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $378.36 $8.51 $9.92 $396.79
3970 Routine Home Care w/Escort $250.01 $5.63 $9.92 $265.56
3971 Continuous Home Care w/AIDS Min 8 Hours $626.09 $14.09 $9.92 $650.10
3972 Continuous Home Care w/AIDS Min 9 Hours $704.35 $15.85 $9.92 $730.12
3973 Continuous Home Care w/AIDS Min 10 Hours $782.61 $17.61 $9.92 $810.14
3974 Continuous Home Care w/AIDS Min 11 Hours $860.87 $19.37 $9.92 $890.16
3975 Continuous Home Care w/AIDS Min 12 Hours $939.14 $21.13 $9.92 $970.19
3976 Continuous Home Care w/AIDS Min 13 Hours $1,017.40 $22.89 $9.92 $1,050.21
3977 Continuous Home Care w/AIDS Min 14 Hours $1,095.66 $24.65 $9.92 $1,130.23
3978 Continuous Home Care w/AIDS Min 15 Hours $1,173.92 $26.41 $9.92 $1,210.25
3979 Continuous Home Care w/AIDS Min 16 Hours $1,252.18 $28.17 $9.92 $1,290.27
3980 Continuous Home Care w/AIDS Min 17 Hours $1,330.44 $29.93 $9.92 $1,370.29
3981 Continuous Home Care w/AIDS Min 18 Hours $1,408.70 $31.70 $9.92 $1,450.32
3982 Continuous Home Care w/AIDS Min 19 Hours $1,486.96 $33.46 $9.92 $1,530.34
3983 Continuous Home Care w/AIDS Min 20 Hours $1,565.23 $35.22 $9.92 $1,610.37
3984 Continuous Home Care w/AIDS Min 21 Hours $1,643.49 $36.98 $9.92 $1,690.39
3985 Continuous Home Care w/AIDS Min 22 Hours $1,721.75 $38.74 $9.92 $1,770.41
3986 Continuous Home Care w/AIDS Min 23 Hours $1,800.01 $40.50 $9.92 $1,850.43
3987 Continuous Home Care w/AIDS Min 24 Hours $1,878.27 $42.26 $9.92 $1,930.45
3988 General Inpatient w/ AIDS $1,334.45 $30.03 $9.92 $1,374.40
3989 Routine Home Care w/ AIDS Escort $396.89 $8.93 $9.92 $415.74
3991 Service Intensity Add-on $69.14 $1.56 $0.00 $70.70

