New York State Children's Medicaid System Transformation

Childrens Home and Community Based Services Rate Summary effective 4/1/2021

      Previous 4/1/2021 Update to Palliative Rates 4/1/2021-3/31/2022* 4/1/2022-Ongoing
Rate Code Description Billing Unit Upstate Rate Downstate Rate Upstate Rate Downstate Rate Upstate Rate Downstate Rate
7933 DAY HABILITATION 15 minute $ 23.40 $ 26.24 $ 29.25 $ 32.80 $ 23.40 $ 26.24
7934 DAY HABILITATION GROUP OF 2 15 minute $ 15.21 $ 17.06 $ 19.01 $ 21.33 $ 15.21 $ 17.06
7935 DAY HABILITATION GROUP OF 3 15 minute $ 11.31 $ 12.68 $ 14.14 $ 15.85 $ 11.31 $ 12.68
8003 CAREGIVER/FAMILY SUPPORTS AND SERVICES 15 minute $ 24.22 $ 27.16 $ 30.28 $ 33.95 $ 24.22 $ 27.16
8004 CAREGIVER FAMILY SUPPORTS AND SERVICES GROUP OF 2 15 minute $ 15.74 $ 17.65 $ 19.68 $ 22.06 $ 15.74 $ 17.65
8005 CAREGIVER FAMILY SUPPORTS AND SERVICES GROUP OF 3 15 minute $ 11.70 $ 13.13 $ 14.63 $ 16.41 $ 11.70 $ 13.13
8006 PREVOCATIONAL SERVICES 15 minute $ 17.94 $ 20.12 $ 22.43 $ 25.15 $ 17.94 $ 20.12
8007 PRE-VOCATIONAL GROUP OF 2 15 minute $ 11.66 $ 13.08 $ 14.58 $ 16.35 $ 11.66 $ 13.08
8008 PRE-VOCATIONAL GROUP OF 3 15 minute $ 8.67 $ 9.73 $ 10.84 $ 12.16 $ 8.67 $ 9.73
8009 COMMUNITY ADVOCACY AND SUPPORT INDIV 15 minute $ 33.60 $ 37.68 $ 42.00 $ 47.10 $ 33.60 $ 37.68
8010 COMMUNITY ADVOCACY AND SUPPORT GROUP OF 2 15 minute $ 21.84 $ 24.49 $ 27.30 $ 30.61 $ 21.84 $ 24.49
8011 COMMUNITY ADVOCACY AND SUPPORT GROUP OF 3 15 minute $ 16.24 $ 18.21 $ 20.30 $ 22.76 $ 16.24 $ 18.21
8012 COMMUNITY HCBS HAB 15 minute $ 10.40 $ 10.43 $ 13.00 $ 13.04 $ 10.40 $ 10.43
8013 COMMUNITY HCBS HAB GROUP OF 2 15 minute $ 6.50 $ 6.51 $ 8.13 $ 8.14 $ 6.50 $ 6.51
8014 COMMUNITY HCBS HAB GROUP OF 3 15 minute $ 4.92 $ 5.20 $ 6.15 $ 6.50 $ 4.92 $ 5.20
8015 SUPPORTED EMPLOYMENT 15 minute $ 21.27 $ 23.85 $ 26.59 $ 29.81 $ 21.27 $ 23.85
8016 PALLIATIVE CARE - PAIN AND SYMPTOM MANAGEMENT 15 minute $ 83.47 $ 93.61 $ 104.34 $ 117.01 $ 83.47 $ 93.61
8017 PALLIATIVE CARE - BEREAVEMENT SERVICES 30 minute $ 67.04 $ 75.19 $ 83.80 $ 93.99 $ 67.04 $ 75.19
8018 PALLIATIVE CARE - MASSAGE THERAPY 15 minute $ 39.60 $ 44.41 $ 49.50 $ 55.51 $ 39.60 $ 44.41
8019 PALLIATIVE CARE - EXPRESSIVE THERAPY 15 minute $ 27.46 $ 30.80 $ 34.33 $ 38.50 $ 27.46 $ 30.80
8023 PLANNED RESPITE - INDIVIDUAL (UP TO 6 HOURS) 15 minute $ 12.28 $ 13.77 $ 15.35 $ 17.21 $ 12.28 $ 13.77
8024 PLANNED RESPITE - INDIVIDUAL (6-12 HOURS) per diem $ 293.21 $ 328.86 $ 366.51 $ 411.08 $ 293.21 $ 328.86
8025 PLANNED RESPITE - INDIVIDUAL (12-24 HOURS) per diem $ 502.64 $ 563.75 $ 628.30 $ 704.69 $ 502.64 $ 563.75
8027 PLANNED RESPITE - GROUP (UP TO 6 HOURS) 15 minute $ 5.94 $ 6.66 $ 7.43 $ 8.33 $ 5.94 $ 6.66
8026 PLANNED RESPITE - GROUP (6-12 HOURS) per diem $ 141.72 $ 158.95 $ 177.15 $ 198.69 $ 141.72 $ 158.95
8028 CRISIS RESPITE (UP TO 6 HOURS) 15 minute $ 14.26 $ 15.99 $ 17.83 $ 19.99 $ 14.26 $ 15.99
8029 CRISIS RESPITE (6-12 HOURS) per diem $ 340.42 $ 381.81 $ 425.53 $ 477.26 $ 340.42 $ 381.81
8030 CRISIS RESPITE (12-24 HOURS) per diem $ 583.54 $ 654.45 $ 729.43 $ 818.06 $ 583.54 $ 654.45
8032 ENVIR MODS - $1.00 UNIT per unit $ 1.00 $ 1.00 $ 1.00 $ 1.00 $ 1.00 $ 1.00
8034 ENVIR MODS - $10.00 UNIT per unit $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00
8035 ENVIR MODS - $100.00 UNIT per unit $ 100.00 $ 100.00 $ 100.00 $ 100.00 $ 100.00 $ 100.00
8036 ENVIR MODS - $1000.00 UNIT per unit $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00
8037 ADAPTIVE AND ASSISTIVE EQUIPMENT - $1.00 UNIT per unit $ 1.00 $ 1.00 $ 1.00 $ 1.00 $ 1.00 $ 1.00
8038 ADAPTIVE AND ASSISTIVE EQUIPMENT - $10.00 UNIT per unit $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00
8039 ADAPTIVE AND ASSISTIVE EQUIPMENT - $100.00 UNIT per unit $ 100.00 $ 100.00 $ 100.00 $ 100.00 $ 100.00 $ 100.00
8040 ADAPTIVE AND ASSISTIVE EQUIPMENT - $1000.00 UNIT per unit $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00
8041 VEHICLE MODIFICATIONS - $1.00 UNIT per unit $ 1.00 $ 1.00 $ 1.00 $ 1.00 $ 1.00 $ 1.00
8042 VEHICLE MODIFICATIONS - $10.00 UNIT per unit $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00
8043 VEHICLE MODIFICATIONS - $100.00 UNIT per unit $ 100.00 $ 100.00 $ 100.00 $ 100.00 $ 100.00 $ 100.00
8044 VEHICLE MODIFICATIONS - $1000.00 UNIT per unit $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,000.00
*Pending CMS approval of April 1st Amendment K to NY.4125 HCBS Waiver.