Certified Hospice Program

Medicaid Rate Sheet

Effective 10/1/16 - 11/30/16

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 WRP
Add–on *
RTR
Add–on *
Total
w/ addons
3945 Routine Home Care $169.82 $5.09 $9.92 $184.83
3946 Inpatient Respite $164.38 $4.93 $9.92 $179.23
3947 General Inpatient Care $659.67 $19.79 $9.92 $689.38
3948 Continuous Home Care – Min 8 Hours $286.31 $8.59 $9.92 $304.82
3949 Continuous Home Care – Min 9 Hours $322.10 $9.66 $9.92 $341.68
3950 Continuous Home Care – Min 10 Hours $357.88 $10.74 $9.92 $378.54
3951 Continuous Home Care – Min 11 Hours $393.67 $11.81 $9.92 $415.40
3952 Continuous Home Care – Min 12 Hours $429.46 $12.88 $9.92 $452.26
3953 Continuous Home Care – Min 13 Hours $465.25 $13.96 $9.92 $489.13
3954 Continuous Home Care – Min 14 Hours $501.04 $15.03 $9.92 $525.99
3955 Continuous Home Care – Min 15 Hours $536.83 $16.10 $9.92 $562.85
3956 Continuous Home Care – Min 16 Hours $572.61 $17.18 $9.92 $599.71
3957 Continuous Home Care – Min 17 Hours $608.40 $18.25 $9.92 $636.57
3958 Continuous Home Care – Min 18 Hours $644.19 $19.33 $9.92 $673.44
3959 Continuous Home Care – Min 19 Hours $679.98 $20.40 $9.92 $710.30
3960 Continuous Home Care – Min 20 Hours $715.77 $21.47 $9.92 $747.16
3961 Continuous Home Care – Min 21 Hours $751.56 $22.55 $9.92 $784.03
3962 Continuous Home Care – Min 22 Hours $787.34 $23.62 $9.92 $820.88
3963 Continuous Home Care – Min 23 Hours $823.13 $24.69 $9.92 $857.74
3964 Continuous Home Care – Min 24 Hours $858.92 $25.77 $9.92 $894.61
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.22 $0.25 $0.50 $8.97
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $272.40 $8.17 $9.92 $290.49
3970 Routine Home Care w/Escort $187.10 $5.61 $9.92 $202.63
3971 Continuous Home Care w/AIDS Min 8 Hours $301.39 $9.04 $9.92 $320.35
3972 Continuous Home Care w/AIDS Min 9 Hours $339.06 $10.17 $9.92 $359.15
3973 Continuous Home Care w/AIDS Min 10 Hours $376.74 $11.30 $9.92 $397.96
3974 Continuous Home Care w/AIDS Min 11 Hours $414.41 $12.43 $9.92 $436.76
3975 Continuous Home Care w/AIDS Min 12 Hours $452.09 $13.56 $9.92 $475.57
3976 Continuous Home Care w/AIDS Min 13 Hours $489.76 $14.69 $9.92 $514.37
3977 Continuous Home Care w/AIDS Min 14 Hours $527.43 $15.82 $9.92 $553.17
3978 Continuous Home Care w/AIDS Min 15 Hours $565.11 $16.95 $9.92 $591.98
3979 Continuous Home Care w/AIDS Min 16 Hours $602.78 $18.08 $9.92 $630.78
3980 Continuous Home Care w/AIDS Min 17 Hours $640.45 $19.21 $9.92 $669.58
3981 Continuous Home Care w/AIDS Min 18 Hours $678.13 $20.34 $9.92 $708.39
3982 Continuous Home Care w/AIDS Min 19 Hours $715.80 $21.47 $9.92 $747.19
3983 Continuous Home Care w/AIDS Min 20 Hours $753.48 $22.60 $9.92 $786.00
3984 Continuous Home Care w/AIDS Min 21 Hours $791.15 $23.73 $9.92 $824.80
3985 Continuous Home Care w/AIDS Min 22 Hours $828.82 $24.86 $9.92 $863.60
3986 Continuous Home Care w/AIDS Min 23 Hours $866.50 $26.00 $9.92 $902.42
3987 Continuous Home Care w/AIDS Min 24 Hours $904.17 $27.13 $9.92 $941.22
3988 General Inpatient w/ AIDS $733.16 $21.99 $9.92 $765.07
3989 Routine Home Care w/ AIDS Escort $289.68 $8.69 $9.92 $308.29

* 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 $166.65 $5.00 $9.92 $181.57
3946 Inpatient Respite $162.03 $4.86 $9.92 $176.81
3947 General Inpatient Care $648.28 $19.45 $9.92 $677.65
3948 Continuous Home Care – Min 8 Hours $280.96 $8.43 $9.92 $299.31
3949 Continuous Home Care – Min 9 Hours $316.08 $9.48 $9.92 $335.48
3950 Continuous Home Care – Min 10 Hours $351.20 $10.54 $9.92 $371.66
3951 Continuous Home Care – Min 11 Hours $386.32 $11.59 $9.92 $407.83
3952 Continuous Home Care – Min 12 Hours $421.44 $12.64 $9.92 $444.00
3953 Continuous Home Care – Min 13 Hours $456.55 $13.70 $9.92 $480.17
3954 Continuous Home Care – Min 14 Hours $491.67 $14.75 $9.92 $516.34
3955 Continuous Home Care – Min 15 Hours $526.79 $15.80 $9.92 $552.51
3956 Continuous Home Care – Min 16 Hours $561.91 $16.86 $9.92 $588.69
3957 Continuous Home Care – Min 17 Hours $597.03 $17.91 $9.92 $624.86
3958 Continuous Home Care – Min 18 Hours $632.15 $18.96 $9.92 $661.03
3959 Continuous Home Care – Min 19 Hours $667.27 $20.02 $9.92 $697.21
3960 Continuous Home Care – Min 20 Hours $702.39 $21.07 $9.92 $733.38
3961 Continuous Home Care – Min 21 Hours $737.51 $22.13 $9.92 $769.56
3962 Continuous Home Care – Min 22 Hours $772.63 $23.18 $9.92 $805.73
3963 Continuous Home Care – Min 23 Hours $807.75 $24.23 $9.92 $841.90
3964 Continuous Home Care – Min 24 Hours $842.87 $25.29 $9.92 $878.08
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.10 $0.24 $0.50 $8.84
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $267.31 $8.02 $9.92 $285.25
3970 Routine Home Care w/Escort $183.93 $5.52 $9.92 $199.37
3971 Continuous Home Care w/AIDS Min 8 Hours $293.50 $8.81 $9.92 $312.23
3972 Continuous Home Care w/AIDS Min 9 Hours $330.18 $9.91 $9.92 $350.01
3973 Continuous Home Care w/AIDS Min 10 Hours $366.87 $11.01 $9.92 $387.80
3974 Continuous Home Care w/AIDS Min 11 Hours $403.56 $12.11 $9.92 $425.59
3975 Continuous Home Care w/AIDS Min 12 Hours $440.25 $13.21 $9.92 $463.38
3976 Continuous Home Care w/AIDS Min 13 Hours $476.93 $14.31 $9.92 $501.16
3977 Continuous Home Care w/AIDS Min 14 Hours $513.62 $15.41 $9.92 $538.95
3978 Continuous Home Care w/AIDS Min 15 Hours $550.31 $16.51 $9.92 $576.74
3979 Continuous Home Care w/AIDS Min 16 Hours $586.99 $17.61 $9.92 $614.52
3980 Continuous Home Care w/AIDS Min 17 Hours $623.68 $18.71 $9.92 $652.31
3981 Continuous Home Care w/AIDS Min 18 Hours $660.37 $19.81 $9.92 $690.10
3982 Continuous Home Care w/AIDS Min 19 Hours $697.05 $20.91 $9.92 $727.88
3983 Continuous Home Care w/AIDS Min 20 Hours $733.74 $22.01 $9.92 $765.67
3984 Continuous Home Care w/AIDS Min 21 Hours $770.43 $23.11 $9.92 $803.46
3985 Continuous Home Care w/AIDS Min 22 Hours $807.12 $24.21 $9.92 $841.25
3986 Continuous Home Care w/AIDS Min 23 Hours $843.80 $25.31 $9.92 $879.03
3987 Continuous Home Care w/AIDS Min 24 Hours $880.49 $26.41 $9.92 $916.82
3988 General Inpatient w/ AIDS $720.50 $21.62 $9.92 $752.04
3989 Routine Home Care w/ AIDS Escort $284.59 $8.54 $9.92 $303.05

