Medicaid Fee-For-Service Reimbursement Rates, Survey Results, April 2014

State RN PT OT SLP MSW HHA Effective Date Notes

AK

AL $27.00/visit $15.00/visit $11.20/visit $18.00/visit $27.00/visit LPN: $27.00; Limit 104 visits per year, PT/OT/SLP for 21 and younger.

AR $145.02/visit $141.02/visit N/A N/A $66.63/visit LPN: $95.47/visit

AZ

$17.02/15-mins (varies by provider, see

notes)

$105.32/visit $105.32/visit $105.32/visit $35.47/visit 10/11/13 See fee schedule for details.

CA $74.86/visit $68.84/visit $71.36/visit $78.43/visit $96.22/visit $45.75/visit 2013 LPN: $51.60/visit

CO $101.09/visit $110.56/visit $111.27/visit $120.14/visit N/A $57.45/1 1/2 hour 2013-14 after 8.26% increase

CT $94.26/visit $80.49/visit $82.82/visit $82.82/visit N/A $24.80/hr 7/1/07 For other rates, see fee schedule.DC See notes. See notes. See notes. See notes. See notes. See notes. See notes. No information found.

DE $151.24/visit $146.52/visit $130.92/visit $116.20/visit $76.00/visit $32.12/visit 2013

Same rates in effect since 10/1/2006; rates to left should be divided by 4 units; billing is in 1/4hr increments.

MSW is covered only by rare exception. Rates are the same for

Medicaid fee for service and managed care.

Directions: Please fill in the appropriate and applicable home health reimbursement rates in the row for your state(s), indicating units as well (i.e. $/hour, etc.). For the subsequent tabs of this spreadsheet, please fill out your state's personal care, private duty nursing, and home and community based waiver services rates as well. Feel free to add rows below the row assigned to your state(s) if necessary.

Medicaid Home Health

FL See notes. See notes. See notes. See notes. See notes. See notes. See notes.

Florida’s Medicaid program (in total) is being moved over into private

HMOs. There were no standardized rates established by legislation, so each plan is negotiating the rates

provider by provider.

GA $64.75/visit $16.18/15 min $16.18/15 min $64.75/visit N/A $64.75/visit 2013

Rates are from a sample provider, not representative of the entire state. Medicaid rates are different for each

provider, based on 20 year old Medicare cost reports with budget

reductions over the years in excess of 15%. Rates are currently between

$45 and $110.

HI N/A N/A N/A N/A N/A $20.00/visit 2013

FFS, almost all are under Managed Care. For full listing, see www.med-quest.us/PDFs/Provider%20Memos/Medicaid%20Fee%20Schedule.pdf

IA $99.54/visit $108.84/visit $109.58/visit $118.27/visit $159.57/visit $45.08/visit 7/1/13 Nonurban

IA $115.43/visit $126.21/visit $127.07/visit $137.14/visit $185.04/visit $52.28/visit 2013Urban MSA 26980-Iowa City (Johnson,

Washington Co). For other urban rates, see fee schedule.

ID

$102.92/visit (rate on file); $197.88/visit

(cap limit)

$123.22/visit (rate on file); $166.40/visit

(cap limit)

$101.17/visit (rate on file); $180.70/visit

(cap limit)

$165.69/visit (rate on file); $212.20/visit (cap limit);

$40.00/visit (rate on file); $80.24/visit (cap limit);

7/25/12See "current provider reimbursement

rates" here.

IL $59.68/visit $59.68/visit $59.68/visit $59.68/visit N/A $59.68/visit FY 2014

IN $41.08/hr $16.31/15-min $15.77/15-min $16.58/15-min N/A $19.27/hr July to Dec

2013

Rates reflect 5% reduction of state-wide rates from 7/1/13 to 12/31/13,

LPN rate is $26.94/hr. Overhead rate is $32.50. Reimbursement is one

overhead per patient per provider per day. Rates change July 1 of each

year based on cost reports.

IN $41.95/hr $16.65/15-min $16.11/15-min $16.93/15-min N/A $19.67/hr Jan to Dec

2014

Rates reflect 3% reduction of state-wide rates from 1/1/14 to 6/30/14,

LPN rate is $27.51/hr. Overhead rate is $33.18. Reimbursement is one

overhead per patient per provider per day. Rates change July 1 of each

year based on cost reports.

KS N/A N/A N/A N/A N/A N/A Most of Kansas Medicaid is now on KanCare (3 MCOs).

KY $87.15/visit $85.05/visit $85.05/visit $85.05/visit $68.25/visit $34.12/visit LPN: $87.15

LA $62.81/visit $57.20/Eval; $10.59/15 min

$54.02/Eval; $8.47/15 min

$47.64/Eval; $7.94/15 min N/A $22.30/visit LPN: $50.24

MA $86.99/visit $68.30/visit $71.20/visit $72.88/visit N/A $6.10/15 minsLast

updated in 2007

MD See notes. See HCBS waiver section

ME $84.95/45-min visit

$93.88/45-min visit

$99.76/45-min visit

$98.34/45-min visit

$84.95/45-min visit

$39.84/45-min visit 2013

See attachment for details (rates in attachment are given in 15 min

intervals).

MI $80.98/visit $78.12/visit $63.39/visit $78.12/visit $51.72/15-min visit Jan. 2013 See fee schedule for details.

MN $70.04/visit$42.71/visit

(PT assistant)

$43.59/visit (OT assistant) $66.71/visit N/A 2013 LPN: $70.04/visit

MN $8.53/15 min $65.71/visit $67.05/visit $66.71/visit N/A $5.13/15 min 2013

MN $69.69/visit$42.50/visit

(PT assistant)

$43.37/visit (OT assistant) $66.71/visit N/A 2011

MN $8.49/15 min $65.38/visit $66.71/visit N/A $5.10/15 min 2011

MO $64.15/visit N/A N/A N/A N/A $64.15/visit current rateVisit rate (1-4 hours). Therapy or

social work not offered as Medicaid Home Health benefit.

