Certified Hospice Program

Medicaid Rate Sheet

Effective: 10/01/2021 - 09/30/2022

  • 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 $179.88 $4.05 $9.92 $193.85
3946 Inpatient Respite $423.12 $9.52 $9.92 $442.56
3947 General Inpatient Care $949.43 $21.36 $9.92 $980.71
3948 Continuous Home Care - Min 8 Hours $423.28 $9.52 $9.92 $442.72
3949 Continuous Home Care - Min 9 Hours $476.19 $10.71 $9.92 $496.82
3950 Continuous Home Care - Min 10 Hours $529.10 $11.90 $9.92 $550.92
3951 Continuous Home Care - Min 11 Hours $582.01 $13.10 $9.92 $605.03
3952 Continuous Home Care - Min 12 Hours $634.92 $14.29 $9.92 $659.13
3953 Continuous Home Care - Min 13 Hours $687.82 $15.48 $9.92 $713.22
3954 Continuous Home Care - Min 14 Hours $740.73 $16.67 $9.92 $767.32
3955 Continuous Home Care - Min 15 Hours $793.64 $17.86 $9.92 $821.42
3956 Continuous Home Care - Min 16 Hours $846.55 $19.05 $9.92 $875.52
3957 Continuous Home Care - Min 17 Hours $899.46 $20.24 $9.92 $929.62
3958 Continuous Home Care - Min 18 Hours $952.37 $21.43 $9.92 $983.72
3959 Continuous Home Care - Min 19 Hours $1,005.28 $22.62 $9.92 $1,037.82
3960 Continuous Home Care - Min 20 Hours $1,058.19 $23.81 $9.92 $1,091.92
3961 Continuous Home Care - Min 21 Hours $1,111.10 $25.00 $9.92 $1,146.02
3962 Continuous Home Care - Min 22 Hours $1,164.01 $26.19 $9.92 $1,200.12
3963 Continuous Home Care - Min 23 Hours $1,216.92 $27.38 $9.92 $1,254.22
3964 Continuous Home Care - Min 24 Hours $1,269.83 $28.57 $9.92 $1,308.32
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.16 $0.48 $0.50 $22.14
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $294.03 $6.62 $9.92 $310.57
3970 Routine Home Care w/Escort $199.24 $4.48 $9.92 $213.64
3971 Continuous Home Care w/AIDS Min 8 Hours $438.68 $9.87 $9.92 $458.47
3972 Continuous Home Care w/AIDS Min 9 Hours $493.51 $11.10 $9.92 $514.53
3973 Continuous Home Care w/AIDS Min 10 Hours $548.35 $12.34 $9.92 $570.61
3974 Continuous Home Care w/AIDS Min 11 Hours $603.18 $13.57 $9.92 $626.67
3975 Continuous Home Care w/AIDS Min 12 Hours $658.02 $14.81 $9.92 $682.75
3976 Continuous Home Care w/AIDS Min 13 Hours $712.85 $16.04 $9.92 $738.81
3977 Continuous Home Care w/AIDS Min 14 Hours $767.68 $17.27 $9.92 $794.87
3978 Continuous Home Care w/AIDS Min 15 Hours $822.52 $18.51 $9.92 $850.95
3979 Continuous Home Care w/AIDS Min 16 Hours $877.35 $19.74 $9.92 $907.01
3980 Continuous Home Care w/AIDS Min 17 Hours $932.19 $20.97 $9.92 $963.08
3981 Continuous Home Care w/AIDS Min 18 Hours $987.02 $22.21 $9.92 $1,019.15
3982 Continuous Home Care w/AIDS Min 19 Hours $1,041.86 $23.44 $9.92 $1,075.22
3983 Continuous Home Care w/AIDS Min 20 Hours $1,096.69 $24.68 $9.92 $1,131.29
3984 Continuous Home Care w/AIDS Min 21 Hours $1,151.53 $25.91 $9.92 $1,187.36
3985 Continuous Home Care w/AIDS Min 22 Hours $1,206.36 $27.14 $9.92 $1,243.42
3986 Continuous Home Care w/AIDS Min 23 Hours $1,261.20 $28.38 $9.92 $1,299.50
3987 Continuous Home Care w/AIDS Min 24 Hours $1,316.03 $29.61 $9.92 $1,355.56
3988 General Inpatient w/ AIDS $1,055.20 $23.74 $9.92 $1,088.86
3989 Routine Home Care w/ AIDS Escort $313.39 $7.05 $9.92 $330.36
3991 Service Intensity Add-on $53.60 $1.21 $0.00 $54.81

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

|top of section| |top of page|

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 $180.06 $4.05 $9.92 $194.03
3946 Inpatient Respite $423.49 $9.53 $9.92 $442.94
3947 General Inpatient Care $950.31 $21.38 $9.92 $981.61
3948 Continuous Home Care - Min 8 Hours $423.75 $9.53 $9.92 $443.20
3949 Continuous Home Care - Min 9 Hours $476.72 $10.73 $9.92 $497.37
3950 Continuous Home Care - Min 10 Hours $529.69 $11.92 $9.92 $551.53
3951 Continuous Home Care - Min 11 Hours $582.66 $13.11 $9.92 $605.69
3952 Continuous Home Care - Min 12 Hours $635.63 $14.30 $9.92 $659.85
3953 Continuous Home Care - Min 13 Hours $688.60 $15.49 $9.92 $714.01
3954 Continuous Home Care - Min 14 Hours $741.57 $16.69 $9.92 $768.18
3955 Continuous Home Care - Min 15 Hours $794.54 $17.88 $9.92 $822.34
3956 Continuous Home Care - Min 16 Hours $847.51 $19.07 $9.92 $876.50
3957 Continuous Home Care - Min 17 Hours $900.48 $20.26 $9.92 $930.66
3958 Continuous Home Care - Min 18 Hours $953.45 $21.45 $9.92 $984.82
3959 Continuous Home Care - Min 19 Hours $1,006.41 $22.64 $9.92 $1,038.97
3960 Continuous Home Care - Min 20 Hours $1,059.38 $23.84 $9.92 $1,093.14
3961 Continuous Home Care - Min 21 Hours $1,112.35 $25.03 $9.92 $1,147.30
3962 Continuous Home Care - Min 22 Hours $1,165.32 $26.22 $9.92 $1,201.46
3963 Continuous Home Care - Min 23 Hours $1,218.29 $27.41 $9.92 $1,255.62
3964 Continuous Home Care - Min 24 Hours $1,271.26 $28.60 $9.92 $1,309.78
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 $294.31 $6.62 $9.92 $310.85
3970 Routine Home Care w/Escort $199.42 $4.49 $9.92 $213.83
3971 Continuous Home Care w/AIDS Min 8 Hours $439.30 $9.88 $9.92 $459.10
3972 Continuous Home Care w/AIDS Min 9 Hours $494.22 $11.12 $9.92 $515.26
3973 Continuous Home Care w/AIDS Min 10 Hours $549.13 $12.36 $9.92 $571.41
3974 Continuous Home Care w/AIDS Min 11 Hours $604.04 $13.59 $9.92 $627.55
3975 Continuous Home Care w/AIDS Min 12 Hours $658.96 $14.83 $9.92 $683.71
3976 Continuous Home Care w/AIDS Min 13 Hours $713.87 $16.06 $9.92 $739.85
3977 Continuous Home Care w/AIDS Min 14 Hours $768.78 $17.30 $9.92 $796.00
3978 Continuous Home Care w/AIDS Min 15 Hours $823.69 $18.53 $9.92 $852.14
3979 Continuous Home Care w/AIDS Min 16 Hours $878.61 $19.77 $9.92 $908.30
3980 Continuous Home Care w/AIDS Min 17 Hours $933.52 $21.00 $9.92 $964.44
3981 Continuous Home Care w/AIDS Min 18 Hours $988.43 $22.24 $9.92 $1,020.59
3982 Continuous Home Care w/AIDS Min 19 Hours $1,043.35 $23.48 $9.92 $1,076.75
3983 Continuous Home Care w/AIDS Min 20 Hours $1,098.26 $24.71 $9.92 $1,132.89
3984 Continuous Home Care w/AIDS Min 21 Hours $1,153.17 $25.95 $9.92 $1,189.04
3985 Continuous Home Care w/AIDS Min 22 Hours $1,208.08 $27.18 $9.92 $1,245.18
3986 Continuous Home Care w/AIDS Min 23 Hours $1,263.00 $28.42 $9.92 $1,301.34
3987 Continuous Home Care w/AIDS Min 24 Hours $1,317.91 $29.65 $9.92 $1,357.48
3988 General Inpatient w/ AIDS $1,056.17 $23.76 $9.92 $1,089.85
3989 Routine Home Care w/ AIDS Escort $313.67 $7.06 $9.92 $330.65
3991 Service Intensity Add-on $53.66 $1.21 $0.00 $54.87