* 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 $196.50 $5.90 $9.92 $212.32
3946 Inpatient Respite $184.21 $5.53 $9.92 $199.66
3947 General Inpatient Care $755.40 $22.66 $9.92 $787.98
3948 Continuous Home Care – Min 8 Hours $331.28 $9.94 $9.92 $351.14
3949 Continuous Home Care – Min 9 Hours $372.69 $11.18 $9.92 $393.79
3950 Continuous Home Care – Min 10 Hours $414.10 $12.42 $9.92 $436.44
3951 Continuous Home Care – Min 11 Hours $455.51 $13.67 $9.92 $479.10
3952 Continuous Home Care – Min 12 Hours $496.93 $14.91 $9.92 $521.76
3953 Continuous Home Care – Min 13 Hours $538.34 $16.15 $9.92 $564.41
3954 Continuous Home Care – Min 14 Hours $579.75 $17.39 $9.92 $607.06
3955 Continuous Home Care – Min 15 Hours $621.16 $18.63 $9.92 $649.71
3956 Continuous Home Care – Min 16 Hours $662.57 $19.88 $9.92 $692.37
3957 Continuous Home Care – Min 17 Hours $703.98 $21.12 $9.92 $735.02
3958 Continuous Home Care – Min 18 Hours $745.39 $22.36 $9.92 $777.67
3959 Continuous Home Care – Min 19 Hours $786.80 $23.60 $9.92 $820.32
3960 Continuous Home Care – Min 20 Hours $828.21 $24.85 $9.92 $862.98
3961 Continuous Home Care – Min 21 Hours $869.62 $26.09 $9.92 $905.63
3962 Continuous Home Care – Min 22 Hours $911.03 $27.33 $9.92 $948.28
3963 Continuous Home Care – Min 23 Hours $952.44 $28.57 $9.92 $990.93
3964 Continuous Home Care – Min 24 Hours $993.85 $29.82 $9.92 $1,033.59
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $9.21 $0.28 $0.50 $9.99
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $315.19 $9.46 $9.92 $334.57
3970 Routine Home Care w/Escort $213.78 $6.41 $9.92 $230.11
3971 Continuous Home Care w/AIDS Min 8 Hours $367.76 $11.03 $9.92 $388.71
3972 Continuous Home Care w/AIDS Min 9 Hours $413.73 $12.41 $9.92 $436.06
3973 Continuous Home Care w/AIDS Min 10 Hours $459.70 $13.79 $9.92 $483.41
3974 Continuous Home Care w/AIDS Min 11 Hours $505.67 $15.17 $9.92 $530.76
3975 Continuous Home Care w/AIDS Min 12 Hours $551.64 $16.55 $9.92 $578.11
3976 Continuous Home Care w/AIDS Min 13 Hours $597.60 $17.93 $9.92 $625.45
3977 Continuous Home Care w/AIDS Min 14 Hours $643.57 $19.31 $9.92 $672.80
3978 Continuous Home Care w/AIDS Min 15 Hours $689.54 $20.69 $9.92 $720.15
3979 Continuous Home Care w/AIDS Min 16 Hours $735.51 $22.07 $9.92 $767.50
3980 Continuous Home Care w/AIDS Min 17 Hours $781.48 $23.44 $9.92 $814.84
3981 Continuous Home Care w/AIDS Min 18 Hours $827.45 $24.82 $9.92 $862.19
3982 Continuous Home Care w/AIDS Min 19 Hours $873.42 $26.20 $9.92 $909.54
3983 Continuous Home Care w/AIDS Min 20 Hours $919.39 $27.58 $9.92 $956.89
3984 Continuous Home Care w/AIDS Min 21 Hours $965.36 $28.96 $9.92 $1,004.24
3985 Continuous Home Care w/AIDS Min 22 Hours $1,011.33 $30.34 $9.92 $1,051.59
3986 Continuous Home Care w/AIDS Min 23 Hours $1,057.30 $31.72 $9.92 $1,098.94
3987 Continuous Home Care w/AIDS Min 24 Hours $1,103.27 $33.10 $9.92 $1,146.29
3988 General Inpatient w/ AIDS $839.55 $25.19 $9.92 $874.66
3989 Routine Home Care w/ AIDS Escort $332.47 $9.97 $9.92 $352.36

* 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 $172.39 $5.17 $9.92 $187.48
3946 Inpatient Respite $166.29 $4.99 $9.92 $181.20
3947 General Inpatient Care $668.89 $20.07 $9.92 $698.88
3948 Continuous Home Care – Min 8 Hours $290.64 $8.72 $9.92 $309.28
3949 Continuous Home Care – Min 9 Hours $326.97 $9.81 $9.92 $346.70
3950 Continuous Home Care – Min 10 Hours $363.30 $10.90 $9.92 $384.12
3951 Continuous Home Care – Min 11 Hours $399.63 $11.99 $9.92 $421.54
3952 Continuous Home Care – Min 12 Hours $435.96 $13.08 $9.92 $458.96
3953 Continuous Home Care – Min 13 Hours $472.29 $14.17 $9.92 $496.38
3954 Continuous Home Care – Min 14 Hours $508.62 $15.26 $9.92 $533.80
3955 Continuous Home Care – Min 15 Hours $544.95 $16.35 $9.92 $571.22
3956 Continuous Home Care – Min 16 Hours $581.28 $17.44 $9.92 $608.64
3957 Continuous Home Care – Min 17 Hours $617.61 $18.53 $9.92 $646.06
3958 Continuous Home Care – Min 18 Hours $653.94 $19.62 $9.92 $683.48
3959 Continuous Home Care – Min 19 Hours $690.27 $20.71 $9.92 $720.90
3960 Continuous Home Care – Min 20 Hours $726.60 $21.80 $9.92 $758.32
3961 Continuous Home Care – Min 21 Hours $762.93 $22.89 $9.92 $795.74
3962 Continuous Home Care – Min 22 Hours $799.26 $23.98 $9.92 $833.16
3963 Continuous Home Care – Min 23 Hours $835.59 $25.07 $9.92 $870.58
3964 Continuous Home Care – Min 24 Hours $871.92 $26.16 $9.92 $908.00
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.31 $0.25 $0.50 $9.06
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $276.52 $8.30 $9.92 $294.74
3970 Routine Home Care w/Escort $189.67 $5.69 $9.92 $205.28
3971 Continuous Home Care w/AIDS Min 8 Hours $307.78 $9.23 $9.92 $326.93
3972 Continuous Home Care w/AIDS Min 9 Hours $346.25 $10.39 $9.92 $366.56
3973 Continuous Home Care w/AIDS Min 10 Hours $384.73 $11.54 $9.92 $406.19
3974 Continuous Home Care w/AIDS Min 11 Hours $423.20 $12.70 $9.92 $445.82
3975 Continuous Home Care w/AIDS Min 12 Hours $461.67 $13.85 $9.92 $485.44
3976 Continuous Home Care w/AIDS Min 13 Hours $500.14 $15.00 $9.92 $525.06
3977 Continuous Home Care w/AIDS Min 14 Hours $538.62 $16.16 $9.92 $564.70
3978 Continuous Home Care w/AIDS Min 15 Hours $577.09 $17.31 $9.92 $604.32
3979 Continuous Home Care w/AIDS Min 16 Hours $615.56 $18.47 $9.92 $643.95
3980 Continuous Home Care w/AIDS Min 17 Hours $654.03 $19.62 $9.92 $683.57
3981 Continuous Home Care w/AIDS Min 18 Hours $692.51 $20.78 $9.92 $723.21
3982 Continuous Home Care w/AIDS Min 19 Hours $730.98 $21.93 $9.92 $762.83
3983 Continuous Home Care w/AIDS Min 20 Hours $769.45 $23.08 $9.92 $802.45
3984 Continuous Home Care w/AIDS Min 21 Hours $807.92 $24.24 $9.92 $842.08
3985 Continuous Home Care w/AIDS Min 22 Hours $846.40 $25.39 $9.92 $881.71
3986 Continuous Home Care w/AIDS Min 23 Hours $884.87 $26.55 $9.92 $921.34
3987 Continuous Home Care w/AIDS Min 24 Hours $923.34 $27.70 $9.92 $960.96
3988 General Inpatient w/ AIDS $743.40 $22.30 $9.92 $775.62
3989 Routine Home Care w/ AIDS Escort $293.80 $8.81 $9.92 $312.53