MS See notes. See notes. See notes. See notes. See notes. See notes. See notes.No standard rates, based on cost report.

Medicaid home health not listed in provider fee schedule.

MT $71.74/visit $71.74/visit $71.74/visit $71.74/visit N/A $32.03/visit 7/1/2013All visits need prior authorization. See

link for details.

NC $103.33/visit $109.60/visit $109.60/visit $109.60/visit N/A $47.28/visit 7/1/2012 LPN: $103.33/visit.

ND See notes. See notes. See notes. See notes. See notes. See notes. See notes.See provider fee schedule. Unclear if

Medicaid home heath, and other home care rates, are included.

NE $84.56/visit $98.20/visit $98.20/visit $98.20/visit N/A $52.22/visit 7/1/2013

See fee schedule for details. Nebraska DHHS plans to implement 100% Medicaid managed care for all

healthcare providers on January 1, 2017. Nebraska’s legislature is also considering

a bill that would delay issuance of Request for Proposals to managed care organizations until September 1, 2015.

NH $90.16/visit $23.25/unit $21.45/unit $16.80/unit N/A

$29.60/visit under 2 hrs.

$5.74/unit for 2 hrs.+

Unit=15 mins. NH Medicaid has moved the “state plan-authorized”

services to managed care on 12/1/13. A large proportion of NH is now on

managed care.

NJ See notes. See notes. See notes. See notes. See notes. See notes. See notes.

In New Jersey, home health services, personal care and private duty are all under Managed Care, and have been

since July 2011. Initially, the plans paid what the FFS program had been paying for each of these services, but

since this past July when initial contracts expired for some agencies,

there were cuts passed along unilaterally. Other agencies’

contracts will expire in June 2014. Perhaps more concerning than the rate reductions themselves is the

ratcheting back of hours, especially in the personal care assistance program. We are not privy to

individual agency rates in their MCO contracts.

NM See notes. See notes. See notes. See notes. See notes. See notes. See notes.

On January 1, 2014, New Mexico moved over to managed

care/Centennial Care, with little left in fee-for-service. Most of the MCOs say they will only pay the Human

Services Department/Medical Assistance Division (HSD/MAD) fee

schedule.

NV

$91.02/visit (Under 21); $71.22/visit

(21 and over)

$14.03/15 min $14.03/15 min $14.03/15 min N/A

$30.32/15 min for first hour; $6.44/15 min for additional

half hour

7/1/2009These rates are urban rates. For details,

see fee schedule.

NY See notes. See notes. See notes. See notes. See notes. See notes. See notes.Rates vary by region. See NY Dept. of

Health website for all rates.

OH $52.20/B; $5.69/U

$69.94/B; $4.50/U

$69.94/B; $4.50/U

$69.94/B; $4.50/U N/A $23.26/B;

$3.00/U SFY 2012

B=Base rate (1st hr.); U=Unit rate (ea. 15min) SFY=State Fiscal Yr. LPN: $52.20/B; $5.69/U. No more than 8 hrs/day (32 units combined.

No more than 14 hrs (56 units) nursing/aide per week.

OK $73.25/visit $20.00/15 min $20.00/15 min $20.00/15 min $33.17/visit 36 visits per year. LPN: $73.25/visit.

OR $182.09/visit $146.22/visit $157.49/visit $147.42/visit N/A $59.82/visit 2013

Services are covered if dx are on the portion of the prioritized list 'above the line' funded by the legislature;

services are covered at 74% of Medicare cost recalculated biennially;

supplies billed at acquisition cost limited at $50/day; SN limited to 2 visits per day with PA; all therapy limited at 1 visit per day with PA;

subject to $3.00/visit copay. LPN: $182.09/visit.

PA $88.00/visit $88.00/visit $88.00/visit N/A N/A $46.00/visit 2008 Fee-for service. PA is now 100% Managed Care.

RI See notes. See notes. See notes. See notes. See notes. See notes. See notes.

Each licensed home care and hospice agency has a different set of

reimbursement rates within their Medicaid contract with RI EOHHS

based on RI's home health reimbursement rate enhancement system. . In addition, legislation currently being considered for an

increase plus COLA to Medicaid only FFS effective October 1.

SC approx. $122/visit

approx. $122/visit

approx. $122/visit

approx. $122/visit N/A

Medicaid HH services are cost settled based on the Medicare cost reports so it varies; in the past, the average cost is around $112 per visit for RN,

ST, OT, PT.

SD $12.50/hr $8.98/15 min $8.98/15 min $13.00/15-min $8.08/15-min 7/1/2013

RN = skilled nursing. See fee schedule for details.

TN N/A N/A N/A N/A N/A N/A TN is 100% managed care.

TX $100.94/visit $112.32/visit $114.51/visit$135.14/

$115.46 per visit

N/A $47.03/visit 2013SLP - $135.14/visit for 0-20 min.;

$115.46/visit for 21-999 min. For details see fee schedules.

UT $90.90/visit $80.66/visit $80.66/visit $79.47/visit N/A $22.56/hr 7/1/2012 For details, see fee schedule.

VA $115.58/visit $135.33/visit $129.10/visit $122.34/visit N/A $57.77/visit 7/1/2009

Northern VA has separate rates. Figures in chart are for the rest of the state.

RN= skilled nursing. RN, PT, OT, SLP rates are for initial assessments. For details

see fee schedules.

VT $108.42/visit $118.56/visit $119.34/visit $128.70/visit $173.68/visit 49.08/visit 11/1/2013VT has a Medicaid home care tax that

reduces the net payments by about 20%. See attachment for historic rates.

