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
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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 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.
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.
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.
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
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
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.
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
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,
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
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
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
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.