Community First Choice Option (CFCO)

Fee For Service Rate Codes for 7/1/2019

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FFS – Home Delivered and Congregate Meals
Rate
Code
Description Effective Date Rate
3183 HOME DELIVERED MEALS – CFCO 7/1/2019 Reference Range $4.25– $12.50
3184 CONGREGATE MEALS – CFCO 7/1/2019 Reference Range $4.25– $12.50
3185 HOME DELIVERED MEALS – (WKND) – CFCO 7/1/2019 Reference Range $4.25– $12.50
NHTD – Home Delivered and Congregate Meals
Rate
Code
Description Effective Date Rate
9781 NHTDWVR Cong/Home Meals Tot Charge Current and after 7/1/19 Reference Range $4.25– $12.50
FFS – Personal Emergency Response Units (PERS)
Rate
Code
Description Effective Date Rate
2513 PERS INSTALLATION CHARGE Current and after 7/1/19 Average rate is approximately $45.00
2514 PERS MONTHLY SERVICE CHARGE Current and after 7/1/19 Limit of one single unit claim per month. Provider–specific average rate of about $30.
FFS – Assistive Technology – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
3186 ASSISTIVE TECHNOLOGY (AT) – CFCO 7/1/2019 Submit charged amount up to $15,000.
TBI – Assistive Technology – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
9857 TBI Waiver Assistive Technology Total Charges Current and after 7/1/19 Submit charged amount up to $15,000.
NHTD Assistive Technology – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
9752 NHTD Assist Tech Total Charges Current and after 7/1/19 Submit charged amount up to $15,000.
CONSOLIDATED CHILDREN´S 1915 (c) Assistive–Adaptive Technology – Annual Cap $15,000
1915(c) Childrens Consolidated Waiver
Rate
Code
Description Effective Date Rate
8037 ADAPTIVE AND ASSISTIVE EQUIPMENT – $1.00 UNIT 7/1/2019 $1.00 PER UNIT.
8038 ADAPTIVE AND ASSISTIVE EQUIPMENT – $10.00 UNIT 7/1/2019 $10.00 PER UNIT.
8039 ADAPTIVE AND ASSISTIVE EQUIPMENT – $100.00 UNIT 7/1/2019 $100.00 PER UNIT.
8040 ADAPTIVE AND ASSISTIVE EQUIPMENT – $1000.00 UNIT 7/1/2019 $1000.00 PER UNIT.
OPWDD Adaptive Technology – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
4482 Adaptive Tech $1/Unit Fee Current and after 7/1/19 Adaptive Tech $1/Unit Fee
4483 Adaptive Tech $10/Unit Fee Current and after 7/1/19 Adaptive Tech $10/Unit Fee
4484 Adaptive Tech $100/Unit Fee Current and after 7/1/19 Adaptive Tech $100/Unit Fee
4485 Adaptive Tech $1000/Unit Fee Current and after 7/1/19 Adaptive Tech $1000/Unit Fee
FFS – V Mods – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
3193 VEHICLE MODIFICATIONS – CFCO 7/1/2019 Submit charged amount up to $15,000.
OPWDD – V Mods – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
3167 VEHICLE ADAPT; OPWDD CFCO;STATE 7/1/2019 $1.00 PER UNIT.
3168 VEHICLE ADAPT; OPWDD CFCO;STATE 7/1/2019 $10.00 PER UNIT.
3169 VEHICLE ADAPT; OPWDD CFCO;STATE 7/1/2019 $100.00 PER UNIT.
3170 VEHICLE ADAPT; OPWDD CFCO;STATE 7/1/2019 $1000.00 PER UNIT.
NHTD V Mods – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
9750 NHTDWVR Vehicle Adaptation Current and after 7/1/19 Submit charged amount up to $15,000.
CONSOLIDATED CHILDREN´S 1915 (c) – V Mods– Annual Cap $15,000
Rate
Code
Description Effective Date Rate
8041 VEHICLE MODIFICATIONS – $1.00 UNIT 7/1/2019 $1.00 PER UNIT.
8042 VEHICLE MODIFICATIONS – $10.00 UNIT 7/1/2019 $10.00 PER UNIT.
8043 VEHICLE MODIFICATIONS – $100.00 UNIT 7/1/2019 $100.00 PER UNIT.
8044 VEHICLE MODIFICATIONS – $1000.00 UNIT 7/1/2019 $1000.00 PER UNIT.
FFS Environmental Modifications – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