WA $89.50/visit $21.00/15-min OR $84.00/hr

$20.99/15-min OR $83.96/hr $90.90/visit N/A $43.07/visit 1-Oct-12

SLP= speech therapy. See home health services fee schedule for other details.

WI

$85.54/visit - skilled

$40.31/visit - med

management

$83.91/visit $81.73/visit $86.63/visit N/A $40.31/visit

Has not been

updated in many years

Requires you to report shift time; therapy assistants must be

supervised by therapist in the home. LPN: $85.54/visit. Rarely pays for

HH Aide; will almost always downcode to Personal Care Worker

(PCW) at 16.08/hour

WV $81.00/visit $88.58/visit $89.17/visit $96.25/visit N/A $36.69/visit CY 2014Rates are rural. No standard rates;

based on cost report. For details see fee schedule.

WY $84.50/visit $84.50/visit $84.50/visit $84.50/visit $130.00/visit $5.00/15 min

Medicaid Fee-For-Service Reimbursement Rates, Survey Results, April 2014

State Rate/Unit Effective Date Notes

AK Rates vary by region. See notes. See notes. See PCS rates.

ALAR $16.76/hr 2008

AZ

$5.23/15-min; $3.09/15-min

(provider type 24, see fee schedule link

in notes)

10/11/13 See fee schedule for details.

CA

In Home Supportive Services (IHSS):

Rates vary by county based on four levels

of acuity

CO $15.04/hr 2013-14 after 8.26% increase on 7/1/13. Also under HCBS.

CT $18.88/hr 7/1/13DC $4.08/15 min 11/8/13 See final rulemaking.

Directions: Please fill in the appropriate and applicable personal care reimbursement rates in the row for your state(s), indicating units as well (i.e. $/hour, etc.). Feel free to add rows below the row assigned to your state(s) if necessary.

Personal Care

DE See notes. See notes.

PAS Personal Attendant, may be family, friend, guardian,

person from registry, or PASA Agency worker. Delaware

does have a PAS (Personal Attendant Rate) and Direct

Care Worker rate for personal care and homemaker. I do not have rates for those programs.

FL See notes. See notes.

Florida’s Medicaid program (in total) is being moved over into private HMOs. There were no standardized rates established by legislation, so each plan is negotiating the rates provider

by provider. GA N/A N/A N/A

HI See notes 2013 Personal Care is now under managed care.

IA $35.65/hr 7/1/13

Home Health Aide in the Home, Per Hour. Rates are for

beneficiaries under 21. See attachment.

ID $3.93/15 min 1/24/11See "current provider

reimbursement rates."

IL$12.00 Non-Agency; $13.75 Agency per

visitFY 2014

IN N/A N/A Not in State Plan.

KS N/A N/A In Kansas, personal care doesn’t have to be licensed.

KYLA

MA $11.36/hr 2014 rate Can't average less than this over a year.

MD

Older Adults Waiver: $13.07/hr (w/o

meds); $17.02/hr (with meds); Living at Home Waiver:

$17.11/hr (no distinction of meds)

See HCBS waiver section

ME $3.75/15 min 1/9/2011Personal Support Services. See

attachment for details.MI

MN $3.92/15 min 1:1 ratio 2013

MN $3.90/15 min 1:1 Ratio 2011

MN $2.58/15 min 1:3 ratio 2013

MN $2.57/15 min 1:3 ratio 2011

MO $4.54/15-min unit 10/1/2013Maximum allowable. Same rates for state plan and HCBS waiver.

See fee schedule for details.

MS See notes. See notes.No standard rates, based on cost

report. Medicaid home health not listed in provider fee schedule.

MT $3.75-$4.23/15 min 7/1/2013

Personal Assistance Attendant -Self-Directed, and Personal

Assistance Attendant -Oversight

MT $4.54-$5.05/15 min 7/1/2013

Personal Assistance Attendant - Agency-Based and Personal

Assistance Nurse Supervision - Agency-Based

NC $15.52/hr 1/1/2013Billed in 15-minute increments.

In-home aide FFS. SPA submitted to reduce to $13.12.

ND See notes. See notes.

See provider fee schedule. Unclear if Medicaid home heath, and other home care rates, are

included.

NE

Nebraska DHHS plans to implement 100% Medicaid

managed care for all healthcare providers on

January 1, 2017. Nebraska’s legislature is also considering a bill that would delay issuance of

Request for Proposals to managed care organizations

until September 1, 2015.

NH $4.38/unit See notes.

HHA & PSCP rates are the same for State Plan services and HCBS waiver services. Unit=15 mins. NH Medicaid has moved the “state plan-

authorized” services to managed care on 12/1/13.

NJ See notes. See notes.

In New Jersey, home health services, personal care and

private duty are all under Managed Care, and have been since July 2011. Initially, the

plans paid what the FFS program had been paying for each of these services, but

since this past July when initial contracts expired for some agencies, there were cuts passed along unilaterally.

Other agencies’ contracts will expire in June 2014. Perhaps more concerning than the rate reductions themselves is the

ratcheting back of hours, especially in the personal care assistance program. We are not privy to individual agency rates in their MCO contracts.

NM See notes. See notes.

On January 1, 2014, New Mexico moved over to

managed care/Centennial Care, with little left in fee-for-service. Most of the MCOs

say they will only pay the Human Services

Department/Medical Assistance Division (HSD/MAD) fee

schedule. NV $17.00/hr

NY See notes. See notes.Rates vary by region. See NY Dept. of Health website for all

rates.

OH$4.34/U for agency aide; $3.13/U for Independent aide

SFY 2014

$4.34 is the state maximum rate for agency aides; unit

rates vary by regions, most < max.

OK

OR $19.97/hour 2013Rates are different by county but range from $19.97/hour to

$21.31.PA See notes. See notes. See HCBS Waiver tab.

RI See notes. See notes.

