N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-6.2
Current through Register Vol. 46, No. 51, December 18, 2024
Section 86-6.2 - Hospice rates of reimbursement(a) Pursuant to 42 USC 1396 a(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: (ii) continuous home care;(iii) inpatient respite care; and(iv) general inpatient care.(2) Payment rates under the supplement 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 with the requirements of 42 USC 1396 a(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: | SMSA Area (Counties Within Area) | Routine Home Care Rate* | Continuous Home Care Rate* | Respite Care Rate* | Inpatient Care Rate* |
| (1) Albany-Schenectady-Troy (Albany, Greene, Montgomery, Rensselaer, Saratoga, and Schenectady) | $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, Richmond, Rockland, 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 Not Covered 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: | SMSA Area | Routine Home Care for AIDS Patients* | Routine Home Care Escort Services* | Routine Home Care for AIDS Patients and Escort* | Continuous Home Care for AIDS Patients* | General Inpatient for AIDS Patients* |
| (Counties Within Area) |
| (1) Albany-Schenectady-Troy (Albany, Greene, Montgomery, Rensselaer, Saratoga, and Schenectady) | $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 not Covered Above | 118.76 | 85.02 | 134.58 | 431.03 | 343.96 |
FN* Rates that appear on this schedule shall be September 30, 1990. Beginning October 1, 1990
(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. The Department will calculate a 10% increase in the hospice residence reimbursement rate for each Wage Equalization Factor (WEF) region, as specified in Appendix 13-A of this Title, relative the rate in effect on March 31, 2018. For fiscal periods beginning April 1, 2018 and ending December 31, 2018, and for every calendar year thereafter, hospice residence reimbursement rates will be equal to 94% of the weighted average Medicaid rate of the nursing facilities located in the WEF region, plus the per diem value based upon the 10% increase calculated pursuant to this subdivision.(i) The hospice rates of reimbursement set forth in this section are subject to the approval of the State Director of the Budget.N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-6.2
Amended New York State Register April 6, 2022/Volume XLIV, Issue 14, eff. 4/6/2022