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Poughkeepsie

Hospice Rate Sheets for the Counties of: DUTCHESS

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $228.91 $5.15 $9.92 $243.98
3946 Inpatient Respite $539.26 $12.13 $9.92 $561.31
3947 General Inpatient Care $1,188.14 $26.73 $9.92 $1,224.79
3948 Continuous Home Care - Min 8 Hours $547.03 $12.31 $9.92 $569.26
3949 Continuous Home Care - Min 9 Hours $615.41 $13.85 $9.92 $639.18
3950 Continuous Home Care - Min 10 Hours $683.78 $15.39 $9.92 $709.09
3951 Continuous Home Care - Min 11 Hours $752.16 $16.92 $9.92 $779.00
3952 Continuous Home Care - Min 12 Hours $820.54 $18.46 $9.92 $848.92
3953 Continuous Home Care - Min 13 Hours $888.92 $20.00 $9.92 $918.84
3954 Continuous Home Care - Min 14 Hours $957.30 $21.54 $9.92 $988.76
3955 Continuous Home Care - Min 15 Hours $1,025.68 $23.08 $9.92 $1,058.68
3956 Continuous Home Care - Min 16 Hours $1,094.05 $24.62 $9.92 $1,128.59
3957 Continuous Home Care - Min 17 Hours $1,162.43 $26.15 $9.92 $1,198.50
3958 Continuous Home Care - Min 18 Hours $1,230.81 $27.69 $9.92 $1,268.42
3959 Continuous Home Care - Min 19 Hours $1,299.19 $29.23 $9.92 $1,338.34
3960 Continuous Home Care - Min 20 Hours $1,367.57 $30.77 $9.92 $1,408.26
3961 Continuous Home Care - Min 21 Hours $1,435.95 $32.31 $9.92 $1,478.18
3962 Continuous Home Care - Min 22 Hours $1,504.32 $33.85 $9.92 $1,548.09
3963 Continuous Home Care - Min 23 Hours $1,572.70 $35.39 $9.92 $1,618.01
3964 Continuous Home Care - Min 24 Hours $1,641.08 $36.92 $9.92 $1,687.92
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $26.96 $0.61 $0.50 $28.07
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $374.16 $8.42 $9.92 $392.50
3970 Routine Home Care w/Escort $247.44 $5.57 $9.92 $262.93
3971 Continuous Home Care w/AIDS Min 8 Hours $617.24 $13.89 $9.92 $641.05
3972 Continuous Home Care w/AIDS Min 9 Hours $694.40 $15.62 $9.92 $719.94
3973 Continuous Home Care w/AIDS Min 10 Hours $771.55 $17.36 $9.92 $798.83
3974 Continuous Home Care w/AIDS Min 11 Hours $848.71 $19.10 $9.92 $877.73
3975 Continuous Home Care w/AIDS Min 12 Hours $925.86 $20.83 $9.92 $956.61
3976 Continuous Home Care w/AIDS Min 13 Hours $1,003.02 $22.57 $9.92 $1,035.51
3977 Continuous Home Care w/AIDS Min 14 Hours $1,080.17 $24.30 $9.92 $1,114.39
3978 Continuous Home Care w/AIDS Min 15 Hours $1,157.33 $26.04 $9.92 $1,193.29
3979 Continuous Home Care w/AIDS Min 16 Hours $1,234.48 $27.78 $9.92 $1,272.18
3980 Continuous Home Care w/AIDS Min 17 Hours $1,311.64 $29.51 $9.92 $1,351.07
3981 Continuous Home Care w/AIDS Min 18 Hours $1,388.79 $31.25 $9.92 $1,429.96
3982 Continuous Home Care w/AIDS Min 19 Hours $1,465.95 $32.98 $9.92 $1,508.85
3983 Continuous Home Care w/AIDS Min 20 Hours $1,543.10 $34.72 $9.92 $1,587.74
3984 Continuous Home Care w/AIDS Min 21 Hours $1,620.26 $36.46 $9.92 $1,666.64
3985 Continuous Home Care w/AIDS Min 22 Hours $1,697.41 $38.19 $9.92 $1,745.52
3986 Continuous Home Care w/AIDS Min 23 Hours $1,774.57 $39.93 $9.92 $1,824.42
3987 Continuous Home Care w/AIDS Min 24 Hours $1,851.72 $41.66 $9.92 $1,903.30
3988 General Inpatient w/ AIDS $1,320.50 $29.71 $9.92 $1,360.13
3989 Routine Home Care w/ AIDS Escort $392.69 $8.84 $9.92 $411.45
3991 Service Intensity Add-on $68.37 $1.54 $0.00 $69.91

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Rochester

Hospice Rate Sheets for the Counties of: LIVINGSTON, MONROE, ONTARIO, ORLEANS, WAYNE