3192 ENVIRONMENTAL MODIFICATIONS – CFCO 7/1/2019 Submit charged amount up to $15,000.
OPWDD Environmental Modifications – Annual Cap 15,000
Rate
Code
Description Effective Date Rate
4476 ENV MODS; OPWDD CFCO; Current and after 7/1/19 $1 PER UNIT FEE; STATE.
4477 ENV MODS; OPWDD CFCO; Current and after 7/1/19 $10 PER UNIT FEE; STATE.
4478 ENV MODS; OPWDD CFCO; Current and after 7/1/19 $100 PER UNIT FEE; STATE.
4479 ENV MODS; OPWDD CFCO; Current and after 7/1/19 $1000 PER UNIT FEE; STATE.
TBI Environmental Modifications – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
9874 TBI WVR ENVIRON MODS $1000.00 PER UNIT FEE Current and after 7/1/19 $1000.00 UNIT.
NHTD Environmental Modifications – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
9762 NHTDWVR ENVIRON MOD TOT CHARGES Current and after 7/1/19 Submit charged amount up to $15,000.
CONSOLIDATED CHILDREN´S 1915 (c) Environmental Modifications – Annual Cap $15,000
Rate
Code
Description Effective Date Rate
8032 ENVIRONMENTAL MODIFICATIONS – $1.00 UNIT 7/1/2019 $1.00 PER UNIT.
8034 ENVIRONMENTAL MODIFICATIONS – $10.00 UNIT 7/1/2019 $10.00 PER UNIT.
8035 ENVIRONMENTAL MODIFICATIONS – $100.00 UNIT 7/1/2019 $100.00 PER UNIT.
8036 ENVIRONMENTAL MODIFICATIONS – $1000.00 UNIT 7/1/2019 $1000.00 PER UNIT.
FFS– MOVING ASSISTANCE $5,000.00 One Time Payment
Rate
Code
Description Effective Date Rate
3188 MOVING ASSISTANCE (HOURLY) –CFCO 7/1/2019 Submit charged amount up to $5,000.
NHTD – MOVING ASSISTANCE $5,000.00 One Time Payment
Rate
Code
Description Effective Date Rate
9787 NHTDWVR MOV ASS´T PROG TOTAL CHARGE Current and after 7/1/19 Submit charged amount up to $5,000.
OPWDD MOVING ASSISTANCE $5,000.00 One Time Payment
Rate
Code
Description Effective Date Rate
7449 MOVING ASSISTANCE 7/1/2019 $10.00 Per Unit. Max $990.00 per day
FFS CTS $5,000 – One Time Payment
Rate
Code
Description Effective Date Rate
3187 COMMUNITY TRANSITION SERVICES (CFCO) 7/1/2019 Submit charged amount up to $5,000.
TBI/NHTD CTS $5,000 – One Time Payment
Rate
Code
Description Effective Date Rate
9758 NHTDWVR COM TRANSIT SVR TOT CHARGE 7/1/2019 Submit charged amount up to $5,000.
9867 TBI WAIVER COMM TRANS RATE CD 20 – $1000.00 PER UNIT 7/1/2019 Submit charged amount up to $5,000.
OPWDD – CTS $5,000 – One Time Payment
Rate
Code
Description Effective Date Rate
4786 COM TRANS SVCS; VIA FI: Vol; Current and after 7/1/19 $10.00 Per Unit. Max $990.00 per day
OPWDD Community Habilitation ( COM HAB) ( SAME)
Rate
Code
Description Effective Date Rate
4722 Comm/Res Hab Vol; INDIV 1/4 HR – Downstate 7/1/2019 $10.43
4722 Comm/Res Hab Vol; INDIV 1/4 HR – Upstate 7/1/2019 $10.40
4723 Comm/Res Hab Vol; Group–2; 1/4 HR – Downstate 7/1/2019 $6.51
4723 Comm/Res Hab Vol; Group–2; 1/4 HR – Upstate 7/1/2019 $6.50
4724 Comm/Res Hab Vol; Group–3; 1/4 HR – Downstate 7/1/2019 $5.20
4724 Comm/Res Hab Vol; Group–3; 1/4 HR – Upstate 7/1/2019 $4.92
4741 Comm/Res Hab: STATE: Group–1; 1/4 HR – Downstate 7/1/2019 $10.43
4741 Comm/Res Hab: STATE: Group–1; 1/4 HR – Upstate 7/1/2019 $10.40
4742 Comm/Res Hab: STATE: Group–2; 1/4 HR – Downstate 7/1/2019 $6.51
4742 Comm/Res Hab: STATE: Group–2; 1/4 HR – Upstate 7/1/2019 $6.50
4743 Comm/Res Hab: STATE: Group–3; 1/4 HR – Downstate 7/1/2019 $5.20
4743 Comm/Res Hab: STATE: Group–3; 1/4 HR – Upstate 7/1/2019 $4.92
4755 COM HAB: Agy Sup: Vol; INDIV 1/4 HR – Downstate 7/1/2019 $10.43
4755 COM HAB: Agy Sup: Vol; INDIV 1/4 HR – Upstate 7/1/2019 $10.40
4756 COM HAB: Agy Sup: Vol; Group 1/4 HR – Downstate 7/1/2019 $6.51
4756 COM HAB: Agy Sup: Vol; Group 1/4 HR – Upstate 7/1/2019 $6.50
CONSOLIDATED CHILDREN´S 1915 (c) Community Habilitation ( COM HAB) (SAME)
Rate
Code
Description Effective Date Rate
8012 Individual – hourly/downstate habilitation 7/1/2019 $41.70