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

|top of section| |top of page|

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 $209.60 $4.72 $9.92 $224.24
3946 Inpatient Respite $487.10 $10.96 $9.92 $507.98
3947 General Inpatient Care $1,099.62 $24.74 $9.92 $1,134.28
3948 Continuous Home Care - Min 8 Hours $504.44 $11.35 $9.92 $525.71
3949 Continuous Home Care - Min 9 Hours $567.50 $12.77 $9.92 $590.19
3950 Continuous Home Care - Min 10 Hours $630.55 $14.19 $9.92 $654.66
3951 Continuous Home Care - Min 11 Hours $693.61 $15.61 $9.92 $719.14
3952 Continuous Home Care - Min 12 Hours $756.67 $17.03 $9.92 $783.62
3953 Continuous Home Care - Min 13 Hours $819.72 $18.44 $9.92 $848.08
3954 Continuous Home Care - Min 14 Hours $882.78 $19.86 $9.92 $912.56
3955 Continuous Home Care - Min 15 Hours $945.83 $21.28 $9.92 $977.03
3956 Continuous Home Care - Min 16 Hours $1,008.89 $22.70 $9.92 $1,041.51
3957 Continuous Home Care - Min 17 Hours $1,071.94 $24.12 $9.92 $1,105.98
3958 Continuous Home Care - Min 18 Hours $1,135.00 $25.54 $9.92 $1,170.46
3959 Continuous Home Care - Min 19 Hours $1,198.05 $26.96 $9.92 $1,234.93
3960 Continuous Home Care - Min 20 Hours $1,261.11 $28.37 $9.92 $1,299.40
3961 Continuous Home Care - Min 21 Hours $1,324.16 $29.79 $9.92 $1,363.87
3962 Continuous Home Care - Min 22 Hours $1,387.22 $31.21 $9.92 $1,428.35
3963 Continuous Home Care - Min 23 Hours $1,450.27 $32.63 $9.92 $1,492.82
3964 Continuous Home Care - Min 24 Hours $1,513.33 $34.05 $9.92 $1,557.30
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $24.36 $0.55 $0.50 $25.41
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $342.61 $7.71 $9.92 $360.24
3970 Routine Home Care w/Escort $228.96 $5.15 $9.92 $244.03
3971 Continuous Home Care w/AIDS Min 8 Hours $545.53 $12.27 $9.92 $567.72
3972 Continuous Home Care w/AIDS Min 9 Hours $613.72 $13.81 $9.92 $637.45
3973 Continuous Home Care w/AIDS Min 10 Hours $681.91 $15.34 $9.92 $707.17
3974 Continuous Home Care w/AIDS Min 11 Hours $750.10 $16.88 $9.92 $776.90
3975 Continuous Home Care w/AIDS Min 12 Hours $818.30 $18.41 $9.92 $846.63
3976 Continuous Home Care w/AIDS Min 13 Hours $886.49 $19.95 $9.92 $916.36
3977 Continuous Home Care w/AIDS Min 14 Hours $954.68 $21.48 $9.92 $986.08
3978 Continuous Home Care w/AIDS Min 15 Hours $1,022.87 $23.01 $9.92 $1,055.80
3979 Continuous Home Care w/AIDS Min 16 Hours $1,091.06 $24.55 $9.92 $1,125.53
3980 Continuous Home Care w/AIDS Min 17 Hours $1,159.25 $26.08 $9.92 $1,195.25
3981 Continuous Home Care w/AIDS Min 18 Hours $1,227.44 $27.62 $9.92 $1,264.98
3982 Continuous Home Care w/AIDS Min 19 Hours $1,295.63 $29.15 $9.92 $1,334.70
3983 Continuous Home Care w/AIDS Min 20 Hours $1,363.83 $30.69 $9.92 $1,404.44
3984 Continuous Home Care w/AIDS Min 21 Hours $1,432.02 $32.22 $9.92 $1,474.16
3985 Continuous Home Care w/AIDS Min 22 Hours $1,500.21 $33.75 $9.92 $1,543.88
3986 Continuous Home Care w/AIDS Min 23 Hours $1,568.40 $35.29 $9.92 $1,613.61
3987 Continuous Home Care w/AIDS Min 24 Hours $1,636.59 $36.82 $9.92 $1,683.33
3988 General Inpatient w/ AIDS $1,222.12 $27.50 $9.92 $1,259.54
3989 Routine Home Care w/ AIDS Escort $361.97 $8.14 $9.92 $380.03
3991 Service Intensity Add-on $62.87 $1.41 $0.00 $64.28

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

|top of section| |top of page|

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 $192.38 $4.33 $9.92 $206.63
3946 Inpatient Respite $450.02 $10.13 $9.92 $470.07
3947 General Inpatient Care $1,012.59 $22.78 $9.92 $1,045.29
3948 Continuous Home Care - Min 8 Hours $457.41 $10.29 $9.92 $477.62
3949 Continuous Home Care - Min 9 Hours $514.58 $11.58 $9.92 $536.08
3950 Continuous Home Care - Min 10 Hours $571.76 $12.86 $9.92 $594.54
3951 Continuous Home Care - Min 11 Hours $628.93 $14.15 $9.92 $653.00
3952 Continuous Home Care - Min 12 Hours $686.11 $15.44 $9.92 $711.47
3953 Continuous Home Care - Min 13 Hours $743.29 $16.72 $9.92 $769.93
3954 Continuous Home Care - Min 14 Hours $800.46 $18.01 $9.92 $828.39
3955 Continuous Home Care - Min 15 Hours $857.64 $19.30 $9.92 $886.86
3956 Continuous Home Care - Min 16 Hours $914.81 $20.58 $9.92 $945.31
3957 Continuous Home Care - Min 17 Hours $971.99 $21.87 $9.92 $1,003.78
3958 Continuous Home Care - Min 18 Hours $1,029.17 $23.16 $9.92 $1,062.25
3959 Continuous Home Care - Min 19 Hours $1,086.34 $24.44 $9.92 $1,120.70
3960 Continuous Home Care - Min 20 Hours $1,143.52 $25.73 $9.92 $1,179.17
3961 Continuous Home Care - Min 21 Hours $1,200.69 $27.02 $9.92 $1,237.63
3962 Continuous Home Care - Min 22 Hours $1,257.87 $28.30 $9.92 $1,296.09
3963 Continuous Home Care - Min 23 Hours $1,315.04 $29.59 $9.92 $1,354.55
3964 Continuous Home Care - Min 24 Hours $1,372.22 $30.87 $9.92 $1,413.01
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $22.50 $0.51 $0.50 $23.51
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $314.45 $7.08 $9.92 $331.45
3970 Routine Home Care w/Escort $211.74 $4.76 $9.92 $226.42
3971 Continuous Home Care w/AIDS Min 8 Hours $483.61 $10.88 $9.92 $504.41
3972 Continuous Home Care w/AIDS Min 9 Hours $544.06 $12.24 $9.92 $566.22
3973 Continuous Home Care w/AIDS Min 10 Hours $604.51 $13.60 $9.92 $628.03
3974 Continuous Home Care w/AIDS Min 11 Hours $664.96 $14.96 $9.92 $689.84
3975 Continuous Home Care w/AIDS Min 12 Hours $725.42 $16.32 $9.92 $751.66
3976 Continuous Home Care w/AIDS Min 13 Hours $785.87 $17.68 $9.92 $813.47
3977 Continuous Home Care w/AIDS Min 14 Hours $846.32 $19.04 $9.92 $875.28
3978 Continuous Home Care w/AIDS Min 15 Hours $906.77 $20.40 $9.92 $937.09
3979 Continuous Home Care w/AIDS Min 16 Hours $967.22 $21.76 $9.92 $998.90
3980 Continuous Home Care w/AIDS Min 17 Hours $1,027.67 $23.12 $9.92 $1,060.71
3981 Continuous Home Care w/AIDS Min 18 Hours $1,088.12 $24.48 $9.92 $1,122.52
3982 Continuous Home Care w/AIDS Min 19 Hours $1,148.57 $25.84 $9.92 $1,184.33
3983 Continuous Home Care w/AIDS Min 20 Hours $1,209.03 $27.20 $9.92 $1,246.15
3984 Continuous Home Care w/AIDS Min 21 Hours $1,269.48 $28.56 $9.92 $1,307.96
3985 Continuous Home Care w/AIDS Min 22 Hours $1,329.93 $29.92 $9.92 $1,369.77
3986 Continuous Home Care w/AIDS Min 23 Hours $1,390.38 $31.28 $9.92 $1,431.58
3987 Continuous Home Care w/AIDS Min 24 Hours $1,450.83 $32.64 $9.92 $1,493.39
3988 General Inpatient w/ AIDS $1,125.39 $25.32 $9.92 $1,160.63
3989 Routine Home Care w/ AIDS Escort $333.81 $7.51 $9.92 $351.24
3991 Service Intensity Add-on $57.50 $1.29 $0.00 $58.79