Each licensed home care and hospice agency has a different

set of reimbursement rates within their Medicaid contract with RI EOHHS based on RI's home health reimbursement rate enhancement system.

SC

$11.70 per hour for PCS level1; $15.50 per hour for PCS Level 2; $8.50 per hour for Agency

companion

2013

Level 1 is assistance with household duties; Level 2 is

help with ADL's and housekeeping.

SDTN See notes. See notes. TN is 100% managed care.TX $2.89/15 min 2013 For details see fee schedules.

UT $16.78/15 min 7/1/2012Rate is for personal care services.

For details, see fee schedule.

VA See notes. See notes.Personal Care rates are the EDCD

rates, see fee schedule.

VT $27.64/visit 11/1/2013See attachment for details, which includes FY12 through FY14 rates.

WA See notes. 1-Jul-13Rates vary. See "home and

community service rates" for personal care rate details.

WI

Supervisory visit by skilled nurse $42.18; Ongoing assessment

by skilled nurse $85.54; $4.02/15min

for PCW

Rates have not changed in many years.

WV $16.00/hrWY

Medicaid Fee-For-Service Reimbursement Rates, Survey Results, April 2014

State LPN/LVN Independent RN Independent LPN/LVN

Agency RN Agency Effective Date Notes

AK See notes. See notes. See eligibility criteria on page 17.ALAR N/A N/A $32.00/hr $38.50/hr Supervisory visit is $38.50/visit.AZ

CA See Waiver Programs under HCBS (next tab).

CO $30.06/hr $40.03/hr 2013-14 after 8.26% increase on 7/1/13CTDC See notes. See notes. See notes. See notes. See notes. No information found.

DE $46.14/hr $51.50/hr 2013Same rates in effect since 10/1/2006. Rates

are the same for Medicaid Extended and managed care.

FL See notes. See notes. See notes. See notes. See notes.

Florida’s Medicaid program (in total) is being moved over into private HMOs. There were

no standardized rates established by legislation, so each plan is negotiating the

rates provider by provider. GA N/A N/A N/A N/A N/A N/A

HI See notes See notes See notes See notes 2013 Private duty nursing is now on managed care.

IA $12.46/15-min $12.46/15-min N/A N/A 7/1/13 Rates are for beneficiaries under 21.IDIL $20.00/hr $26.00/hr $25.47/hr $29.55/hr FY 2014

Directions: Please fill in the appropriate and applicable private duty nursing reimbursement rates in the row for your state(s), indicating units as well (i.e. $/hour, etc.). Feel free to add rows below the row assigned to your state(s) if necessary.

Private Duty Nursing

IN N/A N/A $26.94/hr $41.08/hr 7/1/13 to 12/31/13

Extended care is covered under the Medicaid home health program. Rates are the same as

the Medicaid home health program.

IN N/A N/A $27.51/hr $41.95/hr 1/1/14 to 6/30/14

Extended care is covered under the Medicaid home health program. Rates are the same as

the Medicaid home health program.

KS N/A N/A N/A N/A N/A Kansas does not recognize the term private duty.

KYLA

MA $9.37/15 mins $11.37/15 mins $9.37/15 mins $11.37/15 mins Last updated in 2007

MDME $6.32/15 min $10.58/15 min $6.32/15 min $10.58/15 min 1/9/2011 See fee schedule for details.

MI $5.47-10.94/15 min

$5.47-10.94/15 min

$5.10-11.99/15 min

$5.10-11.99/15 min 10/1/2013 See fee schedule for details.

MN Complex $7.32/15 min

Complex $9.75/15 min

Complex $7.32/15 min

Complex $9.75/15 min 2013

MN $6.24/15 min $8.13/15 min $6.24/15 min $8.13/15 min 2013

MN Complex $7.28/15 min

Complex $9.70/15 min

Complex $7.28/15 min

Complex $9.70/15 min 2011

MN $6.21/15 min $8.09/15 min $6.21/15 min $8.09/15 min 2011

MO N/A N/A $7.55/15-min unit $7.55/15-min unit 10/1/2013 Maximum allowable. See fee schedule for details.

MS

MT N/A N/A $7.01/15 min $8.30/15 min 8/1/2011 Elderly and Disabled Waiver Private Duty Nursing.

MT N/A N/A $6.87/15 min $8.14/15 min EPSDT Private Duty Nursing

NC N/A N/A $36.00/hr $36.00/hr 7/1/2012 Billed in 15-min increments. In home aide FFS. Blended rate for LPN and RN.

ND See notes. See notes. See notes. See notes. See notes.See provider fee schedule. Unclear if Medicaid

home heath, and other home care rates, are included.

NE

Nebraska DHHS plans to implement 100% Medicaid managed care for all healthcare providers on January 1, 2017. Nebraska’s

legislature is also considering a bill that would delay issuance of Request for Proposals to

managed care organizations until September 1, 2015.

NH N/A N/A $38.29/hour $41.85/hour 2013

Some rates were reduced in 2010; no rate increases in many years. Agencies report reductions in authorized hours for PDN

services. Unit=15 mins. NH Medicaid has moved the “state plan-authorized” services to

managed care on 12/1/13.

NJ See notes. See notes. See notes. See notes. See notes.

In New Jersey, home health services, personal care and private duty are all under Managed Care, and have been since July

2011. Initially, the plans paid what the FFS program had been paying for each of these services, but since this past July when initial contracts expired for some agencies, there were cuts passed along unilaterally. Other

agencies’ contracts will expire in June 2014. Perhaps more concerning than the rate

reductions themselves is the ratcheting back of hours, especially in the personal care assistance program. We are not privy to

individual agency rates in their MCO contracts.

NM See notes. See notes. See notes. See notes. See notes.

On January 1, 2014, New Mexico moved over to managed care/Centennial Care, with little

left in fee-for-service. Most of the MCOs say they will only pay the Human Services

Department/Medical Assistance Division (HSD/MAD) fee schedule.