* 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 $166.39 $4.99 $9.92 $181.30
3946 Inpatient Respite $161.83 $4.85 $9.92 $176.60
3947 General Inpatient Care $647.34 $19.42 $9.92 $676.68
3948 Continuous Home Care – Min 8 Hours $280.52 $8.42 $9.92 $298.86
3949 Continuous Home Care – Min 9 Hours $315.58 $9.47 $9.92 $334.97
3950 Continuous Home Care – Min 10 Hours $350.65 $10.52 $9.92 $371.09
3951 Continuous Home Care – Min 11 Hours $385.71 $11.57 $9.92 $407.20
3952 Continuous Home Care – Min 12 Hours $420.78 $12.62 $9.92 $443.32
3953 Continuous Home Care – Min 13 Hours $455.84 $13.68 $9.92 $479.44
3954 Continuous Home Care – Min 14 Hours $490.90 $14.73 $9.92 $515.55
3955 Continuous Home Care – Min 15 Hours $525.97 $15.78 $9.92 $551.67
3956 Continuous Home Care – Min 16 Hours $561.03 $16.83 $9.92 $587.78
3957 Continuous Home Care – Min 17 Hours $596.10 $17.88 $9.92 $623.90
3958 Continuous Home Care – Min 18 Hours $631.16 $18.93 $9.92 $660.01
3959 Continuous Home Care – Min 19 Hours $666.23 $19.99 $9.92 $696.14
3960 Continuous Home Care – Min 20 Hours $701.29 $21.04 $9.92 $732.25
3961 Continuous Home Care – Min 21 Hours $736.36 $22.09 $9.92 $768.37
3962 Continuous Home Care – Min 22 Hours $771.42 $23.14 $9.92 $804.48
3963 Continuous Home Care – Min 23 Hours $806.49 $24.19 $9.92 $840.60
3964 Continuous Home Care – Min 24 Hours $841.55 $25.25 $9.92 $876.72
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.09 $0.24 $0.50 $8.83
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $266.89 $8.01 $9.92 $284.82
3970 Routine Home Care w/Escort $183.67 $5.51 $9.92 $199.10
3971 Continuous Home Care w/AIDS Min 8 Hours $292.84 $8.79 $9.92 $311.55
3972 Continuous Home Care w/AIDS Min 9 Hours $329.45 $9.88 $9.92 $349.25
3973 Continuous Home Care w/AIDS Min 10 Hours $366.05 $10.98 $9.92 $386.95
3974 Continuous Home Care w/AIDS Min 11 Hours $402.66 $12.08 $9.92 $424.66
3975 Continuous Home Care w/AIDS Min 12 Hours $439.27 $13.18 $9.92 $462.37
3976 Continuous Home Care w/AIDS Min 13 Hours $475.87 $14.28 $9.92 $500.07
3977 Continuous Home Care w/AIDS Min 14 Hours $512.48 $15.37 $9.92 $537.77
3978 Continuous Home Care w/AIDS Min 15 Hours $549.08 $16.47 $9.92 $575.47
3979 Continuous Home Care w/AIDS Min 16 Hours $585.69 $17.57 $9.92 $613.18
3980 Continuous Home Care w/AIDS Min 17 Hours $622.29 $18.67 $9.92 $650.88
3981 Continuous Home Care w/AIDS Min 18 Hours $658.90 $19.77 $9.92 $688.59
3982 Continuous Home Care w/AIDS Min 19 Hours $695.50 $20.87 $9.92 $726.29
3983 Continuous Home Care w/AIDS Min 20 Hours $732.11 $21.96 $9.92 $763.99
3984 Continuous Home Care w/AIDS Min 21 Hours $768.71 $23.06 $9.92 $801.69
3985 Continuous Home Care w/AIDS Min 22 Hours $805.32 $24.16 $9.92 $839.40
3986 Continuous Home Care w/AIDS Min 23 Hours $841.92 $25.26 $9.92 $877.10
3987 Continuous Home Care w/AIDS Min 24 Hours $878.53 $26.36 $9.92 $914.81
3988 General Inpatient w/ AIDS $719.45 $21.58 $9.92 $750.95
3989 Routine Home Care w/ AIDS Escort $284.17 $8.53 $9.92 $302.62