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

|top of section| |top of page|

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 $176.55 $3.97 $9.92 $190.44
3946 Inpatient Respite $415.95 $9.36 $9.92 $435.23
3947 General Inpatient Care $932.61 $20.98 $9.92 $963.51
3948 Continuous Home Care - Min 8 Hours $414.19 $9.32 $9.92 $433.43
3949 Continuous Home Care - Min 9 Hours $465.96 $10.48 $9.92 $486.36
3950 Continuous Home Care - Min 10 Hours $517.73 $11.65 $9.92 $539.30
3951 Continuous Home Care - Min 11 Hours $569.51 $12.81 $9.92 $592.24
3952 Continuous Home Care - Min 12 Hours $621.28 $13.98 $9.92 $645.18
3953 Continuous Home Care - Min 13 Hours $673.05 $15.14 $9.92 $698.11
3954 Continuous Home Care - Min 14 Hours $724.83 $16.31 $9.92 $751.06
3955 Continuous Home Care - Min 15 Hours $776.60 $17.47 $9.92 $803.99
3956 Continuous Home Care - Min 16 Hours $828.37 $18.64 $9.92 $856.93
3957 Continuous Home Care - Min 17 Hours $880.15 $19.80 $9.92 $909.87
3958 Continuous Home Care - Min 18 Hours $931.92 $20.97 $9.92 $962.81
3959 Continuous Home Care - Min 19 Hours $983.69 $22.13 $9.92 $1,015.74
3960 Continuous Home Care - Min 20 Hours $1,035.47 $23.30 $9.92 $1,068.69
3961 Continuous Home Care - Min 21 Hours $1,087.24 $24.46 $9.92 $1,121.62
3962 Continuous Home Care - Min 22 Hours $1,139.01 $25.63 $9.92 $1,174.56
3963 Continuous Home Care - Min 23 Hours $1,190.79 $26.79 $9.92 $1,227.50
3964 Continuous Home Care - Min 24 Hours $1,242.56 $27.96 $9.92 $1,280.44
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $20.80 $0.47 $0.50 $21.77
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $288.58 $6.49 $9.92 $304.99
3970 Routine Home Care w/Escort $195.91 $4.41 $9.92 $210.24
3971 Continuous Home Care w/AIDS Min 8 Hours $426.71 $9.60 $9.92 $446.23
3972 Continuous Home Care w/AIDS Min 9 Hours $480.05 $10.80 $9.92 $500.77
3973 Continuous Home Care w/AIDS Min 10 Hours $533.38 $12.00 $9.92 $555.30
3974 Continuous Home Care w/AIDS Min 11 Hours $586.72 $13.20 $9.92 $609.84
3975 Continuous Home Care w/AIDS Min 12 Hours $640.06 $14.40 $9.92 $664.38
3976 Continuous Home Care w/AIDS Min 13 Hours $693.40 $15.60 $9.92 $718.92
3977 Continuous Home Care w/AIDS Min 14 Hours $746.74 $16.80 $9.92 $773.46
3978 Continuous Home Care w/AIDS Min 15 Hours $800.08 $18.00 $9.92 $828.00
3979 Continuous Home Care w/AIDS Min 16 Hours $853.41 $19.20 $9.92 $882.53
3980 Continuous Home Care w/AIDS Min 17 Hours $906.75 $20.40 $9.92 $937.07
3981 Continuous Home Care w/AIDS Min 18 Hours $960.09 $21.60 $9.92 $991.61
3982 Continuous Home Care w/AIDS Min 19 Hours $1,013.43 $22.80 $9.92 $1,046.15
3983 Continuous Home Care w/AIDS Min 20 Hours $1,066.77 $24.00 $9.92 $1,100.69
3984 Continuous Home Care w/AIDS Min 21 Hours $1,120.11 $25.20 $9.92 $1,155.23
3985 Continuous Home Care w/AIDS Min 22 Hours $1,173.44 $26.40 $9.92 $1,209.76
3986 Continuous Home Care w/AIDS Min 23 Hours $1,226.78 $27.60 $9.92 $1,264.30
3987 Continuous Home Care w/AIDS Min 24 Hours $1,280.12 $28.80 $9.92 $1,318.84
3988 General Inpatient w/ AIDS $1,036.50 $23.32 $9.92 $1,069.74
3989 Routine Home Care w/ AIDS Escort $307.94 $6.93 $9.92 $324.79
3991 Service Intensity Add-on $52.57 $1.18 $0.00 $53.75