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $174.22 $3.92 $9.92 $188.06
3946 Inpatient Respite $434.45 $9.78 $9.92 $454.15
3947 General Inpatient Care $920.97 $20.72 $9.92 $951.61
3948 Continuous Home Care - Min 8 Hours $416.34 $9.37 $9.92 $435.63
3949 Continuous Home Care - Min 9 Hours $468.38 $10.54 $9.92 $488.84
3950 Continuous Home Care - Min 10 Hours $520.42 $11.71 $9.92 $542.05
3951 Continuous Home Care - Min 11 Hours $572.46 $12.88 $9.92 $595.26
3952 Continuous Home Care - Min 12 Hours $624.51 $14.05 $9.92 $648.48
3953 Continuous Home Care - Min 13 Hours $676.55 $15.22 $9.92 $701.69
3954 Continuous Home Care - Min 14 Hours $728.59 $16.39 $9.92 $754.90
3955 Continuous Home Care - Min 15 Hours $780.63 $17.56 $9.92 $808.11
3956 Continuous Home Care - Min 16 Hours $832.67 $18.74 $9.92 $861.33
3957 Continuous Home Care - Min 17 Hours $884.72 $19.91 $9.92 $914.55
3958 Continuous Home Care - Min 18 Hours $936.76 $21.08 $9.92 $967.76
3959 Continuous Home Care - Min 19 Hours $988.80 $22.25 $9.92 $1,020.97
3960 Continuous Home Care - Min 20 Hours $1,040.84 $23.42 $9.92 $1,074.18
3961 Continuous Home Care - Min 21 Hours $1,092.88 $24.59 $9.92 $1,127.39
3962 Continuous Home Care - Min 22 Hours $1,144.93 $25.76 $9.92 $1,180.61
3963 Continuous Home Care - Min 23 Hours $1,196.97 $26.93 $9.92 $1,233.82
3964 Continuous Home Care - Min 24 Hours $1,249.01 $28.10 $9.92 $1,287.03
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.72 $0.49 $0.50 $22.71
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $284.77 $6.41 $9.92 $301.10
3970 Routine Home Care w/Escort $192.75 $4.34 $9.92 $207.01
3971 Continuous Home Care w/AIDS Min 8 Hours $428.90 $9.65 $9.92 $448.47
3972 Continuous Home Care w/AIDS Min 9 Hours $482.52 $10.86 $9.92 $503.30
3973 Continuous Home Care w/AIDS Min 10 Hours $536.13 $12.06 $9.92 $558.11
3974 Continuous Home Care w/AIDS Min 11 Hours $589.74 $13.27 $9.92 $612.93
3975 Continuous Home Care w/AIDS Min 12 Hours $643.36 $14.48 $9.92 $667.76
3976 Continuous Home Care w/AIDS Min 13 Hours $696.97 $15.68 $9.92 $722.57
3977 Continuous Home Care w/AIDS Min 14 Hours $750.58 $16.89 $9.92 $777.39
3978 Continuous Home Care w/AIDS Min 15 Hours $804.19 $18.09 $9.92 $832.20
3979 Continuous Home Care w/AIDS Min 16 Hours $857.81 $19.30 $9.92 $887.03
3980 Continuous Home Care w/AIDS Min 17 Hours $911.42 $20.51 $9.92 $941.85
3981 Continuous Home Care w/AIDS Min 18 Hours $965.03 $21.71 $9.92 $996.66
3982 Continuous Home Care w/AIDS Min 19 Hours $1,018.65 $22.92 $9.92 $1,051.49
3983 Continuous Home Care w/AIDS Min 20 Hours $1,072.26 $24.13 $9.92 $1,106.31
3984 Continuous Home Care w/AIDS Min 21 Hours $1,125.87 $25.33 $9.92 $1,161.12
3985 Continuous Home Care w/AIDS Min 22 Hours $1,179.48 $26.54 $9.92 $1,215.94
3986 Continuous Home Care w/AIDS Min 23 Hours $1,233.10 $27.74 $9.92 $1,270.76
3987 Continuous Home Care w/AIDS Min 24 Hours $1,286.71 $28.95 $9.92 $1,325.58
3988 General Inpatient w/ AIDS $1,023.57 $23.03 $9.92 $1,056.52
3989 Routine Home Care w/ AIDS Escort $303.30 $6.82 $9.92 $320.04
3991 Service Intensity Add-on $52.04 $1.17 $0.00 $53.21