* 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 $229.70 $6.89 $9.92 $246.51
3946 Inpatient Respite $208.87 $6.27 $9.92 $225.06
3947 General Inpatient Care $874.52 $26.24 $9.92 $910.68
3948 Continuous Home Care – Min 8 Hours $387.25 $11.62 $9.92 $408.79
3949 Continuous Home Care – Min 9 Hours $435.65 $13.07 $9.92 $458.64
3950 Continuous Home Care – Min 10 Hours $484.06 $14.52 $9.92 $508.50
3951 Continuous Home Care – Min 11 Hours $532.46 $15.97 $9.92 $558.35
3952 Continuous Home Care – Min 12 Hours $580.87 $17.43 $9.92 $608.22
3953 Continuous Home Care – Min 13 Hours $629.28 $18.88 $9.92 $658.08
3954 Continuous Home Care – Min 14 Hours $677.68 $20.33 $9.92 $707.93
3955 Continuous Home Care – Min 15 Hours $726.09 $21.78 $9.92 $757.79
3956 Continuous Home Care – Min 16 Hours $774.49 $23.23 $9.92 $807.64
3957 Continuous Home Care – Min 17 Hours $822.90 $24.69 $9.92 $857.51
3958 Continuous Home Care – Min 18 Hours $871.31 $26.14 $9.92 $907.37
3959 Continuous Home Care – Min 19 Hours $919.71 $27.59 $9.92 $957.22
3960 Continuous Home Care – Min 20 Hours $968.12 $29.04 $9.92 $1,007.08
3961 Continuous Home Care – Min 21 Hours $1,016.52 $30.50 $9.92 $1,056.94
3962 Continuous Home Care – Min 22 Hours $1,064.93 $31.95 $9.92 $1,106.80
3963 Continuous Home Care – Min 23 Hours $1,113.33 $33.40 $9.92 $1,156.65
3964 Continuous Home Care – Min 24 Hours $1,161.74 $34.85 $9.92 $1,206.51
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $10.44 $0.31 $0.50 $11.25
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $368.43 $11.05 $9.92 $389.40
3970 Routine Home Care w/Escort $246.98 $7.41 $9.92 $264.31
3971 Continuous Home Care w/AIDS Min 8 Hours $450.33 $13.51 $9.92 $473.76
3972 Continuous Home Care w/AIDS Min 9 Hours $506.63 $15.20 $9.92 $531.75
3973 Continuous Home Care w/AIDS Min 10 Hours $562.92 $16.89 $9.92 $589.73
3974 Continuous Home Care w/AIDS Min 11 Hours $619.21 $18.58 $9.92 $647.71
3975 Continuous Home Care w/AIDS Min 12 Hours $675.50 $20.27 $9.92 $705.69
3976 Continuous Home Care w/AIDS Min 13 Hours $731.79 $21.95 $9.92 $763.66
3977 Continuous Home Care w/AIDS Min 14 Hours $788.08 $23.64 $9.92 $821.64
3978 Continuous Home Care w/AIDS Min 15 Hours $844.38 $25.33 $9.92 $879.63
3979 Continuous Home Care w/AIDS Min 16 Hours $900.67 $27.02 $9.92 $937.61
3980 Continuous Home Care w/AIDS Min 17 Hours $956.96 $28.71 $9.92 $995.59
3981 Continuous Home Care w/AIDS Min 18 Hours $1,013.25 $30.40 $9.92 $1,053.57
3982 Continuous Home Care w/AIDS Min 19 Hours $1,069.54 $32.09 $9.92 $1,111.55
3983 Continuous Home Care w/AIDS Min 20 Hours $1,125.83 $33.77 $9.92 $1,169.52
3984 Continuous Home Care w/AIDS Min 21 Hours $1,182.13 $35.46 $9.92 $1,227.51
3985 Continuous Home Care w/AIDS Min 22 Hours $1,238.42 $37.15 $9.92 $1,285.49
3986 Continuous Home Care w/AIDS Min 23 Hours $1,294.71 $38.84 $9.92 $1,343.47
3987 Continuous Home Care w/AIDS Min 24 Hours $1,351.00 $40.53 $9.92 $1,401.45
3988 General Inpatient w/ AIDS $971.94 $29.16 $9.92 $1,011.02
3989 Routine Home Care w/ AIDS Escort $385.71 $11.57 $9.92 $407.20

* 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 $229.62 $6.89 $9.92 $246.43
3946 Inpatient Respite $208.82 $6.26 $9.92 $225.00
3947 General Inpatient Care $874.24 $26.23 $9.92 $910.39
3948 Continuous Home Care – Min 8 Hours $387.11 $11.61 $9.92 $408.64
3949 Continuous Home Care – Min 9 Hours $435.50 $13.07 $9.92 $458.49
3950 Continuous Home Care – Min 10 Hours $483.89 $14.52 $9.92 $508.33
3951 Continuous Home Care – Min 11 Hours $532.28 $15.97 $9.92 $558.17
3952 Continuous Home Care – Min 12 Hours $580.67 $17.42 $9.92 $608.01
3953 Continuous Home Care – Min 13 Hours $629.06 $18.87 $9.92 $657.85
3954 Continuous Home Care – Min 14 Hours $677.45 $20.32 $9.92 $707.69
3955 Continuous Home Care – Min 15 Hours $725.84 $21.78 $9.92 $757.54
3956 Continuous Home Care – Min 16 Hours $774.23 $23.23 $9.92 $807.38
3957 Continuous Home Care – Min 17 Hours $822.62 $24.68 $9.92 $857.22
3958 Continuous Home Care – Min 18 Hours $871.01 $26.13 $9.92 $907.06
3959 Continuous Home Care – Min 19 Hours $919.39 $27.58 $9.92 $956.89
3960 Continuous Home Care – Min 20 Hours $967.78 $29.03 $9.92 $1,006.73
3961 Continuous Home Care – Min 21 Hours $1,016.17 $30.49 $9.92 $1,056.58
3962 Continuous Home Care – Min 22 Hours $1,064.56 $31.94 $9.92 $1,106.42
3963 Continuous Home Care – Min 23 Hours $1,112.95 $33.39 $9.92 $1,156.26
3964 Continuous Home Care – Min 24 Hours $1,161.34 $34.84 $9.92 $1,206.10
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $10.44 $0.31 $0.50 $11.25
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $368.30 $11.05 $9.92 $389.27
3970 Routine Home Care w/Escort $246.90 $7.41 $9.92 $264.23
3971 Continuous Home Care w/AIDS Min 8 Hours $450.14 $13.50 $9.92 $473.56
3972 Continuous Home Care w/AIDS Min 9 Hours $506.40 $15.19 $9.92 $531.51
3973 Continuous Home Care w/AIDS Min 10 Hours $562.67 $16.88 $9.92 $589.47
3974 Continuous Home Care w/AIDS Min 11 Hours $618.94 $18.57 $9.92 $647.43
3975 Continuous Home Care w/AIDS Min 12 Hours $675.21 $20.26 $9.92 $705.39
3976 Continuous Home Care w/AIDS Min 13 Hours $731.47 $21.94 $9.92 $763.33
3977 Continuous Home Care w/AIDS Min 14 Hours $787.74 $23.63 $9.92 $821.29
3978 Continuous Home Care w/AIDS Min 15 Hours $844.01 $25.32 $9.92 $879.25
3979 Continuous Home Care w/AIDS Min 16 Hours $900.27 $27.01 $9.92 $937.20
3980 Continuous Home Care w/AIDS Min 17 Hours $956.54 $28.70 $9.92 $995.16
3981 Continuous Home Care w/AIDS Min 18 Hours $1,012.81 $30.38 $9.92 $1,053.11
3982 Continuous Home Care w/AIDS Min 19 Hours $1,069.07 $32.07 $9.92 $1,111.06
3983 Continuous Home Care w/AIDS Min 20 Hours $1,125.34 $33.76 $9.92 $1,169.02
3984 Continuous Home Care w/AIDS Min 21 Hours $1,181.61 $35.45 $9.92 $1,226.98
3985 Continuous Home Care w/AIDS Min 22 Hours $1,237.88 $37.14 $9.92 $1,284.94
3986 Continuous Home Care w/AIDS Min 23 Hours $1,294.14 $38.82 $9.92 $1,342.88
3987 Continuous Home Care w/AIDS Min 24 Hours $1,350.41 $40.51 $9.92 $1,400.84
3988 General Inpatient w/ AIDS $971.63 $29.15 $9.92 $1,010.70
3989 Routine Home Care w/ AIDS Escort $385.58 $11.57 $9.92 $407.07