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

|top of section| |top of page|

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 $241.58 $5.44 $9.92 $256.94
3946 Inpatient Respite $555.94 $12.51 $9.92 $578.37
3947 General Inpatient Care $1,261.21 $28.38 $9.92 $1,299.51
3948 Continuous Home Care - Min 8 Hours $591.77 $13.31 $9.92 $615.00
3949 Continuous Home Care - Min 9 Hours $665.74 $14.98 $9.92 $690.64
3950 Continuous Home Care - Min 10 Hours $739.71 $16.64 $9.92 $766.27
3951 Continuous Home Care - Min 11 Hours $813.68 $18.31 $9.92 $841.91
3952 Continuous Home Care - Min 12 Hours $887.66 $19.97 $9.92 $917.55
3953 Continuous Home Care - Min 13 Hours $961.63 $21.64 $9.92 $993.19
3954 Continuous Home Care - Min 14 Hours $1,035.60 $23.30 $9.92 $1,068.82
3955 Continuous Home Care - Min 15 Hours $1,109.57 $24.97 $9.92 $1,144.46
3956 Continuous Home Care - Min 16 Hours $1,183.54 $26.63 $9.92 $1,220.09
3957 Continuous Home Care - Min 17 Hours $1,257.51 $28.29 $9.92 $1,295.72
3958 Continuous Home Care - Min 18 Hours $1,331.48 $29.96 $9.92 $1,371.36
3959 Continuous Home Care - Min 19 Hours $1,405.45 $31.62 $9.92 $1,446.99
3960 Continuous Home Care - Min 20 Hours $1,479.43 $33.29 $9.92 $1,522.64
3961 Continuous Home Care - Min 21 Hours $1,553.40 $34.95 $9.92 $1,598.27
3962 Continuous Home Care - Min 22 Hours $1,627.37 $36.62 $9.92 $1,673.91
3963 Continuous Home Care - Min 23 Hours $1,701.34 $38.28 $9.92 $1,749.54
3964 Continuous Home Care - Min 24 Hours $1,775.31 $39.94 $9.92 $1,825.17
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $27.80 $0.63 $0.50 $28.93
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $394.88 $8.88 $9.92 $413.68
3970 Routine Home Care w/Escort $260.94 $5.87 $9.92 $276.73
3971 Continuous Home Care w/AIDS Min 8 Hours $660.49 $14.86 $9.92 $685.27
3972 Continuous Home Care w/AIDS Min 9 Hours $743.06 $16.72 $9.92 $769.70
3973 Continuous Home Care w/AIDS Min 10 Hours $825.62 $18.58 $9.92 $854.12
3974 Continuous Home Care w/AIDS Min 11 Hours $908.18 $20.43 $9.92 $938.53
3975 Continuous Home Care w/AIDS Min 12 Hours $990.74 $22.29 $9.92 $1,022.95
3976 Continuous Home Care w/AIDS Min 13 Hours $1,073.30 $24.15 $9.92 $1,107.37
3977 Continuous Home Care w/AIDS Min 14 Hours $1,155.86 $26.01 $9.92 $1,191.79
3978 Continuous Home Care w/AIDS Min 15 Hours $1,238.43 $27.86 $9.92 $1,276.21
3979 Continuous Home Care w/AIDS Min 16 Hours $1,320.99 $29.72 $9.92 $1,360.63
3980 Continuous Home Care w/AIDS Min 17 Hours $1,403.55 $31.58 $9.92 $1,445.05
3981 Continuous Home Care w/AIDS Min 18 Hours $1,486.11 $33.44 $9.92 $1,529.47
3982 Continuous Home Care w/AIDS Min 19 Hours $1,568.67 $35.30 $9.92 $1,613.89
3983 Continuous Home Care w/AIDS Min 20 Hours $1,651.23 $37.15 $9.92 $1,698.30
3984 Continuous Home Care w/AIDS Min 21 Hours $1,733.80 $39.01 $9.92 $1,782.73
3985 Continuous Home Care w/AIDS Min 22 Hours $1,816.36 $40.87 $9.92 $1,867.15
3986 Continuous Home Care w/AIDS Min 23 Hours $1,898.92 $42.73 $9.92 $1,951.57
3987 Continuous Home Care w/AIDS Min 24 Hours $1,981.48 $44.58 $9.92 $2,035.98
3988 General Inpatient w/ AIDS $1,401.71 $31.54 $9.92 $1,443.17
3989 Routine Home Care w/ AIDS Escort $414.24 $9.32 $9.92 $433.48
3991 Service Intensity Add-on $72.85 $1.64 $0.00 $74.49

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

|top of section| |top of page|

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 $248.88 $5.60 $9.92 $264.40
3946 Inpatient Respite $571.66 $12.86 $9.92 $594.44
3947 General Inpatient Care $1,298.11 $29.21 $9.92 $1,337.24
3948 Continuous Home Care - Min 8 Hours $611.71 $13.76 $9.92 $635.39
3949 Continuous Home Care - Min 9 Hours $688.18 $15.48 $9.92 $713.58
3950 Continuous Home Care - Min 10 Hours $764.64 $17.20 $9.92 $791.76
3951 Continuous Home Care - Min 11 Hours $841.11 $18.92 $9.92 $869.95
3952 Continuous Home Care - Min 12 Hours $917.57 $20.65 $9.92 $948.14
3953 Continuous Home Care - Min 13 Hours $994.03 $22.37 $9.92 $1,026.32
3954 Continuous Home Care - Min 14 Hours $1,070.50 $24.09 $9.92 $1,104.51
3955 Continuous Home Care - Min 15 Hours $1,146.96 $25.81 $9.92 $1,182.69
3956 Continuous Home Care - Min 16 Hours $1,223.43 $27.53 $9.92 $1,260.88
3957 Continuous Home Care - Min 17 Hours $1,299.89 $29.25 $9.92 $1,339.06
3958 Continuous Home Care - Min 18 Hours $1,376.36 $30.97 $9.92 $1,417.25
3959 Continuous Home Care - Min 19 Hours $1,452.82 $32.69 $9.92 $1,495.43
3960 Continuous Home Care - Min 20 Hours $1,529.28 $34.41 $9.92 $1,573.61
3961 Continuous Home Care - Min 21 Hours $1,605.75 $36.13 $9.92 $1,651.80
3962 Continuous Home Care - Min 22 Hours $1,682.21 $37.85 $9.92 $1,729.98
3963 Continuous Home Care - Min 23 Hours $1,758.68 $39.57 $9.92 $1,808.17
3964 Continuous Home Care - Min 24 Hours $1,835.14 $41.29 $9.92 $1,886.35
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $28.58 $0.64 $0.50 $29.72
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $406.81 $9.15 $9.92 $425.88
3970 Routine Home Care w/Escort $268.24 $6.04 $9.92 $284.20
3971 Continuous Home Care w/AIDS Min 8 Hours $686.75 $15.45 $9.92 $712.12
3972 Continuous Home Care w/AIDS Min 9 Hours $772.59 $17.38 $9.92 $799.89
3973 Continuous Home Care w/AIDS Min 10 Hours $858.44 $19.31 $9.92 $887.67
3974 Continuous Home Care w/AIDS Min 11 Hours $944.28 $21.25 $9.92 $975.45
3975 Continuous Home Care w/AIDS Min 12 Hours $1,030.13 $23.18 $9.92 $1,063.23
3976 Continuous Home Care w/AIDS Min 13 Hours $1,115.97 $25.11 $9.92 $1,151.00
3977 Continuous Home Care w/AIDS Min 14 Hours $1,201.81 $27.04 $9.92 $1,238.77
3978 Continuous Home Care w/AIDS Min 15 Hours $1,287.66 $28.97 $9.92 $1,326.55
3979 Continuous Home Care w/AIDS Min 16 Hours $1,373.50 $30.90 $9.92 $1,414.32
3980 Continuous Home Care w/AIDS Min 17 Hours $1,459.34 $32.84 $9.92 $1,502.10
3981 Continuous Home Care w/AIDS Min 18 Hours $1,545.19 $34.77 $9.92 $1,589.88
3982 Continuous Home Care w/AIDS Min 19 Hours $1,631.03 $36.70 $9.92 $1,677.65
3983 Continuous Home Care w/AIDS Min 20 Hours $1,716.88 $38.63 $9.92 $1,765.43
3984 Continuous Home Care w/AIDS Min 21 Hours $1,802.72 $40.56 $9.92 $1,853.20
3985 Continuous Home Care w/AIDS Min 22 Hours $1,888.56 $42.49 $9.92 $1,940.97
3986 Continuous Home Care w/AIDS Min 23 Hours $1,974.41 $44.42 $9.92 $2,028.75
3987 Continuous Home Care w/AIDS Min 24 Hours $2,060.25 $46.36 $9.92 $2,116.53
3988 General Inpatient w/ AIDS $1,442.72 $32.46 $9.92 $1,485.10
3989 Routine Home Care w/ AIDS Escort $426.17 $9.59 $9.92 $445.68
3991 Service Intensity Add-on $75.13 $1.69 $0.00 $76.82