NV

$39.00 per hour (under 21) -

$27.28 per hour (21 and over)

$49.00 per hour (under 21) -$36.73

(21 and over)

$39.00 per hour (under 21) -

$27.28 per hour (21 and over)

$49.00 per hour (under 21) -$36.73

(21 and over)

NY See notes. See notes. See notes. See notes. See notes.Rates vary by region. See NY Dept of Health

website for all rates.

OH $41.76/B; $5.69/U $41.76/B; $5.69/U $52.20/B; $5.69/U $52.20/B; $5.69/U SFY 2012 Nurses rates same for LPN & RN.

OK

OR See notes See notes See notes See notes 2004

Oregon covers care by visit or by shift for LPN/RN and as approved via an Acuity

Scoring Grid to determine patients eligibility. LPN/RN visits are up to 2/day; LPN -

$14.79/visit; RN - $16.59/visit; Shift care is covered for 4-12 hours; LPN - $29.66/shift;

RN - $34.90/shift. No reimb. for family members to provide service and not reimb.

for care when HH/H is being provided.

PA $40.00 $40.00 2008

RI See notes. See notes. See notes. See notes. See notes.

Each licensed home care and hospice agency has a different set of reimbursement rates

within their Medicaid contract with RI EOHHS based on RI's home health reimbursement

rate enhancement system.

SC N/A N/A$26.62 Enhanced Child; $23.77 adult patient (per hour)

$34.22 Enhanced Child; $31.37

Adult7/8/2011 Enhanced child up to age 21.

SD $22.34 $30.67 7/1/2013 See fee schedule for details.TN See notes. See notes. See notes. See notes. See notes. TN is 100% managed care.

TX $5.82/$6.69 UA Modifier

$8.51/$9.78 UA Modifier

$8.09/$8.87 UA Modifier

$11.05/12.71 UA Modifier 2013 15 Minutes. For details see fee schedules.

UT

VA See notes. See notes. See notes. See notes. See notes.Private duty nursing rates are the technology

waivers rates. See fee schedule.VT N/A N/A N/A N/A N/A N/A

WA$6.81/15-min; $9.18/15-min

(overtime)

$8.83/15-min; $11.92/15-min

(overtime)

$6.81/15-min; $9.18/15-min

(overtime)

$8.83/15-min; $11.92/15-min 2007

See "home and community service rates" for private duty nursing details.

WI $40.31/visit

WV $14/hr $18/hr $14/hr $18/hr Jan-14

Private duty is not regulated in WV. There’s no way really to even identify the providers. Very few of the home health agencies in the state are participating. These are Medicaid

rates.WY

Medicaid Fee-For-Service Reimbursement Rates, Survey Results, April 2014

State Rate/Unit Effective Date Notes

AK See notes. See notes.Rates vary by region. See waiver

rates.AL

AR

homemaker-$16.76/hr; adult companion-$16.76/hr; respite-$16.76/hr; home

delivered meals-$7.03/meal; adult day care-$7.68/hr.

AZ

CA Multipurpose Senior Services Program 2013

Provides HCBS to Medi-Cal beneficiaries who are 65 or over and disabled as an alternative to

nursing facility placement and allows individuals to remain in their homes. Under 1915(d).

Directions: Please fill in the appropriate and applicable home and community-based waiver services reimbursement rates in the row for your state(s), indicating units as well (i.e. $/hour, etc.). If your state has multiple home and community based waiver services, please itemize these separately if possible, and also indicate the type of caregiver associated with each rate. Feel free to add rows below the row assigned to your state(s) if necessary.

Home and Community-Based Waiver Services

CA Various HCBS Programs 2013

See below for: 1) HCBS Waiver for Californians with

Developmental Disabilities 2) California Nursing Facility Acute

(NF A/B) 3) HIV/AIDS 4) California Pediatric Palliative Care

5) California Assisted Living 6) Multipurpose Senior Services

Program 7) Early Periodic Screening, Diagnosis and

Treatment (EPSDT) 8) In Home Operations 9) California San

Francisco Living Benefit

CA

1) Bridge to Reform: Continuing Care Imitative: Rates have not been

established yet through the health plans 2) California Community Transition:

RN: $31.94 hr LVN: $24.42 hr CHHA or CAN: $3.62 per 15 mins

CA

HCBS Waiver for Californian with Developmental Disabilities:

Reimbursed in accordance with the Schedule of Maximum Allowances for

Home and Community-Based Services, under In-Home Operations Waiver Program (see In Home Operations

below).

2013

Provides HCBS to regional center consumers with developmental

disabilities, enabling them to living in the community rather than in an intermediate care facility for the developmentally disabled.

CA

California Nursing Facility Acute Z6716 SKILLED NURSING-RN, 1 HR $40.57, Z6718 SKILLED NURSING-LVN, 1 HR

$29.41Z6720 HOME HEALTH AIDE, 1 HR

$18.90, Z6744 SHARED NURSING-RN, 1 HR $44.63, Z6746 SHARED NURSING,

LVN, 1 HR $32.35Z6748 SHARED NURSING, HHA, 1 HR $20.79, Z6771 CASE MANAGEMENT-

RN, 1 HR $45.43, Z6795 SVC COORDINATION-RN, 1 HR $35.77

Z6752 FAMILY TRAINING, 1 HR $45.43, Z6818 PRIVATE-DUTY NURSING-RN, 1 HR $40.57, Z6819 RESPITE SERVICES-

RN, 1 HR $40.57Z6825 PRIVATE-DUTY NURSING SHARED-RN, 1 HR $44.63, Z6831

PRIVATE DUTY NURSING-LVN, 1 HR $29.41, Z6730 SKILLED NURSING-RN, 1 HR $40.57, Z6732 SKILLED NURSING-

LVN, 1 HR $29.41, Z6734 HOME HEALTH AIDE, 1 HR $18.90, Z6772 NF AUDIOLOGY SERVICES, ½ HR $23.82, Z6773 CASE MANAGEMENT-RN, 1 HR $45.43, Z6784 FAMILY TRAINING, 1 HR $45.43, Z6797 SVC COORDINATION-

RN, 1 HR $35.77, Z6806 SHARED NURSING-RN, 1 HR $44.63, Z6808

2013

Provides services in the home to beneficiaries who would otherwise

receive care in an intermediate care facility, a skilled nursing facility, a subacute nursing

facility, or an acute care hospital.