* 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 $196.50 $5.90 $9.92 $212.32
3946 Inpatient Respite $184.21 $5.53 $9.92 $199.66
3947 General Inpatient Care $755.40 $22.66 $9.92 $787.98
3948 Continuous Home Care – Min 8 Hours $331.28 $9.94 $9.92 $351.14
3949 Continuous Home Care – Min 9 Hours $372.69 $11.18 $9.92 $393.79
3950 Continuous Home Care – Min 10 Hours $414.10 $12.42 $9.92 $436.44
3951 Continuous Home Care – Min 11 Hours $455.51 $13.67 $9.92 $479.10
3952 Continuous Home Care – Min 12 Hours $496.93 $14.91 $9.92 $521.76
3953 Continuous Home Care – Min 13 Hours $538.34 $16.15 $9.92 $564.41
3954 Continuous Home Care – Min 14 Hours $579.75 $17.39 $9.92 $607.06
3955 Continuous Home Care – Min 15 Hours $621.16 $18.63 $9.92 $649.71
3956 Continuous Home Care – Min 16 Hours $662.57 $19.88 $9.92 $692.37
3957 Continuous Home Care – Min 17 Hours $703.98 $21.12 $9.92 $735.02
3958 Continuous Home Care – Min 18 Hours $745.39 $22.36 $9.92 $777.67
3959 Continuous Home Care – Min 19 Hours $786.80 $23.60 $9.92 $820.32
3960 Continuous Home Care – Min 20 Hours $828.21 $24.85 $9.92 $862.98
3961 Continuous Home Care – Min 21 Hours $869.62 $26.09 $9.92 $905.63
3962 Continuous Home Care – Min 22 Hours $911.03 $27.33 $9.92 $948.28
3963 Continuous Home Care – Min 23 Hours $952.44 $28.57 $9.92 $990.93
3964 Continuous Home Care – Min 24 Hours $993.85 $29.82 $9.92 $1,033.59
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $9.21 $0.28 $0.50 $9.99
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $315.19 $9.46 $9.92 $334.57
3970 Routine Home Care w/Escort $213.78 $6.41 $9.92 $230.11
3971 Continuous Home Care w/AIDS Min 8 Hours $367.76 $11.03 $9.92 $388.71
3972 Continuous Home Care w/AIDS Min 9 Hours $413.73 $12.41 $9.92 $436.06
3973 Continuous Home Care w/AIDS Min 10 Hours $459.70 $13.79 $9.92 $483.41
3974 Continuous Home Care w/AIDS Min 11 Hours $505.67 $15.17 $9.92 $530.76
3975 Continuous Home Care w/AIDS Min 12 Hours $551.64 $16.55 $9.92 $578.11
3976 Continuous Home Care w/AIDS Min 13 Hours $597.60 $17.93 $9.92 $625.45
3977 Continuous Home Care w/AIDS Min 14 Hours $643.57 $19.31 $9.92 $672.80
3978 Continuous Home Care w/AIDS Min 15 Hours $689.54 $20.69 $9.92 $720.15
3979 Continuous Home Care w/AIDS Min 16 Hours $735.51 $22.07 $9.92 $767.50
3980 Continuous Home Care w/AIDS Min 17 Hours $781.48 $23.44 $9.92 $814.84
3981 Continuous Home Care w/AIDS Min 18 Hours $827.45 $24.82 $9.92 $862.19
3982 Continuous Home Care w/AIDS Min 19 Hours $873.42 $26.20 $9.92 $909.54
3983 Continuous Home Care w/AIDS Min 20 Hours $919.39 $27.58 $9.92 $956.89
3984 Continuous Home Care w/AIDS Min 21 Hours $965.36 $28.96 $9.92 $1,004.24
3985 Continuous Home Care w/AIDS Min 22 Hours $1,011.33 $30.34 $9.92 $1,051.59
3986 Continuous Home Care w/AIDS Min 23 Hours $1,057.30 $31.72 $9.92 $1,098.94
3987 Continuous Home Care w/AIDS Min 24 Hours $1,103.27 $33.10 $9.92 $1,146.29
3988 General Inpatient w/ AIDS $839.55 $25.19 $9.92 $874.66
3989 Routine Home Care w/ AIDS Escort $332.47 $9.97 $9.92 $352.36

* 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 $229.62 $6.89 $9.92 $246.43
3946 Inpatient Respite $208.82 $6.26 $9.92 $225.00
3947 General Inpatient Care $874.24 $26.23 $9.92 $910.39
3948 Continuous Home Care – Min 8 Hours $387.11 $11.61 $9.92 $408.64
3949 Continuous Home Care – Min 9 Hours $435.50 $13.07 $9.92 $458.49
3950 Continuous Home Care – Min 10 Hours $483.89 $14.52 $9.92 $508.33
3951 Continuous Home Care – Min 11 Hours $532.28 $15.97 $9.92 $558.17
3952 Continuous Home Care – Min 12 Hours $580.67 $17.42 $9.92 $608.01
3953 Continuous Home Care – Min 13 Hours $629.06 $18.87 $9.92 $657.85
3954 Continuous Home Care – Min 14 Hours $677.45 $20.32 $9.92 $707.69
3955 Continuous Home Care – Min 15 Hours $725.84 $21.78 $9.92 $757.54
3956 Continuous Home Care – Min 16 Hours $774.23 $23.23 $9.92 $807.38
3957 Continuous Home Care – Min 17 Hours $822.62 $24.68 $9.92 $857.22
3958 Continuous Home Care – Min 18 Hours $871.01 $26.13 $9.92 $907.06
3959 Continuous Home Care – Min 19 Hours $919.39 $27.58 $9.92 $956.89
3960 Continuous Home Care – Min 20 Hours $967.78 $29.03 $9.92 $1,006.73
3961 Continuous Home Care – Min 21 Hours $1,016.17 $30.49 $9.92 $1,056.58
3962 Continuous Home Care – Min 22 Hours $1,064.56 $31.94 $9.92 $1,106.42
3963 Continuous Home Care – Min 23 Hours $1,112.95 $33.39 $9.92 $1,156.26
3964 Continuous Home Care – Min 24 Hours $1,161.34 $34.84 $9.92 $1,206.10
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $10.44 $0.31 $0.50 $11.25
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $368.30 $11.05 $9.92 $389.27
3970 Routine Home Care w/Escort $246.90 $7.41 $9.92 $264.23
3971 Continuous Home Care w/AIDS Min 8 Hours $450.14 $13.50 $9.92 $473.56
3972 Continuous Home Care w/AIDS Min 9 Hours $506.40 $15.19 $9.92 $531.51
3973 Continuous Home Care w/AIDS Min 10 Hours $562.67 $16.88 $9.92 $589.47
3974 Continuous Home Care w/AIDS Min 11 Hours $618.94 $18.57 $9.92 $647.43
3975 Continuous Home Care w/AIDS Min 12 Hours $675.21 $20.26 $9.92 $705.39
3976 Continuous Home Care w/AIDS Min 13 Hours $731.47 $21.94 $9.92 $763.33
3977 Continuous Home Care w/AIDS Min 14 Hours $787.74 $23.63 $9.92 $821.29
3978 Continuous Home Care w/AIDS Min 15 Hours $844.01 $25.32 $9.92 $879.25
3979 Continuous Home Care w/AIDS Min 16 Hours $900.27 $27.01 $9.92 $937.20
3980 Continuous Home Care w/AIDS Min 17 Hours $956.54 $28.70 $9.92 $995.16
3981 Continuous Home Care w/AIDS Min 18 Hours $1,012.81 $30.38 $9.92 $1,053.11
3982 Continuous Home Care w/AIDS Min 19 Hours $1,069.07 $32.07 $9.92 $1,111.06
3983 Continuous Home Care w/AIDS Min 20 Hours $1,125.34 $33.76 $9.92 $1,169.02
3984 Continuous Home Care w/AIDS Min 21 Hours $1,181.61 $35.45 $9.92 $1,226.98
3985 Continuous Home Care w/AIDS Min 22 Hours $1,237.88 $37.14 $9.92 $1,284.94
3986 Continuous Home Care w/AIDS Min 23 Hours $1,294.14 $38.82 $9.92 $1,342.88
3987 Continuous Home Care w/AIDS Min 24 Hours $1,350.41 $40.51 $9.92 $1,400.84
3988 General Inpatient w/ AIDS $971.63 $29.15 $9.92 $1,010.70
3989 Routine Home Care w/ AIDS Escort $385.58 $11.57 $9.92 $407.07