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

|top of section| |top of page|

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 $209.60 $4.72 $9.92 $224.24
3946 Inpatient Respite $487.10 $10.96 $9.92 $507.98
3947 General Inpatient Care $1,099.62 $24.74 $9.92 $1,134.28
3948 Continuous Home Care - Min 8 Hours $504.44 $11.35 $9.92 $525.71
3949 Continuous Home Care - Min 9 Hours $567.50 $12.77 $9.92 $590.19
3950 Continuous Home Care - Min 10 Hours $630.55 $14.19 $9.92 $654.66
3951 Continuous Home Care - Min 11 Hours $693.61 $15.61 $9.92 $719.14
3952 Continuous Home Care - Min 12 Hours $756.67 $17.03 $9.92 $783.62
3953 Continuous Home Care - Min 13 Hours $819.72 $18.44 $9.92 $848.08
3954 Continuous Home Care - Min 14 Hours $882.78 $19.86 $9.92 $912.56
3955 Continuous Home Care - Min 15 Hours $945.83 $21.28 $9.92 $977.03
3956 Continuous Home Care - Min 16 Hours $1,008.89 $22.70 $9.92 $1,041.51
3957 Continuous Home Care - Min 17 Hours $1,071.94 $24.12 $9.92 $1,105.98
3958 Continuous Home Care - Min 18 Hours $1,135.00 $25.54 $9.92 $1,170.46
3959 Continuous Home Care - Min 19 Hours $1,198.05 $26.96 $9.92 $1,234.93
3960 Continuous Home Care - Min 20 Hours $1,261.11 $28.37 $9.92 $1,299.40
3961 Continuous Home Care - Min 21 Hours $1,324.16 $29.79 $9.92 $1,363.87
3962 Continuous Home Care - Min 22 Hours $1,387.22 $31.21 $9.92 $1,428.35
3963 Continuous Home Care - Min 23 Hours $1,450.27 $32.63 $9.92 $1,492.82
3964 Continuous Home Care - Min 24 Hours $1,513.33 $34.05 $9.92 $1,557.30
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $24.36 $0.55 $0.50 $25.41
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $342.61 $7.71 $9.92 $360.24
3970 Routine Home Care w/Escort $228.96 $5.15 $9.92 $244.03
3971 Continuous Home Care w/AIDS Min 8 Hours $545.53 $12.27 $9.92 $567.72
3972 Continuous Home Care w/AIDS Min 9 Hours $613.72 $13.81 $9.92 $637.45
3973 Continuous Home Care w/AIDS Min 10 Hours $681.91 $15.34 $9.92 $707.17
3974 Continuous Home Care w/AIDS Min 11 Hours $750.10 $16.88 $9.92 $776.90
3975 Continuous Home Care w/AIDS Min 12 Hours $818.30 $18.41 $9.92 $846.63
3976 Continuous Home Care w/AIDS Min 13 Hours $886.49 $19.95 $9.92 $916.36
3977 Continuous Home Care w/AIDS Min 14 Hours $954.68 $21.48 $9.92 $986.08
3978 Continuous Home Care w/AIDS Min 15 Hours $1,022.87 $23.01 $9.92 $1,055.80
3979 Continuous Home Care w/AIDS Min 16 Hours $1,091.06 $24.55 $9.92 $1,125.53
3980 Continuous Home Care w/AIDS Min 17 Hours $1,159.25 $26.08 $9.92 $1,195.25
3981 Continuous Home Care w/AIDS Min 18 Hours $1,227.44 $27.62 $9.92 $1,264.98
3982 Continuous Home Care w/AIDS Min 19 Hours $1,295.63 $29.15 $9.92 $1,334.70
3983 Continuous Home Care w/AIDS Min 20 Hours $1,363.83 $30.69 $9.92 $1,404.44
3984 Continuous Home Care w/AIDS Min 21 Hours $1,432.02 $32.22 $9.92 $1,474.16
3985 Continuous Home Care w/AIDS Min 22 Hours $1,500.21 $33.75 $9.92 $1,543.88
3986 Continuous Home Care w/AIDS Min 23 Hours $1,568.40 $35.29 $9.92 $1,613.61
3987 Continuous Home Care w/AIDS Min 24 Hours $1,636.59 $36.82 $9.92 $1,683.33
3988 General Inpatient w/ AIDS $1,222.12 $27.50 $9.92 $1,259.54
3989 Routine Home Care w/ AIDS Escort $361.97 $8.14 $9.92 $380.03
3991 Service Intensity Add-on $62.87 $1.41 $0.00 $64.28

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

|top of section| |top of page|

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 $248.88 $5.60 $9.92 $264.40
3946 Inpatient Respite $571.66 $12.86 $9.92 $594.44
3947 General Inpatient Care $1,298.11 $29.21 $9.92 $1,337.24
3948 Continuous Home Care - Min 8 Hours $611.71 $13.76 $9.92 $635.39
3949 Continuous Home Care - Min 9 Hours $688.18 $15.48 $9.92 $713.58
3950 Continuous Home Care - Min 10 Hours $764.64 $17.20 $9.92 $791.76
3951 Continuous Home Care - Min 11 Hours $841.11 $18.92 $9.92 $869.95
3952 Continuous Home Care - Min 12 Hours $917.57 $20.65 $9.92 $948.14
3953 Continuous Home Care - Min 13 Hours $994.03 $22.37 $9.92 $1,026.32
3954 Continuous Home Care - Min 14 Hours $1,070.50 $24.09 $9.92 $1,104.51
3955 Continuous Home Care - Min 15 Hours $1,146.96 $25.81 $9.92 $1,182.69
3956 Continuous Home Care - Min 16 Hours $1,223.43 $27.53 $9.92 $1,260.88
3957 Continuous Home Care - Min 17 Hours $1,299.89 $29.25 $9.92 $1,339.06
3958 Continuous Home Care - Min 18 Hours $1,376.36 $30.97 $9.92 $1,417.25
3959 Continuous Home Care - Min 19 Hours $1,452.82 $32.69 $9.92 $1,495.43
3960 Continuous Home Care - Min 20 Hours $1,529.28 $34.41 $9.92 $1,573.61
3961 Continuous Home Care - Min 21 Hours $1,605.75 $36.13 $9.92 $1,651.80
3962 Continuous Home Care - Min 22 Hours $1,682.21 $37.85 $9.92 $1,729.98
3963 Continuous Home Care - Min 23 Hours $1,758.68 $39.57 $9.92 $1,808.17
3964 Continuous Home Care - Min 24 Hours $1,835.14 $41.29 $9.92 $1,886.35
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $28.58 $0.64 $0.50 $29.72
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $406.81 $9.15 $9.92 $425.88
3970 Routine Home Care w/Escort $268.24 $6.04 $9.92 $284.20
3971 Continuous Home Care w/AIDS Min 8 Hours $686.75 $15.45 $9.92 $712.12
3972 Continuous Home Care w/AIDS Min 9 Hours $772.59 $17.38 $9.92 $799.89
3973 Continuous Home Care w/AIDS Min 10 Hours $858.44 $19.31 $9.92 $887.67
3974 Continuous Home Care w/AIDS Min 11 Hours $944.28 $21.25 $9.92 $975.45
3975 Continuous Home Care w/AIDS Min 12 Hours $1,030.13 $23.18 $9.92 $1,063.23
3976 Continuous Home Care w/AIDS Min 13 Hours $1,115.97 $25.11 $9.92 $1,151.00
3977 Continuous Home Care w/AIDS Min 14 Hours $1,201.81 $27.04 $9.92 $1,238.77
3978 Continuous Home Care w/AIDS Min 15 Hours $1,287.66 $28.97 $9.92 $1,326.55
3979 Continuous Home Care w/AIDS Min 16 Hours $1,373.50 $30.90 $9.92 $1,414.32
3980 Continuous Home Care w/AIDS Min 17 Hours $1,459.34 $32.84 $9.92 $1,502.10
3981 Continuous Home Care w/AIDS Min 18 Hours $1,545.19 $34.77 $9.92 $1,589.88
3982 Continuous Home Care w/AIDS Min 19 Hours $1,631.03 $36.70 $9.92 $1,677.65
3983 Continuous Home Care w/AIDS Min 20 Hours $1,716.88 $38.63 $9.92 $1,765.43
3984 Continuous Home Care w/AIDS Min 21 Hours $1,802.72 $40.56 $9.92 $1,853.20
3985 Continuous Home Care w/AIDS Min 22 Hours $1,888.56 $42.49 $9.92 $1,940.97
3986 Continuous Home Care w/AIDS Min 23 Hours $1,974.41 $44.42 $9.92 $2,028.75
3987 Continuous Home Care w/AIDS Min 24 Hours $2,060.25 $46.36 $9.92 $2,116.53
3988 General Inpatient w/ AIDS $1,442.72 $32.46 $9.92 $1,485.10
3989 Routine Home Care w/ AIDS Escort $426.17 $9.59 $9.92 $445.68
3991 Service Intensity Add-on $75.13 $1.69 $0.00 $76.82

