2016 Personal Care Hotline Rates

The Department of Health (DOH) posted a Dear Administrator Letter (DAL) on the Health Commerce System (HCS) outlining the final Personal Care and/or Consumer Directed program reimbursement rates for the period of Jan. 1, 2016 – Dec. 31, 2016.

A brief summary:

• Trend Factor: again a zero percent trend factor in accordance with past NYS budgets;
• Non-NYC Worker Recruitment and Retention: 8.7 percent adjustment will be included in the 2016 rates for non-NYC personal care service providers who submitted their signed attestation for using funds for the purpose of improving Recruitment and Retention (R&R) of non-supervisory personal care services workers or any worker with direct patient care responsibility. The uniform allocation percentage add-on of 8.7 percent is determined in accordance with the statutory methodology to allocate the authorized funding of $28.5M. Included in the R&R add-on of 8.7 percent is the adjustments to reimburse non-NYC personal care providers the uniform additional hourly Fair Labor Standards Act (FLSA) add-on amount as published in the FLSA adjustment rates that was effective as of Oct. 2015.
• Aide and Training Ceiling: the rates include an adjustment to the live-in ceiling for both personal care/consumer directed to be based on 13 hours of care, consistent with MLTC Policy 14-08.
• Appeals: An appeal by a provider whose rates have changed must be filed within 30 days of the receipt of the DAL, 30 days from June 6, 2016.

As usual, any questions about the calculations of the 2016 Medicaid rates should be directed to Kathy Omecinsky at 518-473-4421.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871