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Title: Section 86-6.2 - Hospice rates of reimbursement

Effective Date

05/10/2002

86-6.2 Hospice rates of reimbursement. (a) Pursuant to 42 USC 1396a (a)(13)(D), rates of reimbursement for hospice shall be in amounts no lower than the amounts used under part A of title XVIII of the Social Security Act. Hospices may be eligible for supplemental rates of payment under the supplemental financial assistance program in accordance with the provisions set forth in section 86-6.6 of this Subpart.

(1) The hospice payment rates are established to reimburse each of the following four specific categories of hospice care:

(i) routine home care;

(ii) continuous home care;

(iii) inpatient respite care; and

(iv) general inpatient care.

(2) Payment rates under the supplemental financial assistance program are established to reimburse each of the following special need categories of hospice care:

(i) routine home care for AIDS patients;

(ii) routine home care with escort services;

(iii) routine home care for AIDS patients with escort services;

(iv) continuous home care for AIDS patients;

(v) general inpatient care for AIDS patients;

(vi) room and board services for persons receiving care in a hospice residence.

(b) Except as otherwise stated, each hospice payment rate established pursuant to this Subpart is a prospectively determined per diem amount which has been adjusted consistent wit the requirements of 42 USC 1396a (a)(13)(D) to reflect regional variations in wage levels.

(c) Per-diem payments shall be for only one of the categories of hospice care listed in either paragraph (1) or paragraph (2) of subdivision (a) of this section for any particular day, provided that payments for continuous home care days will vary depending upon the number of hours of continuous home care provided.

(d) For continuous home care, the rates established pursuant to subdivisions (f) and (g) of this section shall be divided by 24 to yield an hourly rate. The number of hours of continuous home care provided in a given day is then multiplied by the resulting hourly rate to yield a continuous home care payment amount for that day. A minimum of 8 hours of predominantly nursing care must be furnished on a particular day to qualify for the continuous home care reimbursement rate pursuant to this section.

(e) Beginning October 1, 1990 annual adjustments to the hospice payment rates for each category of hospice care established in this section shall be made using trend factors developed by the Commissioner of Health pursuant to section 86-6.5 of this Subpart.

(f) The hospice reimbursement rates for the four standard categories of care for hospices located within the various New York State Standard Metropolitan Statistical Areas (SMSA) and rural areas are as follows:

*Routine *Continuous *InpatientHome Care Home *Respite CareSMSA Area Rate Care Rate Care Rate Rate(Counties Within Area)
(1) Albany-Schenectady-Troy,(Albany, Greene,Montgomery,Rensselaer,Saratoga andSchenectady) $70.20 $409.31 $77.64 $313.61
(2) Binghamton(Broome, Tioga 73.43 428.14 80.40 326.97
(3) Buffalo(Erie) 74.79 436.07 81.57 332.60
(4) Elmira(Chemung) 77.24 450.36 83.67 342.74
(5) Glens Falls(Warren, Washington) 69.71 406.46 77.22 311.58
(6) Nassau-Suffolk(Nassau, Suffolk) 86.81 506.19 91.87 382.38
(7) New York(Bronx, Kings, New York,Putnam, Queens, RichmondRockland, Westchester) 94.97 553.75 98.85 416.14
(8) Niagara Falls(Niagara) 69.33 404.27 76.90 310.02
(9) Orange County(Orange) 76.22 444.40 82.79 338.52
(10) Poughkeepsie(Dutchess) 80.69 470.45 86.62 357.04
(11) Rochester(Livingston, Monroe,Ontario, Orleans, Wayne) 77.88 454.07 84.21 345.38
(12) Syracuse(Madison, Onondaga,Oswego) 99.66 581.12 102.87 435.57
(13) Utica-Rome(Herkimer, Oneida) 72.52 422.82 79.62 323.19
(14) NON-SMSA Area (Rural)Includes Counties NotCovered Above 69.20 403.51 76.79 309.48
*Rates that appear on this schedule shall be effective January 1, 1990 through September 30, 1990. Beginning October 1, 1990 annual adjustments will be made to these rates pursuant to section 86-6.5 of this Subpart.
(g) The reimbursement rates under the Supplemental Financial Assistance Program for the special need categories of care for hospices located within the various New York State Standard Metropolitan Statistical Areas (SMSA) and rural areas are as follows:
*Routine*Routine *Routine Home Care *Continuous *GeneralHome Care Home Care for AIDS Home Care Inpatientfor AIDS Escort Patients for AIDS for AIDSPatients Services & Escort Patients PatientsServicesSMSA AREA(Counties Within Area)(1) Albany-Schenectady-Troy(Albany, Greene, Montgomery,Rensselaer, Saratoga, andSchenectady) 120.53 86.02 136.35 439.64 348.55
(2) Binghamton(Broome, Tioga) 126.27 89.25 142.09 467.55 363.39
(3) Buffalo(Erie) 128.69 90.61 144.51 479.32 369.65
(4) Elmira(Chemung) 133.04 93.06 148.86 500.52 380.92
(5) Glens Falls(Warren, Washington) 119.66 85.53 135.48 435.40 346.29
(6) Nassau-Suffolk(Nassau, Suffolk) 150.06 102.63 165.88 583.32 424.98
(7) New York(Bronx, Kings, New York,Putnam, Queens, Richmond,Rockland, Westchester) 164.56 110.79 180.38 653.85 462.50
(8) Niagara Falls(Niagara) 118.99 85.15 134.81 432.15 344.56
(9) Orange County(Orange) 131.23 92.04 147.05 491.68 376.23
(10) Poughkeepsie(Dutchess) 139.18 96.51 155.00 530.37 396.81
(11) Rochester(Livingston, Monroe,Ontario, Orleans, Wayne) 134.17 93.70 149.99 506.02 383.86
(12) Syracuse(Madison, Onondaga,Oswego) 172.90 115.48 188.72 694.44 484.09
(13) Utica-Rome(Herkimer, Oneida) 124.64 88.34 140.46 459.66 359.19
(14) NON-SMSA Area (Rural)Includes Counties NotCovered Above 118.76 85.02 134.58 431.03 343.96

*Rates that appear on this schedule shall be effective July 1, 1990 through September 30, 1990. Beginning October 1, 1990 annual adjustments will be made to these rates pursuant to section 86-6.5 of this Subpart.

(h) Daily payment will be made to a hospice residence for Medicaid–eligible patients who have elected hospice care and reside in a hospice residence. Payment shall be made for a hospice residence patient to take into account the room and board furnished by the hospice residence and will be in an amount equal to 94% of the weighted average Medicaid rate of the nursing facilities located in the region that the hospice residence is located in, as specified in Appendix 13-A, infra, of this Title.

(i) The hospice rates of reimbursement set forth in this section are subject to the approval of the State Director of the Budget.

Volume

VOLUME A-2 (Title 10)

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