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

|top of section| |top of page|

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 $234.53 $5.28 $9.92 $249.73
3946 Inpatient Respite $540.77 $12.17 $9.92 $562.86
3947 General Inpatient Care $1,225.59 $27.58 $9.92 $1,263.09
3948 Continuous Home Care - Min 8 Hours $572.52 $12.88 $9.92 $595.32
3949 Continuous Home Care - Min 9 Hours $644.09 $14.49 $9.92 $668.50
3950 Continuous Home Care - Min 10 Hours $715.65 $16.10 $9.92 $741.67
3951 Continuous Home Care - Min 11 Hours $787.22 $17.71 $9.92 $814.85
3952 Continuous Home Care - Min 12 Hours $858.79 $19.32 $9.92 $888.03
3953 Continuous Home Care - Min 13 Hours $930.35 $20.93 $9.92 $961.20
3954 Continuous Home Care - Min 14 Hours $1,001.92 $22.54 $9.92 $1,034.38
3955 Continuous Home Care - Min 15 Hours $1,073.48 $24.15 $9.92 $1,107.55
3956 Continuous Home Care - Min 16 Hours $1,145.05 $25.76 $9.92 $1,180.73
3957 Continuous Home Care - Min 17 Hours $1,216.61 $27.37 $9.92 $1,253.90
3958 Continuous Home Care - Min 18 Hours $1,288.18 $28.98 $9.92 $1,327.08
3959 Continuous Home Care - Min 19 Hours $1,359.74 $30.59 $9.92 $1,400.25
3960 Continuous Home Care - Min 20 Hours $1,431.31 $32.20 $9.92 $1,473.43
3961 Continuous Home Care - Min 21 Hours $1,502.87 $33.81 $9.92 $1,546.60
3962 Continuous Home Care - Min 22 Hours $1,574.44 $35.42 $9.92 $1,619.78
3963 Continuous Home Care - Min 23 Hours $1,646.00 $37.04 $9.92 $1,692.96
3964 Continuous Home Care - Min 24 Hours $1,717.57 $38.65 $9.92 $1,766.14
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $27.04 $0.61 $0.50 $28.15
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $383.36 $8.63 $9.92 $401.91
3970 Routine Home Care w/Escort $253.89 $5.71 $9.92 $269.52
3971 Continuous Home Care w/AIDS Min 8 Hours $635.16 $14.29 $9.92 $659.37
3972 Continuous Home Care w/AIDS Min 9 Hours $714.55 $16.08 $9.92 $740.55
3973 Continuous Home Care w/AIDS Min 10 Hours $793.95 $17.86 $9.92 $821.73
3974 Continuous Home Care w/AIDS Min 11 Hours $873.34 $19.65 $9.92 $902.91
3975 Continuous Home Care w/AIDS Min 12 Hours $952.74 $21.44 $9.92 $984.10
3976 Continuous Home Care w/AIDS Min 13 Hours $1,032.13 $23.22 $9.92 $1,065.27
3977 Continuous Home Care w/AIDS Min 14 Hours $1,111.52 $25.01 $9.92 $1,146.45
3978 Continuous Home Care w/AIDS Min 15 Hours $1,190.92 $26.80 $9.92 $1,227.64
3979 Continuous Home Care w/AIDS Min 16 Hours $1,270.31 $28.58 $9.92 $1,308.81
3980 Continuous Home Care w/AIDS Min 17 Hours $1,349.71 $30.37 $9.92 $1,390.00
3981 Continuous Home Care w/AIDS Min 18 Hours $1,429.10 $32.15 $9.92 $1,471.17
3982 Continuous Home Care w/AIDS Min 19 Hours $1,508.50 $33.94 $9.92 $1,552.36
3983 Continuous Home Care w/AIDS Min 20 Hours $1,587.89 $35.73 $9.92 $1,633.54
3984 Continuous Home Care w/AIDS Min 21 Hours $1,667.29 $37.51 $9.92 $1,714.72
3985 Continuous Home Care w/AIDS Min 22 Hours $1,746.68 $39.30 $9.92 $1,795.90
3986 Continuous Home Care w/AIDS Min 23 Hours $1,826.08 $41.09 $9.92 $1,877.09
3987 Continuous Home Care w/AIDS Min 24 Hours $1,905.47 $42.87 $9.92 $1,958.26
3988 General Inpatient w/ AIDS $1,362.12 $30.65 $9.92 $1,402.69
3989 Routine Home Care w/ AIDS Escort $402.72 $9.06 $9.92 $421.70
3991 Service Intensity Add-on $70.65 $1.59 $0.00 $72.24

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

|top of section| |top of page|

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 $189.77 $4.27 $9.92 $203.96
3946 Inpatient Respite $444.42 $10.00 $9.92 $464.34
3947 General Inpatient Care $999.43 $22.49 $9.92 $1,031.84
3948 Continuous Home Care - Min 8 Hours $450.30 $10.13 $9.92 $470.35
3949 Continuous Home Care - Min 9 Hours $506.58 $11.40 $9.92 $527.90
3950 Continuous Home Care - Min 10 Hours $562.87 $12.66 $9.92 $585.45
3951 Continuous Home Care - Min 11 Hours $619.16 $13.93 $9.92 $643.01
3952 Continuous Home Care - Min 12 Hours $675.45 $15.20 $9.92 $700.57
3953 Continuous Home Care - Min 13 Hours $731.73 $16.46 $9.92 $758.11
3954 Continuous Home Care - Min 14 Hours $788.02 $17.73 $9.92 $815.67
3955 Continuous Home Care - Min 15 Hours $844.31 $19.00 $9.92 $873.23
3956 Continuous Home Care - Min 16 Hours $900.59 $20.26 $9.92 $930.77
3957 Continuous Home Care - Min 17 Hours $956.88 $21.53 $9.92 $988.33
3958 Continuous Home Care - Min 18 Hours $1,013.17 $22.80 $9.92 $1,045.89
3959 Continuous Home Care - Min 19 Hours $1,069.45 $24.06 $9.92 $1,103.43
3960 Continuous Home Care - Min 20 Hours $1,125.74 $25.33 $9.92 $1,160.99
3961 Continuous Home Care - Min 21 Hours $1,182.03 $26.60 $9.92 $1,218.55
3962 Continuous Home Care - Min 22 Hours $1,238.32 $27.86 $9.92 $1,276.10
3963 Continuous Home Care - Min 23 Hours $1,294.60 $29.13 $9.92 $1,333.65
3964 Continuous Home Care - Min 24 Hours $1,350.89 $30.40 $9.92 $1,391.21
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $22.22 $0.50 $0.50 $23.22
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $310.20 $6.98 $9.92 $327.10
3970 Routine Home Care w/Escort $209.13 $4.71 $9.92 $223.76
3971 Continuous Home Care w/AIDS Min 8 Hours $474.25 $10.67 $9.92 $494.84
3972 Continuous Home Care w/AIDS Min 9 Hours $533.53 $12.00 $9.92 $555.45
3973 Continuous Home Care w/AIDS Min 10 Hours $592.81 $13.34 $9.92 $616.07
3974 Continuous Home Care w/AIDS Min 11 Hours $652.09 $14.67 $9.92 $676.68
3975 Continuous Home Care w/AIDS Min 12 Hours $711.37 $16.01 $9.92 $737.30
3976 Continuous Home Care w/AIDS Min 13 Hours $770.65 $17.34 $9.92 $797.91
3977 Continuous Home Care w/AIDS Min 14 Hours $829.93 $18.67 $9.92 $858.52
3978 Continuous Home Care w/AIDS Min 15 Hours $889.21 $20.01 $9.92 $919.14
3979 Continuous Home Care w/AIDS Min 16 Hours $948.49 $21.34 $9.92 $979.75
3980 Continuous Home Care w/AIDS Min 17 Hours $1,007.77 $22.67 $9.92 $1,040.36
3981 Continuous Home Care w/AIDS Min 18 Hours $1,067.06 $24.01 $9.92 $1,100.99
3982 Continuous Home Care w/AIDS Min 19 Hours $1,126.34 $25.34 $9.92 $1,161.60
3983 Continuous Home Care w/AIDS Min 20 Hours $1,185.62 $26.68 $9.92 $1,222.22
3984 Continuous Home Care w/AIDS Min 21 Hours $1,244.90 $28.01 $9.92 $1,282.83
3985 Continuous Home Care w/AIDS Min 22 Hours $1,304.18 $29.34 $9.92 $1,343.44
3986 Continuous Home Care w/AIDS Min 23 Hours $1,363.46 $30.68 $9.92 $1,404.06
3987 Continuous Home Care w/AIDS Min 24 Hours $1,422.74 $32.01 $9.92 $1,464.67
3988 General Inpatient w/ AIDS $1,110.77 $24.99 $9.92 $1,145.68
3989 Routine Home Care w/ AIDS Escort $329.56 $7.42 $9.92 $346.90
3991 Service Intensity Add-on $56.69 $1.28 $0.00 $57.97