CAHIV/AIDS: RN: $10.15 per 15 mins LVN: 7.36 per 15 mins Attendant care: $4.73

per 15 mins2013

Maximum allowable for each waiver client is $13,209 per

calendar year and includes all Medi-Cal Waiver Program service

procedure codes

CA

California Pediatric Palliative Care: Procedure Code G9001 Coordinated care fee, initial rate. To be used for at least 22 hours of initial assessment services $1,000 One-time payment

T2022 Monthly case management. 1 Unit = 4-12 hours per month of required care coordination services, per child $229.17

per month 12 units per year G9012 Other specified case

management. Supplemental hourly care coordination rate to be utilized after

monthly maximum of 12 hours has been exhausted $45.43 per hour 60 hours

every 90 days Expressive Therapies code: Procedure

Code G0176 Activity therapy, 45 minutes or more per session Includes art,

music, child life, and massage therapy $35.00 Limit: FOUR units per day; up to

60 hours every 90 days Family Training code: Procedure Code

S5110 Home care training, family; per 15 minute unit. $11.36 per unit (RN

employed by HHA/HA) $8.94 per unit (Individual Nurse Practitioner billing

independently) Limit: 12 units per day 100 hours per year, per child

In-home Respite Care code: T1005

2013

A new Waiver that offers children with life limiting conditions a

range of home-based hospice like services while maintaining the

option of receiving curative treatment.

CA

California Assisted Living: •Care Coordination: $200/participant/month

•Nursing Facility Transition Care Coordination: $1,000/participant, a one

time fee only.•Assisted Living Services:

Tier 1 -- $52/participant/day Tier 2 -- $62/participant/day Tier 3 -- $71/participant/day Tier 4 -- $82/participant/day

•Assisted Care in Publicly Funded Housing:

Tier 1 -- $52/participant/dayTier 2 -- $62/participant/dayTier 3 -- $71/participant/dayTier 4 -- $82/participant/day

•Room and Board: All ALWP providers receive room and board (rent) payments

from ALWP participants. The current room and board rate for RCFE assisted

living is as follows:$993 per month based on income of

$1,122.00 from Social Security (SS) or Supplemental Security Income (SSI), less

$129.00 for the personal needs allowance).

$1,013 per month based on income of $1,142.00 or greater, less $129.00 for the

personal needs allowance

2013

Provides HCBS as an alternative to long-term nursing facility

placement to beneficiaries over 21 yrs of age in either of two

settings: a residential care facility for the elderly or in publicly subsidized housing with a

licensed home health agency providing assisted care services.•Assistance in

developing and updating ALWP participant's Individualized

Service Plans (ISP) which details in part, the frequency and timing of assistance. Participants play active roles in the development

process and must sign their ISP; •Providing personal care and

assistance with ADLs and IADLs sufficient to meet both the

scheduled and unscheduled needs of the residents;

•Washing, drying and folding laundry;

•Performing all necessary housekeeping tasks;

•Maintaining the facility; •Providing three meals per day plus snacks. Food must meet

CA

Early Periodic Screening, Diagnosis and Treatment: RN: $40.57 hr LVN:

$29.41 hr RN supervision: $45.43 CHHA: $18.90 hr

2013

CAIn Home Operations: RN: $36.26 hr

LVN: $26.92 hr CHHA: $18.90 hr Transitional Case Management: $40.60 hr

2013

Serves those who were previously enrolled in the (NF A/B) waiver who have continuously been

enrolled in the In Home Operations Waiver prior to

January 2002, and who require direct care services provided

primarily by a licensed nurse or those who have been receiving continuous care in a hospital for 36 months or greater and have physician-ordered direct care services that are greater than those available in the NF A/B waiver for the beneficiary's

assessed level of care.

CA

California San Francisco Living: Reimbursed at one of three levels of

intensity.The rates are: $65/day, $85/day and

$110/day. These rates reflect the current rates paid by San Francisco DPH to licensed residential providers serving

persons who would likely meet the target population criteria. 50% of waiver

participants are expected to require the CLSB waiver services at level 1, 40% at

level 2, and 10% at level 3. We therefore used the weighted average to allocate

costs or $78/day.This rate is also used in housing settings. The projected cost for the CLSB waiver

service equals the product of unduplicated users of the service and the average units per user (which is equal to the length of stay) and the average cost

per unit of service.Enhanced Care Coordination (called

enhanced care coordination in the waiver application) is reimbursed at 1 of 2 levels:

routine ($250 month) or enhanced/intensive ($500 month). These rates are based on San Francisco DPH costs for these two levels of enhanced care coordination provided to persons

2013

Provides care coordination, community living support

benefit in licensed settings, behavior assessment and planning, community living support benefit in housing

sites, enhanced care coordination, environmental

accessibility adaptations, home delivered meals for aged

individuals ages 65 - no max age, physical and other disabilities ages 21-64

CO $15.04/hr 2013-14 after 8.26% increase on 7/1/13. Under 1915(c).

CT

Katie Beckett Waiver, case mgmt: $23.56/15 mins; Medication

administration by home care agency professional: $60.52/visit

7/1/2007

DC See notes. See notes. No information found.

