LHCSA January 2022 Rate Sheet

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New York State Department of Health

Agency:
MMIS ID: xxxxxxxx
Locator Code: xxx
County:
Region:

Rate Components Personal Care Services
Level One Level Two Level Two Hard To Serve Live-in Shared Aide Level One Shared Aide Level Two Nursing Supervision Nursing Assessment
  Direct Care & Training
(1) Direct Care & Training Costs  
(2) Direct Care & Training Regional Ceiling (capped at 115% of regional average)
(3) Direct Care & Training Rate (Lower of Direct Care & Training Costs or Regional Ceiling) [Lower of (1) or (2)] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
  Administration
(4) Admin Cost (excluding Capital and Background & Fingerprinting)  
(5) Admin Ceiling (capped at 28% of Total Costs)
(6) Direct Care & Training Regional Ceiling
(7) Lower of Admin Cost or Admin Ceiling or DC&T Ceiling [Lower of (4), (5) or (6)]
(8) Capital Costs
(9) Background & Fingerprinting Costs
(10) Admin Cost (including Capital and Background & Fingerprinting) [(7) + (8) + (9)] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
(11) Admin and Direct Care & Training Rate [(3) + (10)] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
  Rate Add-Ons
(12) Profit / Surplus  
(13) Total Rate [(11) + (12)] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
(14) Public Charge Rate                
(15) Lower of Total Rate or Public Charge Rate (if > $0)                
(16) Minimum Wage                
(17) Worker Recruitment & Retention [(15) + (16)] * 4.56%                
(18) Final Rate [(15) + (16) + (17)]                                                                                              One Client $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
  Two Clients $0.00 $0.00 $0.00 $0.00 $0.00 $0.00    
One Client 1/4 hour $0.00 $0.00 $0.00          
Two Clients 1/4 hour $0.00 $0.00 $0.00          

Agency:
MMIS ID: xxxxxxxx
Locator Code: xxx
County:
Region:

Rate Components
Level One Level Two Level Two Hard To Serve Live-in Shared Aide Level One Shared Aide Level Two Nursing Supervision Nursing Assessment
1. Direct Care & Training Costs
(1) Direct Care & Training cost by service (Sch 3b col 005/006 & 007-010)                
(2) Hours/Visits by service (Sch 5b col 023 or 024)                
(3) Direct Care & Training cost per hour/visit $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2. Admin Cost (excluding Capital and Background & Fingerprinting)
(1) Program admin cost by service (Sch 3b col 004)                
(2) Total program admin cost across Sch 3b (Sch 3b col 004 line 010)  
(3) Admin Percent [(1) / (2)]                
(4) Hours/Visits by service (Sch 5b col 023 or col 024)                
(5) Admin Cost per hour/visit [(1) / (4)]                
(6) Capital Cost across Sch 4b (Sch 4b total of col 004 lines 002-003 & 005-011 & 015)  
(7) Capital Cost per hour/visit by service [(3) * (6) / (4)]                
(8) Background & Fingerprinting across Sch 4b (Sch 4b col 003 line 001)  
(9) Background & Fingerprinting Cost per hour/visit by service [(3) * (8) / (4)]                
(10) Admin Cost (excluding Capital and Background & Fingerprinting) [(5) - (7) - (9)] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
3. Admin Ceiling
(1) Allowable Cost by service (Sch 3b col 003)                
(2) Hours/Visits by service (Sch 5b col 023 or 024))                
(3) Admin Ceiling [28% * (1) / (2)] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
4. Profit / Surplus Add-On
(1) Admin and Direct Care & Training Rate                
(2) Allowable costs for aide wages and benefits across Sch 3b (Sch 3b col 005/006 & 008-010)  
(3) Total Allowable cost across Sch 3b (Sch 3b col 003)  
(4) 6 Months T-Bill rate (As on 29 Sept 2021)  
(5) Profit / Surplus Percentage Adjustment [(2) / (3) * (4)]  
(6) Profit / Surplus Add-On [(1)*(5)] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
5. Public Charge Rate
(1) Public Charge Rate (Sch 7b col 001)                
6. Minimum Wage Adjustment
  2022 2021 2020 2019 2018 2017
(1) Base Rate Increase
Downstate $1.00 $1.00 $1.00 $1.00 $1.00 $0.00
Upstate $0.70 $0.70 $0.70 $0.70 $0.70 $0.70
(2) Fringe Benefits
Downstate $0.18 $0.18 $0.18 $0.18 $0.28 $0.00
Upstate $0.12 $0.12 $0.12 $0.12 $0.20 $0.20
(3) MW Increase
Downstate (Base Rate + Fringe Benefits) $1.18 $1.18 $1.18 $1.18 $1.28 $0.00
Upstate (Base Rate + Fringe Benefits) $0.82 $0.82 $0.82 $0.82 $0.90 $0.90
2022 MW Adjustment Live-in (13 hours) Other Personal Care Services
Downstate $77.77 $5.98
Upstate $65.99 $5.08