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

|top of section| |top of page|

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 $205.87 $4.63 $9.92 $220.42
3946 Inpatient Respite $479.07 $10.78 $9.92 $499.77
3947 General Inpatient Care $1,080.76 $24.32 $9.92 $1,115.00
3948 Continuous Home Care - Min 8 Hours $494.25 $11.12 $9.92 $515.29
3949 Continuous Home Care - Min 9 Hours $556.04 $12.51 $9.92 $578.47
3950 Continuous Home Care - Min 10 Hours $617.82 $13.90 $9.92 $641.64
3951 Continuous Home Care - Min 11 Hours $679.60 $15.29 $9.92 $704.81
3952 Continuous Home Care - Min 12 Hours $741.38 $16.68 $9.92 $767.98
3953 Continuous Home Care - Min 13 Hours $803.16 $18.07 $9.92 $831.15
3954 Continuous Home Care - Min 14 Hours $864.94 $19.46 $9.92 $894.32
3955 Continuous Home Care - Min 15 Hours $926.73 $20.85 $9.92 $957.50
3956 Continuous Home Care - Min 16 Hours $988.51 $22.24 $9.92 $1,020.67
3957 Continuous Home Care - Min 17 Hours $1,050.29 $23.63 $9.92 $1,083.84
3958 Continuous Home Care - Min 18 Hours $1,112.07 $25.02 $9.92 $1,147.01
3959 Continuous Home Care - Min 19 Hours $1,173.85 $26.41 $9.92 $1,210.18
3960 Continuous Home Care - Min 20 Hours $1,235.63 $27.80 $9.92 $1,273.35
3961 Continuous Home Care - Min 21 Hours $1,297.42 $29.19 $9.92 $1,336.53
3962 Continuous Home Care - Min 22 Hours $1,359.20 $30.58 $9.92 $1,399.70
3963 Continuous Home Care - Min 23 Hours $1,420.98 $31.97 $9.92 $1,462.87
3964 Continuous Home Care - Min 24 Hours $1,482.76 $33.36 $9.92 $1,526.04
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $23.95 $0.54 $0.50 $24.99
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $336.51 $7.57 $9.92 $354.00
3970 Routine Home Care w/Escort $225.23 $5.07 $9.92 $240.22
3971 Continuous Home Care w/AIDS Min 8 Hours $532.11 $11.97 $9.92 $554.00
3972 Continuous Home Care w/AIDS Min 9 Hours $598.63 $13.47 $9.92 $622.02
3973 Continuous Home Care w/AIDS Min 10 Hours $665.14 $14.97 $9.92 $690.03
3974 Continuous Home Care w/AIDS Min 11 Hours $731.66 $16.46 $9.92 $758.04
3975 Continuous Home Care w/AIDS Min 12 Hours $798.17 $17.96 $9.92 $826.05
3976 Continuous Home Care w/AIDS Min 13 Hours $864.68 $19.46 $9.92 $894.06
3977 Continuous Home Care w/AIDS Min 14 Hours $931.20 $20.95 $9.92 $962.07
3978 Continuous Home Care w/AIDS Min 15 Hours $997.71 $22.45 $9.92 $1,030.08
3979 Continuous Home Care w/AIDS Min 16 Hours $1,064.23 $23.95 $9.92 $1,098.10
3980 Continuous Home Care w/AIDS Min 17 Hours $1,130.74 $25.44 $9.92 $1,166.10
3981 Continuous Home Care w/AIDS Min 18 Hours $1,197.26 $26.94 $9.92 $1,234.12
3982 Continuous Home Care w/AIDS Min 19 Hours $1,263.77 $28.43 $9.92 $1,302.12
3983 Continuous Home Care w/AIDS Min 20 Hours $1,330.28 $29.93 $9.92 $1,370.13
3984 Continuous Home Care w/AIDS Min 21 Hours $1,396.80 $31.43 $9.92 $1,438.15
3985 Continuous Home Care w/AIDS Min 22 Hours $1,463.31 $32.92 $9.92 $1,506.15
3986 Continuous Home Care w/AIDS Min 23 Hours $1,529.83 $34.42 $9.92 $1,574.17
3987 Continuous Home Care w/AIDS Min 24 Hours $1,596.34 $35.92 $9.92 $1,642.18
3988 General Inpatient w/ AIDS $1,201.16 $27.03 $9.92 $1,238.11
3989 Routine Home Care w/ AIDS Escort $355.87 $8.01 $9.92 $373.80
3991 Service Intensity Add-on $61.71 $1.39 $0.00 $63.10

