Respite Rate Announcement for HCBS Provider and MMCPs
- Announcement also available in Portable Document File (PDF)
Notification to HCBS Providers, Medicaid Managed Care Plans, HH/C-YES Care Managers
Children´s Waiver Home and Community Based Services (HCBS) Planned and Crisis Respite Rates Change
This notice is to inform Children´s Waiver HCBS Respite providers of changes to Planned and Crisis Respite rates. These revisions include an adjustment to the rate structure that better aligns with service provision. A new rate for Individual Overnight Planned Respite and a per diem rate for Group Planned Respite have been added. Providers should refer to the Children´s Home and Community Based Services Provider Manual and the New York State Children´s Health and Behavioral Health Services Billing and Coding Manual for additional guidance on the standards for delivering these services to children/youth enrolled in the Children´s Waiver.
Below is a schedule of the rate changes along with associated billing codes for the new components.
The effective date for all revised HCBS Planned and Crisis Respite rates is September 10, 2020. The following rate changes were completed in eMedNY in billing cycle 2271.
- Planned Respite Individual – Adjusted rate code 8024 and added new rate code 8025
- Planned Respite Group – Added new rate code 8026
- Crisis Respite – Adjusted rate code 8029
| Rate Code | Rate Description | Billing Region | From Rate | To Rate |
|---|---|---|---|---|
| 8024 | Planned Respite – Individual (6-12 hours) | Upstate | $223.41 | $293.21 |
| 8024 | Planned Respite – Individual (6-12 hours) | Downstate | $250.56 | $328.86 |
| 8025 | Planned Respite – Individual (12-24 hours) | Upstate | - | $502.64 |
| 8025 | Planned Respite – Individual (12-24 hours) | Downstate | - | $563.75 |
| 8026 | Planned Respite – Group (6-12 hours) | Upstate | - | $141.72 |
| 8026 | Planned Respite – Group (6-12 hours) | Downstate | - | $158.95 |
| 8029 | Crisis Respite (6-12 hours) | Upstate | $259.35 | $340.42 |
| 8029 | Crisis Respite (6-12 hours) | Downstate | $290.86 | $381.81 |
Adjudicated Medicaid Fee-for-Service claims for Planned and Crisis Respite provided on or after September 10, 2020 will be automatically adjusted in eMedNY.
Medicaid Managed Care Plan (MMCP), including Mainstream Medicaid Managed Care Plan and HIV Special Needs Plan, adjudicated claims for Planned and Crisis Respite services provided on or after September 10, 2020 will be adjusted by the MMCP. Medicaid Managed Care Plans must ensure that providers receive adjustments to adjudicated claims by June 11, 2021 for Planned and Crisis Respite provided on or after September 10, 2020.
Questions about the revisions to Planned and Crisis Respite Rates can be sent to Bh.Transition@health.ny.gov.
March 2021