DE$26.52 Personal Care minimum HHA level required (75hr Training) or CNA

(150hr Training)2013

Code: S5103 Rates in effect since 7/1/2011 rate to left should be divided by 4 units; billing is in 1/4hr increments. Managed care

as of 4/1/2012.

FL

Florida’s Medicaid program (in total) is being moved over into private HMOs. There were no

standardized rates established by legislation, so each plan is

negotiating the rates provider by provider.

GA $4.21/15 min 2013 Under 1915(d).

HI See notes. 2013Almost all of Hawaii Medicaid is

on Managed Care (pending about <100 people on FFS).

IA CDAC-agency $5.30/15 min 2013 Under 1915(c).

ID See "current provider reimbursement rates." 1/24/11See "current provider

reimbursement rates."

IL

Homemaker: $17.14 per hour--paid to agency that employs worker; Personal

Assistant: $11.55 per hour--worker hired by disabled adult

FY 2014 $1.61 enhanced rate for agencies that provide health insurance

IN

Under 1915(c). A&D Waiver: Attendant Care = $4.79/15-min, Attendant Care (Consumer Directed) = $2.75/15-min,

Homemaker Services (NOS) = $3.78/15-min, RN Respite Services = $9.93/15-min,

LPN Respite Services = $6.83/15-min, Respite HHA = $5.12/15-min.

2013 - Rate information from

the FSSA Division of Aging

Website

There have been rate increases since Jan 2011. There will be rate

increases to some waiver services with an anticipated

January 1, 2014 effective date.

IN

Under 1915(c). TBI Waiver: Attendant Care (Agency) = $3.99/15 min, Attendant

Care (Consumer Directed) = N/A, Homemaker Services (NOS) = $3.15/15-

min., RN Respite Services = $7.78/15-min, LPN Respite Services = $5.91/15-

min, Respite HHA =$4.00/15-min.

2013 - Rate information from

the FSSA, Division of Aging

website

There have been rate increases since Jan 2011. There will be rate increases to some waiver services with an anticipated

January 1, 2014 effective date.

KS N/A N/A Most of Kansas Medicaid is now on KanCare (3 MCOs).

KYLA

MA See notes. See notes.

For HCBS waivers, Medicaid rates are paid for skilled and aide

services. There is no website with waiver rates. The program is

administered by various AAAs (called ASAPS).

MD

Medicaid covers the Personal Care and RN services through some waiver programs. Older Adults Waiver -

Personal Care w/o Meds ($13.07/hr); Personal Care w/ Meds ($17.02/hr); RN Monitoring ($62.44/hr). Living At Home Waiver - Personal Care Services (No

distinction of meds: $17.11/hr); RN Monitoring ($39.18/hr).

ME Varied 8/3/2013 See fee schedule for details.MI

MN Case Mix A $2249/monthly 2013There are A-F within the case mix

categories. We list our highest paid case mix.

MO Varied 10/1/2013Rates vary based on waiver and

service. See fee schedule for details.

MS See fee schedule for ID/DD waivers.

MT Varied 7/1/2013Rates vary based on waiver and

service. See link for details.

NC $13.88/hr 7/1/2012

Rate is for CAP/DA, CAP/C, and CAP/Choice. Billed in 15-min

increments. In home aide FFS. CAP/Choice is our consumer

directed care option.

ND See notes. See notes.See provider fee schedule. Unclear if

Medicaid home heath, and other home care rates, are included.

NE

Nebraska DHHS plans to implement 100% Medicaid

managed care for all healthcare providers on January 1, 2017. Nebraska’s legislature is also

considering a bill that would delay issuance of Request for

Proposals to managed care organizations until September 1,

2015.

NHRN: $90.16/visit; HHA: $29.60 for visit

under 2 hrs.; $5.74/unit for 2 hrs.+; PSCP: $4.38/unit; Homemaker: $4.56/unit

2013

Unit=15 mins. NH Medicaid has moved the “state plan-authorized”

services to managed care on 12/1/13. Most waiver services and HCBS are still on a fee

schedule with the State. HHA & PSCP rates are the same for

State Plan services and HCBS waiver services.

NJ

NM See notes. See notes.

On January 1, 2014, New Mexico moved over to managed

care/Centennial Care, with little left in fee-for-service. Most of

the MCOs say they will only pay the Human Services

Department/Medical Assistance Division (HSD/MAD) fee

schedule.

NV

NY

NYS does have the following waiver programs: Long Term Home Health Care

Program (LTHHCP, aka – Lombardi Program or Nursing Home without Walls), Care at Home, Traumatic Brain Injury and

Nursing Home Transition & Diversion Waiver programs. However, only the

LTHHCP rates are posted to this NYS LTC Rate Website. See notes for link.

See fee schedule for details.

OH Same as PDN - Independent & Agency Nurses SFY 2012

Under 1915(d): Agency Aide-$23.26/B; $3/U; Independent Aide-

$18.61/B; $3/U

OK See fee schedule for Advantage (HCBS Waiver) rates.

OR See notes. See notes. See attachment for details.

PA $4.29-$4.78/15-min. 2012

Under 1915(c). Rates vary depending on what Region (1-4) of Personal Assistance Services

Agency.

RI See notes. See notes.

Each licensed home care and hospice agency has a different

set of reimbursement rates within their Medicaid contract with RI EOHHS based on RI's home health reimbursement rate

enhancement system.

SC $15.21/hr 7/8/2011 Under 1915(c).SDTN See notes. See notes. TN is 100% managed care.