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

|top of section| |top of page|

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 $189.26 $4.26 $9.92 $203.44
3946 Inpatient Respite $443.32 $9.97 $9.92 $463.21
3947 General Inpatient Care $996.85 $22.43 $9.92 $1,029.20
3948 Continuous Home Care - Min 8 Hours $448.90 $10.10 $9.92 $468.92
3949 Continuous Home Care - Min 9 Hours $505.02 $11.36 $9.92 $526.30
3950 Continuous Home Care - Min 10 Hours $561.13 $12.63 $9.92 $583.68
3951 Continuous Home Care - Min 11 Hours $617.24 $13.89 $9.92 $641.05
3952 Continuous Home Care - Min 12 Hours $673.36 $15.15 $9.92 $698.43
3953 Continuous Home Care - Min 13 Hours $729.47 $16.41 $9.92 $755.80
3954 Continuous Home Care - Min 14 Hours $785.58 $17.68 $9.92 $813.18
3955 Continuous Home Care - Min 15 Hours $841.69 $18.94 $9.92 $870.55
3956 Continuous Home Care - Min 16 Hours $897.81 $20.20 $9.92 $927.93
3957 Continuous Home Care - Min 17 Hours $953.92 $21.46 $9.92 $985.30
3958 Continuous Home Care - Min 18 Hours $1,010.03 $22.73 $9.92 $1,042.68
3959 Continuous Home Care - Min 19 Hours $1,066.15 $23.99 $9.92 $1,100.06
3960 Continuous Home Care - Min 20 Hours $1,122.26 $25.25 $9.92 $1,157.43
3961 Continuous Home Care - Min 21 Hours $1,178.37 $26.51 $9.92 $1,214.80
3962 Continuous Home Care - Min 22 Hours $1,234.48 $27.78 $9.92 $1,272.18
3963 Continuous Home Care - Min 23 Hours $1,290.60 $29.04 $9.92 $1,329.56
3964 Continuous Home Care - Min 24 Hours $1,346.71 $30.30 $9.92 $1,386.93
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $22.17 $0.50 $0.50 $23.17
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $309.36 $6.96 $9.92 $326.24
3970 Routine Home Care w/Escort $208.62 $4.69 $9.92 $223.23
3971 Continuous Home Care w/AIDS Min 8 Hours $472.41 $10.63 $9.92 $492.96
3972 Continuous Home Care w/AIDS Min 9 Hours $531.47 $11.96 $9.92 $553.35
3973 Continuous Home Care w/AIDS Min 10 Hours $590.52 $13.29 $9.92 $613.73
3974 Continuous Home Care w/AIDS Min 11 Hours $649.57 $14.62 $9.92 $674.11
3975 Continuous Home Care w/AIDS Min 12 Hours $708.62 $15.94 $9.92 $734.48
3976 Continuous Home Care w/AIDS Min 13 Hours $767.67 $17.27 $9.92 $794.86
3977 Continuous Home Care w/AIDS Min 14 Hours $826.72 $18.60 $9.92 $855.24
3978 Continuous Home Care w/AIDS Min 15 Hours $885.78 $19.93 $9.92 $915.63
3979 Continuous Home Care w/AIDS Min 16 Hours $944.83 $21.26 $9.92 $976.01
3980 Continuous Home Care w/AIDS Min 17 Hours $1,003.88 $22.59 $9.92 $1,036.39
3981 Continuous Home Care w/AIDS Min 18 Hours $1,062.93 $23.92 $9.92 $1,096.77
3982 Continuous Home Care w/AIDS Min 19 Hours $1,121.98 $25.24 $9.92 $1,157.14
3983 Continuous Home Care w/AIDS Min 20 Hours $1,181.03 $26.57 $9.92 $1,217.52
3984 Continuous Home Care w/AIDS Min 21 Hours $1,240.09 $27.90 $9.92 $1,277.91
3985 Continuous Home Care w/AIDS Min 22 Hours $1,299.14 $29.23 $9.92 $1,338.29
3986 Continuous Home Care w/AIDS Min 23 Hours $1,358.19 $30.56 $9.92 $1,398.67
3987 Continuous Home Care w/AIDS Min 24 Hours $1,417.24 $31.89 $9.92 $1,459.05
3988 General Inpatient w/ AIDS $1,107.90 $24.93 $9.92 $1,142.75
3989 Routine Home Care w/ AIDS Escort $328.72 $7.40 $9.92 $346.04
3991 Service Intensity Add-on $56.53 $1.27 $0.00 $57.80

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

|top of section| |top of page|

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 $183.47 $4.13 $9.92 $197.52
3946 Inpatient Respite $430.83 $9.69 $9.92 $450.44
3947 General Inpatient Care $967.54 $21.77 $9.92 $999.23
3948 Continuous Home Care - Min 8 Hours $433.07 $9.74 $9.92 $452.73
3949 Continuous Home Care - Min 9 Hours $487.20 $10.96 $9.92 $508.08
3950 Continuous Home Care - Min 10 Hours $541.33 $12.18 $9.92 $563.43
3951 Continuous Home Care - Min 11 Hours $595.47 $13.40 $9.92 $618.79
3952 Continuous Home Care - Min 12 Hours $649.60 $14.62 $9.92 $674.14
3953 Continuous Home Care - Min 13 Hours $703.73 $15.83 $9.92 $729.48
3954 Continuous Home Care - Min 14 Hours $757.87 $17.05 $9.92 $784.84
3955 Continuous Home Care - Min 15 Hours $812.00 $18.27 $9.92 $840.19
3956 Continuous Home Care - Min 16 Hours $866.13 $19.49 $9.92 $895.54
3957 Continuous Home Care - Min 17 Hours $920.27 $20.71 $9.92 $950.90
3958 Continuous Home Care - Min 18 Hours $974.40 $21.92 $9.92 $1,006.24
3959 Continuous Home Care - Min 19 Hours $1,028.53 $23.14 $9.92 $1,061.59
3960 Continuous Home Care - Min 20 Hours $1,082.67 $24.36 $9.92 $1,116.95
3961 Continuous Home Care - Min 21 Hours $1,136.80 $25.58 $9.92 $1,172.30
3962 Continuous Home Care - Min 22 Hours $1,190.93 $26.80 $9.92 $1,227.65
3963 Continuous Home Care - Min 23 Hours $1,245.07 $28.01 $9.92 $1,283.00
3964 Continuous Home Care - Min 24 Hours $1,299.20 $29.23 $9.92 $1,338.35
3965 Hospice Inpatient Respite Care Coinsurance Rate - 5% of 3946 $21.54 $0.48 $0.50 $22.52
3966 Drugs Coinsurance Rate $1.00 $0.00 $0.00 $1.00
3969 Routine Home Care w/AIDS $299.88 $6.75 $9.92 $316.55
3970 Routine Home Care w/Escort $202.83 $4.56 $9.92 $217.31
3971 Continuous Home Care w/AIDS Min 8 Hours $451.56 $10.16 $9.92 $471.64
3972 Continuous Home Care w/AIDS Min 9 Hours $508.01 $11.43 $9.92 $529.36
3973 Continuous Home Care w/AIDS Min 10 Hours $564.45 $12.70 $9.92 $587.07
3974 Continuous Home Care w/AIDS Min 11 Hours $620.90 $13.97 $9.92 $644.79
3975 Continuous Home Care w/AIDS Min 12 Hours $677.35 $15.24 $9.92 $702.51
3976 Continuous Home Care w/AIDS Min 13 Hours $733.79 $16.51 $9.92 $760.22
3977 Continuous Home Care w/AIDS Min 14 Hours $790.24 $17.78 $9.92 $817.94
3978 Continuous Home Care w/AIDS Min 15 Hours $846.68 $19.05 $9.92 $875.65
3979 Continuous Home Care w/AIDS Min 16 Hours $903.13 $20.32 $9.92 $933.37
3980 Continuous Home Care w/AIDS Min 17 Hours $959.57 $21.59 $9.92 $991.08
3981 Continuous Home Care w/AIDS Min 18 Hours $1,016.02 $22.86 $9.92 $1,048.80
3982 Continuous Home Care w/AIDS Min 19 Hours $1,072.46 $24.13 $9.92 $1,106.51
3983 Continuous Home Care w/AIDS Min 20 Hours $1,128.91 $25.40 $9.92 $1,164.23
3984 Continuous Home Care w/AIDS Min 21 Hours $1,185.35 $26.67 $9.92 $1,221.94
3985 Continuous Home Care w/AIDS Min 22 Hours $1,241.80 $27.94 $9.92 $1,279.66
3986 Continuous Home Care w/AIDS Min 23 Hours $1,298.24 $29.21 $9.92 $1,337.37
3987 Continuous Home Care w/AIDS Min 24 Hours $1,354.69 $30.48 $9.92 $1,395.09
3988 General Inpatient w/ AIDS $1,075.32 $24.19 $9.92 $1,109.43
3989 Routine Home Care w/ AIDS Escort $319.24 $7.18 $9.92 $336.34
3991 Service Intensity Add-on $54.72 $1.23 $0.00 $55.95

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

|top of section| |top of page|