8012 Individual – hourly/upstate habilitation 7/1/2019 $41.61
8013 Group of 2 hourly/downstate habilitation 7/1/2019 $26.04
8013 Group of 2 hourly/upstate habilitation 7/1/2019 $26.01
8014 Group of 3+ hourly/downstate habilitation 7/1/2019 $20.78
8014 Group of 3+ hourly/upstate habilitation 7/1/2019 $19.67
FFS– NON WAIVER – SAME
Personal care rate codes + a new companion add on code when applicable
Rate
Code
Description Effective Date Rate
3171 ADL/IADL SKILL ACQUISITION SVCS – CFCO NON–DD (Rate code 3171 for upstate and downstate is the same), As of 7/1/19 NYC $5.50, Rest of State $11.00
CDPAP – SAME
Rate
Code
Description Effective Date Rate
2401 CDPAP 1 CLIENT, HOURLY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2402 CDPAP 2 OR MORE CLIENTS HOURLY, PER CLIENT 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2403 CDPAP 1 CLIENT, HOURLY, ENHANCED 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2404 CDPAP 2 OR MORE CLIENTS HOURLY PER CLIENT EN 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2405 CDPAP 1 CLIENT LIVE–IN 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2406 CDPAP 2 OR MORE CLIENTS, PER CLIENT LIVE–IN 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2422 CDPAP 1 CLIENT, QUARTER HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2423 CDPAP 2 CLIENTS, PER CLIENT, QUARTER HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2424 CDPAP 1 CLIENT ENHANCED RATE QUARTER HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2425 CDPAP 2 CLIENTS, PER CLIENT,ENHANCED RATE QUARTER HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
CERTIFIED HOME HEALTH AIDE SAME
Rate
Code
Description Effective Date Rate
2499 HOME HEALTH SHARED AIDE 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/chha/rates
2610 HOME HEALTH AIDE   https://www.health.ny.gov/facilities/long_term_care/reimbursement/chha/rates
PERSONAL CARE LEVELS I & II SAME
Rate
Code
Description Effective Date Rate
2501 PCA LEVEL 1, SHARED AIDE, BASIC, HOURLY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2502 PCA LEVEL II, SHARED AIDE, BASIC, HOURLY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2507 PCA LEVEL 1, SHARED AIDE, BASIC, QUARTER HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2508 PCA LEVEL II, SHARED AIDE, BASIC, QUARTER HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2593 PCA LEVEL I, 1 CLIENT, QUARTER HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2594 PCA LEVEL I, 2 CLIENTS, PER CLIENT 1/4 HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2595 PCA LEVEL II, 1 CLIENT, 1/4 HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2596 PCA LEVEL II, 2 CLIENTS PER CLIENT 1/4 HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2597 PCA LEVEL II, 1 CLIENT, HARD TO SERVE, 1/4 HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2598 PCA LEVEL II, 2 CLIENTS, HARD TO SERVE 1/4 HOUR 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2601 PCA LEVEL I, ONE CLIENT HOURLY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2602 PCA LEVEL 1 TWO CLIENTS HOURLY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2623 PCA LEVEL 2 TWO CLIENTS HOURLY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2622 PCA LEVEL 2 ONE CLIENT HOURLY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2626 PCA LEVEL 2 ONE CLIENT HOURLY – SECONDARY CODE 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2627 PCA LEVEL 2 2 CLIENTS HOURLY – PER CLIENT, SECONDARY CODE 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2632 PCA LEVEL 2, ONE CLIENT DAILY 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
2633 PCA LEVEL 2, 2 CLIENTS DAILY (PER CLIENT) 1/1/2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
 
Rate Codes highlighted in yellow are pending CMS approval
* NEW RATE CODES ARE IN BOLD