* 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 $210.10 $6.30 $9.92 $226.32
3946 Inpatient Respite $194.31 $5.83 $9.92 $210.06
3947 General Inpatient Care $804.19 $24.13 $9.92 $838.24
3948 Continuous Home Care – Min 8 Hours $354.20 $10.63 $9.92 $374.75
3949 Continuous Home Care – Min 9 Hours $398.48 $11.95 $9.92 $420.35
3950 Continuous Home Care – Min 10 Hours $442.75 $13.28 $9.92 $465.95
3951 Continuous Home Care – Min 11 Hours $487.03 $14.61 $9.92 $511.56
3952 Continuous Home Care – Min 12 Hours $531.31 $15.94 $9.92 $557.17
3953 Continuous Home Care – Min 13 Hours $575.58 $17.27 $9.92 $602.77
3954 Continuous Home Care – Min 14 Hours $619.86 $18.60 $9.92 $648.38
3955 Continuous Home Care – Min 15 Hours $664.13 $19.92 $9.92 $693.97
3956 Continuous Home Care – Min 16 Hours $708.41 $21.25 $9.92 $739.58
3957 Continuous Home Care – Min 17 Hours $752.68 $22.58 $9.92 $785.18
3958 Continuous Home Care – Min 18 Hours $796.96 $23.91 $9.92 $830.79
3959 Continuous Home Care – Min 19 Hours $841.23 $25.24 $9.92 $876.39
3960 Continuous Home Care – Min 20 Hours $885.51 $26.57 $9.92 $922.00
3961 Continuous Home Care – Min 21 Hours $929.78 $27.89 $9.92 $967.59
3962 Continuous Home Care – Min 22 Hours $974.06 $29.22 $9.92 $1,013.20
3963 Continuous Home Care – Min 23 Hours $1,018.33 $30.55 $9.92 $1,058.80
3964 Continuous Home Care – Min 24 Hours $1,062.61 $31.88 $9.92 $1,104.41
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $9.72 $0.29 $0.50 $10.51
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $336.99 $10.11 $9.92 $357.02
3970 Routine Home Care w/Escort $227.38 $6.82 $9.92 $244.12
3971 Continuous Home Care w/AIDS Min 8 Hours $401.58 $12.05 $9.92 $423.55
3972 Continuous Home Care w/AIDS Min 9 Hours $451.77 $13.55 $9.92 $475.24
3973 Continuous Home Care w/AIDS Min 10 Hours $501.97 $15.06 $9.92 $526.95
3974 Continuous Home Care w/AIDS Min 11 Hours $552.17 $16.57 $9.92 $578.66
3975 Continuous Home Care w/AIDS Min 12 Hours $602.37 $18.07 $9.92 $630.36
3976 Continuous Home Care w/AIDS Min 13 Hours $652.56 $19.58 $9.92 $682.06
3977 Continuous Home Care w/AIDS Min 14 Hours $702.76 $21.08 $9.92 $733.76
3978 Continuous Home Care w/AIDS Min 15 Hours $752.96 $22.59 $9.92 $785.47
3979 Continuous Home Care w/AIDS Min 16 Hours $803.15 $24.09 $9.92 $837.16
3980 Continuous Home Care w/AIDS Min 17 Hours $853.35 $25.60 $9.92 $888.87
3981 Continuous Home Care w/AIDS Min 18 Hours $903.55 $27.11 $9.92 $940.58
3982 Continuous Home Care w/AIDS Min 19 Hours $953.74 $28.61 $9.92 $992.27
3983 Continuous Home Care w/AIDS Min 20 Hours $1,003.94 $30.12 $9.92 $1,043.98
3984 Continuous Home Care w/AIDS Min 21 Hours $1,054.14 $31.62 $9.92 $1,095.68
3985 Continuous Home Care w/AIDS Min 22 Hours $1,104.34 $33.13 $9.92 $1,147.39
3986 Continuous Home Care w/AIDS Min 23 Hours $1,154.53 $34.64 $9.92 $1,199.09
3987 Continuous Home Care w/AIDS Min 24 Hours $1,204.73 $36.14 $9.92 $1,250.79
3988 General Inpatient w/ AIDS $893.78 $26.81 $9.92 $930.51
3989 Routine Home Care w/ AIDS Escort $354.27 $10.63 $9.92 $374.82

* 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 $172.88 $5.19 $9.92 $187.99
3946 Inpatient Respite $166.65 $5.00 $9.92 $181.57
3947 General Inpatient Care $670.63 $20.12 $9.92 $700.67
3948 Continuous Home Care – Min 8 Hours $291.46 $8.74 $9.92 $310.12
3949 Continuous Home Care – Min 9 Hours $327.89 $9.84 $9.92 $347.65
3950 Continuous Home Care – Min 10 Hours $364.32 $10.93 $9.92 $385.17
3951 Continuous Home Care – Min 11 Hours $400.75 $12.02 $9.92 $422.69
3952 Continuous Home Care – Min 12 Hours $437.19 $13.12 $9.92 $460.23
3953 Continuous Home Care – Min 13 Hours $473.62 $14.21 $9.92 $497.75
3954 Continuous Home Care – Min 14 Hours $510.05 $15.30 $9.92 $535.27
3955 Continuous Home Care – Min 15 Hours $546.48 $16.39 $9.92 $572.79
3956 Continuous Home Care – Min 16 Hours $582.91 $17.49 $9.92 $610.32
3957 Continuous Home Care – Min 17 Hours $619.35 $18.58 $9.92 $647.85
3958 Continuous Home Care – Min 18 Hours $655.78 $19.67 $9.92 $685.37
3959 Continuous Home Care – Min 19 Hours $692.21 $20.77 $9.92 $722.90
3960 Continuous Home Care – Min 20 Hours $728.64 $21.86 $9.92 $760.42
3961 Continuous Home Care – Min 21 Hours $765.07 $22.95 $9.92 $797.94
3962 Continuous Home Care – Min 22 Hours $801.51 $24.05 $9.92 $835.48
3963 Continuous Home Care – Min 23 Hours $837.94 $25.14 $9.92 $873.00
3964 Continuous Home Care – Min 24 Hours $874.37 $26.23 $9.92 $910.52
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.33 $0.25 $0.50 $9.08
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $277.29 $8.32 $9.92 $295.53
3970 Routine Home Care w/Escort $190.16 $5.70 $9.92 $205.78
3971 Continuous Home Care w/AIDS Min 8 Hours $308.99 $9.27 $9.92 $328.18
3972 Continuous Home Care w/AIDS Min 9 Hours $347.61 $10.43 $9.92 $367.96
3973 Continuous Home Care w/AIDS Min 10 Hours $386.23 $11.59 $9.92 $407.74
3974 Continuous Home Care w/AIDS Min 11 Hours $424.86 $12.75 $9.92 $447.53
3975 Continuous Home Care w/AIDS Min 12 Hours $463.48 $13.90 $9.92 $487.30
3976 Continuous Home Care w/AIDS Min 13 Hours $502.10 $15.06 $9.92 $527.08
3977 Continuous Home Care w/AIDS Min 14 Hours $540.73 $16.22 $9.92 $566.87
3978 Continuous Home Care w/AIDS Min 15 Hours $579.35 $17.38 $9.92 $606.65
3979 Continuous Home Care w/AIDS Min 16 Hours $617.97 $18.54 $9.92 $646.43
3980 Continuous Home Care w/AIDS Min 17 Hours $656.60 $19.70 $9.92 $686.22
3981 Continuous Home Care w/AIDS Min 18 Hours $695.22 $20.86 $9.92 $726.00
3982 Continuous Home Care w/AIDS Min 19 Hours $733.84 $22.02 $9.92 $765.78
3983 Continuous Home Care w/AIDS Min 20 Hours $772.47 $23.17 $9.92 $805.56
3984 Continuous Home Care w/AIDS Min 21 Hours $811.09 $24.33 $9.92 $845.34
3985 Continuous Home Care w/AIDS Min 22 Hours $849.71 $25.49 $9.92 $885.12
3986 Continuous Home Care w/AIDS Min 23 Hours $888.34 $26.65 $9.92 $924.91
3987 Continuous Home Care w/AIDS Min 24 Hours $926.96 $27.81 $9.92 $964.69
3988 General Inpatient w/ AIDS $745.34 $22.36 $9.92 $777.62
3989 Routine Home Care w/ AIDS Escort $294.57 $8.84 $9.92 $313.33