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Syracuse

Hospice Rate Sheets for the Counties of: MADISON, ONONDAGA, OSWEGO

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $196.84 $4.43 $9.92 $211.19
3946 Inpatient Respite $477.79 $10.75 $9.92 $498.46
3947 General Inpatient Care $1,031.45 $23.21 $9.92 $1,064.58
3948 Continuous Home Care - Min 8 Hours $470.38 $10.58 $9.92 $490.88
3949 Continuous Home Care - Min 9 Hours $529.18 $11.91 $9.92 $551.01
3950 Continuous Home Care - Min 10 Hours $587.98 $13.23 $9.92 $611.13
3951 Continuous Home Care - Min 11 Hours $646.77 $14.55 $9.92 $671.24
3952 Continuous Home Care - Min 12 Hours $705.57 $15.88 $9.92 $731.37
3953 Continuous Home Care - Min 13 Hours $764.37 $17.20 $9.92 $791.49
3954 Continuous Home Care - Min 14 Hours $823.17 $18.52 $9.92 $851.61
3955 Continuous Home Care - Min 15 Hours $881.96 $19.84 $9.92 $911.72
3956 Continuous Home Care - Min 16 Hours $940.76 $21.17 $9.92 $971.85
3957 Continuous Home Care - Min 17 Hours $999.56 $22.49 $9.92 $1,031.97
3958 Continuous Home Care - Min 18 Hours $1,058.36 $23.81 $9.92 $1,092.09
3959 Continuous Home Care - Min 19 Hours $1,117.15 $25.14 $9.92 $1,152.21
3960 Continuous Home Care - Min 20 Hours $1,175.95 $26.46 $9.92 $1,212.33
3961 Continuous Home Care - Min 21 Hours $1,234.75 $27.78 $9.92 $1,272.45
3962 Continuous Home Care - Min 22 Hours $1,293.55 $29.10 $9.92 $1,332.57
3963 Continuous Home Care - Min 23 Hours $1,352.34 $30.43 $9.92 $1,392.69
3964 Continuous Home Care - Min 24 Hours $1,411.14 $31.75 $9.92 $1,452.81
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $23.89 $0.54 $0.50 $24.93
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $321.73 $7.24 $9.92 $338.89
3970 Routine Home Care w/Escort $215.37 $4.85 $9.92 $230.14
3971 Continuous Home Care w/AIDS Min 8 Hours $506.78 $11.40 $9.92 $528.10
3972 Continuous Home Care w/AIDS Min 9 Hours $570.13 $12.83 $9.92 $592.88
3973 Continuous Home Care w/AIDS Min 10 Hours $633.48 $14.25 $9.92 $657.65
3974 Continuous Home Care w/AIDS Min 11 Hours $696.83 $15.68 $9.92 $722.43
3975 Continuous Home Care w/AIDS Min 12 Hours $760.18 $17.10 $9.92 $787.20
3976 Continuous Home Care w/AIDS Min 13 Hours $823.52 $18.53 $9.92 $851.97
3977 Continuous Home Care w/AIDS Min 14 Hours $886.87 $19.95 $9.92 $916.74
3978 Continuous Home Care w/AIDS Min 15 Hours $950.22 $21.38 $9.92 $981.52
3979 Continuous Home Care w/AIDS Min 16 Hours $1,013.57 $22.81 $9.92 $1,046.30
3980 Continuous Home Care w/AIDS Min 17 Hours $1,076.91 $24.23 $9.92 $1,111.06
3981 Continuous Home Care w/AIDS Min 18 Hours $1,140.26 $25.66 $9.92 $1,175.84
3982 Continuous Home Care w/AIDS Min 19 Hours $1,203.61 $27.08 $9.92 $1,240.61
3983 Continuous Home Care w/AIDS Min 20 Hours $1,266.96 $28.51 $9.92 $1,305.39
3984 Continuous Home Care w/AIDS Min 21 Hours $1,330.31 $29.93 $9.92 $1,370.16
3985 Continuous Home Care w/AIDS Min 22 Hours $1,393.65 $31.36 $9.92 $1,434.93
3986 Continuous Home Care w/AIDS Min 23 Hours $1,457.00 $32.78 $9.92 $1,499.70
3987 Continuous Home Care w/AIDS Min 24 Hours $1,520.35 $34.21 $9.92 $1,564.48
3988 General Inpatient w/ AIDS $1,146.35 $25.79 $9.92 $1,182.06
3989 Routine Home Care w/ AIDS Escort $340.26 $7.66 $9.92 $357.84
3991 Service Intensity Add-on $58.79 $1.32 $0.00 $60.11