TX

Community Living Assistance and Support Services (CLASS) RN - per hour $43.39Specialized RN - per hour $49.90LVN -per hour $29.69Specialized LVN - per hour $34.14Physical Therapy (PT) - per hour $77.43Occupational Therapy (OT -) per hour $72.95Speech & Language Therapy (SP) - per hour $76.29

2013 For details, see fee schedules.

TX

Community Based Alternatives (CBA) PAS - per hour $8.90 - $10.65 based on participant level, admin $2.30RN - per hour $43.39Specialized RN - per hour $49.90LVN - per hour $29.69Specialized LVN - per hour $34.14Physical Therapy (PT) - per hour $77.43Occupational Therapy (OT) - per hour $72.95Speech & Language Therapy (SP) - per hour$76.29

2013 For details, see fee schedules.

TX

Texas Home Living (TxHml) Direct Care, Indirect Care, Total RN - per hour $40.98, $2.41, $43.39Specialized RN - per hour$47.13, $2.77, $49.90LVN - per hour$26.97, $2.72, $29.69Specialized LVN per hour$31.02, $3.12, $34.14

2013 For details, see fee schedules.

TX

Medically Dependent Children Program (MDCP) Respite and Adjunct Services - provided by: RN - per hour $43.39Specialized RN - per hour $49.90Respite and Adjunct Services Provided by a LVN - per hour $29.69Specialized LVN - per hour $34.14Attendant without delegation by an RN - per hour $11.66Attendant with delegation by an RN - per hour $12.66

2013 For details, see fee schedules.

TX

Deaf Blind with Multiple Disabilities (DBMD) RN - per hour $43.39Specialized RN - per hour $49.90LVN - per hour $29.69Specialized LVN - per hour $34.14Physical Therapy (PT) - per hour $77.43Occupational Therapy (OT) - per hour $72.95Speech & Language Therapy (SP) - per hour $76.29

2013 For details, see fee schedules.

TX

Home and Community-Based Services (HCS) Direct Care, Indirect Care, Total RN - per hour $40.98, $2.41, $43.39Specialized RN - per hour$47.13, $2.77, $49.90LVN - per hour$26.97, $2.72, $29.69Specialized LVN per hour$31.02, $3.12, $34.14 Physical Therapy - per hour$73.25, $4.18, $77.43Occupational Therapy - per hour$68.97, $3.98, $72.95Speech Therapy - per hour$69.78, $6.51, $76.29

2013 For details, see fee schedules.

UTVA See notes. See notes. For details, see fee schedules.

VT$69.28/visit case management svs;

$6.91/15 min PCA; $5.51/15 min homemaker

FY 2014

Case management services, PCAs, and homemakers are part of HCB

waiver services. See attachment for details.

WA See "home and community service rates" HCBS rates.

See "home and community

service rates" HCBS rates.

See "home and community service rates" HCBS rates.

WIWV $15/hr AD Waiver

WY

RN: $35.25/hr; HHA/PCA/Respite Care $5.00/15 min; Case Management:

$8.81/day.

Medicaid Fee-For-Service Reimbursement Rates, Survey Results, April 2014

State Rate/Unit Effective Date Notes

AKALARAZCACO

CT

homemaker $16.32/hr; companion $14.52/hr

7/1/2007

DC See notes. See notes. No information found.

DE Unknown 2012

PAS Personal Attendant, may be family, friend, guardian, person from

registry, or PASA Agency worker. Delaware does have a PAS (Personal

Attendant Rate) and Direct Care Worker rate for personal care and

homemaker. I do not have rates for those programs.

Directions: Please fill in any other appropriate and applicable reimbursement rates in the row for your state(s), indicating units as well (i.e. $/hour, etc.). Please also indicate the type of caregiver associated with each rate. Feel free to add rows below the row assigned to your state(s) if necessary.

Other Reimbursement Rates

FL See notes. See notes.

Florida’s Medicaid program (in total) is being moved over into private HMOs.

There were no standardized rates established by legislation, so each plan

is negotiating the rates provider by provider.

GA

HI See notes. 2013Almost all of Hawaii Medicaid is on

Managed Care (pending about <100 people on FFS).

IAID

IL

Home Health Agency Visits 2 hours or less:

LPN/RN $65.25

FY 2014 Rehab Services Home Services Program

IN

KS N/A N/A Most of Kansas Medicaid is now on KanCare (3 MCOs).

KYLAMAMDMEMIMNMO

MS See hospice fee schedule.

See EPSDT fee schedule.

MTNC

ND See notes. See notes.See provider fee schedule. Unclear if

Medicaid home heath, and other home care rates, are included.

NE

NH See notes. See notes.

NH Medicaid is moving the “state plan-authorized” services to managed care on 12/1/13. Most waiver services and HCBS will still be on a fee schedule

with the State.

NJ See notes. See notes.

In New Jersey, home health services, personal care and private duty are all under Managed Care, and have been

since July 2011. Initially, the plans paid what the FFS program had been paying for each of these services, but

since this past July when initial contracts expired for some agencies,

there were cuts passed along unilaterally. Other agencies’ contracts

will expire in June 2014. Perhaps more concerning than the rate

reductions themselves is the ratcheting back of hours, especially in the

personal care assistance program. We are not privy to individual agency

rates in their MCO contracts.

NM See notes. See notes.

On January 1, 2014, New Mexico moves over to managed

care/Centennial Care, with little left in fee-for-service. Most of the MCOs say they will only pay the Human

Services Department/Medical Assistance Division (HSD/MAD) fee

schedule. NVNY

OH

OK

The OHCA waiver programs and private duty nursing for kids program all pay from Proc Code T1000 (a 15-

min code.) It pays $6.30. Other nursing in waivers is based on G0154 or T1002, paying $13.50 for 15 min. Hospice in waivers pays $119.10 per

day, billed with S9126.

ORPARISCSD See hospice fee schedule.TN See notes. See notes. TN is 100% managed care.

TX For attendance based services, see fee schedules.

UTVA

VT

VT gets higher rates for HT which is High Tech nursing (ventilator

dependent children, etc. ), and separate rates for maternal child care.

WAWIWVWY