* 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 $188.41 $5.65 $9.92 $203.98
3946 Inpatient Respite $178.20 $5.35 $9.92 $193.47
3947 General Inpatient Care $726.38 $21.79 $9.92 $758.09
3948 Continuous Home Care – Min 8 Hours $317.65 $9.53 $9.92 $337.10
3949 Continuous Home Care – Min 9 Hours $357.35 $10.72 $9.92 $377.99
3950 Continuous Home Care – Min 10 Hours $397.06 $11.91 $9.92 $418.89
3951 Continuous Home Care – Min 11 Hours $436.76 $13.10 $9.92 $459.78
3952 Continuous Home Care – Min 12 Hours $476.47 $14.29 $9.92 $500.68
3953 Continuous Home Care – Min 13 Hours $516.18 $15.49 $9.92 $541.59
3954 Continuous Home Care – Min 14 Hours $555.88 $16.68 $9.92 $582.48
3955 Continuous Home Care – Min 15 Hours $595.59 $17.87 $9.92 $623.38
3956 Continuous Home Care – Min 16 Hours $635.29 $19.06 $9.92 $664.27
3957 Continuous Home Care – Min 17 Hours $675.00 $20.25 $9.92 $705.17
3958 Continuous Home Care – Min 18 Hours $714.71 $21.44 $9.92 $746.07
3959 Continuous Home Care – Min 19 Hours $754.41 $22.63 $9.92 $786.96
3960 Continuous Home Care – Min 20 Hours $794.12 $23.82 $9.92 $827.86
3961 Continuous Home Care – Min 21 Hours $833.82 $25.01 $9.92 $868.75
3962 Continuous Home Care – Min 22 Hours $873.53 $26.21 $9.92 $909.66
3963 Continuous Home Care – Min 23 Hours $913.23 $27.40 $9.92 $950.55
3964 Continuous Home Care – Min 24 Hours $952.94 $28.59 $9.92 $991.45
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.91 $0.27 $0.50 $9.68
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $302.21 $9.07 $9.92 $321.20
3970 Routine Home Care w/Escort $205.69 $6.17 $9.92 $221.78
3971 Continuous Home Care w/AIDS Min 8 Hours $347.63 $10.43 $9.92 $367.98
3972 Continuous Home Care w/AIDS Min 9 Hours $391.09 $11.73 $9.92 $412.74
3973 Continuous Home Care w/AIDS Min 10 Hours $434.54 $13.04 $9.92 $457.50
3974 Continuous Home Care w/AIDS Min 11 Hours $478.00 $14.34 $9.92 $502.26
3975 Continuous Home Care w/AIDS Min 12 Hours $521.45 $15.64 $9.92 $547.01
3976 Continuous Home Care w/AIDS Min 13 Hours $564.90 $16.95 $9.92 $591.77
3977 Continuous Home Care w/AIDS Min 14 Hours $608.36 $18.25 $9.92 $636.53
3978 Continuous Home Care w/AIDS Min 15 Hours $651.81 $19.55 $9.92 $681.28
3979 Continuous Home Care w/AIDS Min 16 Hours $695.27 $20.86 $9.92 $726.05
3980 Continuous Home Care w/AIDS Min 17 Hours $738.72 $22.16 $9.92 $770.80
3981 Continuous Home Care w/AIDS Min 18 Hours $782.18 $23.47 $9.92 $815.57
3982 Continuous Home Care w/AIDS Min 19 Hours $825.63 $24.77 $9.92 $860.32
3983 Continuous Home Care w/AIDS Min 20 Hours $869.08 $26.07 $9.92 $905.07
3984 Continuous Home Care w/AIDS Min 21 Hours $912.54 $27.38 $9.92 $949.84
3985 Continuous Home Care w/AIDS Min 22 Hours $955.99 $28.68 $9.92 $994.59
3986 Continuous Home Care w/AIDS Min 23 Hours $999.45 $29.98 $9.92 $1,039.35
3987 Continuous Home Care w/AIDS Min 24 Hours $1,042.90 $31.29 $9.92 $1,084.11
3988 General Inpatient w/ AIDS $807.30 $24.22 $9.92 $841.44
3989 Routine Home Care w/ AIDS Escort $319.49 $9.58 $9.92 $338.99

* 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: MADISON, ONONDAGA, OSWEGO