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Utica-Rome

Hospice Rate Sheets for the Counties of: HERKIMER, ONEIDA

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $184.37 $4.15 $9.92 $198.44
3946 Inpatient Respite $453.89 $10.21 $9.92 $474.02
3947 General Inpatient Care $970.52 $21.84 $9.92 $1,002.28
3948 Continuous Home Care - Min 8 Hours $440.58 $9.91 $9.92 $460.41
3949 Continuous Home Care - Min 9 Hours $495.65 $11.15 $9.92 $516.72
3950 Continuous Home Care - Min 10 Hours $550.72 $12.39 $9.92 $573.03
3951 Continuous Home Care - Min 11 Hours $605.79 $13.63 $9.92 $629.34
3952 Continuous Home Care - Min 12 Hours $660.87 $14.87 $9.92 $685.66
3953 Continuous Home Care - Min 13 Hours $715.94 $16.11 $9.92 $741.97
3954 Continuous Home Care - Min 14 Hours $771.01 $17.35 $9.92 $798.28
3955 Continuous Home Care - Min 15 Hours $826.08 $18.59 $9.92 $854.59
3956 Continuous Home Care - Min 16 Hours $881.15 $19.83 $9.92 $910.90
3957 Continuous Home Care - Min 17 Hours $936.23 $21.07 $9.92 $967.22
3958 Continuous Home Care - Min 18 Hours $991.30 $22.30 $9.92 $1,023.52
3959 Continuous Home Care - Min 19 Hours $1,046.37 $23.54 $9.92 $1,079.83
3960 Continuous Home Care - Min 20 Hours $1,101.44 $24.78 $9.92 $1,136.14
3961 Continuous Home Care - Min 21 Hours $1,156.51 $26.02 $9.92 $1,192.45
3962 Continuous Home Care - Min 22 Hours $1,211.59 $27.26 $9.92 $1,248.77
3963 Continuous Home Care - Min 23 Hours $1,266.66 $28.50 $9.92 $1,305.08
3964 Continuous Home Care - Min 24 Hours $1,321.73 $29.74 $9.92 $1,361.39
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $22.69 $0.51 $0.50 $23.70
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $301.35 $6.78 $9.92 $318.05
3970 Routine Home Care w/Escort $202.90 $4.57 $9.92 $217.39
3971 Continuous Home Care w/AIDS Min 8 Hours $463.83 $10.44 $9.92 $484.19
3972 Continuous Home Care w/AIDS Min 9 Hours $521.81 $11.74 $9.92 $543.47
3973 Continuous Home Care w/AIDS Min 10 Hours $579.79 $13.05 $9.92 $602.76
3974 Continuous Home Care w/AIDS Min 11 Hours $637.77 $14.35 $9.92 $662.04
3975 Continuous Home Care w/AIDS Min 12 Hours $695.75 $15.65 $9.92 $721.32
3976 Continuous Home Care w/AIDS Min 13 Hours $753.73 $16.96 $9.92 $780.61
3977 Continuous Home Care w/AIDS Min 14 Hours $811.71 $18.26 $9.92 $839.89
3978 Continuous Home Care w/AIDS Min 15 Hours $869.69 $19.57 $9.92 $899.18
3979 Continuous Home Care w/AIDS Min 16 Hours $927.67 $20.87 $9.92 $958.46
3980 Continuous Home Care w/AIDS Min 17 Hours $985.65 $22.18 $9.92 $1,017.75
3981 Continuous Home Care w/AIDS Min 18 Hours $1,043.63 $23.48 $9.92 $1,077.03
3982 Continuous Home Care w/AIDS Min 19 Hours $1,101.60 $24.79 $9.92 $1,136.31
3983 Continuous Home Care w/AIDS Min 20 Hours $1,159.58 $26.09 $9.92 $1,195.59
3984 Continuous Home Care w/AIDS Min 21 Hours $1,217.56 $27.40 $9.92 $1,254.88
3985 Continuous Home Care w/AIDS Min 22 Hours $1,275.54 $28.70 $9.92 $1,314.16
3986 Continuous Home Care w/AIDS Min 23 Hours $1,333.52 $30.00 $9.92 $1,373.44
3987 Continuous Home Care w/AIDS Min 24 Hours $1,391.50 $31.31 $9.92 $1,432.73
3988 General Inpatient w/ AIDS $1,078.64 $24.27 $9.92 $1,112.83
3989 Routine Home Care w/ AIDS Escort $319.88 $7.20 $9.92 $337.00
3991 Service Intensity Add-on $55.07 $1.24 $0.00 $56.31

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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SMSA: Rural

Hospice Rate Sheets for the Counties of: ALLEGANY, CATTARAUGUS, CAYUGA, CHAUTAUQUA, CHENANGO, CLINTON, COLUMBIA, CORTLAND, DELAWARE, ESSEX, FRANKLIN, FULTON, GENESEE, HAMILTON, JEFFERSON, LEWIS, OTSEGO, SCHOHARIE, SCHUYLER, SENECA, ST. LAWRENCE, STEUBEN, SULLIVAN, TOMPKINS, ULSTER, WYOMING, YATES

