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Title: Section 86-5.11 - Computation of individual hourly or per-visit service rate

Effective Date


86-5.11 Computation of individual hourly or per-visit service rate.

(a) Individual service rates, except for rates established pursuant to section 86-1.46(b) of this Subpart, shall be computed on the basis of allowable fiscal and statistical data submitted by the LTHHCP. The computed rates shall be all-inclusive rates, taking into consideration total allowable costs.

(b) To the allowable basic rate based on actual LTHHCP cost, there shall be added a factor to adjust allowable costs during the effective period of the cost-based reimbursement rate. Such adjustments shall not be made to rates based on budgeted costs. This adjustment shall be determined as follows:

(1) The elements of a long-term home health care program's cost shall be weighted based upon data for the following categories:

(i) salaries;

(ii) employee health and welfare expense;

(iii) nonpayroll administrative and general expense;

(iv) nonpayroll housekeeping and maintenance expense; and

(v) nonpayroll professional care expense.

(2) Each weight shall be adjusted by the appropriate price index for each category noted in paragraph (1) of this subdivision.

(3) Geographic differentials may be established, where appropriate.


VOLUME A-2 (Title 10)