Rate
Code
Description Base Rate WRP
Add–on *
RTR
Add–on *
Total
w/ addons
3945 Routine Home Care $177.91 $5.34 $9.92 $193.17
3946 Inpatient Respite $170.39 $5.11 $9.92 $185.42
3947 General Inpatient Care $688.70 $20.66 $9.92 $719.28
3948 Continuous Home Care – Min 8 Hours $299.94 $9.00 $9.92 $318.86
3949 Continuous Home Care – Min 9 Hours $337.44 $10.12 $9.92 $357.48
3950 Continuous Home Care – Min 10 Hours $374.93 $11.25 $9.92 $396.10
3951 Continuous Home Care – Min 11 Hours $412.42 $12.37 $9.92 $434.71
3952 Continuous Home Care – Min 12 Hours $449.92 $13.50 $9.92 $473.34
3953 Continuous Home Care – Min 13 Hours $487.41 $14.62 $9.92 $511.95
3954 Continuous Home Care – Min 14 Hours $524.90 $15.75 $9.92 $550.57
3955 Continuous Home Care – Min 15 Hours $562.39 $16.87 $9.92 $589.18
3956 Continuous Home Care – Min 16 Hours $599.89 $18.00 $9.92 $627.81
3957 Continuous Home Care – Min 17 Hours $637.38 $19.12 $9.92 $666.42
3958 Continuous Home Care – Min 18 Hours $674.87 $20.25 $9.92 $705.04
3959 Continuous Home Care – Min 19 Hours $712.37 $21.37 $9.92 $743.66
3960 Continuous Home Care – Min 20 Hours $749.86 $22.50 $9.92 $782.28
3961 Continuous Home Care – Min 21 Hours $787.35 $23.62 $9.92 $820.89
3962 Continuous Home Care – Min 22 Hours $824.84 $24.75 $9.92 $859.51
3963 Continuous Home Care – Min 23 Hours $862.34 $25.87 $9.92 $898.13
3964 Continuous Home Care – Min 24 Hours $899.83 $26.99 $9.92 $936.74
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.52 $0.26 $0.50 $9.28
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $285.37 $8.56 $9.92 $303.85
3970 Routine Home Care w/Escort $195.19 $5.86 $9.92 $210.97
3971 Continuous Home Care w/AIDS Min 8 Hours $321.51 $9.65 $9.92 $341.08
3972 Continuous Home Care w/AIDS Min 9 Hours $361.70 $10.85 $9.92 $382.47
3973 Continuous Home Care w/AIDS Min 10 Hours $401.89 $12.06 $9.92 $423.87
3974 Continuous Home Care w/AIDS Min 11 Hours $442.08 $13.26 $9.92 $465.26
3975 Continuous Home Care w/AIDS Min 12 Hours $482.27 $14.47 $9.92 $506.66
3976 Continuous Home Care w/AIDS Min 13 Hours $522.45 $15.67 $9.92 $548.04
3977 Continuous Home Care w/AIDS Min 14 Hours $562.64 $16.88 $9.92 $589.44
3978 Continuous Home Care w/AIDS Min 15 Hours $602.83 $18.08 $9.92 $630.83
3979 Continuous Home Care w/AIDS Min 16 Hours $643.02 $19.29 $9.92 $672.23
3980 Continuous Home Care w/AIDS Min 17 Hours $683.21 $20.50 $9.92 $713.63
3981 Continuous Home Care w/AIDS Min 18 Hours $723.40 $21.70 $9.92 $755.02
3982 Continuous Home Care w/AIDS Min 19 Hours $763.59 $22.91 $9.92 $796.42
3983 Continuous Home Care w/AIDS Min 20 Hours $803.78 $24.11 $9.92 $837.81
3984 Continuous Home Care w/AIDS Min 21 Hours $843.96 $25.32 $9.92 $879.20
3985 Continuous Home Care w/AIDS Min 22 Hours $884.15 $26.52 $9.92 $920.59
3986 Continuous Home Care w/AIDS Min 23 Hours $924.34 $27.73 $9.92 $961.99
3987 Continuous Home Care w/AIDS Min 24 Hours $964.53 $28.94 $9.92 $1,003.39
3988 General Inpatient w/ AIDS $765.42 $22.96 $9.92 $798.30
3989 Routine Home Care w/ AIDS Escort $302.65 $9.08 $9.92 $321.65

* 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 $167.82 $5.03 $9.92 $182.77
3946 Inpatient Respite $162.89 $4.89 $9.92 $177.70
3947 General Inpatient Care $652.47 $19.57 $9.92 $681.96
3948 Continuous Home Care – Min 8 Hours $282.93 $8.49 $9.92 $301.34
3949 Continuous Home Care – Min 9 Hours $318.29 $9.55 $9.92 $337.76
3950 Continuous Home Care – Min 10 Hours $353.66 $10.61 $9.92 $374.19
3951 Continuous Home Care – Min 11 Hours $389.02 $11.67 $9.92 $410.61
3952 Continuous Home Care – Min 12 Hours $424.39 $12.73 $9.92 $447.04
3953 Continuous Home Care – Min 13 Hours $459.76 $13.79 $9.92 $483.47
3954 Continuous Home Care – Min 14 Hours $495.12 $14.85 $9.92 $519.89
3955 Continuous Home Care – Min 15 Hours $530.49 $15.91 $9.92 $556.32
3956 Continuous Home Care – Min 16 Hours $565.85 $16.98 $9.92 $592.75
3957 Continuous Home Care – Min 17 Hours $601.22 $18.04 $9.92 $629.18
3958 Continuous Home Care – Min 18 Hours $636.59 $19.10 $9.92 $665.61
3959 Continuous Home Care – Min 19 Hours $671.95 $20.16 $9.92 $702.03
3960 Continuous Home Care – Min 20 Hours $707.32 $21.22 $9.92 $738.46
3961 Continuous Home Care – Min 21 Hours $742.68 $22.28 $9.92 $774.88
3962 Continuous Home Care – Min 22 Hours $778.05 $23.34 $9.92 $811.31
3963 Continuous Home Care – Min 23 Hours $813.41 $24.40 $9.92 $847.73
3964 Continuous Home Care – Min 24 Hours $848.78 $25.46 $9.92 $884.16
3965 Hospice Inpatient Respite Care Coinsurance Rate –
5% of 3946 $8.14 $0.24 $0.50 $8.88
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $269.18 $8.08 $9.92 $287.18
3970 Routine Home Care w/Escort $185.10 $5.55 $9.92 $200.57
3971 Continuous Home Care w/AIDS Min 8 Hours $296.40 $8.89 $9.92 $315.21
3972 Continuous Home Care w/AIDS Min 9 Hours $333.45 $10.00 $9.92 $353.37
3973 Continuous Home Care w/AIDS Min 10 Hours $370.50 $11.12 $9.92 $391.54
3974 Continuous Home Care w/AIDS Min 11 Hours $407.55 $12.23 $9.92 $429.70
3975 Continuous Home Care w/AIDS Min 12 Hours $444.60 $13.34 $9.92 $467.86
3976 Continuous Home Care w/AIDS Min 13 Hours $481.65 $14.45 $9.92 $506.02
3977 Continuous Home Care w/AIDS Min 14 Hours $518.70 $15.56 $9.92 $544.18
3978 Continuous Home Care w/AIDS Min 15 Hours $555.75 $16.67 $9.92 $582.34
3979 Continuous Home Care w/AIDS Min 16 Hours $592.80 $17.78 $9.92 $620.50
3980 Continuous Home Care w/AIDS Min 17 Hours $629.85 $18.90 $9.92 $658.67
3981 Continuous Home Care w/AIDS Min 18 Hours $666.90 $20.01 $9.92 $696.83
3982 Continuous Home Care w/AIDS Min 19 Hours $703.95 $21.12 $9.92 $734.99
3983 Continuous Home Care w/AIDS Min 20 Hours $741.00 $22.23 $9.92 $773.15
3984 Continuous Home Care w/AIDS Min 21 Hours $778.05 $23.34 $9.92 $811.31
3985 Continuous Home Care w/AIDS Min 22 Hours $815.10 $24.45 $9.92 $849.47
3986 Continuous Home Care w/AIDS Min 23 Hours $852.15 $25.56 $9.92 $887.63
3987 Continuous Home Care w/AIDS Min 24 Hours $889.20 $26.68 $9.92 $925.80
3988 General Inpatient w/ AIDS $725.16 $21.75 $9.92 $756.83
3989 Routine Home Care w/ AIDS Escort $286.46 $8.59 $9.92 $304.97

* WRR = ´Worker Recruitment and Retention addon´ if applicable

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

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