Rate
Code
Description Base Rate WRP
Add-on *
RTR
Add-on *
Total
w/ addons
3945 Routine Home Care $173.98 $3.91 $9.92 $187.81
3946 Inpatient Respite $433.99 $9.76 $9.92 $453.67
3947 General Inpatient Care $919.80 $20.70 $9.92 $950.42
3948 Continuous Home Care - Min 8 Hours $415.76 $9.35 $9.92 $435.03
3949 Continuous Home Care - Min 9 Hours $467.73 $10.52 $9.92 $488.17
3950 Continuous Home Care - Min 10 Hours $519.70 $11.69 $9.92 $541.31
3951 Continuous Home Care - Min 11 Hours $571.67 $12.86 $9.92 $594.45
3952 Continuous Home Care - Min 12 Hours $623.65 $14.03 $9.92 $647.60
3953 Continuous Home Care - Min 13 Hours $675.62 $15.20 $9.92 $700.74
3954 Continuous Home Care - Min 14 Hours $727.59 $16.37 $9.92 $753.88
3955 Continuous Home Care - Min 15 Hours $779.56 $17.54 $9.92 $807.02
3956 Continuous Home Care - Min 16 Hours $831.53 $18.71 $9.92 $860.16
3957 Continuous Home Care - Min 17 Hours $883.50 $19.88 $9.92 $913.30
3958 Continuous Home Care - Min 18 Hours $935.47 $21.05 $9.92 $966.44
3959 Continuous Home Care - Min 19 Hours $987.44 $22.22 $9.92 $1,019.58
3960 Continuous Home Care - Min 20 Hours $1,039.41 $23.39 $9.92 $1,072.72
3961 Continuous Home Care - Min 21 Hours $1,091.38 $24.56 $9.92 $1,125.86
3962 Continuous Home Care - Min 22 Hours $1,143.35 $25.73 $9.92 $1,179.00
3963 Continuous Home Care - Min 23 Hours $1,195.32 $26.89 $9.92 $1,232.13
3964 Continuous Home Care - Min 24 Hours $1,247.29 $28.06 $9.92 $1,285.27
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.70 $0.49 $0.50 $22.69
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $284.37 $6.40 $9.92 $300.69
3970 Routine Home Care w/Escort $192.51 $4.33 $9.92 $206.76
3971 Continuous Home Care w/AIDS Min 8 Hours $428.07 $9.63 $9.92 $447.62
3972 Continuous Home Care w/AIDS Min 9 Hours $481.58 $10.84 $9.92 $502.34
3973 Continuous Home Care w/AIDS Min 10 Hours $535.09 $12.04 $9.92 $557.05
3974 Continuous Home Care w/AIDS Min 11 Hours $588.60 $13.24 $9.92 $611.76
3975 Continuous Home Care w/AIDS Min 12 Hours $642.11 $14.45 $9.92 $666.48
3976 Continuous Home Care w/AIDS Min 13 Hours $695.62 $15.65 $9.92 $721.19
3977 Continuous Home Care w/AIDS Min 14 Hours $749.13 $16.86 $9.92 $775.91
3978 Continuous Home Care w/AIDS Min 15 Hours $802.64 $18.06 $9.92 $830.62
3979 Continuous Home Care w/AIDS Min 16 Hours $856.15 $19.26 $9.92 $885.33
3980 Continuous Home Care w/AIDS Min 17 Hours $909.66 $20.47 $9.92 $940.05
3981 Continuous Home Care w/AIDS Min 18 Hours $963.17 $21.67 $9.92 $994.76
3982 Continuous Home Care w/AIDS Min 19 Hours $1,016.67 $22.88 $9.92 $1,049.47
3983 Continuous Home Care w/AIDS Min 20 Hours $1,070.18 $24.08 $9.92 $1,104.18
3984 Continuous Home Care w/AIDS Min 21 Hours $1,123.69 $25.28 $9.92 $1,158.89
3985 Continuous Home Care w/AIDS Min 22 Hours $1,177.20 $26.49 $9.92 $1,213.61
3986 Continuous Home Care w/AIDS Min 23 Hours $1,230.71 $27.69 $9.92 $1,268.32
3987 Continuous Home Care w/AIDS Min 24 Hours $1,284.22 $28.89 $9.92 $1,323.03
3988 General Inpatient w/ AIDS $1,022.27 $23.00 $9.92 $1,055.19
3989 Routine Home Care w/ AIDS Escort $302.90 $6.82 $9.92 $319.64
3991 Service Intensity Add-on $51.97 $1.17 $0.00 $53.14

* WRR =´Worker Recruitment and Retention addon´ if applicable
* RTR =´Recruitment, Training and Retention addon´ if applicable

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